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treatment and prevention of infection > Gastrointestinal Infections > Flashcards

Gastrointestinal Infections Flashcards

1
Q

List the common symptoms of acute gastroenteritis

A

Diarrhoea
Nausea and vomiting
Abdominal pain
Fever

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2
Q

List the clinical syndromes of gastroenteritis

A 
Acute gastroenteritis 
Dysentery (blood in diarrhoea)
Traveller’s diarrhoea 
Post antibiotic diarrhoea 
Chronic diarrhoea >2-3 weeks
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3
Q

Name the bacteria normally associated with gastroenteritis, from most to least popular

A 
Campylobacter 
Salmonella
Shigella
Escherichia coli 
E.coli 0157
Clostridium difficile
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4
Q

Name the common viruses known to cause gastroenteritis

A

Norovirus
Rotavirus
Adenovirus

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5
Q

Name the common Protozoa in gastroenteritis

A

Cryptosporidium
Giardia lambila
Entamoeba histolytica

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6
Q

What must happen for dysentery to occurs

What pathogen does not cause dysentery

A

Need to damage mucosa

Virus and cryptosporidium can’t cause dysentery

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7
Q

What bacteria is not relevant in travellers diarrhoea

A

C.diff

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8
Q

The more c.diff that is found, the greater the

A

Damage to the mucosa

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9
Q

What do you find with chronic diarrhoea

A

Likely to come from travellers diarrhoea from parasites

Post-infection syndromes can be irritable bowel or malabsorption

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10
Q

What are the differential diagnosis with gastroenteritis

As you get older, more complications can happen so you need to determine if it is contagious

A 
Inflammatory bowel disease
Diverticula disease
Ischaemic colitis
Colorectal carcinoma 
Malabsorption 
Pneumonia
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11
Q

If someone presents with diarrhoea, what should you do?

A

Take a stool sample
Microscopy (cysts, parasites (OCP for particular parasite))
And culture
Check for rotavirus or c.diff

More so in hospital than in general practice if ill enough

May have to get more than one specimen if need more parasites numbers

Sometimes need to do a colonoscopy

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12
Q

List the general management for diarrhoea

A 
Oral or IV rehydrates 
Analgesia 
Antiemetics (ondansetron) 
Avoid antidiarrhoeal agents (loperamide), e.g. dysentery in children 
Isolation in hospital 
Notification to public health 
Return to work or school
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13
Q

Example of giving an antibiotic in diarrhoea symptom

A

Suspected c.diff diarrhoea - metronidazole or vancomycin

Travellers diarrhoea <80% due to bacteria, more likely to make a difference
If due to parasites, confirm on stool, chronic symptoms and no response to ciprofloxacin

There’s controversial area for antibiotics being used for acute gastroenteritis

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14
Q

Risk of using antibiotic therapy in gastroenteritis

A

Prolong the duration of carriage (salmonella)
Antibiotic-associated diarrhoea
Antibiotic resistance
Adverse drug events

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15
Q

Is the incidence of symptomatic UTIs get older with age?

A

Yes because decrease of oestrogen, affects bacteria a and mucosal area, those bacteria can win the numbers in the environment

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16
Q

Asymptomatic bacteriuria

A

Truest asymptomatic
Don’t need to do anything

Institutionalised elderly 15-50%
100% in long term in dwelling catheters

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17
Q

Pathogens is I of UTIs, what is the most common route?

A

The ascending route

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18
Q

How does the ascending route occur

A

Intestinal flora comes though GI tract and migrates across the skin to the urethra

Some strains are uropathogenic (can live in urine)

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19
Q

What can cause uropathogenic strains more likely to cause trouble/ appear

A

Diarrhoea
Oestrogen deficiency
Spermicides (increase numbers and adherence)
Urodynamics (flow and structure anatomy)
Bacteria with motile flagellate and adherence, allows them to ascent

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20
Q

How are these bacteria able to move? And bind

A

Motile flagella
Called type 1 fimbriae
.bind to mannose-containing epithelial receptors: uroplakin 1 and 2
.tamm horsfall protein which is shed in the urine to fools the e.coli to bind on to that instead and so flushed out
.IgA produced to binds to e.coli to prevent it binding

Also have p fimbriae to bind

21
Q

What is P fimbriae

A

Produced by the bacteria which bing to Gal-Gal, on urethral epithelial cells

22
Q

What other components does urobacteria like?

A

Urea as food

Acidic environment

23
Q

What is the inflammatory response to a UTI

A

PMNs
Cytokines

Humoral Immune system

24
Q

And the most common pathogens for UTI

A

Escherichia coli

Staphylococcus saprophyticus (sexually active young women)

Proteus (swarms) 
Pseudomonas
Klebsiella
Enterobacter
Enterococcus 
Staphylococcus aureus
25
Q

What is the antibiotic route of UTI called?

A

Haematogenous route

26
Q

List symptoms to lower UTI

A 
Cystitis 
Dysuria
Frequency 
Urgency
Suprapubic pain/tenderness
Can have haematuria or fever 
Cloudy, smelly urine
27
Q

Lost symptoms of pyelonephritis (upper UTI of the kidneys I)

A

Lion pain and tenderness (where kidneys are)
Fever
Sometimes nausea and vomiting
With/without lower tract symptoms

28
Q

List the presentations in children and older adults

A

Children - failure to thrive due to recurrent infections

Older adults - can just be confusion and ‘off legs’

29
Q

Urinalysis
What happens if you find nitrite
Leucocyte esterase

A

Nitrite- don’t make it ourselves, formed by bacteria apart from enterococci

Others 
Blood
Bilirubin 
Ascorbic acid 
Nitrofurantoin

False negatives if there’s blood, lots of bilirubin, on antibiotics

30
Q

Urine microscopy to confirm diagnosis

A

Pyuria - >100 leukocytes/ml

Culture >105 organisms /ml

31
Q

List the management for asymptomatic UTI

A

Repeat urine culture and watch for development of symptoms

Expect if pregnant, means that they have an increased likelihood of earlier delivery. You would treat.
Or ureter transplant people

32
Q

List the management for symptomatic

A

Empirical treatment or treat after urinalysis

May need imaging

33
Q

List non-specific therapy for UTI

A

Fluid rehydration
Urinary pH- low pH is antibacterial
Analgesia- not recommended for treatment but may help symptom

34
Q

List the useful agents for UTI (good at getting in Urine)

A

Nitrofurantoin
Picmecillinam
Fosfomycin

Oral cephalosporins
Co-amoxiclav

IV tazocin

35
Q

What is the length of treatment for cystitis and pyelonephritis

A

Cystitis- 3 days

Pyelonephritis 10-14 days, not all treatments get in the kidney

36
Q

What is the definitions for UTIs in

Cure
Persistence
Relapse
Reinfection.

A

Cure - negative culture 1-2 weeks after treatment
Persistence - bacteruria 48 hours after treatment

Relapse - within 1-2 weeks with the same organisms

Reinfection - different bug whilst on treatment or after finishing

37
Q

Name the key syndromes of STIs

A

Genital ulcer
Genital discharge
Other lesions

38
Q

Describe feature of herpes simplex 2 everything u know

A

Painful ulcers with local lymphadenopathy
Recurrent
Confirm diagnosis with PCR

Treat with aciclovir
May need long term suppression
May shed virus without ulcers

39
Q 
Describe 
Primary chancre 
Latency 
Secondary syphilis 
Tertiary syphilis
A

Primary chancre - painless, May heal spontaneously, local lymphadenopathy

Latency - still there

Secondary syphilis - many different presentations (macular, coppery rash, May involve palms and soles), core generalised lymphadenopathy, condylomata lata (moles). Can become latent

Tertiary syphilis- lots of presentations

40
Q

How do we treat syphilis (early, no tertiary)

A

Benzathine pencilling G

Procaine penicillin

Doxycycline (if allergic)

41
Q

How to treat tertiary syphilis

Including neurosyphilis and late latent syphilis

A

Benzathine penicillin or doxycycline

Monitor serological response
Reinfection possible

42
Q

Tell me what you know about chancroid

A

Has ulcers similar to syphilis but the base is more necrotic with exudate (ooze)

Usually single lesions caused by gram-negative organism

Treat with azithromycin or ceftriaxone

43
Q

Name two other ulcers not talked about in detail

A

Granuloma inguinale

Lymphogranuloma venereum

44
Q

What should you do about urethritis/certvictis

A

Swan for gram stain, culture looking for diplococci- looking for gonorrhoea
Urinalysis and NAAT testing

45
Q

Urethritis and cervicitis is often a co-infection, with what?

A

Neisseria gonorrhoea

Non-gonococcal
.chlamydia
.ureaplasma
.HSV

46
Q

Other than discharge, what else can gonorrhoea cause?

And same for chlamydia

A 
Conjunctivitis 
Septic arthritis 
Pharyngeal infection 
Peri-hepatitis 
Disseminated disease

Conjunctivitis for chlamydia

47
Q

How to treat gonorrhoea

A

Ceftriaxone
And
Azithromycin

But have found extreme resistant gonorrhoea

New guidance
CRO and doxycycline

48
Q

Say some things about genital warts - HPV

A

Diffuse range of size and shape
Usually asymptomatic
If very large and cauliflower like called- condylomata aluminata

Treatment is with scraping, cryotherapy, keratolytics, podophyllin, imiquimod

treatment and prevention of infection (13 decks)

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