Gastrointestinal OI Flashcards
(125 cards)
1
Q
Which organism is the most common cause of oropharyngeal infection and oesophagitis?
A
Candida sp
2
Q
What symptoms should prompt suspicion of oesophagitis?
A
PAIN on swallowing \+/- reflux or dysphagia
3
Q
What viral infections are causes of HIV-related oesophagitis?
A
HSV
CMV
4
Q
What mycobacterium can present with oropharyngeal or oesophageal disease?
A
TB
5
Q
Where does ulceration occur caused by primary syphilis?
A
ORAL
GENITAL
PERIANAL
6
Q
What MEDICATIONS are common causes for OESOPHAGITIS?
A
DOXYCYCLINE
NSAIDS
POTASSIUM supplements
IRON tablets
7
Q
When is ENDOSCOPY indicated in OESOPHAGITIS?
A
FAILED empirical treatment for candidiasis
8
Q
What is the FIRST line treatment for CMV oesophagitis?
A
Intravenous GANCICLOVIR 5mg/kg
TWICE daily
2-4 weeks
until symptoms RESOLVED
9
Q
When is it appropriate to use ORAL valganciclovir as TREATMENT for CMV oesophagitis?
A
if symptoms not SEVERE enough to interfere with SWALLOW or ABSORPTION
10
Q
What ORAL treatment can be given for CMV oesophagitis?
A
VALGANCICLOVIR 900MG
TWICE daily
11
Q
When is MAINTENANCE therapy for CMV disease indicated?
A
if OPHTHALMIC disease
12
Q
What is the FIRST line treatment for HSV oesophagitis?
A
Intravenous ACICLOVIR 5-10mg/kg THREE times daily then ORAL valaciclovir or famciclovir 14 days
13
Q
What is the REGIMEN of oral valaciclovir following IV acyclovir for HSV oesophagitis?
A
VALACICLOVIR 1gram
TWICE daily
14
Q
What is the alternative REGIMEN of oral famciclovir following IV acyclovir for HSV oesophagitis?
A
FAMCICLOVIR 500mg
THREE times daily
15
Q
What is the duration of treatment in total (IV+oral) for HSV oesophagitis?
A
FOURTEEN (14) days
16
Q
What alternative antiviral can be used for ganciclovir-RESISTANT CMV?
A
Intravenous FOSCARNET 90mg/kg
TWICE daily
17
Q
What is the REGIMEN for FOSCARNET for ganciclovir-RESISTANT CMV?
A
Intravenous FOSCARNET 90mg/kg
TWICE daily
18
Q
What alternative antiviral can be used for aciclovir-RESISTANT HSV?
A
Intravenous FOSCARNET 40mg/kg
TWICE or THREE times daily
19
Q
What is the REGIMEN for FOSCARNET for aciclovir-RESISTANT HSV?
A
Intravenous FOSCARNET 40mg/kg
TWICE or THREE times daily
20
Q
What is an alternative antiviral for both CMV or HSV disease if intolerance or resistance to acyclovir, ganciclovir or foscarnet?
A
CIDOFOVIR 5mg/kg
once WEEKLY
2 weeks
21
Q
In addition to herpes antivirals what else is indicated as part of treatment for people with HIV?
A
ART
22
Q
What is the prevalence of DIARRHOEA in PLW HIV on ART?
A
18%
23
Q
What is the definition of DIARRHOEA?
A
more than TWO bowel movements per day
24
Q
What is the definition of ACUTE diarrhoea?
A
LESS than FOUR weeks
25
What is the definition of CHRONIC diarrhoea?
MORE than FOUR weeks
26
In PLW HIV what is chronic diarrhoea more likely to be associated with?
OPPORTUNISTIC infection
27
What are the major BACTERIAL causes of HIV-related DIARRHOEA?
```
CAMPYLOBACTER
C DIFFICILE
ECOLI
SALMONELLA
SHIGELLA
TB
NON-TB MYCOBACTERIUM (MAC or KANSAII)
CHLAMYDIA/LGV
```
28
What are the MYCOBACTERIAL causes of HIV-related DIARRHOEA?
TB
MYCOBACTERIUM AVIAN-INTRACELLULARE COMPLEX
MYCOBACTERIUM KANSAII
29
What are the major PARASITE/FUNGAL causes of HIV-related DIARRHOEA?
```
CRYPTOSPORIDIUM
CYCLOSPORA
GIARDIA
ENTAMOEBA
CYSTOISOSPORA
MICROSPORIDIA
STRONGYLOIDES
```
30
What are the major VIRAL causes of HIV-related DIARRHOEA?
```
CMV
HSV
ROTAVIRUS
NOROVIRUS
ADENOVIRUS
ASTROVIRUS
CORONAVIRUS
```
31
What are the major NON-INFECTIOUS causes of HIV-related DIARRHOEA?
ART
KAPOSI SARCOMA
LYMPHOMA
PANCREATIC EXOCRINE INSUFFICIENCY
32
In what specific risk group is SHIGELLA more common?
HIV positive MSM vs HIV negative
33
What clinical syndromes is diarrhoea associated with due to LGV?
PROCTOCOLITIS
| ENTERITIS
34
What factors increase the likelihood of diarrhoea in PLW HIV?
OLDER age
LOW CD4
Travel to LOW/MIDDLE INCOME countries
35
What are risk factors for C DIFFICILE in PLW HIV?
HOSPITALISATION
GASTRIC ACID SUPPRESSION
LOW CD4
ANTIBIOTIC USE
36
What other clinical features may be present with BACTERIAL GASTROENTERITIS?
BLOODY diarrhoea
Abdominal PAIN
FEVER
SEPSIS
37
What impact does HIV have on the risk of BACTERAEMIA secondary to gastroenteritis?
INCREASED but LOW overall
38
Which symptoms are most common presentation of LGV in PLW HIV?
TENESMUS
CONSTIPATION
DIARRHOEA
ANAL DISCHARGE
39
What investigations are required for BACTERIAL diarrhoea?
```
STOOL culture
BLOOD culture
+/-
COLONOSCOPY
+/-
BIOPSY
```
40
What is the TREATMENT for ACUTE bacterial DIARRHOEA?
No treatment if CD4 >200
41
At what CD4 count is treatment indicated for ACUTE bacterial DIARRHOEA?
CD4 <200
42
What ANTIMICROBIAL is indicated in treatment of CAMPYLOBACTER?
AZITHROMYCIN
43
What ANTIMICROBIAL is indicated in treatment of C DIFFICILE?
Mild - METRONIDAZOLE
Severe - VANCOMYCIN
or
FIDAXOMICIN
44
What ANTIMICROBIAL is indicated in treatment of SALMONELLA?
CIPROFLOXACIN
or
CEFTRIAXONE
45
What ANTIMICROBIAL is indicated in treatment of SHIGELLA?
CIPROFLOXACIN
or
AZITHROMYCIN
46
What ANTIMICROBIAL is indicated in treatment of CHLAMYDIA LGV?
DOXYCYCLINE
47
Which organisms are developing CIPROFLOXACIN-RESISTANCE?
CAMPYLOBACTER
SALMONELLA
SHIGELLA
48
Is antimicrobial therapy indicated in prevention of bacterial diarrhoea in PLW HIV?
No
| ART only
49
At what stage of life can PRIMARY CMV infection occur?
Any stage
50
When does CMV disease occur?
when REACTIVATED in the IMMUNOCOMPROMISED host
51
What is the most common pathogen causing VIRAL enteritis in PLW HIV?
CMV
52
What is the risk factor for developing CMV disease in PLW HIV?
CD4<50
53
Which part of the GI tract is most commonly affected by CMV in PLW HIV?
OESOPHAGUS
or
COLON
54
What are the complications of CMV colitis?
```
WEIGHT LOSS
ANOREXIA
ABDOMINAL PAIN
CHRONIC DIARRHOEA
FATIGUE
```
55
What systemic symptoms or signs may be present in CMV colitis?
FEVER
| CYTOPENIAS
56
What are the SERIOUS complications of CMV colitis?
TOXIC DILATATION of COLON
HAEMORRHAGE
PERFORATION
57
What other system should be checked for CMV disease if there is CMV colitis?
EYES for RETINITIS
58
If CMV retinitis is identified how does this impact on HIV and CMV treatment?
start CMV treatment FIRST
| delay ART until 2 weeks
59
Why is ART start delayed in context of CMV retinitis?
to reduce risk of IRIS
60
Is a delay in ART start recommended in treatment of CMV colitis?
NO
| unless eye disease also
61
If a person with CMV colitis and HIV viral load does not fall appropriately after ART start what should be measured?
Therapeutic DRUG MONITORING
| incase of malabsorption
62
What are the characteristic features on histopathology of CMV disease?
'Owls eyes' INCLUSIONS
| positive IMMUNOHISTOCHEMICAL stain for CMV
63
In addition to histopathology what other investigations are useful to diagnose CMV?
characteristic mucosal ULCERATION
| CMV VIRAEMIA
64
Is CMV antibody a useful diagnostic test?
NO
| but if negative makes CMV disease unlikely
65
In addition to investigation for CMV what other tests are indicated for investigation of viral gastroenteritis?
VIRAL PCR of STOOL
66
What VIRUSES is treatment indicated for GI disease?
CMV
HSV
ADENOVIRUS (if clinically significant)
67
Which antiviral is used in clinically significant ADENOVIRUS GI disease?
CIDOFOVIR
68
Why is ganciclovir preferred over foscarnet for CMV disease?
less side effects
69
What is the MAINTENANCE regimen for CMV retinitis after induction?
VALGANCICLOVIR 900MG
| ONCE daily
70
When can PROPHYLACTIC antiviral therapy for CMV retinitis be stopped?
evidence of IMMUNE RECONSTITUTION ART 6 months
| CD4 >100
71
What are the THREE potential reasons for failed treatment of CMV GI disease?
lack of IMMUNE RECONSTITUTION
poor ABSORPTION
antiviral RESISTANCE
72
What are the risk factors for antiviral RESISTANCE in CMV disease?
Prolonged CMV treatment >6 weeks
| HIGH initial CMV viral load
73
Mutations in which gene confer CMV resistance to GANCICLOVIR?
UL97
74
Mutations in which gene confer CMV resistance to FOSCARNET?
UL54
75
Which NEW antiviral has potential role in CMV infection in haematopoietic cell or solid organ transplant?
MARABAVIR
76
Which NEW antiviral has potential role in CMV PROPHYLAXIS after transplant?
LETERMOVIR
77
What specific features of diarrhoea are typical of a viral cause?
NON-BLOODY
| WATERY
78
What is supportive treatment indicated for viral diarrhoea?
HYDRATION
79
What investigations are indicated for diarrhoea caused by parasites?
STOOL MICROSCOPY, culture and PCR
80
How is CRYPTOSPORIDIUM infection acquired?
INGESTION of contaminated WATER by human or animal FAECES
or
Sexual - FAECO-ORAL route
81
Which part of the GI tract does CRYPTOSPORIDIUM predominantly affect?
SMALL BOWEL mucosa
82
What clinical features may be present in CRYPTOSPORIDIUM GI disease?
PROFUSE, watery, non-bloody diarrhoea
Fever
Nause +/- vomiting
LOWER abdominal pain
83
What other organ complications can occur due to CRYPTOSPORIDIUM GI disease?
CHOLANGITIS
| PANCREATITIS
84
Through what mechanism does cryptosporidium cause cholangitis or pancreatitis?
EPITHELIA of both pancreatic DUCT and biliary TRACT infected (communicating with small bowel)
85
What are the features of SCLEROSING CHOLANGITIS associated with CRYPTOSPORIDIUM?
Right upper quadrant PAIN
vomiting
raised ALP
86
What other organ disease has been associated with cryptosporidium in PLW HIV and advanced disease?
PULMONARY CRYPTOSPORIDIOSIS
87
Why are more than one stool sample required for cryptosporidium?
INTERMITTENT oocyst secretion
88
What stain is used in microscopy for cryptosporidium?
AURAMINE
or
ZIEHL-NEELSEN
89
What is the TREATMENT for CRYPTOSPORIDIUM?
ART
90
What is SUPPORTIVE treatment for CRYPTOSPORIDIUM?
HYDRATION
ELECTROLYTE replacement
ANTI-MOTILITY drugs
DIETICIAN
91
What methods can be used to ensure safe drinking water to avoid CRYPTOSPORIDIUM?
FILTER (absolute 1-um)
BOIL
(chlorination does not work)
92
How is MICROSPORIDIA infection acquired?
contaminated WATER
or
contact with infected FAECES or URINE
93
What groups of people gets clinical disease with MICROSPORIDIA?
IMMUNOSUPPRESSED
94
At what CD4 count does clinical disease with MICROSPORIDIA occur?
<100 cells
95
What STAIN is required to identify MICROSPORIDIA on microscopy?
CHROMOTROPE
&
CHEMOFLUORESCENT
96
What is the TREATMENT for MICROSPORIDIA?
ART
97
ENCEPHALITOZOON INTESTINALIS is a microsporidia for which specific treatment is indicated - what is it?
ALBENDAZOLE 400mg
TWICE daily
21 days
98
What are the CLINICAL features of GIARDIA?
```
NAUSEA
BLOATING
CRAMP-LIKE abdominal pain
INDIGESTION
BELCHING
chronic DIARRHOEA
```
99
What is the TREATMENT for GIARDIA?
```
METRONIDAZOLE 400mg
THREE times daily
7 days
or
1gram ONCE daily
3 days
```
100
Other than metronidazole what is an alternative treatment for giardiasis?
```
TINIDAZOLE 500mg
TWICE daily
7 days
or
2gram
SINGLE dose
```
101
If a person is re-infected by GIARDIA what should be considered?
TEST house hold or sexual CONTACTS
102
How is ENTAMOEBA infection acquired?
INGESTION of CYSTS in contaminated human faeces
103
How does ENTAMOEBA cause GI disease?
TROPHOZOITE (active stage of life cycle) adheres to colonic EPITHELIAL cells
INVADES through mucosa into SUBMUCOSAL tissue causing COLITIS
104
What complication can occur with ENTAMOEBA infection?
```
HAEMATOGENOUS spread
extra-intestinal disease
liver ABSCESS (& other sites)
```
105
Which is the most common site for extra-intestinal disease from entamoeba?
LIVER abscess
106
What proportion of people with entamoeba infection develop clinical DISEASE?
10%
107
Within what time frame will people develop clinical disease from point of entamoeba infection?
within ONE year
108
What is the typical presentation of liver ABSCESS from entamoeba infection?
FEVER
RIGHT UPPER QUADRANT PAIN
TENDERNESS
109
What is the gold standard investigation for ENTAMOEBA?
stool PCR
110
What is the REGIMEN of choice for AMOEBIC COLITIS or liver ABSCESS?
METRONIDAZOLE 800mg
THREE times daily
5-10 days
followed by PAROMYCIN
111
Why is PAROMYCIN indicated after treatment for ENTAMOEBA?
to clear CYSTS from gut
112
What treatment is indicated for CYCLOSPORIASIS and CYSTOISOSPORIASIS?
CO-TRIMOXAZOLE
113
What is STRONGYLOIDES?
gut NEMATODE
114
What is the implication of STRONGYLOIDES infection in IMMUNOCOMPROMISED people?
LIFE-THREATENING hyper infection syndrome
115
What commonly used drug may induce a STRONGYLOIDES hyper infection syndrome?
CORTICOSTEROID
116
What is abnormal in a full blood count in STRONGYLOIDES infection?
EOSINOPHILIA
117
How is STRONGYLOIDES diagnosed?
Stool culture identifies LARVAE
118
What is the FIRST line treatment of STRONGYLOIDES?
IVERMECTIN 200microgram/kg
DAILY
TWO days
119
Following treatment for STRONGYLOIDES what investigation must be done to check for cleared infection?
repeat STOOL CULTURE
120
What is SCHISTOSOMIASIS caused by?
Parasitic BLOOD FLUKE
121
How is SCHISTOSOMIASIS investigated?
examination of FAECES and URINE
122
What is the treatment for SCHISTOSOMIASIS?
PRAZIQUANTEL
123
Which FUNGAL infections have been reported RARELY in LOWER GI tract disease?
```
candidiasis
histoplasmosis
cryptococcosis
aspergillosis
paracoccidioidomycosis
pneumocystis
talaromycosis
```
124
What type of organism is CRYPTOSPORIDIUM?
protozoan parasite
125
Treatment for entamoeba or giardia?
metronidazole
