AIDS and the GI tract

Question 1

Name 4 conditions that occur in the oral cavity in a patient that also has AIDS.

Answer 1

1. Oral candidiasis: Candida a.
2. Hairy Leukoplakia: EBV, HPV
3. Aphthoous Ulcers: CMV, HSV, HIV
4. Kaposi Sarcoma: HHV-8

(aphthous ulcers are canker sores)

Question 2

3 most common bugs that infect the esophagus in patients with AIDS.

Answer 2

1. Candida a.
2. CMV
3. HSV

Question 3

Treatment for Candida Esophagitis.

Answer 3

Normally oral thrush appears first, so patients with oral thrush have the esophagus treated concurrently even without endoscopy to confirm if the esophagus is even affected.

Topical agents (minor symptoms): clotrimazole, nystatin

Oral Agents: ketoconazole, fluconazole, Amphotercin B

Question 4

Characteristic lesions on the esophageal mucosa in HSV esophagitis.

Answer 4

Volcano Ulcers

Question 5

Treatment for HSV esophagitis.

Answer 5

Acyclovir

For resistant strains: foscarnet, vidarabine

Question 6

Most common life-threatening infection in AIDS patients.

Answer 6

CMV

Question 7

Type of ulcer seen in CMV esophagitis.

Answer 7

Large deep ulcers

Question 8

Treatment for CMV esophagitis.

Answer 8

Ganciclovir

Foscarnet in ganciclovir resistant strains

Question 9

Adverse effects of ganciclovir and foscarnet.

Answer 9

Ganciclovir: thrombocytopenia, leukopenia (should not be used with AZT)

Foscarnet: renal failure, hypocalcemia

Question 10

Cause of idiopathic ulcers in AIDS patients and treatements.

Answer 10

Originally unknown (idiopathic) but now HIV is believed to cause the ulcers.

Treat: steroids, thalidomide

Question 11

Most common AIDS associated pathology of the stomach.

Answer 11

Kaposi Sarcoma (HHV-8)

Question 12

Most common etiology of AIDS-associated diarrhea.

Answer 12

Infection

Question 13

Why do AIDS pts. infected with Cryptosporidium present with lactose intolerance?

Answer 13

Parasites cause villous atrophy in small bowel.

Question 14

Why is fever absent in most AIDS patients with infection?

Answer 14

Immune system is weak.

Question 15

Treatment for Cryptosporidium infection.

Answer 15

Zidovudine (AZT): to boost immune system.

-nucleoside RT inhibitor

Question 16

Treatment for Isospera b. infection

Answer 16

TMP-SMX

Question 17

Complication and treatment of Microsporidia infection.

Answer 17

Has the ability to disseminate thru the body.

Treatment is usually ineffective but albendazole works the best

Question 18

Most common manifestation of CMV enteric infection.

Answer 18

Huge ulcers in the Right Colon

Question 19

Common manifestation of Mycobacterium Avium Complex (MAC).

Answer 19

Malabsorption syndrome

Question 20

Dx and Tx for Idiopathic Diarrhea in AIDS patients.

Answer 20

Dx: rule out all other infection, toxin, or autoimmune causes in AIDS patients

Tx. Somatostain analog (octreotide)

Question 21

What is responsible for Sqamous Cell Carcinoma in AIDS patients in the anorectal area?

Answer 21

HPV

Question 22

Most common sites of Kaposi Sarcoma.

Answer 22

Gingiva, hard palate, stomach, intestine

asymptomatic unless obstruction occurs

Question 23

Most common AIDS-associated liver disorder.

Answer 23

MAC/MAI (mycobacterium avium complex/infection)

Question 24

Best way to diagnose MAC in the liver.

Answer 24

Biopsy

Question 25

Liver tests that rise in CMV infection of the liver.

Answer 25

ALP
AST
ALT

Question 26

Pathogenesis, causative agent, and Tx for Biliary Peliosis Hepatitis.

Answer 26

Path: Infection causes dilation of blood filled sinusoids causing fever, abdominal pain, lytic bone lesions

Bug: Rochalimaea henselae or R. Quintana

Tx. Erythromycin or Tetracyclines