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GI > Week 5 > Flashcards

Week 5 Flashcards

1
Q

A patient comes back from a volunteering in refugee camps complaining of frequent diarrhoea. They have gone 6 times in the past 24 hrs. They describe it as watery. What is the most likley cause?

A

Cholera

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2
Q

What investigations would you do on a patient complaining of bloody diarrhoea?

A

Stool culture

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3
Q

What would you give to a patient who is travelling to stop diarrhoea to stop their symptoms worsening?

A

Single dose of ciprofloxacin (fluoroquinolone)

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4
Q

What is the empirical treatment for a patient with enteric fever?

A

IV ceftriaxone

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5
Q

What antibiotics can be given for patients with enteric fever (typhoid or paratyphi)?

A

Ciprofloxacin (resistance 70%)

Azithromycin

Ceftriaxone

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6
Q

What can cause pre-hepatic jaundice?

A

Malaria

HUS - complication of diarrhoeal illness e.g. e.coli 0157

Sickle cell crisis triggered by infection

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7
Q

What can cause hepatic jaundice?

A 
Hepatitis A and E
Weils disease
Malaria
Enteric fever
Rickettsia - Rocky mountain spotted fever, scrub typhus etc
Viral haemorrhagic fever
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8
Q

What causes post-hepatic jaundice?

A

Ascending cholangitis

Helminths

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9
Q

What investigations would you do for a patient with amoebiasis?

A

Stool microscopy (protozoa)

AXR - check for toxic megacolon

Endoscopy for biopsy (not if evidence of toxic dilation)

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10
Q

A patient comes in after a holiday abroad with fever and sweats. They have a lot of upper abdominal pain and sometimes some tummy upset.
They are complaining of tenderness over their right lower ribs.

On examination they are: pyrexic
Evidence of hepatomegaly

What investigations are you going to do?

A 
LFTs
CXR
CT scan
Serology
Stool microscopy
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11
Q

What is the management of an amoebic liver abscess?

A

Metronidazole and tinidazole

To clear gut lumen of parasites - paramomycin/diloxanide

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12
Q

What is giardiasis caused by?

A

Flagellated protozoa

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13
Q

What is the treatment for giardiasis?

A

Metronidazole or tinidazole

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14
Q

Is absorption of water in the gut an active process or a passive process?

A

Passive

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15
Q

What is the absorption of water in the gut driven by?

A

Transport of solutes (particularly Na+)

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16
Q

What problems can diarrhoea cause?

A

Dehydration (Na+ and H2O loss)
Metabolic acidosis/alkalosis
Hypokalaemia

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17
Q

What is the management of diarrhoea?

A

Maintenance of fluid and electrolyte balance (1st line - life saving)

Use of antimicrobial agents in severe cases only

Use of antimotility and spasmolytic agents - symptomatic relief in selected cases

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18
Q

What are some antimicrobials that are used in the management of severe diseases?

A

Co-trimoxazole

Erythromycin

Ciprofloxacin/Norfloxacin

Doxycycline

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19
Q

What is used in the treatment of C.diff?

A

Metronidazole (oral/IV)

Vancomycin (oral)

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20
Q

What is used to treatm amoebiasis and giardiasis?

A

Metronidazole

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21
Q

When should anti-motility agents not be used?

A

Acute infective diarrhoeas

IBS

IBD

diverticulosis

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22
Q

What are the main opiates used in diarrhoea?

A

Loperamide

Diphenoxylate

Codeine

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23
Q

What do laxatives do?

A

Produce a milder action resulting in passage of soft but formed stools

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24
Q

What do purgitives do?

A

Produce a stronger action leading to more fluid evacuation

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25
Name an osmotic laxative
Lactulose
26
Name a bulk laxative
methylcellulose
27
Name a stimulant purgative
Bisacodyl
28
Name a faecal softener
Docusate sodium
29
What 2 toxins does C.diff produce?
Enterotoxin Cytotoxin
30
What is the bacteria? Gram +ve Bacillus Spore-bearing
C.diff
31
How is rotavirus diagnosed?
PCR on faeces
32
What is the treatment for rotavirus?
Re-hydration (preferably orally)
33
If a patient has salmonella or E.coli 0157, where should they be admitted?
ID unit (Infectious Diseases)
34
What is the definition of acute diarrhoea?
Sudden onset Lasts less than 2 weeks
35
What is the definition of chronic diarrhoea?
Diarrhoea which lasts for more than 4 weeks Most cases are not infectious
36
What is the definition of persistent diarrhoea?
Diarrhoea lasting between 2 and 4 weeks
37
What causes diarrhoea?
Stimulation of net fluid and electrolyte secretion Increased propulsive muscle contractions Mucosal destruction and increased permeability Nutrient malabsorption
38
How long does toxin mediated food poisoning take to incubate? What bacteria usually cause this?
1-6hrs Staph. aureus Clostridium perfringens etc No blood or pus in faeces
39
What is the most common cause of traveller's diarrhoea?
Enterotoxigenic E.coli (ETEC)
40
What is one of the major resevoirs for E.coli 0157?
Healthy cattle
41
How long is the incubation period for campylobacter?
2-5 days
42
What is Guillain-Barre syndrome?
Affects the nerves Mainly affects the feet, hands and limbs, causing problems such as numbness, weakness and pain
43
What is the antibiotic treatment for severe campylobacter?
Clarithromycin or azithromycin
44
What does bloody diarrhoea indicate?
Colonic inflammation
45
``` If a patient presents with diarrhoea and they describe it as: Large stool volume Not urgent No tenesmus A little bit of mucus Moderate increase in number ``` Where is the problem likely to be?
Small bowel and colonic
46
``` If a patient comes in with diarrhoea and describes it as: Small in volume Frequent Urgent Tenesmus Mucus Blood ``` Where is the problem likely to be?
Recto-sigmoid
47
What is the treatment of typhoid?
Azithromycin
48
If a patient has E.coli, what tests are you going to do?
Stool cytotoxin
49
What are high risk antibiotics for the development of C.diff?
``` Fluoroquinolones Cephalosporins Clindamycin Carbapenems Co-amoxiclave ```
50
What is the antibiotic treatment of amoebiasis?
Metronidazole
51
What is the treatment for Giardia lamblia?
Metronidazole
52
Which IBD is Th1 mediated? Which IBD is Th1/Th2 mediated/NKTC?
Crohn's UC
53
What does smoking protect against?
Ulcerative colitis
54
A mutated form of which gene is found in 10-20% of patients with Crohn's disease?
NOD2
55
What does NOD2 contribute to?
Normal mucosal defences
56
What IBD is Th1 mediated?
Crohn's
57
What IBD is Th1/Th2 mediated?
UC
58
What tests would you do in someone who had severe ulcerative colitis?
Bloods: CRP and Albumin Plain AXR Endoscopy Histology
59
What does thumb printing on an x-ray show?
Ischaemic colitis Mucosal oedema
60
What is the histology of UC?
Absence of goblet cells Crypt distortion Abscesses Affects the mucosal layer only
61
What IBD has an increased risk of colorectal cancer?
UC
62
What IBD gives rise to an increased risk of Primary Sclerosing Colangitis?
Ulcerative Colitis
63
What is the mean age of diagnosis for Crohn's disease?
27
64
What IBD presents as transmural inflammation?
Crohn's
65
What is the IBD that gives Peri-anal disease?
Crohn's
66
What intestinal bowel disease can increase the risk of fistulas?
Crohn's
67
What investigations would you do on a person who you suspected had Crohn's?
Evidince of wt loss RIF mass Peri-anal signs Bloods: CRP, albumin, platelets, B12, ferritin
68
What is the IBD? Cobblestoning Fat-wrapping Fissure Thickened intestinal wall
Crohn's
69
``` What is the IBD? Ulceration Crypt distortion Loss of haustra Pseudopolyps ```
UC
70
Chronic active colitis with granumloma formation is a sign of what disease?
Crohn's
71
What is the pathology of Crohn's disease?
Cobblestoning Fat-wrapping Fissures Thickened intestinal wall Skip lesions
72
What disease increases the chances of gallstones?
Crohn's disease
73
What IBD increases the risk of bowel obstructions?
Crohn's
74
Diarrhoea with pus and mucus is common in which IBD?
Ulcerative colitis
75
What IBD can cause toxic megacolon?
UC
76
What IBD has no granulomas?
UC
77
What is the treatment for Crohn's disease?
Steroids Immunosupporessants Anti-TNF therapy
78
What is the treatment for Ulcerative Colitis?
5ASA - Sulphasalazine Steroids Immunosupporessants Anti-TNF therapy
79
Give an example of a 5-ASA
Sulphasalazine Balsalazide Mesalazine Pentasa
80
What are some examples of immunosuppressants?
Azathioprine Mercaptopurine Methotrexate
81
What is infliximab?
Anti-TNF therapy
82
Give an anti-TNF drug
Infliximab
83
What does Anti-TNF therapy do?
Promotes apoptosis of activated T-lymphcytes
84
What is the best antibiotic for chlamydia?
Doxycycline
85
What is LKB1?
Tumour suppressor

GI (22 decks)

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