Tropical Gastroenterology

Question 1

symptoms of tropical GI disease

Answer 1

fever
rash
hepatosplenomegaly 
lymphadenopathy
insect bites
wounds

Question 2

describe acute travellers diarrhoea

Answer 2

3 loose stool in 24 hour

Question 3

microorganism’s causing travellers diarrhoea

Answer 3

enterotoxigenic E.coli - most common
campylobacter, salmonella, shigella
amoebic diarrhoea

Question 4

cruise ship pathogens causing travellers diarrhoea

Answer 4

norovirus

rotavirus

Question 5

micro-organisms causing bloody diarrhoea (dysentery)

Answer 5

E.coli0157

amoebic colitis

Question 6

micro-organisms causing profuse watery diarrhoea

Answer 6

cholera - toxin mediated disease

Question 7

tests for acute traveller’s diarrhoea

Answer 7

stool culture

Question 8

treatment for acute traveller’s diarrhoea

Answer 8

supportive - fluid hydration
ciprofloxacin - travelling
azithromycin - used in antibiotic resistance

Question 9

what is enteric fever

Answer 9

typhoid or paratyphoid fever
common in those returning from India and SE Asia
incubation period 7-18 days

Question 10

microorganisms causing enteric fever

Answer 10

salmonella typi or paratyphoid

Question 11

symptoms of enteric fever

Answer 11

fever
headache
constipation or diarrhoea
dry cough

Question 12

complications of enteric fever

Answer 12

GI bleeding
GI perforation
encephalopathy
bone and joint infection

Question 13

tests for enteric fever

Answer 13

laboratory precautions;
blood
stool
urine 
bone marrow

Question 14

treatment for enteric fever + sepsis

Answer 14

ceftiaxone

Question 15

treatment for enteric fever

Answer 15

empirical;
ciprofloxacin - fluoroquinolone
azithromycin
ceftriaxone

Question 16

causes of pre-hepatic (haemolytic) fever and jaundice

Answer 16

malaria
HUS (complication of E.coli, shigella gastroenteritis)
sickle cell triggered by infection

Question 17

causes of hepatic fever and jaundice

Answer 17

hepatitis A and E
Leptospirosis – Weils diseases (Icteric, haemorrhagic and renal failure)
Malaria
Enteric fever
Rickettsia (scrub typhus, Rocky Mountain spotted fever etc)
Viral haemorrhagic fever

Question 18

causes of post-hepatic fever and jaundice

Answer 18

ascending cholangitis

helminths

Question 19

tests for fever and jaundice

Answer 19

Malaria blood film and rapid antigen
Blood film - red cell fragmentation
FBC/UE/LFT/coagulation
Blood cultures
ultrasound abdomen
Serological testing for viruses

Question 20

treatment for fever and jaundice

Answer 20

isolation and infection control
Supportive – dialysis if acute kidney injury
If acute liver failure – hepatology/transplant unit
Directed to pathogen isolated

Question 21

amoebiasis

Answer 21

an infection caused by Entamoeba histolytica - a protozoa

Question 22

how is amoebiasis spread

Answer 22

via faecal-oral spread

poor sanitation

Question 23

symptoms of amoebiasis

Answer 23

asymptomatic

shed cysts in stools chronically

Question 24

symptoms of amoebic dysentery

Answer 24

abdominal pain 
fever
blood diarrhoea/colitis
toxic and unwell
abdominal tenderness
peritonism

Question 25

tests for amoebiasis

Answer 25

stool culture
AXR- toxic megacolon
endoscopy - biopsy

Question 26

amoebic liver abscess

Answer 26

infection of liver caused by Entamoeba histolytica

Incubation period 8-20 weeks

Question 27

epidemiology of amoebic liver abscess

Answer 27

men

Question 28

symptoms of amoebic liver abscess

Answer 28

fever, sweats
upper abdominal pain 
dysentery
hepatomegaly 
point tenderness over right lower ribs

Question 29

tests for amoeba liver abscess

Answer 29

abnormal LFTs
CXR - raised right hemi-diaphragm
ultrasound/CT
serology
stool culture

Question 30

treatment for amoebic liver abscess

Answer 30

metronidazole
tinidazle
Paramomycin/diloxanide - clears gut lumen of pathogens

Question 31

giardiasis

Answer 31

diarrheal disease caused by Giardia intestinalis (lamblia)

incubation 7 days

Question 32

where does giardiasis effect

Answer 32

duodenum

proximal jejunum

Question 33

how is giardiasis spread

Answer 33

faecal-oral

contaminated water

Question 34

symptoms of giardiasis

Answer 34

watery, malodorous diarrhoea
bloating, flatulence
abdominal cramps
weight loss

Question 35

tests for giardiasis

Answer 35

stool culture

OGD - duodenal biospy

Question 36

treatment for giardiasis

Answer 36

metronidazole or tinidazle

Question 37

where do helminth infections effect

Answer 37

gut tissue

Question 38

helminth infections

Answer 38

often associated with eoinophilia

diagnosed by adult worm passed or eggs in stool

Question 39

helminths parasites

Answer 39

nematodes (roundworms)
trematodes (flukes)
cestodes (tapreworms)

Question 40

types of nematodes

Answer 40

intestinal roundworms - ascariasis (most common)

tissue roundworms

Question 41

types of cestodes

Answer 41

intestinal

larval - Taenia solium, saginatum

Question 42

types of trematodes

Answer 42

Schistosomiasis – fresh water exposure

Question 43

chronic infection of Schistosomiasis

Answer 43

Adult worms located in portal venules which can lead to hepatolmegaly and liver fibrosis and portal hypertension

Question 44

infection of ascariasis

Answer 44

egg hatches in small intestine
invade gut wall into venous system and via liver and heart reach lungs – break into alveoli – ascend tracheobroncial tree and swallowed
in the gut develop into adult worm - produce eggs.

Question 45

infection of cestodes

Answer 45

undercooked meat containing infectious larval cysts

cysticercosis - tissue cysts in muscle and brain causing seizures

Question 46

chagas disease

Answer 46

infection caused by Trypanasoma cruzi

Question 47

spread of chagas disease

Answer 47

kissing bug (Triatome)

Question 48

signs of chagas disease

Answer 48

parasymphathetic denervation affecting the colon and or oesophagus
Megaoesophagus