Gastroenterology > GIT Infections > Flashcards

GIT Infections Flashcards

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1
Q

Pathogens that cause gastroenteritis

A

Viruses, bacteria, protozoa, helminth

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2
Q

Common symptoms of gastroenteritis

A

Fever, abdominal pain, diarrhoea, vomiting, nausea

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3
Q

Which age groups have higher incidence of morbidity and mortality in gastroenteritis

A

Kids, the elderly

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4
Q

Mild severity gastroenteritis

A

Patient able to undertake normal activities

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5
Q

Moderate severity gastroenteritis

A

Able to function but need to modify normal activities

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6
Q

Severe gastroenteritis

A

Patient incapacitated, may require hospital admission

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7
Q

Symptoms of severe gastroenteritis

A

Fever, tachycardia, increased WBC count, severe abdominal pain, loss of blood in stool, severe diarrhoea

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8
Q

Symptoms of viral gastroenteritis

A

Upper GIT (nausea, vomiting), typically acute (resolves in 24-48hrs)

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9
Q

How long does viral gastroenteritis last

A

Typically acute (resolves in 24-48hrs)

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10
Q

Symptoms of bacterial gastroenteritis

A

Fever, tenesmus (urge to deficate frequently), bloody stool

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11
Q

Symptoms of toxin mediated gastroenteritis

A

Vomiting, nausea, abdominal pain, diarrhoea if present occurs later

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12
Q

How long does toxin mediated gastroenteritis take to start

A

Short incubation period (several hours only)

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13
Q

Host defences against MOs entering the GIT

A

Stomach acidity, flora in the GIT, mucus layer, intestinal motility (reduces contact time), immune system, genetics

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14
Q

What is inocclum size

A

How many bacteria you ingest and its type

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15
Q

What factors help bacteria adhere more to intestine

A

Low net negative charge and high hydrophobicity

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16
Q

Exotoxins

A

Produced inside bacteria and secreted or released by lysis

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17
Q

Endotoxins

A

Part of cell wall, liberated when bacteria dies and cell wall breaks apart

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18
Q

Microbiological testing for gastroenteritis

A

Stool sample/blood sample

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19
Q

When is microbial testing done for gastroenteritis

A

Outbreaks, lasts longer than a few days, immunocompromised, at risk environments eg residential aged care

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20
Q

Types of microbiological testing for gastroenteritis

A

Culture/sensitivity test, view sample under microscope and identifies microorganisms, ELISA (antibody test) PCR

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21
Q

Advantages of PCR

A

Screen for broad range of pathogens, rapid results, substantially improved yield

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22
Q

Disadvantages of PCR

A

Positive result doesn’t necessarily mean disease (can be positive but asymptomatic), multiple pathogens often identified, does not enable antimicrobial susceptibility testing

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23
Q

Most common MO for viral gastroenteritis

A

Norovirus

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24
Q

Most common MO for viral gastro in kids

A

Rotavirus

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25
Treatment for norovirus
No drug treatment, oral rehydration
26
Clinical features to assess dehydration in children
Percentage loss of body weight before becoming ill best, if not, urine output, number of wet nappies, number of times vomiting, number of times asking for water/fluids
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Mild or moderate dehydration treatment in children
Oral rehydration solution or nasogastric fluid replacement
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Severe dehydration treatment in children
IV fluids/hospitalisation- 0.9% saline
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When is fluid via nasogastric tube indicated in children
Mild or moderate dehydration when vomiting often or refusing to take fluids
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Mild or moderate dehydration in adults Tx
Oral rehydration solution 2-3L over 24 hrs
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How do you make oral rehydration solution more tolerable
Put in fridge if not palatable, give 50mL every 15-30mins
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Severe dehydration in adults Tx
IV fluids/hospitalisation or subcutaneous fluids
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What are the differences between watery and dysentery diarrhoea
Dysentery diarrhoea is bloody and normally more severe
34
What is empirical treatment
Treating blindly without knowing the causative MO
35
When is empirical treatment not indicated for bacterial gastroenteritis
Children with bloody diarrhoea without fever or sepsis
36
First line empirical treatment
Ciprofloxacin 500mg q12h for 3 days or norfloxacin 400mg q12h for 3 days
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Empirical treatment for bacterial gastroenteritis in quinolone resistance
Azithromycin 500mg OD for 3 days
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Empirical treatment for bacterial gastroenteritis when oral therapy not tolerated
Ceftriaxone IV daily for 3 days
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Medications to manage campylobacter enteritis
All 1st line: azithromycin 500mg OD for 3 days, ciprofloxacin 500mg q12h for 3 days, norfloxacin 400mg q12h for 3 days
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Quinolone use in children
Weigh up risk vs benefit- life or death or only ABX available
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When is ABX for salmonella enteritis indicated
Kids, severe symptoms, sepsis, synthetic heart valve patients, immunocompromised
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Medications used to treat salmonella enteritis
1st line, azithromycin 1g day one then 500mg for further 4 days OR ciprofloxacin 500mg q12h for 5 days, or if susceptible to amoxicillin use amoxicillin q8h for 5 days
43
When is IV treatment used for salmonella enteritis
Can't tolerate oral therapy, infants 0-3 months old, bacteria in bloodstream
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How do we treat shigellosis
Self limiting replace fluids and avoid contact with others if severe use antibiotics
45
Antibiotics in shigellosis
Ceftriaxone 2g IV daily for 5 days to reduce duration by 2 days and stop the spread
46
Medications to treat vibrio cholerae
1st line azithromycin 1g single dose or ciprofloxacin 1g single dose
47
How many doses of cholera vaccine do adults get
2
48
How many doses of cholera vaccine do kids get
3
49
When is cholera vaccine contraindicated
At the same time as the live oral typhoid vaccine- have to wait 6 hours
50
Factors that increase risk of acquiring c.diff
Broad spectrum ABX, hospital and immunocompromised, chemotherapy, long term PPI use
51
How do we treat the first episode of mild/moderate c.diff
1st line = metronidazole 400mg q8h for 10 days 2nd line = vancomycin 125mg q6h for 10 days
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How do we treat the first recurrence of c.diff
1st line = vancomycin 125mg q6h for 10 days 2nd line = fidaxomicin 200mg q12h for 10 days
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How do we treat the 2nd recurrence of c.diff
1st line = faecal microbiota transplant 2nd line = vancomycin 125mg q6h for 14 days 3rd line = fidaxomicin 200mg q12h for 10 days
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MOA of penicillins
inhibit cell wall synthesis
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MOA of cephalosporins
Inhibit cell wall synthesis
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MOA of macrolides
Inhibit 50S ribosomal subunit
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MOA of quinolones
Inhibit DNA gyrase/topoisomerase 4
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MOA of metronidazole
Create free radicals
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MOA of fidaxomicin
Inhibit RNA polymerase
60
Signs and symptoms of severe c.diff
Fever, increased number of WBCs, severe abdominal pain and diarrhoea, decreased serum albumin, increased serum creatinine and blood lactate, organ failure
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Treatment for severe c.diff
Vancomycin 125mg q6h for 10 days
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Treatment for severe c.diff + shock, hypotension, ileus or toxic megacolon
Metronidazole 500mg IV q8h for 10 days + usual vancomycin (125mg q6h for 10 days)
63
Severe c.diff treatment if irresponsive to other treatment or severe ileus
Standard Tx + vancomycin retention enema
64
Signs and symptoms of travellers diarrhoea
Weakness, fatigue, malaise, loss of appetite, abdominal pain, diarrhoea
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Most common MO to cause travellers diarrhoea
Enterotoxigenic e. coli
66
Tx for mild travellers diarrhoea
1-3 stools a day- rest, oral rehydration, paracetamol for fever
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Tx for moderate-severe travellers diarrhoea associated with dehydration
1st line = azithromycin 1g single dose or norfloxacin 800mg single dose 2nd line = ciprofloxacin 750mg single dose
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Tx for moderate-severe travellers diarrhoea associated with fever +/or blood in stool
Same medicines as dehydration associated but for 3 days (1st line = azithromycin 1g single dose or norfloxacin 800mg single dose 2nd line = ciprofloxacin 750mg single dose)
69
Non-pharmacological prevention of travellers diarrhoea
Only eat hot steamy food, avoid street food, avoid raw food, only eat what you can peel, only drink sealed bottled beverages, have good hygiene
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Pharmacological prevention of travellers diarrhoea
Norfloxacin 400mg once daily starting on day of travel, continue during and for 1-2 days after leaving the area of concern (max 3 weeks)
71
Common groups affected by parasite infections
Immunocompromised, international travellers, areas with poor hygiene
72
Acute signs and symptoms of giardia lamblia
Diarrhoea, cramp like abdominal pain, bloating, flatulence, malaise, anorexia, nausea, belching
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Chronic signs and symptoms of giardia lamblia
Diarrhoea that alternates with constipation, weight loss, lactose intolerance, vitamin B12 + fat soluble vitamin deficiencies
74
Group most commonly affected by giardia lamblia
Children aged 1-4
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How is giardia lamblia transmitted
Contaminated water
76
How is giardia treated
1st line = tinidazole 2g single dose (SAS needed but better compliance with less side effects) 2nd line = metronidazole 2g OD for 3 days OR metronidazole 400mg q8h for 5 days
77
Signs and symptoms of cryptosporidiosis in immunocompetent patients
Diarrhoea, abdominal pain, fever, vomiting, malaise, anorexia, joint pain, headache
78
Signs and symptoms of cryptosporidiosis in immunocompromised patients
Cholera like amounts of watery diarrhoea, weight loss, malabsorption, spread to other organs
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When is treatment not required for cryptosporidiosis
Immunocompetent patients or not severe cases in immunocompromised
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Signs and symptoms of amoebiasis
Bloody stool, abdominal cramps, flatulence, moderate leukocytosis, amebic liver abcess, high fever, pain in liver area
82
Treatment of asymptomatic amoebiasis
Paromomycin 500mg q8h for 7 days
83
Treatment of mild symptomatic amoebiasis
1st line = tinidazole 2g OD for 3 days 2nd line = metronidazole 600mg q8h for 7 days Then paromomycin Tx
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Treatment of severe symptomatic amoebiasis
1st line = tinidazole 2g OD for 5 days 2nd line = metronidazole 800mg q8h for 7 days If oral therapy not tolerated give metronidazole IV Then paromomycin Tx
85
Hookworm treatment
1st line = albendazole 2nd line = mebendazole 3rd line = pyrantel
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Albendazole and mebendazole MOA
Inhibit microtubule polymerisation by binding to beta tubulin
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Pyrantel MOA
Inhibit cholinesterase, releases acetylcholine that paralyses the worm
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Roundworm Tx
1st line = albendazole 2nd line = mebendazole 3rd line = pyrantel
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Whipworm Tx
1st line = albendazole 2nd line = mebendazole
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Symptoms of threadworm
Itchy anus at night, irritable/can't sleep, anorexia, fatigue
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Treatment for threadworm
Single dose of mebendazole OR pyrantel OR albendazole (all 1st line) repeat in 2 weeks for newly hatched worms
92
Non-pharmacological management of threadworm
Shower in the morning, change underwear and wash in hot water, cotton gloves and nails cut short to stop scratching, vaccuum, launder everything on hot cycle, hygiene, notify school
93
Referral points for threadworm
Less than 1 year old, unsure of diagnosis, systemic symptoms, no response after correct treatment with proper compliance
Gastroenterology
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