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Infections of the GI tract Flashcards

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1
Q

What is the difference between microbiome and microbiotia?

A

Microbiome: all the genome within the gut environment

Microbiota: all the organisms within the gut environment

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2
Q

What are the functions of the gut microbiota?

A
  • pathogen inhibition
  • immune protection
  • nutrient metabolism - synthesis vit B + K
  • Drug metabolsim
  • Gut brain axis
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3
Q

What approach would you take on investigating the symtpoms of a patient with a suspected GI infection?

A
  • Is there diarrhoea? - onset, duration, frequency, consistency
  • Is there mucus/ blood in stools?
  • Is there vomiting? - onset, frequency
  • Is there pain? - site, radiation, intermittent, continuous
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4
Q

What Past medical history would be useful to know in a suspected GI infection?

A
  • History of immunocompromise / immuodeficiency
  • Any other GI conditions
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5
Q

What are some important social questions to ask if someone presents with a suscpected GI infection?

A
  • Recent travel history? - where, when and how long, what they did whilst they were there
  • Drug history - recent antibiotics? proton pump inhibitors? laxatives? immunsuppressants?
  • Social History - occupation
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6
Q

What things can you look for on GI examination that can help establish if there is a GI infetion?

A

Volume status: Check mucous membranes, BP, pulse, JVP

Abdominal exam: ileus, peritontitis

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7
Q

What investigations can be done on a stool sample to help identify GI infection?

A
  • Stool culture
  • Enzyme immunoassay
  • PCR
  • Microscopy

Impossible to do all, need to know what sample you’re looking for

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8
Q

What infectious causes can cause watery diarrhoea?

A
  • Norovirus
  • Rotavirus
  • C. difficile
  • Enterotoxigenic E. Coli
  • Giardia lamblia
  • Cryptosporidium parvum
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9
Q

What infectious causes can cause inflammatory diarrhoea?

A
  • Non- typhoidal salmonella
  • Campylobater
  • Clostridiodes difficile
  • Shigella
  • E. coli O157
  • Entamoeba hysoltica
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10
Q

What are the 2 general subdivisions of salmonella infection?

A

Typhoidal salmonella which causes enteric fever (Salmonella typhi and Salmonella paratyphi)

Non-typhoidal salmonella whichc causes gastroenteriris (Salmonells enteritidis, Salmonella virchow)

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11
Q

What are some of the general features of non- typhoidal salmonella?

A
  • Diarrhoea
  • Nausea
  • Vomiting
  • Abdominal Cramps
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12
Q

How is non- typhoidal salmonella transmitted?

A
  • In food
  • Faeco- orally
  • Animals
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13
Q

What are some of the complication sof non-typhoidal salmonella infection?

A
  • Bacteraemia
  • Endovascular infections
  • Abscesses
  • Osteomyeltitis
  • Septic arthritis
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14
Q

How do you treat non-typhoidal salmonella?

A

usuall self limiting

If bateraemic: can use antibitoics, ciprofloxacin, azithromycin, ceftriaxone

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15
Q

What are the most 2 common organisms of infection with camylobacter?

A

Camplyobacter jejuni

Camplyobacter coli

Gram -ve corkscrew like bacterium

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16
Q

What are some of the general features of a campylobacter infection?

A
  • abdominal cramping
  • diarrhoea
  • may have fever and malaise
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17
Q

What is the transmission route of camplyobacter?

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A

Food, water or animal contact

18
Q

How do you treat campylobacter?

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A

Usually self limiting

Treat immunocompromised patients, elderly or severe infetion with macrolides or fluoroquinolones

19
Q

What are some of the complications of a campylobacter infection?

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A
  • Reactive Arthritis
  • Guillain-Barre Syndrome (GBS) - ascending paralysis
20
Q

What kind of food/ drink can cause campylobacter?

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A
  • Uncooked poultry - peaks on BBQ over summer
  • Milk- transmitted by birds pecking milk tops
  • Uncooked defrosted turkey
21
Q

Which types of shigella can cause dysentry? (blood diarrhoea)

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A

Shigella dysenteria 1 / Shigella flexneri

22
Q

What are some of the general features of an infection with Shigella?

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A
  • Fevers
  • Frequent low volume, blood stools
  • Tenesmus
  • Nausea and vomiting usually asbent
23
Q

How can shigella be trasmitted?

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A
  • Faeco - oral
  • Food and water
  • Person-to-person can occur due to low infective dose
24
Q

What are some of the complications of shigella infections?

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A

Intestinal (rare): proctisis, rectal prolapse, toxic megacolon, perforation, obstruction

Systemic: bacteraemia, seizures (children), reactive arthritis, haemolytic iraemic syndrome

25
What treatment can you give for shigella?
**Usually self limiting** If not give ciprofloxacin, azithromycin, ceftriaxone
26
Which E.coli subtype prodcues shiga toxin?
E. coli O157
27
Describe the clinical features and aetiology of E.coli O157 infection
* Very contagious infection * causes painful, bloody diarrhoea and haemolytic uraemic syndrome * Children \<10 year and elderly particularly vulnerable * **No fever** * **Worsened** by antibiotics → cause more toxin to be produced
28
What is haemolytic uraemic syndrome?
Diease characterised by: Non immune mediated haemolytic anaemia, thrombocytopenia and acute kidney injury
29
What kind of bacteria is *clostridiodes difficile*?
**Anaerobic gram negative bacilli**
30
How do c. dificile bacterium remain in the environment for so long?
Produce **spores** that are very resistant Not killed by handgel - always use soap and water after a diaorrhoea infection
31
What are some risk factors for developing an infection from *clostridiodes difficile*?
* Age \>65 * Antibiotic therapy * PPI therapy * prolonged hospitalisation
32
What complications can arise from infection with *clostridiodes difficile*?
* Toxic megacolon, * colitis * perforation
33
How do you treat a *clostriodes difficile* infection?
* Metrondiazole * Oral Vancomycin * Fidazomicin - superior for recurrent infection * Faecal microbiota transplant - repooulates gut with healthy microbiota
34
Describe the clinical features and aetiology of a norovirus infection
* Causes profuse diarrhoea and vomiting * Transmitted faceo-orally, direct contact or aerosols * Highly infectious due to low infective dose * Usually self limiting (1-2 days)
35
Describe the clinical features and aetiology of a rotavirus infection
* Cause of gastroenteriris in young children * Transmitted faeco-rally * highly infective * General features of diarrhoea, vomiting and fever * Usualy self limiting with supportive treatment
36
What rare complications can arise from a rotavirus infection?
* seizures * encephalopathy * acute encephalitis
37
Describe the clinical features and aetiology of a cryptosporidium infection
* **Intracellular protozoan parasite** * *Cryptosporidium parvum* main species to cause infection * Associated with sporadic, **water associated** outbreaks i.e. swimming pools * Usually self limiting within 10-14 days * Treat with nitazoxanide if immunocompromised
38
Describe the clinical features and aetiology of a giardia infection
* Caused by giardia duodenalis, a protozoa parasite * can last in cold water for months * Children, immunocompromised patients and cystic fibrosis are high risk * Transmited in food, water, faeco-orally * Features of malaise, steatorrhoea, abdominal cramps and bloating * Chronic infection can cause malabsorption and weight loss
39
How do you treat a giardia infection?
**NOT self limiting** If symptomatic give metronidazole or nitazoxanide
40
Describe the clinical features and aetiology of a entamoeba histolytica infection
* protozoan parasite * most infections **asymptomatic** * Can cause amoebic dysentry * Transmitted in food, water, faeco-orally **highly transmissable** * General features: diarrhoea, abdominal pain, fulminany colitis with necrosis and perforation * Treat with high dose metronidazole followed by an intraluminal agent

GI System (15 decks)

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