Tropical Gastroenterology Flashcards
What history should be taken in a patient presenting with fever upon returning from travel?
Where did they go (urban or rural) When did they go/get back When did the symptoms start Any insect bites Any other symptoms Anyone else unwell they were travelling with What did they do whilst away (swimming, animal contact, bat caves, walking, sex, work) What precautions did they take?`
What examination should be undertaken in a returned traveller?
Fever Rash Hepatosplenomegaly Lymphadenopathy Insect bites Wounds
What can cause a fever in a returned traveller?
Respiratory tract infections - pneumonia/infleunza Traveler's diarrhoea Malaria Enteric fever Arboviruses
What is acute traveller’s diarrhoea?
3 loose stools in 24hours
Associted with self-reported fever
What can cause traveller’s diarrhoea?
Enterotoxigenic E.coli Campylobacter Salmonella Shigella Norovirus Rotavirus
How should traveller’s diarrhoea be investigated?
Stool culutre
Stool wet prep on recently passed stool for amoebic trophozoitez
How should traveller’s diarrhoea be treated?
Supportive - fluid rehydration
What can cause enteric fever?
Typhoid or paratyphoid fever
Salmonella typhi
What is the incubation period for typhoid fever?
7-18 days
What are the symptoms of enteric fever cuased by typhoid?
Fever Headache, constipation or diarrhoea Dry cough GI bleeding GI perforation Encelopathy Bone and joint infections
When should enteric fever be treated (salmonella)?
If the patient is unstable treat emperically with IV ceftriaxone, ciprofloxacin or azithomycin
What can cause pre-hepatic fever and jaundice?
Malaria
HUS as a complication of darrhoeal illness (E.coli 0157 or shigella)
What can cause hepatic fever and jaundice?
Hep A and E Leptospirossi (weils diseases) Malaria Enteric fever Rickettsia Viral haemorrhagic fever
What can cause post-hepatic jaundice and fever?
Ascending cholangitis
Helminths
How should jaundice and fever be investigated?
Malaria blood film and rapid antigen Blood film for red cell fragementation FBC/UE/LFT/coagulation Blood cultures USS abdomen Serological testing for viruses
How should jaundice and fever be managed?
Appropriate isolation and infection control procedures
Supportive
What is chagas disease?
Transmitted by the kissing bug
Causes parasymp denervation affecting the colon and/or oesophagus
How is aemoebiasis spread?
Faecal-oral spread, strong association with poor sanitaion
Sheds cysts in stools chronologically
What are the symptoms of amoebic dysentry?
Abdominal pain
Fever
Bloody diarrhoea
Toxic and unwell, abdominal tenderness, peritonism
How should amoebic dysentry be investigated?
Stool microscopy for trohozites or cysts
AXR - toxic megacolon
Endoscopy for biopsy
What is the presentation of amoebic liver abscesses?
Fever, sweats Upper abdominal pain History of GI upset Hepatomegaly Point tenderness over right lower ribs
How should amoebic liver abscesses be investigated?
Abnormal LFTs CXR - raised right hemi-diaphragm USS/CT scan Serology Stool microscopy
How should amoebic liver abscesses be treated?
Metrondiaole
What is giardia?
A giardia intestinalis, flagellated protozoa
Where does giardiasis affect?
Duodenum and proxminal jejunum `
`How does giargia spread?
Faecal-oral with an incubatino of 7 days
How does giargia present?
Watery, malodorous diarrhoea
Bloating, flactulence
Abdominal cramps
Weight loss
How is giargia investigated?
Stool microscopy for cycsts
OGD for duodenal biopsy
How is giardiasis treated?
Metrondiazole
Where do helminth infections present?
In the gut tissues
Often associated with eosinophlila
What is the most common common helminthic infection?
Ascariasis
