Approach to GI infections Flashcards
(23 cards)
What are the host defenses that are associated with different areas of the GI Tract?
Esophagus- Motility/Aciidty
Stomach- Acidity/Motility
Small/Large Int- Normal Flora/motility
What are the common clinical syndromes and pathogens that appear in each part of GI?
Esophagus- Esophagitis
Stomach-
Small/Large Int- ###
What is common presentation of Esophagitis?
Dysphagia with or without odynophagia Retrosternal pain Candida- no ulcers HSV 1- ulcerations, most common virus CMV- Ulcerations, entire GI tract
What are the Tx of common Esophageal microbes?
Candida: Oral Fluconazole, IV Echinocandin, or Ampho B
Herpes Simp: Acyclovir
CMV: IV Gancyclovir, Oral Valgancyclovir
How is the somach infected by microbes?
Microbes neutrlize acid barrier
-inc enteric bacterial and parasitic inf.
-Inc normal flora in small bowel
H Pylori
How is H Pylori Diagnosed Non-Invasively?
Non-invasive: Urea Breath Test, stool antigen, Serology
How is H Pylori Diagnosed Invasively?
Invasive studies: Biopsy urease test(less sensitive when taking PPI or GI bleed), Histology, Culture
What is the Tx of H. Pylori?
…
What is the test for effective Tx of H Pylori?
Non-Invasive preferred -Urea Breath test -Stool antigen (Not IgG Ab test) Endoscopy
What is Diarrhea?
A passage of abnormally liquid or unformed stools at increased frequency
acute: 4weeks
What can fresh stool tell you?
Gross description: Watery, mucoid, bloody
Microscopic eval: Parasites, mal digested meat fibers, Lipid droplets
What exposure is commonly seen with giardia infection?
Ingestion of stream water
What exposure is commonly seen with Cryptosporidium infection?
Daycare centers, swimming pools
What exposure is commonly seen with Entamoeba histolytica infection?
Travel to endemic areas
What are the microbes that often give symptoms via preformed toxin?
Bacillus Cerus
S. Aureus
C. Perfringens
What are the microbes that often give symptoms via Enterotoxin?
Vibrio Cholerae
ET E.Coli
Klebsiella pneumoniae
Aeromonas sp
What are the microbes that often give symptoms via Cytotoxin?
C. Difficile
Hemorrhagic E. Coli
What is the most common cause of identifiable antibiotic associated diarrhea?
C. Difficile
A and B toxin
What is the most commonly used Abtx used for C. Diff?
Vancomycin and Metronidozol
Metro is used more than Vanco bc of Vanco Resistant enterococci
What form of Vancomycin is used?
Oral Vancomycin does not penetrate the gut wall and keeps high concentrations of Drug in the gut lumen.
WHat is the typical dose for high and low dose Abtx Treatment?
High: 500mg Metro PO TID
Low: 125mg Vanco PO QID
What are treatments for recurrent C. Diff infections?
1st same regimen
No Metro past 1st recurrence or long term chronic therapy
2nd or later with vanco with taper or pulse therapy
Probiotics not recommended.
What is the tx for lower GI tract infections?
Supportive including fluids and electrolytes
Bismuth subsalicylate or antiperistaltic if watery diarrhea(no fever or blood)
Pathogen specific Abtx when indicated.
