W9 GI, Dental, Eye Flashcards
What is Diverticulitis?
- Diverticulitis and diverticular disease are related digestive conditions that affect the large intestine
- Diverticula are small bulges or pockets that can develop in the lining of the intestine as people age – usually asymptomatic, called diverticulosis
- Diverticula causing symptoms, such as pain in the abdomen, becomes diverticular disease
- Identification and treatment of diverticular disease covered further in GI ISU
- Treatment normally involves dietary manipulation (fibre), symptomatic medications and can progress further, e.g. surgery
- If the diverticula become inflamed or infected, causing more severe symptoms, it’s called acute diverticulitis
What is Acute diverticulitis?
Symptoms?
- If diverticula become inflamed and infected symptoms include:
- Constant, more severe abdominal pain
- Pyrexia
- diarrhoea or constipation
- mucus or blood in the stools, or sometimes rectal bleeding
At this point, referral to GP or sometimes hospital is necessary.
When to refer diverticulitis? (5)
- Uncontrollable abdo pain
- Dehydrated or at risk of dehydration and Unable to take/tolerate oral fluids at home
- Unable to take/tolerate oral abx at home
- Aged over 65 years
- Significant comorbidity or immunosuppression
What is Gastroenteritis?
What are the symptoms?
- Defined as a transient disorder due to enteric infection with viruses, bacteria, or parasites.
- Sudden onset diarrhoea, faecal urgency, blood/mucous in stools
- May also be nausea or sudden onset of vomiting
- Fever or general malaise
- Abdominal pain/cramping
- Many be associated: headache, myalgia, bloating, weight loss
Gastroenteritis – key questions to ask
- Symptoms (as above)
- Onset, frequency, severity
- Risk factors for dehydration – reduced fluid intake, reduced urine output
- Recent food intake
- Recent exposure to contaminated water
- Recent foreign travel
- Contact with other suspected cases
- Recent antibiotic/PPI use
- Occupation
Causes of Gastroenteritis?
- Transmission of gastrointestinal infection from person-to-person may occur through one or more of a variety of different pathways, including faecal-oral, foodborne, environmental, and airborne routes
- Most often self-limiting in a day or so and caused by a virus
- However, can be bacterial or parasitic
Viruses- Norovirus, Rotavirus
Bacteria- E.coli, Shigella, Salmonella, Campylobacter, C.diff
Parasites- Cryptosporidium, Giardia
Bacterial causes of Gastroenteritis:
Campylobacter, E.coli, Salmonella
How are these transferred?
How long do these bacteria last?
Campylobacter
* Usually associated with the consumption of contaminated food and drink, such as undercooked meat (especially poultry), unpasteurised milk, or untreated water
* Most cases are self-limiting within 2–3 days and usually resolve within 1 week
E.coli:
* transmitted through contaminated food, particularly meat, salad products, water, and unpasteurised milk
* also by person to person contact and from animals
* usually self-limiting and resolves within 10 days
Salmonella:
* contaminated food is the most common source, such as red and white meats, raw eggs, milk, and dairy products
* sometimes person-to-person and from animals
* usually lasts for 4–7 days, and people usually recover spontaneously
Bacterial causes of Gastroenteritis:
Shigella, C.diff
How are they transferred?
How long do they last?
Shigella
* most commonly transmitted person-to-person by the faecal-oral route, particularly in households, nurseries, and schools
* rarely, it can be transmitted through contaminated food, or sexually transmitted
* usually resolves in 5–7 days
C. difficile
* Usually lives harmlessly in the bowel along with lots of other types of bacteria
* Antibiotic treatment can upset the balance and allow infection
* Usually needs 10-day course of antibiotics
Parasites
How are they transmitted?
How long do they last?
Cryptosporidiosis
* transmitted by animal-to-human or human-to-human contact, by occupational or recreational exposure to contaminated land or water, or by consuming contaminated water or food
* usually lasts for 1–2 weeks, and recurrence of symptoms is reported in around one-third of cases
- Giardiasis
- can be transmitted by person-to-person spread by the faecal-oral route; by contact with the faeces of infected animals; by consumption of contaminated food or drink; waterborne including swimming in contaminated water; or by sexual transmission, particularly among
men who have sex with men - many cases are associated with recent foreign travel, particularly from South Asia
Treatment for Gastroenteritis?
Oral re-hydration therapy, e.g. Dioralyte
* first-line therapy even when referring
Antimotility drugs not routinely recommended and contraindicated if: (3)
- blood/pus/mucous present in stools
- high fever
- confirmed infection with Shigella or certain E.coli strains
Antibiotics not routinely recommended but may be recommended in certain severe cases of confirmed bacterial infection:
- Campylobacter: clarithromycin 250–500 mg twice daily for 5–7 days, within 3 days of onset of illness
- E. coli: no effective antibiotic treatment available for Shiga toxin-producing E. coli
(STEC) infection - Salmonella: antibiotic treatment is not usually needed
- Shigella: specialist advice needed
- C. difficile: depends on infection, but vancomycin most common
- Cryptosporidiosis: no specific treatment licensed in the UK
- Giardiasis: tinidazole 2g as a single dose
In all cases, if diarrhoea +/- vomiting for more than a day:
What should be done?
Stop the DAMN drugs (where appropriate):
* Diuretics
* ACEi/ARB
* Metformin (and other antidiabetics, e.g. SGLT2i, gliclazide)
* NSAIDs
Welsh eye care scheme:
Patient with an acute problem with their vision can be seen for which following issues? (6)
Minor eye injury
Red eye
Painful eye
Foreign body
Sudden loss/change in vision
New onset flashes/floaters
You can self-refer to a local optometrist without the need to see a GP:
Red flags for ophthalmology referral: (7)
- Reduced visual acuity.
- Marked eye pain, headache or photophobia.
- Red sticky eye in a neonate (within 30 days of birth).
- History of trauma (mechanical, chemical or ultraviolet) or possible foreign
body. - Copious rapidly progressive discharge — may indicate gonococcal infection.
- Infection with a herpes virus.
- Soft contact lens use with corneal symptoms (such as photophobia and
watering).
Conjunctivitis (bacterial) - revision
Treatment= chloramphenicol 1% eye ointment OR 0.5% eye drops
C/I= children under 2 or pregnant/breastfeeding women
Styes (hordeola)
- Acute-onset painful, localized swelling (papule or furuncle) near the eyelid
margin that develops over several days - usually unilateral
- external: usually around an eyelash follicle
- internal: swelling tender and localised on eyelid, may point outwards or
inwards
Treatment of Stye:
- Antibiotic treatment not indicated unless:
- accompanying conjunctivitis warrants it
- large internal stye not clearing
What is Blepharitis?
- Burning, itching and/or crusting of the eyelids
- Symptoms are worse in the mornings
- Both eyes are affected
- Recurrent hordeolum
- Contact lens intolerance
- Often occur intermittently with exacerbations and remissions over a long
period
Treatment of Blepharitis:
- Education: this is a chronic, intermittent condition which requires ongoing
maintenance treatment — cure is generally not possible - Symptomatic treatment: twice daily gentle cleaning with warm water (+/-
1:10 dilution baby shampoo), warm compress, avoid mascara and eye make
-up - Antibiotic: for anterior blepharitis, consider topical antibiotic (such as
chloramphenicol) to be rubbed into the lid margin
Dental abscess
- Pain – often sudden-onset over a day or two, throbbing, interfering with
sleep, tooth/gum tender to touch - Unpleasant taste
- Fever and malaise
- Trismus in severe cases
Treatment
- Emergency if airway compromised, spreading infection, significant swelling
making it difficult to open the eye - Otherwise refer to dentist
- analgesia
- often: amoxicillin, clarithromycin, metronidazole, phenoxymethylpenicillin
