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GI > Tropical Gastroenterology > Flashcards

Tropical Gastroenterology Flashcards

1
Q

What are key findings on examination on a returned traveller with symptoms?

A 
Fever
Rash
Hepatosplenomegaly
Lymphadenopathy
Insect bites
Wounds
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2
Q

What are possible causes of fever in a returned traveller?

A

Respiratory tract infections – pneumonia/influenza
Travellers diarrhoea
Malaria
Enteric fever (typhoid/paratyphoid fever)
Arboviruses – Dengue/Chikungunya

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3
Q

What is traveller’s diarrhoea defined as?

A

3 loose stools in 24 hours

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4
Q

What typically causes travellers diarrhoea?

What are other reasonably common causes?

A

Enterotoxigenic E. coli

Also Campylobacter, Salmonella, Shigella

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5
Q

What is a likely cause of diarrhoea if the patient has been on a cruise ship?

A

Norovirus and rotavirus

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6
Q

What is a likely cause of bloody diarrhoea?

A

E coli 0157

Amoebic colitis

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7
Q

What is a likely cause of profuse watery diarrhoea often associated with outbreaks in refugee camps?

A

Cholera

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8
Q

What investigations are carried out for traveller’s diarrhoea?

A

Stool culture

Stool wet prep on recently passed stool for amoebic trophozoites

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9
Q

How is traveller’s diarrhoea treated?

A

Supportive: fluid rehydration
Bloody diarrhea with systemic upset may warrant treatment
In those travelling a fluoroquinolone (ciprofloxacin) single dose can stop worsening (a three day course is often recommended - simple gastroenteritis will resolve without treatment)
Antibiotic resistance – now very common especially in Asia where a macrolide (azithromycin) may be more useful

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10
Q

What are the possible types of enteric fever?

What causes them?

A

Typhoid fever caused by Salmonella typhi

Paratyphoid fever caused by Salmonella paratyphi

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11
Q

Which patients is enteric fever most common in?

A

Most common in those returning from Indian subcontinent and SE Asia
Often in people visiting family or friends

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12
Q

What is the incubation period for enteric fever?

A

Incubation period 7-18 days (though occasionally up to 60 days)

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13
Q

What are the symptoms of enteric fever?

A

Fever

Non-specific:
Headache
Constipation or diarrhoea
Dry cough

Complications:
GI bleeding
GI perforation
Encephalopathy
Bone and joint infection
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14
Q

Where can the pathogens be isolated from in enteric fever?

A

Blood, stool or urine

Sometimes bone marrow

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15
Q

How are patients with enteric fever managed?

A

In hospital they should be isolated immediately if the diagnosis is considered.
If the patient is septic, treat empirically with IV ceftriaxone.

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16
Q

What are prehepatic/haemolytic causes of jaundice, associated with GI infection?

A

Malaria
HUS as a complication of diarrhoeal illness- E.coli 0157/Shigella
Sickle cell crisis triggered by infection

17
Q

What are hepatic causes of jaundice associated with GI infection?

A

Hepatitis A and E – acute (occasionally Hepatitis B)
Leptospirosis – Weils diseases (Icteric, haemorrhagic and renal failure)
Malaria
Enteric fever
Typhus
Viral haemorrhagic fever

18
Q

What are post-hepatic causes of jaundice associated with GI disease?

A

ascending cholangitis – and helminths

19
Q

What investigations are done in fever and jaundice?

A 
Malaria blood film and rapid antigen
Blood film for red cell fragmentation
FBC/UE/LFT/coagulation
Blood cultures
USS abdomen
Serological testing for viruses
20
Q

What is the management and treatment for fever with jaundice?

A

Appropriate isolation and infection control procedures
Supportive – may need dialysis if acute kidney injury
If acute liver failure – hepatology/transplant unit
Directed to pathogen isolated
Discussion with infectious diseases

21
Q

How does amoebic liver abscess present?

A

Incubation period 8-20 weeks – symptoms develop over 2-4 weeks - Fever, cough, aching abdominal pain, hepatomegaly, sometimes a history of GI upset (dysentery) – usually male

22
Q

How is amoebic liver abscess investigated?

A

CXR – raised right hemi-diaphragm. Abnormal LFTs. USS/CT scan. Serology. Stool microscopy often negative. Exclude hydatid disease before aspiration if from high risk country (Middle East, Central Asia)

23
Q

What is the management for amoebic liver abscess?

A

–metronidazole
If pyogenic abscess a possibility then treat with
appropriate antibiotics whilst awaiting
diagnostic investigations.
Need to clear the gut lumen of parasites
Paramomycin/diloxanide

24
Q

What are helminth infections?
Where are they found?
What are they associated with?

A

Parasites
Found in the gut and in the tissues.
Often associated with eosinophilia

25
Q

How are Helminth infections often diagnosed?

A

Often diagnosed by the adult worm passed or the eggs in stool

26
Q

Give examples of Helminths

A

Nematodes (Roundworms):
Intestinal roundworms
Tissue roundworms (filariasis)

Trematodes (Flukes)

Cestodes (Tapeworms):
Intestinal
Larval

27
Q

What is the most common intestinal nematode (roundworm)?

What is its lifecycle?

A

Ascariasis

Life cycle:
Egg ingested – hatch in small intestine – invade gut wall into venous system and via liver and heart reach lungs – break into alveoli – ascend tracheobroncial tree then swallowed and in the gut develop into adult worm where they start to produce eggs.

28
Q

Give 2 examples of trematodes (flukes)

A

Trematodes (flukes)
Schistosomiasis – fresh water exposure
Acute infection
Chronic infection
Adult worms located in portal venules which can lead to hepatolmegaly and liver fibrosis and portal hypertension
Liver flukes – Clonorchis/Fasciola – SE Asia

29
Q

Give examples of cestodes or tapeworms and where they come from

A 
Taenia solium (Pork) or saginatum (Beef) – acquired by eating undercooked meat containing infectious larval cysts 
Taenia solium eggs (autoinoculation or from human faeces) can cause – cysticercosis – tissue cysts muscle and brain
30
Q

Give two examples of protozoan infections

A

Giardia lamblia

Trypanasoma cruzi – Amercian Trypanosmiasis, Chagas’ Disease

31
Q

What are the symptoms of Giardiasis?

A

diarrhoea
chronic diarrhoea
malabsoprtion
weight loss

32
Q

How is Giardiasis diagnosed?

A

look for cysts or parasites in stool

33
Q

How is Giardiasis treated?

A

Metronidazole

34
Q

How is Trypanasoma cruzi transmitted?

A

By the kissing bug- Triatome

35
Q

What does Trypanasoma cruzi cause?

A

Causes parasymphathetic denervation affecting the colon and or oesophagus
Megaoesophagus

GI (59 decks)

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