1b// GI Infections Flashcards
What are the differential diagnoses for…
What investigations would you order for suspected infections/ non-infectious diarrhoea?
How do you measure severity of C. Diff infection?
How do you manage a non severe disease?
How do you manage a severe disease/ fulminant colitis?
What is the most likely diagnosis for a large intestine distention and infection?
Toxic megacolon
Small bowel obstruction
Large bowel obstruction
Ileus
Toxic Megacolon
What is the first line treatment for a patient with fulminant colitis with toxic megacolon? And what else would you do?
Medical therapy with antibiotics and supportive management
- Patient is transferred to ITU for invasive monitoring
- IV fluid resuscitation & inotropic support
- Discharged 10 days later on extended course of oral vancomycin
What are indications for surgery? (5)
Colonic perforation
Necrosis or full-thickness ischaemia
Intra-abdominal hypertension or abdominal compartment syndrome
Clinical signs of peritonitis or worsening abdominal examination despite adequate medical therapy
End-organ failure
What is this?
Pseudomembranous colitis:
Most often associated with C. difficile infection
Manifestation of severe colonic disease
Characteristic yellow-white plaques that form pseudomembranes on the mucosa
Confirmed on endoscopy +/- biopsy
What is the most likely diagnosis?
Toxic megacolon
Ulcerative colitis
Large bowel obstruction
Pseudomembranous colitis
Crohn’s disease
Extra info about patient…
26F, otherwise healthy.
3 months history of diarrhoea (4x/day) with rectal bleeding.
Associated urgency and mucous.
PMHx: Nil, no medications of note.
SHx: Ex-smoker, stopped 9 months ago.
No recent travel.
26F presenting with a long history of loose motions & PR bleeding who is clinically stable
Blood tests showing ↑ed WCC & CRP indicating an inflammatory/infective process with no complications.
Ulcerative Colitis
What are the management options for ulcerative colitis?
Steroids
5 ASA
Immunosuppressants
- Azathioprine
- Methotrexate
Biologic therapy
Others –diet, FMT, antibiotics, probiotics, novel agents
How do you classify the severity of ulcerative colitis?
UC severity:
Different scopes including clinical disease activity index, Montreal classification and Trulov & Witt scores.
Mild…
4 x BMs/day, no systemic toxicity, normal ESR/CRP, mild symptoms.
Moderate…
> 4x BMs/day, mild anaemia, mild symptoms, minimal systemic toxicity, nutrition maintained and no weight loss.
Severe…
> 6 BMs/day, severe symptoms, systemic toxicity, significant anaemia, increased ESR/CRP and weight loss.
What would you do next if this happened after treating for ulcerative colitis?
Progress update after treating the UC twice… What would you do next?
