Unit 3 Case 2: GIT infection Flashcards
what is crohns
type of inflammatory bowel disease
most commonly occurs in small intestine and colon, can affect part of GIT from mouth to the anus
symptoms of crohns
diarrhoea
abdominal cramps
blood in stool
fissures in the lining of the anus
stricture
fistula
fistula
caused by inflammation
abnormal channel formed between one part of intestine or another
may be between intestine and vagina or bladder
tests used to help diagnose crohns
bloods
stool
endoscopy
colonoscopy
CT and MRIs
tissue scan or biopsy
classifications of drugs that can be used for crohns
anti-inflammatory
immunosuppressors
pain relievers
anti-inflammatory drugs in crohns
corticosteroids such as prednisolone and budesonide
immunosuppressors in crohns
azathiopurine
mercaptopurine
methotrexate
other medications used in crohns treatment
acetaminophen- pain reliever
anti diarrhoeals
other treatments of crohns
nutrition therapy
surgery in more severe cases
amoeba
single-celled eukaryotic organism that changes its shape
moves by pseudopodia
found in water, soil and damp
pseudopodia
temporary projections of the cell
engulf bacteria and other particles as food by phagocytosis
amoebiasis
GI infections that develops when entamoeba histolytica enters intestines
parasite lays eggs that develop into mature cysts and leave through stool
infection is transmitted when you eat or drink something the parasite has contaminated
symptoms of amoebiasis
cramping
diarrhoea
nausea
fever
parasite
organism that lives on/in host organism and gets food from expense of its host
3 main classes
3 main classes of parasites
protozoa
helminths
ectoparasites
protozoa
unicellular
live and multiply inside of your body
transmits through faecal oral route
helminths
multicellular
live in and outside of your body
ectoparasites
multicellular
ticks fleas lice mites that live and feed off your skin
parasitic infections
spread via contaminated food water soil blood equal contact and insect vectors
6 strains of E coli known to cause diarrhoea
shiga toxin producing E coli/verocytotoxin producing e coli/ Enterhohemorrhagic e coli
enteropathogenic e coli
enteroaggressive e coli
enteroinvasive e coli
diffusely adherent e coli
enterotoxigenic E. coli
STEC ETEC EAEC VTEC EHEC EIEC EPIC DAEC
STEC VTEC EHEC
severe food borne disease
severe diarrhoea, stomach cramps, vomiting
can lead to haemolytic ureic syndrome that can cause kidney damage/failre
toxins in intestines from STEC travel into bloodstream and destroy RBCs
EPEC
adheres to intestinal epithelial cells
causes diarrhoea
EAEC
adheres to small and large intestinal epithelia
causes acute and chronic diarrhoea
EIEC
invades colonic epithelial cells
lyses phagosome
DAEC
defined by a pattern of diffuse adherence where bacteria covers entire cell surface
ETEC
prodcue special toxnis which stimulate the lining of the intestines causing them to secrete excess fluid
therefore diarrhoea
produces heat stable and heat liable toxins
causes diarrhoea, abdominal cramping, fever, nausea
microbiological testing of E.coli
cultures of samples of urine, stool and other infected material taken to culture bacteria and specific toxins idenitfid
suscpetibility testingmay occur if the bacteria are identified to see which antibiotics are effective
what is the stool smaple tested for
colour
consistency
shape
odour
mucus
looks for parasites and their cysts
gram staining of E coli
negative
bacilli
motile
variable capsule
flagellated
catalase psoitive
what is c.difficile
clostridium difficule is anaerobic, spore-formig gram postive bacillus
causes spectrum of antibiotic associated colitis through release of exotoxins called clostridial toxins
infiltrate and destroy target cells
symptoms of C difficile
diarrhoea
high temperature
loss of appetite
feeling sick
stomach ache
what are the c difficile symptoms caused by
imbalance of bacteria in the bowel due to antibiotics causing infection
how can c difficile be spread
by faeces
who is at risk of C difficile
over 65
taking or have recently taken antibiotics
staying at hospital or care home for long period of time
immunosuppressed
long term health conditions like dioabetes or kidney failure or chemotherapy
taking PPI
if you have had a C diff infection
treatment for C difficile
stop antibiotics you are taking if possible
10 day course of another antibiotic that can treat the c difficile infection
advice on how to avoid dehydration
dont take medication to relieve diarrhoea
common bacteiral gut infections
campylobacter jejuni
salmonella
shingella
common parasitic gut infections
giardia lamblia
cryptosporidium parvum
entamoeba histolytica
common viral gut infections
adenovirus
rotavirus
norovirus
surveillance of worldwide diseases
world health organisation uses global burden of disease
reducing worldwide gut infections
care in selecting food/ drink
good sanitisation
proper sewage disposal and drainage
safe drinking water wide spread vaccination
drugs in this case
prednisolone
adalimumab
picolax
metronidazole
what is a pre-surgical prophylaxis antibiotic
antibiotics given to patient before a surgery in order to reduce the risk of post-surgical infections
3 main antibiotics used as a pre-surgical prophylaxis
cafazolin
vancomycin
gentamicin
limitations of pre-surgical prophylaxis antibiotics
should be discontnued before 24 hous as there may be alteration in patient or hospital bacteria lflora
leading to bacterial resistance, colonisation
what is an ileocolic resection
surgical removal of the cecum and the ileum
most common operation performed for Crohn
may be accomplished by open or laparoscopy surgery
open surgery
once large incision made in the abdomen where the surgery will be carried out
laproscopy surgery
several smaller incisions made in the abdomen
safer option
with the aid of a small camera
procedure of ileocolic resection
patient asked to eat low residue diet for few days prior and take some laxatives
open or laprascopic
removal of caecum and ileum
anastomosis of end of small intestine to the beginning of the large intestin
intravenous drip given to the pateint
patient usually remains in hospital for week
stool testing for parasites
amoebic dysentery
giardia duodenalis
OCP testing: 3 samples over 10 dya period with no more than 24 hours, cyst and ova shedding is intermittent
barium, oil, magnesium or rystalline compounds can lead to unsatisfactory results
ova
egg
cyst
shell that protects the parasites during a stage in their life
testing for C diff
stool chart 5-7
stool sample
GDH EIA: rule out C diff rapid
C diff toxin EIA: detect c diff toxins, low sensitivity, alongside other testing
PCR; detect presence of c diff and toxins that produce these genes
Stool testing
what is an IV fluid
liquids injected into a persons veins through an IV tube
prevent or treat dehydration and electrolyte imbalances
3 categories of IV fluids
hypertonic
hypotonic
isotonic
hypertonic
solute has highe rconcentration than cell
direction of osmosis is water drawn out of cells
cells shrink
can result in intravascular fluid overload and pulmonary edema
cant be used extensively
isotonic IV fluids
no change in concentration gradeint
cells neither shrink or exppand
treat vomiting diarrhoea shock
hypotonic IV fluids
solute concentration lower than the cells
osmotic direction is into the cells
shouldnt be given to patients ith icnreased intercranial pressure as may exacerbate effects of cerebral edema
further cateogries of IV fluids
crystalloid
colloid
crystalloids
small molecules
able to diffuse across semi-permeable membranes
intracellular
used to increase fluid volume and intravascular space
incase of hypovolemia
colloid
larger molecules
dont cross semi-permeable membranes
remain intravascular rather than entering the cells
remain in the blood longer
used as plasma expandrs
normal saline
0.9% nacl
crystalloid
isotonic
hydration due to vomiting and diarrhoea
can be used in conjunction with blood administration
not for cardiac or renal complications as high sodium can cause excess fluid retention
half normal saline
0.45% normal salie
hypotonic
crystalloid
raise fluid volume
waterreplacement
sodium chloride depletion
lactated ringers
normal saline with additional electrolytes
isotonic
crystalloid
contains Na, Cl, Ca, K
for dehydration, burn victims, hypovolemia, acute blood loss
not for renal failure or liver disease as contains potassijm
dextrose IV fluids categories
in water
in saline
in lactated ringers
dextrose in water
istonic in bag
hypotonic absorbed
rehydration
dextrose in saline
isotonic in the bag
hypertonic absorbed
circulatory insufficiency
dextrose in lactated ringers
isotonic in the bag
hypotonic absorbed
can’t be used for renal or liver failure
or if diabetic
rehydration therapy
solution msuyt contain Na and gluocse
sodium ions pass through the glucose symporter
process of active transport driven by the high sodium concentration
sodium only passes if glucose prwsent
sodium high to low
glucose low to high
higher concentration of sodium and glucose in the cell
on the basal cell is na/k+ atpase
sodium against concentration gradient
gluocse through gluocse uniporter passively
increased glucose and sodium concentration in blood lowers water potential
water moves by osmosis from small intestine to the blood
rehydration
what is dehydration
condition resulting when body loses more fluid than takes in
imbalance dirsupts usualy levels of salt and sugar in the blood
can interfere with body functions
diuresis
increased or excessive production of urine
electrolytes
minerals in body with natural positive or negative charge
in blood, urine, tissues and other body fluids
balance water
serum sodium concentration
amount of sodium relative to volume of water in the blood
pathophysiology of dehydration
total body water distributed into extracellular and intracellular components
fluid from extracellular depletes first then intra
intra loss results in cell shrinkage and metabolic dysfunciton
can be classified according to serum sodium concentration
hypernatremia
may produce body cavity effusions (ascites)
pitting edema
hyponatremia
decreased produces signs of volume depletion
dry mucous membranes
decreased skin turgor
decreased bloodpressyre
increased pulse when sitting up from supine positions
isonatremia
normal skin turgor and hydration
pathophysiology of the vomiting reflex
involuntary forceful expulsion of contents of ones stomach throug hthe mouth
3 steps: vomitng develops, retching and act
controlled by vomiting centre and chemoreceptor trigger zone in the medulla oblongata
emesis
deep breath taken
glottis closed and larynx raised
opens upper oesophageal sphincter
diaphragm contracted sharply downwards
created negative pressure in thorax
facilitates opening of oesphagus and idstal oesphageal sphincter
simultaneously with the downward movement of the diaphragm the muscles of the abdomen vigorously contract and squeeze the stomach and increasing intragastric pressure
pylorsu is closes and oesphagus is relatively open there is an exit route
impact of crohns disease
diet
fatigue
brain-gut axis
relatiosnhips and sex
reproductive health
travelling and insurance
pregnancy and breast feeding
mental health crohns
anxiety
depresison
stress
low mood
self esteem disordered eating
