Tropical Gastro Flashcards
What questions would you ask about travel?
Where they been, about accommodation, when they got back and when started feeling unwell, insect bites, is anyone else ill
What examinations would you look for?
fever, rash, hepatospleenomegaly, lymphadenopathy, insect bites, wounds
What can a fever indicate?
pneumonia/flu etc,
travellers diarrhoea,
Enteric virus
Arbovirus
Acute Traveller’s diarrhoea
3 loose stools in 24 hours
fever
E.coli, campylobacter, salmonella and shigella
What investigations would you do?
Stool culture
Stool wet prep
What treatment would you do?
supportive - Oral/IV fluids
Anti-motilities
Ciprofloxacin in the form of Flouroquinolone.
Azithromycin may be used
Enteric Fever
Incubation - 7-18 days (up to 60)
India/East Asia is most common source
What are symptoms of Enteric Fever?
headache constipation/diarrhoea dry cough GI bleeding GI perforation Encephalopathy Bone and joint infection
Enteric fever treatments?
IV ceftriaxone, azithromycin and ciprofloxacin
What causes enteric fever?
Salmonella typhi or paratyphi
What are Pre-Hepatic causes of jaundice?
Malaria
HUS
Sickle cell diseases triggered by infection
What are hepatic causes of jaundice?
Hep A and C Leptospirosis Malaria Enteric fever and Typhus Viral Haemorrhage fever
What are the Post-Hepatic causes of jaundice?
Ascending cholangitis and helminths
What investigations would you do?
FBC/UE/LFT/coagulation blood cultures USS abdomen serology blood film
Amoebic Liver Abscess
Incubation = 8-20 weeks
fever, cough, abdo pain, hepatomegaly GI upset
Helminth infections?
Nematodes, Trematodes, Cestodes
How are infections transmitted during sex?
Direct inoculation Secretions ingestion fomites IVDU Trauma
How do you treat Gonorrhoea NAAT and culture +ve (Urine rectum pharynx)
Ceftriaxone 500mg im stat
Doxycycline 10mg bd 7/7
How do you treat Chlamydia +ve (non LGV) (urine rectum)
Test of cure 2-3/52, public health interventions
How is Rectal Gonorrhoea transmitted?
direct contact of mucosal surfaces
For proctitis: anal sex, transmucosal spread, ?fomite
Caused by Neisseria gonorrhoea
Symptoms of rectal gonorrhoea?
Incubation - 5-10 days
low abdo pain, diarrhoea, rectal bleeding, anal discharge, tenesmus, urethra discharge, dysuria or asymptomatic.
Inflamed mucosae and purulent exudate
Management of rectal gonorrhoea?
Cephalosporin Chlamydia treatment Comprehensive STI screening Test of cure Public health investigations
Complications of rectal gonorrhoea
Abscess formation, increased susceptibility and infectiousness to HIV
Rectal Chlamydia transmission?
direct contact of mucosal surfaces
For proctitis: anal sex, transmucosal spread, ?fomite
Symptoms of rectal chlamydia?
70% asymptomatic
anal discomfort/itch discharge
Gram stain rectal swab, CT PCR all sites
Rectal Chlamydia treatments?
Azithromycin (stat dose) Doxycycline (7/7 course) test of cure (6/52) STI testing Public health investigations
What is primary syphilis
Solitary painless ulcer
What is secondary syphilis?
Mucosal patches and ulcers
Mouth, anogenital, rectal condylomata lata
systemic inflammation
Hepatitis
How is Herpes simplex transmitted?
ano-genital or oro-anal.
Usually HSV 2
Peri-anal mucosa but may extend to rectum
What are symptoms of Herpes simplex virus?
Pain, ulcers, painful, defaecation, bleeding, mucus, viraemic symptoms (in primary infection)
How is Human Papilomavirus transmitted?
ano-genital, oro-anal
HPV 6,11,16,18
Primary Lymphogranuloma venereum?
3-30 days ulcers
Secondary Lymphogranuloma venereum?
3-6/12
inguinal service
ano-rectal syndrome
Tertiary Lymphogranuloma venereum?
strictures
fistulae
genital elephantiasis
Associations with Lymphogranuloma venereum?
group sex
drug use
syphilis
hepatitis C
HIV and GI tract?
Gut-associated lymphoid tissue is the largest immune compartment in the body.
Mucosal lymphocytes: rectum foreskin and cervico-vagina
Higher proportion of CD+4 T helper cells express CCR5.
Dense clustering of lymphocytes
Clinical result of GALT loss
HIV enteropathies
opportunistic infection
persisten immune activation - microbial translocation
Accelerated immunosenescence
