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GI Diseases Flashcards

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1
Q

What is the major host defense in the esophagus? Small/large intestines?

A

Motility/acidity

Motility/normal flora

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2
Q

What are the three major pathogens that infect the esophagus?

A

Candida
HSV
CMV

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3
Q

What is the major pathogen that infects the stomach?

A

H. Pylori

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4
Q

What are the four major pathogens of the Small/large intestines?

A

C. diff
E. coli
Salmonella
Shigella

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5
Q

What are the common ssx of esophagitis?

A
  • Dysphagia wwo odynophagia
  • Retrosternal pain
  • Fever (sometimes)
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6
Q

What are the gross findings of candida infection of the esophagus?

A

White, non-ulcerative plaques

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7
Q

What are the gross findings of HSVI (II) infection of the esophagus?

A

Ulcerations

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8
Q

What is the most common viral infection of the esophagus?

A

HSV I

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9
Q

What are the gross characteristics of CMV infections of the esophagus?

A

Ulcerations

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10
Q

What species of candida is resistant to fluconazole?

A

Candida krusei

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11
Q

What are the findings of an esophagram with esophagitis?

A

Loss of the smooth appearance

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12
Q

What is the advantage of a culture over PCR?

A

PCR just tells you if it is there, not if it’s the causative agent

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13
Q

What is the treatment for candida esophagitis?

A

Oral fluconazole fro 2-3 weeks

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14
Q

What is the alternative to oral antifungals for candida esophagitis?

A

IV echinocandin or amp B

inhibit the synthesis of glucan in the cell wall, via noncompetitive inhibition of the enzyme 1,3-β glucan synthase

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15
Q

What is the treatment for herpes esophagitis? MOA?

A

Acyclovir

Converted by thymidine kinases to inhibit DNA polymerases

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16
Q

What is the treatment for CMV esophagitis? MOA?

A

IV ganciclovir or oral valganciclovir

Synthetic analogue of guanosine, that is converted into dGTP to inhibit DNA polymerases

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17
Q

What is the enzyme H. Pylori has that allows it to survive in the low pH of the stomach?

A

Urease

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18
Q

What is the effect of altered stomach lining/pH in the rest of the GI tract?

A

Alters flora in mouth and intestines

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19
Q

What are the three non-invasive ways to diagnose H. Pylori infection?

A
  • Urea breath test
  • Stool antigen
  • Serology
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20
Q

What is the method of choice for diagnosing H. Pylori infection if an endoscopy is indicated? What may interfere with this?

A

Biopsy urease test

PPIs will alter this result

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21
Q

What is the major disadvantage of stool antigen testing for H. Pylori?

A

May have false positives if treated

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22
Q

What is the major downside of serology testing for H. Pylori infection?

A

Doesn’t distinguish between active and past infection

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23
Q

What is the treatment for H. Pylori infection? (3)

A

PPI
Clarithromycin
amox

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24
Q

How long should treatment last for H. Pylori before checking again?

A

6-8 weeks

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25
When do IgG antibodies fall with H. Pylori infections?
6 months
26
When are false negative results seen with H. Pylori treatment?
Less than 4 weeks after treatment Within 2 weeks of a PPI
27
When is an endoscopy indicated for GI tract infections?
If gastric ulcer and to exclude cancer
28
What is the clinical definition of diarrhea?
3 or more watery stools within a 24 hour period
29
When is a further diagnostic evaluation warranted for GI tract symptoms? (non-obvious)
- Temp of more than 101.3 F | - More than 6 unformed stools /24 hours of illness
30
What are the characteristics of diarrhea that can aid you in diagnosing the infection or assessing the severity?
- Frequency - Volume - Duration
31
What is the clinical definition of acute, persistent, and chronic diarrhea?
Acute = less than 2 weeks 2-4 weeks = persistent More than 4 weeks = chronic
32
True or false: the vast majority of diarrhea cases in the US are caused by infectious agents
True
33
What are the things that can be elucidated from diarrhea samples?
- Parasitic infection - Mal digested food - Lipid droplets
34
Curved gram negative rod that causes diarrhea= ?
Vibrio cholerae
35
Reheated rice syndrome = ?
Bacillus cereus
36
Raw milk diarrhea?
Salmonella
37
Poultry or raw milk/cheese diarrhea = ?
Campylobacter
38
What is the common infectious cause of diarrhea that occurs in daycare centers?
Shigella
39
What are the foods associated with shellfish or coconut milk?
Vibrio cholerae
40
Processed meats bacteria = ?
Listeria monocytogenes
41
Home canned foods bacteria = ?
Clostridium spp
42
What are the four major viral causes of GI illnesses?
Rotavirus Norovirus Hep A CMV
43
What parasite is characterized by daycare centers and ingestions of stream water?
Giardia
44
What are the endemic areas for entamoeba histolytica?
Mexico
45
What diarrhea causing parasite is found in daycare centers, swimming pools, and animal exposure?
Crytosporidium
46
What parasite is found in raspberries that causes diarrhea?
Cyclospora
47
Microsporidium diarrhea is usually found in whom?
AIDS pts
48
What is the incubation period for: bacillus cereus?
1-8 hours
49
What is the incubation period for: s. aureus
8-24 hours
50
What are the three major bacteria that have preformed toxins that cause GI illness
- Bacillus cereus - S. Aureus - C. Perfringens
51
What are the four major enterotoxic bacteria?
- V. Cholerae - ETEC - Klebsiella pneumoniae - Aeromonas
52
What are the two major cytotoxic bacteria?
- C diff | - EHEC
53
What is the incubation period for enterotoxic bacteria?
8-72 hours
54
What is the incubation period for: cytotoxic bacteria?
Day(s)
55
Inflammatory or noninflammatory symptom: voluminous stool?
Non-inflammatory
56
Inflammatory or noninflammatory symptom: fecal leukocytes present
Inflammatory
57
What are the typical pathogens of inflammatory diarrhea? (3)
Shigella Campy Salmonella
58
What are the typical pathogens for noninflammatory diarrhea? (2)
VIbrio cholerae | ETEC
59
What is the therapy for inflammatory vs noninflammatory diarrhea?
Inflammatory = rehydrate and abx Non = abx if severely ill
60
What is the bacteria that causes HUS?
E.coli O157:H7
61
What is the metabolic disturbance that can occur with HUS?
Azotemia
62
What is the approach to therapy for hemorrhagic diarrhea?
Supportive; abx may increase risk of HUS
63
What are the two major toxins that C.diff has?
Toxin A and toxin B
64
What is the best test for C. Diff?
Culture
65
Testing for C. Diff should be performed on what type of stool?
Diarrheal stool
66
True or false: testing for C.diff in stool in asymptomatic pts can prove useful
False--don't do it
67
Is PCR widely available for C. Diff?
Not widely
68
What is the sensitivity/specificity of endoscopy for diagnosing C. Diff?
51 and 100%
69
What is the sensitivity/specificity of culture for diagnosing C. Diff?
90%ish for both
70
What is the sensitivity/specificity of cell culture cytotoxin test for diagnosing C. Diff?
70-100% for both
71
What is the sensitivity/specificity of EIA toxin test for diagnosing C. Diff?
65-95 sensitive | 75-100 specific
72
What is the sensitivity/specificity of PCR for diagnosing C. Diff?
90s for both
73
What is the treatment for C. diff?
Vanco or metronidazole
74
What indicated a mild-moderate C. Diff infx? (2) What drug is indicated?
- WBC less than 15 - Cr less than 1.5x premorbid levels Metronidazole
75
What indicated a severe C. Diff infx? (2) What drug is indicated?
- WBC greater than 15 - Cr more than 1.5x premorbid levels Vanco
76
What is the dosage for vanco?
125mg
77
What is the abx of choice for a second bout of c.diff?
use the same regimen
78
True or false: metronidazole is the preferred abx of choice for recurrence /long term chronic C.diff therapy
False-- do not use more than once
79
Are probiotics recommended to prevent primary CDI?
No--Limited data to support
80
What is the major side effect of long term metronidazole use?
Peripheral neuropathy
81
Who should never receive probiotics during/after C. DIff infx?
Immunosuppressed
82
Why are antiperistaltic agents not indicated for infectious diarrhea?
May cause toxic megacolon
83
What is the MOA of loperamide?
Loperamide is an opioid-receptor agonist and acts on the μ-opioid receptors in the myenteric plexus of the large intestine

Infectious Disease (18 decks)

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