GI infections

Question 1

What does inflammation do to albumin?

Answer 1

Inflammation drops albumin

Question 2

What are differentials for watery diarrhoea?

Answer 2

1. infectious diarrhoea: c.diff, salmonella, e.coli etc

2. non-infectious: antibiotic side effect, post-infectious IBS, IBD, microscopic colitis

Question 3

What investigations should you do for watery diarrhoea?

Answer 3

Blood test, stool sample/culture, chest/abdo x-ray

Question 4

What is management for c.diff if not severe?

Answer 4

• Isolate patient for infection control, stop antibiotic they are on, fluid management, nutrition.
• Antibiotic therapy with oral vancomycin or diaxomicin or metronidazole.
• Possible FMT.

Question 5

What is management if severe c.diff disease or fulminant colitis?

Answer 5

Antibiotics, supportive care, close monitoring, early surgical consultation

Question 6

what is a severe consequence of c.diff?

Answer 6

fulminant colitis

Question 7

What is toxic megacolon?

Answer 7

Severe form of fulminant colitis with dilation of large bowel

Question 8

What is first line treatment for toxic megacolon? What are indications for surgery?

Answer 8

Antibiotics + supportive. Fluid resucitation + inotropic support.
- Indications for surgery: colonic perforation, necrosis or full thickness ischemia, intra-abdominal hypertension or abdominal compartment syndrome, peritonitis, end-organ failure

Question 9

What is pseudomembranous colitis? When does it usually occur? how is it confirmed?

Answer 9

• Occurs most often after c.diff
• severe colonic disease,
• yellow-white plaques that form pseudomembranes on mucosa.
• Confirmed on endoscopy + biopsy

Question 10

What does 3 month history of diarrhoea with rectal bleeding, mucus, urgency, high WCC, CRP high, high platelets indicate?

Answer 10

IBD - inflammatory bowel disease

Question 11

What molecule is a biomarker of active inflammation in IBD?

Answer 11

calprotectin

Question 12

What is FIT?

Answer 12

• Fecal immunochemical test.
• Detects hidden blood in stool.
• Positive in IBD

Question 13

Colonoscopy showing left sided inflammatory changes, chronic inflammation with no granulomas indicates what?

Answer 13

Ulcerative colitis

Question 14

What is management for ulcerative colitis?

Answer 14

-Steroids, 5-ASA, immune suppressants (azathioprine, methotrexate), diet, FMT, antibiotics, probiotics, novel agents

Question 15

What are different severities of ulcerative colitis?

Answer 15

• Mild: 4xBM/day, no systemic toxicity, normal ESR/CRP, mild symptoms.
• Moderate: >4xBM/day, mild anaemia, mild symptoms, minimal systemic toxicity, no weight loss/nutrition maintained.
• Severe: > 6xBM/day, severe symptoms and systemic toxicity, significant anaemia, increased ESR/CRP, weight loss

Question 16

If ulcerative colitis flares up again what should you do?

Answer 16

-Repeat blood tests to see stage, manage with steroid for remission (start prednisolone) educate on side effects, immunomodulators eg. azathioprine

Question 17

If flare up of UC after being put on immunomodulators again?

Answer 17

Rule out infection, consult, IV steroids x 3 days, start infilixab while continuing azathioprine.

Question 18

What do aminosalicylates do?

Answer 18

Reduce inflammation in gut

Question 19

What do immunosupressants like steroids/azathioprine do?

Answer 19

Reduce activity of immune system

Question 20

What do biological therapies do?

Answer 20

Antibody based treatments given by injection targeting specific part of immune system