Tropical Gastroenterology Flashcards
symptoms of tropical GI disease
fever rash hepatosplenomegaly lymphadenopathy insect bites wounds
describe acute travellers diarrhoea
3 loose stool in 24 hour
microorganism’s causing travellers diarrhoea
enterotoxigenic E.coli - most common
campylobacter, salmonella, shigella
amoebic diarrhoea
cruise ship pathogens causing travellers diarrhoea
norovirus
rotavirus
micro-organisms causing bloody diarrhoea (dysentery)
E.coli0157
amoebic colitis
micro-organisms causing profuse watery diarrhoea
cholera - toxin mediated disease
tests for acute traveller’s diarrhoea
stool culture
treatment for acute traveller’s diarrhoea
supportive - fluid hydration
ciprofloxacin - travelling
azithromycin - used in antibiotic resistance
what is enteric fever
typhoid or paratyphoid fever
common in those returning from India and SE Asia
incubation period 7-18 days
microorganisms causing enteric fever
salmonella typi or paratyphoid
symptoms of enteric fever
fever
headache
constipation or diarrhoea
dry cough
complications of enteric fever
GI bleeding
GI perforation
encephalopathy
bone and joint infection
tests for enteric fever
laboratory precautions; blood stool urine bone marrow
treatment for enteric fever + sepsis
ceftiaxone
treatment for enteric fever
empirical;
ciprofloxacin - fluoroquinolone
azithromycin
ceftriaxone
causes of pre-hepatic (haemolytic) fever and jaundice
malaria
HUS (complication of E.coli, shigella gastroenteritis)
sickle cell triggered by infection
causes of hepatic fever and jaundice
hepatitis A and E
Leptospirosis – Weils diseases (Icteric, haemorrhagic and renal failure)
Malaria
Enteric fever
Rickettsia (scrub typhus, Rocky Mountain spotted fever etc)
Viral haemorrhagic fever
causes of post-hepatic fever and jaundice
ascending cholangitis
helminths
tests for fever and jaundice
Malaria blood film and rapid antigen Blood film - red cell fragmentation FBC/UE/LFT/coagulation Blood cultures ultrasound abdomen Serological testing for viruses
treatment for fever and jaundice
isolation and infection control
Supportive – dialysis if acute kidney injury
If acute liver failure – hepatology/transplant unit
Directed to pathogen isolated
amoebiasis
an infection caused by Entamoeba histolytica - a protozoa
how is amoebiasis spread
via faecal-oral spread
poor sanitation
symptoms of amoebiasis
asymptomatic
shed cysts in stools chronically
symptoms of amoebic dysentery
abdominal pain fever blood diarrhoea/colitis toxic and unwell abdominal tenderness peritonism
tests for amoebiasis
stool culture
AXR- toxic megacolon
endoscopy - biopsy
amoebic liver abscess
infection of liver caused by Entamoeba histolytica
Incubation period 8-20 weeks
epidemiology of amoebic liver abscess
men
symptoms of amoebic liver abscess
fever, sweats upper abdominal pain dysentery hepatomegaly point tenderness over right lower ribs
tests for amoeba liver abscess
abnormal LFTs CXR - raised right hemi-diaphragm ultrasound/CT serology stool culture
treatment for amoebic liver abscess
metronidazole
tinidazle
Paramomycin/diloxanide - clears gut lumen of pathogens
giardiasis
diarrheal disease caused by Giardia intestinalis (lamblia)
incubation 7 days
where does giardiasis effect
duodenum
proximal jejunum
how is giardiasis spread
faecal-oral
contaminated water
symptoms of giardiasis
watery, malodorous diarrhoea
bloating, flatulence
abdominal cramps
weight loss
tests for giardiasis
stool culture
OGD - duodenal biospy
treatment for giardiasis
metronidazole or tinidazle
where do helminth infections effect
gut tissue
helminth infections
often associated with eoinophilia
diagnosed by adult worm passed or eggs in stool
helminths parasites
nematodes (roundworms)
trematodes (flukes)
cestodes (tapreworms)
types of nematodes
intestinal roundworms - ascariasis (most common)
tissue roundworms
types of cestodes
intestinal
larval - Taenia solium, saginatum
types of trematodes
Schistosomiasis – fresh water exposure
chronic infection of Schistosomiasis
Adult worms located in portal venules which can lead to hepatolmegaly and liver fibrosis and portal hypertension
infection of ascariasis
egg hatches in small intestine
invade gut wall into venous system and via liver and heart reach lungs – break into alveoli – ascend tracheobroncial tree and swallowed
in the gut develop into adult worm - produce eggs.
infection of cestodes
undercooked meat containing infectious larval cysts
cysticercosis - tissue cysts in muscle and brain causing seizures
chagas disease
infection caused by Trypanasoma cruzi
spread of chagas disease
kissing bug (Triatome)
signs of chagas disease
parasymphathetic denervation affecting the colon and or oesophagus
Megaoesophagus
