Tropical Gastroenterology

Question 1

What should you look for in a returned traveller when doing an examination?

Answer 1

Fever
Rash
Hepatosplenomegaly
Lymphadenopathy
Insect bites
Wounds

Question 2

What might fever in a returned traveller be indicative of?

Answer 2

Resp tract infections - pneumonia/influenza

Travellers diarrhoea
Malaria
Enteric fever (typhoid etc)
Arboviruses

Question 3

Describe acute travellers diarrhoea?

Answer 3

Typically Enterotoxigenic E.coli
Can also be camplyobacter, salmonella, shigella
Cruise ships - Noro/rotavirus

Question 4

What might be the cause of travellers diarrhoea on cruise ships?

Answer 4

Noro/rotavirus

Question 5

What would profuse watery diarrhoea indicate?

Answer 5

Cholera - toxin mediated disease often associated with outbreaks - refugee camps

Question 6

What investigations would you do for acute travellers diarrhoea?

Answer 6

Stool culture

Question 7

What would the treatment for actor travellers diarrhoea be?

Answer 7

Supportive - rehydration

Question 8

What is enteric fever?

Answer 8

Typhoid or parathyroid fever

Question 9

What is enteric fever most common in?

Answer 9

Those returning from indian subcontinent and SE asia

Question 10

What is the incubation period for enteric fever (typhoid)?

Answer 10

7-18days

can be up to 60 days

Question 11

What are the symptoms for enteric fever (typhoid)?

Answer 11

Fever

Non-specific
Headache
Constipation or diarrhoea
Dry cough

Question 12

What are the complications of enteric fever (typhoid)?

Answer 12

Complications
GI bleeding
GI perforation
Encephalopathy
Bone and joint infection

Question 13

What is enteric fever (typhoid) caused by?

Answer 13

Salmonella

Question 14

What are some causes of fever and jaundice (pre hepatic - haemolytic)?

Answer 14

Malaria
HUS as complication of E.coli
Sickle cell crisis triggered by infection

Question 15

What are some causes of fever and jaundice (hepatic)?

Answer 15

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

Question 16

What are some causes of fever and jaundice (post-hepatic)?

Answer 16

Ascending cholangitis

helminths

Question 17

What is amoebic liver abscess?

Answer 17

A amoebic liver abscess is a type of liver abscess caused by amebiasis. It is the involvement of liver tissue by trophozoites of the organism Entamoeba histolytica and of is abscess due to necrosis.

Question 18

What is the presentation of amoebic liver abscess?

Answer 18

Incubation period 8-20 weeks

Fever, cough, aching abdo pain etc - usually male

Question 19

What is the management of amoebic liver abscess?

Answer 19

Metronidazole

Question 20

What are helminth infections?

Answer 20

Soil-transmitted helminth infections are caused by different species of parasitic worms. They are transmitted by eggs present in human faeces, which contaminate the soil in areas where sanitation is poor.

(worms and parasites etc)

Question 21

What are some protozoan infections?

Answer 21

Guardia lamblia - cysts or parasits in the stool, treat metronidazole

Trypanosome cruzi (chagas’ disease)