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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
Q

Name an osmotic laxative

A

Lactulose

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26
Q

Name a bulk laxative

A

methylcellulose

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27
Q

Name a stimulant purgative

A

Bisacodyl

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28
Q

Name a faecal softener

A

Docusate sodium

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29
Q

What 2 toxins does C.diff produce?

A

Enterotoxin

Cytotoxin

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30
Q

What is the bacteria?

Gram +ve

Bacillus

Spore-bearing

A

C.diff

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31
Q

How is rotavirus diagnosed?

A

PCR on faeces

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32
Q

What is the treatment for rotavirus?

A

Re-hydration (preferably orally)

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33
Q

If a patient has salmonella or E.coli 0157, where should they be admitted?

A

ID unit (Infectious Diseases)

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34
Q

What is the definition of acute diarrhoea?

A

Sudden onset

Lasts less than 2 weeks

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35
Q

What is the definition of chronic diarrhoea?

A

Diarrhoea which lasts for more than 4 weeks

Most cases are not infectious

36
Q

What is the definition of persistent diarrhoea?

A

Diarrhoea lasting between 2 and 4 weeks

37
Q

What causes diarrhoea?

A

Stimulation of net fluid and electrolyte secretion

Increased propulsive muscle contractions

Mucosal destruction and increased permeability

Nutrient malabsorption

38
Q

How long does toxin mediated food poisoning take to incubate?

What bacteria usually cause this?

A

1-6hrs

Staph. aureus
Clostridium perfringens
etc

No blood or pus in faeces

39
Q

What is the most common cause of traveller’s diarrhoea?

A

Enterotoxigenic E.coli (ETEC)

40
Q

What is one of the major resevoirs for E.coli 0157?

A

Healthy cattle

41
Q

How long is the incubation period for campylobacter?

A

2-5 days

42
Q

What is Guillain-Barre syndrome?

A

Affects the nerves

Mainly affects the feet, hands and limbs, causing problems such as numbness, weakness and pain

43
Q

What is the antibiotic treatment for severe campylobacter?

A

Clarithromycin or azithromycin

44
Q

What does bloody diarrhoea indicate?

A

Colonic inflammation

45
Q 
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?

A

Small bowel and colonic

46
Q 
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?

A

Recto-sigmoid

47
Q

What is the treatment of typhoid?

A

Azithromycin

48
Q

If a patient has E.coli, what tests are you going to do?

A

Stool cytotoxin

49
Q

What are high risk antibiotics for the development of C.diff?

A 
Fluoroquinolones
Cephalosporins
Clindamycin
Carbapenems
Co-amoxiclave
50
Q

What is the antibiotic treatment of amoebiasis?

A

Metronidazole

51
Q

What is the treatment for Giardia lamblia?

A

Metronidazole

52
Q

Which IBD is Th1 mediated?

Which IBD is Th1/Th2 mediated/NKTC?

A

Crohn’s

UC

53
Q

What does smoking protect against?

A

Ulcerative colitis

54
Q

A mutated form of which gene is found in 10-20% of patients with Crohn’s disease?

A

NOD2

55
Q

What does NOD2 contribute to?

A

Normal mucosal defences

56
Q

What IBD is Th1 mediated?

A

Crohn’s

57
Q

What IBD is Th1/Th2 mediated?

A

UC

58
Q

What tests would you do in someone who had severe ulcerative colitis?

A

Bloods: CRP and Albumin

Plain AXR

Endoscopy

Histology

59
Q

What does thumb printing on an x-ray show?

A

Ischaemic colitis

Mucosal oedema

60
Q

What is the histology of UC?

A

Absence of goblet cells

Crypt distortion

Abscesses

Affects the mucosal layer only

61
Q

What IBD has an increased risk of colorectal cancer?

A

UC

62
Q

What IBD gives rise to an increased risk of Primary Sclerosing Colangitis?

A

Ulcerative Colitis

63
Q

What is the mean age of diagnosis for Crohn’s disease?

A

27

64
Q

What IBD presents as transmural inflammation?

A

Crohn’s

65
Q

What is the IBD that gives Peri-anal disease?

A

Crohn’s

66
Q

What intestinal bowel disease can increase the risk of fistulas?

A

Crohn’s

67
Q

What investigations would you do on a person who you suspected had Crohn’s?

A

Evidince of wt loss

RIF mass

Peri-anal signs

Bloods: CRP, albumin, platelets, B12, ferritin

68
Q

What is the IBD?

Cobblestoning
Fat-wrapping
Fissure
Thickened intestinal wall

A

Crohn’s

69
Q 
What is the IBD?
Ulceration
Crypt distortion
Loss of haustra
Pseudopolyps
A

UC

70
Q

Chronic active colitis with granumloma formation is a sign of what disease?

A

Crohn’s

71
Q

What is the pathology of Crohn’s disease?

A

Cobblestoning
Fat-wrapping
Fissures
Thickened intestinal wall

Skip lesions

72
Q

What disease increases the chances of gallstones?

A

Crohn’s disease

73
Q

What IBD increases the risk of bowel obstructions?

A

Crohn’s

74
Q

Diarrhoea with pus and mucus is common in which IBD?

A

Ulcerative colitis

75
Q

What IBD can cause toxic megacolon?

A

UC

76
Q

What IBD has no granulomas?

A

UC

77
Q

What is the treatment for Crohn’s disease?

A

Steroids
Immunosupporessants
Anti-TNF therapy

78
Q

What is the treatment for Ulcerative Colitis?

A

5ASA - Sulphasalazine
Steroids
Immunosupporessants
Anti-TNF therapy

79
Q

Give an example of a 5-ASA

A

Sulphasalazine

Balsalazide

Mesalazine

Pentasa

80
Q

What are some examples of immunosuppressants?

A

Azathioprine
Mercaptopurine

Methotrexate

81
Q

What is infliximab?

A

Anti-TNF therapy

82
Q

Give an anti-TNF drug

A

Infliximab

83
Q

What does Anti-TNF therapy do?

A

Promotes apoptosis of activated T-lymphcytes

84
Q

What is the best antibiotic for chlamydia?

A

Doxycycline

85
Q

What is LKB1?

A

Tumour suppressor

GI (22 decks)

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