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GI 4 > AIDS > Flashcards

AIDS Flashcards

1
Q

oropharyngeal disease in AIDS

A
  • oral Candidiasis - oral thrush, most common GI complication in HIV-infected patients
  • oral hairy leukoplakia - EBV and HPV
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2
Q

common causes of esophagitis in AIDS

A
  • Candida albicans
  • HSV
  • CMV
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3
Q

characteristics of candidal esophagitis

A
  • endoscopically typified by whitish-yellow plaques
  • cytologic brushings
  • diagnosis of candidal esophagitis in setting of HIV infection confirms progression to AIDS
  • yeast and/or pseudohyphae
  • most frequent occurring fungal infections in patients with HIV infection
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4
Q

diagnosis of candidal esophagitis

A
  • esophagoscopy preferable to barium study

- cytologic brushings superior to biopsies due to superficial, relatively noninvasive nature of candidal infections

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5
Q

treatment of Candidal esophagitis

A
  • clotrimazole
  • nystatin
  • ketoconazole
  • fluconazole
  • amphotericin B
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6
Q

ketoconazole

A
  • requires gastric acid secretion for absorption
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7
Q

fluconazole

A
  • superior to ketoconazole

- DOC in Candidal esophagitis

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8
Q

amphotericin B

A
  • used in patients unable to swallow, those who fail therapy with other antifungal agents, and those with dissemination
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9
Q

HSV esophagitis

A
  • intense retrosternal pain and odynophagia
  • less common cause of esophagitis than Candida
  • vesicles lead to “volcano ulcerations”
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10
Q

cytologic findings of HSV esophagitis

A
  • multinucleated giant cells along with ballooning degeneration
  • ground glass nuclei
  • Cowdry type A eosinophilic intranuclear inclusion bodies with epithelial cells
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11
Q

complications of HSV esophagitis

A
  • bacterial or fungal superinfection, especially with Candida
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12
Q

HSV esophagitis diagnosis

A
  • endoscopy superior to radiology
  • cytology: intranuclear inclusion bodies
  • radiology: progressive circular or diamond shaped halos representing surrounding edematous mucosa
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13
Q

treatment of HSV esophagitis

A
  • acyclovir for 10-14 days

- vidarabine and foscarnet for resistant strains

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14
Q

CMV esophagitis

A
  • almost exclusively in IC patients
  • most common life-threatening opportunistic viral infection in patients with AIDS
  • most causes of CMV esophagitis arise from reactivation of latent virus
  • a lot more pain than seen with Candida or HSV
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15
Q

diagnosis of CMV esophagitis

A
  • endoscopy required for diagnosis
  • biopsy is superior to cytologic brushings or culture
  • basophilic intranuclear inclusion bodies (owls eye inclusions)
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16
Q

treatment of CMV esophagitis

A
  • ganciclovir

- foscarnet for resistant strains

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17
Q

ganciclovir toxicity

A
  • toxicity includes leukopenia and thrombocytopenia

- zidovudine (AZT) should be discontinued or dose decreased due to potential for severe leukopenia

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18
Q

foscarnet toxicity

A
  • renal failure and hypocalcemia
19
Q

most common digestive organ to be involved with Kaposi’s sarcoma

A
  • stomach
20
Q

AIDS gastropathy

A
  • diminished gastric acid secretion in association with antiparietal cell antibodies and gastric atrophy
21
Q

diarrhea and AIDS

A
  • most common and often most morbid GI manifestation of AIDS
  • gays are more likely to have diarrhea
  • AIDS patients with diarrhea have more weight loss and a greater degree of immunosuppression (decreased CD4, T helper cells)
22
Q

cryptosporidia

A
  • can cause diarrhea in both immunocompetent and IC people
  • large volume stools and lack of inflammation suggests a secretory or toxin-mediated process
  • IC hosts include AIDS, hypogammaglobulinemia, leukemia
  • CD4 counts are frequently < 100 and usually < 50 cells/mm3
  • malabsorption and lactose intolerance are common
23
Q

crypto symptoms

A
  • watery diarrhea
  • N/V
  • crampy abdominal pain
  • flatulence
  • weight loss
  • LACK OF FEVER- LACK OF IMMUNE RESPONSE
24
Q

crypto diagnosis

A
  • stains acid fast

- biopsy

25
Q

crypto treatment

A
  • ART tx in AIDS patients to improve immune function
26
Q

isoporiasis

A
  • clinical illness indistniguishable from crypto

- eosinophilia is common

27
Q

treatment of isosopora

A
  • TMP-SMX
28
Q

microsporidia

A
  • ubiquitous, spore forming, obligate intracellular parasite
  • likely to infect the jejunum
  • found in gays who travel to tropical regions
  • CD4 counts typically < 50 cells/mm3
  • malabsorption is common
  • septata intestinalis: has the ability to disseminate, found in kidney and liver
29
Q

symptoms of microsporidia

A
  • multiple, watery BMs
  • abdominal pain
  • flatulence
  • progressive weight loss
  • LACK OF FEVER
30
Q

two infections that do not have fever

A
  • crytpo and microsporidia
31
Q

treatment of microsporidia

A
  • improve CD4 counts and immunologic response

- albendazole may be effective against septata intestinalis

32
Q

mycobacterium avium complex (MAC)

A
  • typically indicates a systemic infection
  • small intestinal more common than colonic
  • may produce malabsorption
  • gut lesion in histology resembles Whipples (differentiate using acid-fast staining)
33
Q

diagnosis of MAC

A
  • acid fast organisms in the blood, stool and duodenal fluid

- differentiation from TB requires culture

34
Q

neoplastic disease in AIDs

A
  • Kaposi’s sarcoma

- found in gingiva, palate, stomach, and intestine

35
Q

hepatic MAI/AIDS

A
  • most specific hepatic disease in AIDS

- marked increase in ALP and milder increases in transaminases

36
Q

pathologic lesion found in hepatic MAI/AIDS

A
  • poorly formed granulomas contained acid-fast bacilli within foamy histiocytes
37
Q

diagnosis of hepatic MAI/AIDS

A
  • biopsy of liver
38
Q

hepatic CMV/AIDS

A
  • second most common intrahepatic infection in AIDS
  • hepatomegaly is usually present
  • mildly elevated ALP and transaminases
  • intracytoplasmic inclusions, mononuclear cell infiltrate, and focal hepatic necrosis seen in biopsy
39
Q

biliary pelioisis hepatitis

A
  • fever, ab pain, LYTIC BONE LESIONS
  • liver biopsy: sinusoidal dilatation, blood filled
  • Rochalimaea hensela and Rochalimaea quintana
  • treated with erythromycin or tetracycline
40
Q

lymphoma and AIDS

A
  • usually of non-Hodgkins type (B cell origin)

- poor response to chemotherapy

41
Q

symptoms of lymphoma in AIDS

A
  • NIGHT SWEATS
  • lymphadenopathy
  • RUQ pain
  • hepatomegaly
  • fever
42
Q

TB

A
  • more common in IVDAs than in gays
  • diagnoses by culture of acid-fast bacilli from liver tissue
  • hepatomegaly common and lesions are seen radiographically
43
Q

viral hepatitis and AIDS

A
  • HCV present in up to 89% of HIV-infected IVDAs
44
Q

biliary tract disease etiologies

A
  • CMV
  • crypto
  • microsporidium
  • any combo

GI 4 (11 decks)

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