Gastrointestinal Infections III

Question 1

What is the name for inflammation of the angles of the mouth?

What are te usual etilogical agents responsible?

Answer 1

Angular Cheilitis

Angular stomatitis or perleche

• Etiology:
  
  • Candida albicans- usually
  • Yellow crusting – Staphylococcus aureus

Question 2

Angular Cheilitis is most common in which demographic?

Answer 2

• elderly, children who suck their digits, adn in people with riboflavin or irion deficiency
• Elderly
  
  • sagging facial muscles adn ill filling dentures
  • causes maceration of skin resultin in inflammation
• can be sign of anemia or vitamin deficiency

Question 3

Angular Ceilitis Diagnosis?

Treatment?

Prevention?

Answer 3

• Diagnosis
  
  • swab & culture
    
    • S. aureus - blood plates/others
    • C. albicans - sabouraud dextrose agar
• Treatment
  
  • Antigungal or antibacterial agent depending on cause
  • hydrocortizone if chronic
• Prevention
  
  • proper nutrition
  • proper fitting dentures

Question 4

Answer 4

• Oral candidiasis

Oral hairy leukoplakia usually occurs at the corners of themouth & you cannot remove it

Question 5

Answer 5

Oral hairy leukoplakia

Question 6

What is the most common cause of benign viral parotitis?

Answer 6

Paramyxovirus

mumps

Question 7

What are the possible complicated associated with mumps?

Answer 7

• Aseptic meningitis (parotitis absent up to 50%)
  
  • asymptomatic infections occur in 40-50% mumps
  • symptomatic CNS infections occur in 10% clinical cases
  • adults & boys at higher risk
  • perminant sequelae occur in 25% – 1% die
  • can result in encephalitis (fatal 1.4%)
• Oophoritis and Epididymoorchitis
  
  • testicular swelling, tenderness, nausea, vomiting, and fever
  • most common complication postpubertal males
  • ovarian inflammation in 5% postpubertal females
• Deafness
  
  • 1 in 15,000– usually unilateral
  • sudden onset & damage is permanant
• During pregnancy can lead to fetal death in 1st trimeser

Question 8

Incubation period for Mumps?

Symptoms?

Answer 8

• Incubation: 14-25 days
• Usually asymptomatic
  
  • may present as lower respiratory tract infection– esp in preschool children
• If symptomatic
  
  • prodrome: myalgia, headache, anorexia, malaise, low-grade fever
  • parotitis: swollen and tender salivary glands with earache (30-40% patients)
  • can be bilateral or unilateral
  • symptoms occur w/in first 2 days, usually gone after 10 days

Question 9

How is mumps transmitted?

What is the most affected demographic?

Answer 9

• highly contagious
  
  • airborne transmission w/ infected droplet nuclei or saliva
  • direct person-person contact
  • most common in winter-spring
  • infections 3 days before symptoms & 9 days after symptoms disappear
• primarily childhood infection w/ 60% cases occurring in children <15 years of age
• no carrier state is known

Question 10

Mumps Pathogenesis

Answer 10

• Virus replicates in nasopharynx and regional lymph nodes
• viremia 12-25 days later
• multiple tissues infected durign viremia
  
  • hemagglutinin-neuraminidase or virus binds to trisaccharids (alpha2,3-linked sialic acid) on host cells
• Tropisms for glandular tissue & CNS
  
  • meninges, salivary glands, testes, ovaries, pancreas, kidneys, thyroid, eyes, and mammary glands

Question 11

Mumps diagnosis

Answer 11

• clinically obvious
  
  • jelly-like feel; NOT warm
• isolate virus from saliva, urine, and CSF
• serology EIA fro IgM and IgG
  
  • IgM: first few days (acute)
  • IgG: requies 2 samples 2 weeks apart
    
    • if titer is rising, indication acute case
    • not rising = past case/immunized

Question 12

Mumps treatment and prevention

Answer 12

• Treatment
  
  • treat the symptoms
• Prevention
  
  • MMR vaccine (live attenuated)
    
    • not given to pregnant people
  • 95% develop immune response – given 12-15 months
  • booster 4-6 years

Question 13

What is the etilogical agent of acute bacterial parotitis?

Manifestations?

Answer 13

• Etilogy
  
  • S. aureus
• Manifestations
  
  • swellign salivary glands
  • chewing increases pain
  • skin- erythema, warm
  • massage- purulent saliva (differentiate bacterial vs. viral)

Question 14

What demographic is most commonly affected by acute bacterial parotitis?

Answer 14

• elderly- takign medications that affect flow of saliva
• dehydrated
• choronically ill
• postoperative patients
• patients with dry mouth

Question 15

Pathogenesis of Acute bacterial parotitis

Answer 15

• flow of saliva affected
• bacteria enter duct
• ascend to gland
• inflammation adn pain

Question 16

Diagnosis of actue parotitis?

Treatment?

Prevention?

Answer 16

• Diagnosis
  
  • skin erythematous, warm
  • massage to express purulent material
  • gram stain and culture
• Treatment
  
  • IV antibiotic
  • rehydrate patient
  • may need surgery
• Prevention
  
  • proper hydration of chronically ill, elderly and postoperative patients

Question 17

Answer 17

Ludwig’s angina

• w/ bacterial parotitis, movement of the tongue wouldn’t cause pain– chewing will, though

Question 18

Answer 18

Viral Parotitis

Question 19

Answer 19

bacterial parotitis

Question 20

Answer 20

Oral hairy leukoplakia– caused by Epstein Barr

Question 21

What is the name for inflammation of the esophagus?

It is associated with what two specific symptoms?

Possible causes?

Answer 21

Esophagitis

• Associated with
  
  • dysphagia (trouble swallowing)
  • odynophagia (painful swallowing)
• causes
  
  • GERD
  • Infections
  • Medications

Question 22

Etilogical infectious agents responsible for esophagitis?

Answer 22

• Candida albicans
• CMV (cytomegalovirus)
• HSV (herpes simplex virus)
• HIV
• VZV (varicilla zoster virus)

Question 23

Esophagitis symptoms?

What demographic is most commonly affected?

Answer 23

• Symptoms
  
  • dysphagia, odynophagia, heatburn, retrosternal discomfort or pain, nausea, vomiting, fever, sepsis, abdominal pain, epigastric pain, cough
• Epidemiology
  
  • most common in immunosuppressed
    
    • AIDS, Leukemia,Lymphoma, diabetes, alcoholism, motility disorders, patients undergoing ratiation and chemotherapy)
    • rare in general population <5%

Question 24

Patogenesis of esophagitis?

–with relation to the most common causes

Answer 24

• C. albicans - most common all patients
• HIV- low CD4- more liekly to get fungal
• HSV and CMV- AIDS & transplant patients
  
  • CMV more common than HSV in AIDS patients
  • Transplant
    
    • HSV early
    • CMV 2-6 months after transplant

Question 25

How is esophagitis diagnosed?

Answer 25

* odynophagia is unique to infectious esophagitis * Esophagogastroduodenoscopy (EGD) * to see and biopsy the esphagus * Candida albicans * thrush * plaques in esophagus, creamy white or pale yellow w/ underlying raw base * stain & look for yeast * HSV * abrupt onset * early lesions- small vesicles middle to distal esophagus * later- ulcers with raised edge (volcano lesions * Lok for Tzanck cells * CMV * onset of symptoms gradual * only in immnocompromised hosts * large solitary shallow ulcer or multiple discrete lesions at distal end esophagus * culture * HIV * multple small thrush-lie lesions * durign priamry HIV infection * later on giand deep uncers * fistula, perforation, hemorrhage or superinfections * VZV * usually has skin lesions consisten w/ chicken pox or shingles

Question 26

Treatment esophagitis? Prevention?

Answer 26

* Tratment * Antifungal or antiviral agent depending on the cause of the infection * Steriods to lower inflammation * Prevention * Don't get immuno-suppressed if you don't have to

Question 27

What is the most common etilogical cause of chronic active gastritis and peptic ulcer disease? What are the two kinds of peptic ulcer disease?

Answer 27

* Etiology * Helicobacter pylori * Peptic ulcer disease * gastric ulcer disease * duodenal ulcer disease

Question 28

Symptoms of Chronic active gastritis?

Answer 28

* often asymptomatic * moderate * pain or discomfort in pit of stomach * pain in left upper abdomen * travels to back of belly * burning, gnawing, sore, vague discomfort * belching w/o relief, nausea, vomiting * critically ill * pale and sweaty * may have tachycardia * severe illness- bleeding from stomach, faint or feel like fainting * vomit blood * blood or dark sticky, foul smelling stools

Question 29

Symptoms of peptic ulcer disease

Answer 29

* Gnawing or burign pain inepigastrium * bleeding that may result in anemia, weakness, and fatigue * hematemesis, melena or hematochezia * gastric ulcers * pain made worse by eating * duodenal ulcers * pain relieved by eating or antacids

Question 30

Why does eating food increase pain caused by gastric ulcers but decrease pain caused by duodenal ulcers?

Answer 30

* Nerves respond to protons (exposed by ulcer) * at lower pH, more protons, more pain stimulus * In the stomach, when you are eating acid is being made, * increasing pain * However, the duodenum produced bicarbonate in response to eating (b/c it does not like low pH), so it increases the pH while you are eating * decreasing pain