Week 9 - GI Disease 2 Flashcards
What are the most common causes of acute gastroenteritis?
50% Norovirus
20% Campylobacter
Rest - Salmonella, Shigella, C.Diff
What is likely cause of diarrhoea with blood?
Shigella
Campylobacter
Enterovirus
Ecoli 0157
What is the likely cause of diarrhoea with crampy abdo pain?
Campylobacter
Diarrhoea + systemic features (fever, headache, myalgia)?
Shigella
How long does it take for acute gastroenteritis to resolve?
24-96 hours
What investigations should you do for gastroenteritis?
Usually resolves before investigations warranted
Can do Stool MC&S, AXR (exclude toxic megacolon)
If >2w - colonoscopy / flexi sig to exclude IBD
How can you manage Ps with acute gastroenteritis?
Encourage oral fluids
IV fluids
Anti-emetics
Poss empirical Abx
Why should you not give anti diarrhoea meds in Ps with acute gastroenteritis?
Is the body’s way of trying to get rid of infection - preventing that with anti-diarrhoeals may prolong the infection
What can you give for Campylobacter infection?
If >1w or deteriorating / pregnancy / IC - give Ciprofloxacin
What syndrome can you sometimes get after a campylobacter infection?
Guillain-Barre
Very rare and serious condition that affects the nerves.
It mainly affects the feet, hands and limbs, causing problems such as numbness, weakness and pain. Immune system has gone haywire and started attacking the nerves.
The main treatments are:
intravenous immunoglobulin (IVIG) – a treatment made from donated blood that helps bring your immune system under control
plasma exchange (plasmapheresis) – an alternative to IVIG where a machine is used to filter your blood to remove the harmful substances that are attacking your nerves
treatments to reduce symptoms such as painkillers
treatments to support body functions, such as a machine to help with breathing and/or a feeding tube
Most people need to stay in hospital for a few weeks to a few months.
Can you give Abx for shigella?
Only if Shigella shigae or shigella dysenteriae
Which bacterial infection can mimic Crohn’s?
Yersinia enterocolitica - Ps present with acute onset diarrhoea, and a scan suggests some thickening of the terminal ileum - think Crohns but culture to make sure not Yersinia.
Which bacterial infection can cause hemorrhagic colitis and HUS?
Ecoli 0157
What type of bacteria is C Diff?
Gram positive, spore-forming, anaerobic bacillus
What is a potential SE of C Diff infection?
Pseudomembranous colitis
What treatment is given for C Diff?
Metronidazole
Vancomycin
Fidaxomicin
What is the commonest non-bacterial cause of V&D?
Norovirus
What is the treatment for norovirus?
Supportive - fluids, anti-emetics, anti-diarrhoeals
Where can TB cause GI problems?
Ileocaecal
Peritoneum = peritonitis
Exudative ascites with lymphocytosis
Positive for acid fast bacilli
Raised adenosine deaminase
With imaging showing bowel wall thickening can suggest what?
How would you treat?
TB
Rx - as for pulmonary TB
Which bacteria are acid fast bacilli?
Mycobacteria - most common = TB and leprosy
How can you get amoebiasis?
Usually ingestion of faecally contaminated food or water
What infection can present similarly to UC with proctocolitis and rarely can cause toxic megacolon?
Amoebic dysentery
Which amoeba causes amoebic dysentry?
How is this diagnosed?
Entamoeba histolytica
Diagnosed via ELISA with stool sample or serology
How is dysentry treated?
Metronidazole
Abscess drainage if needed
Which parasite can cause small bowel malabsorption?
Giardia
Which parasite can cause amoebic dysentery and liver abscesses?
Entamoeba histolytica
Which parasite can cause IDA?
Hookworm
Which parasite can cause hydatic cysts?
Tapeworm - hydatid disease - linked to sheep - get flukes that cause cysts in liver and other organs 🤮
Which parasite can cause biliary obstruction?
Liver flukes (parasitic flatworms - from livestock) - like living in the bile duct 🤮🤢
Which parasite can cause non-cirrhotic portal hypertension?
Shistosomiasis
How can HIV affect the gut?
Can cause villous atrophy and crypt malabsorption (direct) and also immunosuppression (indirect) allows other pathogens to grow in the bowel - e.g. candidiasis or cryptosporidium
What is the Rx for a HSV infection?
Acyclovir
What type of bowel disorder is IBS?
Functional bowel disorder
What are the Sx of IBS?
Abdo pain / discomfort associated with defecation or CIBH + features of disordered defecation.
What are the diagnostic criteria of IBS?
Recurrent abdo pain or discomfort for at least 3 days per month in last 3 months
with 2 or more of:
- improved Sx with defecation
- onset ass with change of frequency in stool
- onset ass with a change in form of stool
What are the subtypes of IBS?
IBS-C
IBS-D
IBS-M
💩
What tests can you do for IBS?
Calprotectin (>150 = raised)
Stool MC&S
Bloods inc Coeliac screen (anti-ttg) and CRP
Colonoscopy
Breath tests
Colonic transit studies
What lifestyle advice can you give to Ps with IBS?
Lifestyle modification - Low FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides and polyols)
exclude fermentable long chain carbs - which pull fluid into the bowel and gas = liquid and bloating.
What Rx can you give for IBS with constipation?
1st line = Osmotic laxative + buscopan or peppermint oil for the pain
2nd line = Prucalopride or Linacliotide
What Rx can you give for IBS with diarrhoea?
1st line = loperamide + buscopan or peppermint oil
2nd line = Rifaximin or TCA (amitriptyline)
How can you distinguish IBS from IBD?
By faecal calprotectin levels
Which gene is involved in CF?
CFTR gene
How is the intestine affected by CF?
What is DIOS?
Distal Intestinal obstruction syndrome - thick stool blocks the intestinal tube either partially or completely
GORD is common in CF Ps. Why is this a bad thing?
It can worsen respiratory Sx.
How can CF affect the liver?
Can cause CF associated liver disease => raised ALT, AST, GGT. This is because the defect causes bile to be increasingly thick and sticky => obstruction and cirrhosis or steatosis.
How is colorectal cancer affected in CF?
Incidence increases x5-x10 - therefore need screening from 40yo.
How is anaesthesia affected by CF?
Ps with CF - are hypermetabolic - liver is used to producing more energy because they waste energy producing mucus in their lungs. Are also less able to absorb nutrients - need for more and less able to absorb. Liver therefore faster - so anaesthetists have to use more drugs (also for ABxs).
How do CF affect nutrition?
Have a higher metabolic load from mucus production + respiratory pathogens
also have impaired absorption - need to make sure they sufficient nutrients
Which two enzymes are needed to metabolise alcohol?
Alcohol dehydrogenase
Aldehyde dehydrogenase
What is alcohol converted to in the body?
Cholesterol
Fatty acids
Ketone bodies
CO2
What does methanol metabolise to?
What Rx can you give a P with methanol consumption?
Formaldehyde then Formic acid - both toxic and can cause blindness as optic nerve cells are particularly sensitive.
1) Folate - can reduce the reaction and breaks up formic acid
2) Ethanol - alcohol dehydrogenase binds more readily to this - and displaces the binding of the methanol - slows down the reaction.
What can ethylene glycol poisoning cause? (Antifreeze)
Kidney failure - because oxalic acid crystals can deposit in the kidney
What are the metabolic effects of alcohol?
Metabolism of alcohol creates lots of NADH
This makes the body believe it is in an energy rich environment - don’t need to do TCA and glycolysis - suppresses a lot of these processes.
Get inc in ACoA as TCA slows -> inc in ketones in the blood
Fatty acid and 3Gs are also produced from the breakdown of alcohol => deposited in hepatocytes => fatty liver
Low NAD+:NADH ratio also inhibits gluconeogenesis => blood glucose level drops = hypoglycaemia
How can you tell from a liver screen that there is likely to be excess alcohol consumption?
Raised MCV
AST > ALT
Raised IgA
Raised GGT
Which calculator is used to quantify liver damage?
Fibrosis-4 Calculator
What are specific clinical features of alcoholic liver disease?
Dupuytren’s contractures
Parotid swelling
What are the stages of liver damage?
How can liver cells appear on histology with alcoholic liver disease?
Steatosis (globules of fat in cytoplasm)
Balloon degeneration + Mallory-Denk bodies
Fibrosis
Which two vessels supply the liver with blood?
Hepatic artery (1/3)
Portal vein (2/3)
What is it called when a thrombosis develops in the hepatic vein causing blockage of the outflow of blood.
Presents with a triad of
- abdo pain
- hepatomegaly
- ascites?
Budd-Chiari syndrome
How is Budd-Chiari syndrome managed?
Anticoagulation (heparin or warfarin) + investigate and treat underlying cause
What quick screening tool can you use to check for alcoholism?
CAGE Tool
- Ever felt the need to CUT down on drinking?
- Have people ANNOYED you by criticising your drinking?
- Have you ever felt GUILTY about the amount you drink?
- Ever have an EYE OPENER?
4 = alcoholism, 2-3 highly suspicious
What are the signs of alcohol withdrawal?
HITS
Hallucinations
Insomnia and Inc vital signs
Tremens delirium
Shakes, seizures and sweats
What tool is used to assess withdrawal?
CIWA score (Clinical Institute Withdrawal Assessment)
What tool is used to assess severity of dependence on alcohol?
SADQ Score
Which drug can be given for alcohol withdrawal?
Chlordiazepoxide
