Tropical Gastro

Question 1

What questions would you ask about travel?

Answer 1

Where they been, about accommodation, when they got back and when started feeling unwell, insect bites, is anyone else ill

Question 2

What examinations would you look for?

Answer 2

fever, rash, hepatospleenomegaly, lymphadenopathy, insect bites, wounds

Question 3

What can a fever indicate?

Answer 3

pneumonia/flu etc,
travellers diarrhoea,
Enteric virus
Arbovirus

Question 4

Acute Traveller’s diarrhoea

Answer 4

3 loose stools in 24 hours
fever
E.coli, campylobacter, salmonella and shigella

Question 5

What investigations would you do?

Answer 5

Stool culture

Stool wet prep

Question 6

What treatment would you do?

Answer 6

supportive - Oral/IV fluids
Anti-motilities
Ciprofloxacin in the form of Flouroquinolone.
Azithromycin may be used

Question 7

Enteric Fever

Answer 7

Incubation - 7-18 days (up to 60)

India/East Asia is most common source

Question 8

What are symptoms of Enteric Fever?

Answer 8

headache
constipation/diarrhoea
dry cough
GI bleeding
GI perforation
Encephalopathy
Bone and joint infection

Question 9

Enteric fever treatments?

Answer 9

IV ceftriaxone, azithromycin and ciprofloxacin

Question 10

What causes enteric fever?

Answer 10

Salmonella typhi or paratyphi

Question 11

What are Pre-Hepatic causes of jaundice?

Answer 11

Malaria
HUS
Sickle cell diseases triggered by infection

Question 12

What are hepatic causes of jaundice?

Answer 12

Hep A and C
Leptospirosis 
Malaria
Enteric fever and Typhus
Viral Haemorrhage fever

Question 13

What are the Post-Hepatic causes of jaundice?

Answer 13

Ascending cholangitis and helminths

Question 14

What investigations would you do?

Answer 14

FBC/UE/LFT/coagulation
blood cultures
USS abdomen 
serology
blood film

Question 15

Amoebic Liver Abscess

Answer 15

Incubation = 8-20 weeks

fever, cough, abdo pain, hepatomegaly GI upset

Question 16

Helminth infections?

Answer 16

Nematodes, Trematodes, Cestodes

Question 17

How are infections transmitted during sex?

Answer 17

Direct inoculation
Secretions
ingestion
fomites 
IVDU
Trauma

Question 18

How do you treat Gonorrhoea NAAT and culture +ve (Urine rectum pharynx)

Answer 18

Ceftriaxone 500mg im stat

Doxycycline 10mg bd 7/7

Question 19

How do you treat Chlamydia +ve (non LGV) (urine rectum)

Answer 19

Test of cure 2-3/52, public health interventions

Question 20

How is Rectal Gonorrhoea transmitted?

Answer 20

direct contact of mucosal surfaces
For proctitis: anal sex, transmucosal spread, ?fomite
Caused by Neisseria gonorrhoea

Question 21

Symptoms of rectal gonorrhoea?

Answer 21

Incubation - 5-10 days
low abdo pain, diarrhoea, rectal bleeding, anal discharge, tenesmus, urethra discharge, dysuria or asymptomatic.
Inflamed mucosae and purulent exudate

Question 22

Management of rectal gonorrhoea?

Answer 22

Cephalosporin 
Chlamydia treatment 
Comprehensive STI screening
Test of cure
 Public health investigations

Question 23

Complications of rectal gonorrhoea

Answer 23

Abscess formation, increased susceptibility and infectiousness to HIV

Question 24

Rectal Chlamydia transmission?

Answer 24

direct contact of mucosal surfaces

For proctitis: anal sex, transmucosal spread, ?fomite

Question 25

Symptoms of rectal chlamydia?

Answer 25

70% asymptomatic
anal discomfort/itch discharge
Gram stain rectal swab, CT PCR all sites

Question 26

Rectal Chlamydia treatments?

Answer 26

Azithromycin (stat dose)
Doxycycline (7/7 course)
test of cure (6/52)
STI testing 
Public health investigations

Question 27

What is primary syphilis

Answer 27

Solitary painless ulcer

Question 28

What is secondary syphilis?

Answer 28

Mucosal patches and ulcers
Mouth, anogenital, rectal condylomata lata
systemic inflammation
Hepatitis

Question 29

How is Herpes simplex transmitted?

Answer 29

ano-genital or oro-anal.
Usually HSV 2
Peri-anal mucosa but may extend to rectum

Question 30

What are symptoms of Herpes simplex virus?

Answer 30

Pain, ulcers, painful, defaecation, bleeding, mucus, viraemic symptoms (in primary infection)

Question 31

How is Human Papilomavirus transmitted?

Answer 31

ano-genital, oro-anal

HPV 6,11,16,18

Question 32

Primary Lymphogranuloma venereum?

Answer 32

3-30 days ulcers

Question 33

Secondary Lymphogranuloma venereum?

Answer 33

3-6/12
inguinal service
ano-rectal syndrome

Question 34

Tertiary Lymphogranuloma venereum?

Answer 34

strictures
fistulae
genital elephantiasis

Question 35

Associations with Lymphogranuloma venereum?

Answer 35

group sex
drug use
syphilis
hepatitis C

Question 36

HIV and GI tract?

Answer 36

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

Question 37

Clinical result of GALT loss

Answer 37

HIV enteropathies
opportunistic infection
persisten immune activation - microbial translocation
Accelerated immunosenescence