Infections of the GIT and Hepatobiliary system

Question 1

Bacteria are protective against most intraluminal infection however can also be pathogenic if in the wrong part of the body such as

Answer 1

peritoneum

Question 2

How many species of bacteria are found in the GI tract?

Answer 2

Over 400, predominantly anaeobes

Question 3

What is ‘normal flora’

Answer 3

the community of microorganisms that live on another living organism without causing disease

Question 4

Stable normal flora produces antimicrobial substances such as … which discourage infection

Answer 4

bacteriocins and short chain fatty acids

Question 5

Bacteriocins and short chain fatty acids made by normal flora inhibit overgrowth of e______ pathogens and prevent colonisation by e____ pathogens

Answer 5

endogenous,
exogenous

Question 6

What kills most swallowed pathogens?

Answer 6

Gastric acid

Question 7

What increases the risk of intraluminal infection?

Answer 7

Less gastric acid or broad spectrum antibiotics

Question 8

Clostridium difficile contains e___ that can survive the acidity of the stomach and reach the large intestine

Answer 8

endospores

Question 9

C. difficile is gram _____, spore forming bacteria

Answer 9

positive

Question 10

Many with c diff can be asymptomatic but can become a problem if the normal gut flora is altered, notably due to….

Answer 10

broad spectrum antibiotics

Question 11

What is the rule of Cs?

Question 12

clindamycin, ciproflxacin, co-amoxiclav and cephalosporins

Question 13

Altered gut flora can also occur due to acid reducing drugs such as…

Answer 13

PPIs, NG feeding and immunocompromise

Question 14

How do you treat C. diff?

Answer 14

Metronidazole
or
oral vancomycin
(in refractory cases sometimes faecal transplant)

Question 15

What is the definition of diarrhoea?

Answer 15

3 or more loose/liquid stools within 24 hours

Question 16

What are some infective causes of diarrhoea?

Answer 16

campylobacter, salmonella, HIV, bacterial or amoebic dysentery, cholera, systemic infections

Question 17

What are some non-infective causes of diarrhoea?

Answer 17

Inflammatory:
Ulcerative colitis, Chron’s, Diverticular disease

Loss of absorptive area: coeliac, small bowel resection, tropical sprue

Pancreatic disease: pancreatitis, cancer

Drugs: antibiotics, magnesium, digoxin

Colon cancer

Systemic disease (thyrotoxicosis, uraemia, carcinoid

IBS, gastrectomy

Question 18

What may floating stool indicate?

Answer 18

Fat content, malabsorption, Coeliac?

Question 19

Blood or mucous in stool may indicate…

Answer 19

inflammatory/invasive infection, cancer?

Question 20

True or false: puppies can carry campylobacter

Answer 20

True

Question 21

True or false: reptiles can carry salmonella

Answer 21

True

Question 22

What infection commonly comes from cooked meats?

Answer 22

Clostridium perfringens

Question 23

What bacteria comes from reheated rice and causes lots of vomiting?

Answer 23

Bacillus cereus

Question 24

Giardia causes offensive diarrhoea, chronic bloating, flatulence and is more common in…

Answer 24

nurseries or old age facilities

Question 25

Where can cryptosporidium be found?

Answer 25

Cryptosporidium

Question 26

Which food is salmonella commonly from?

Answer 26

Poultry, eggs and dairy

Question 27

Where is vibrio parahaemolyticus often from?

Answer 27

Shellfish

Question 28

What is a common cause of food poisoning, especially from meats and BBQs

Answer 28

campylobacter

Question 29

In the UK, __-__% of diarrhoea are caused by viruses eg rotavirus, norovirus

Answer 29

50-70%

Question 30

What are common causes of Traveller's diarrhoea?

Answer 30

Enterotoxigenic e.coli Campylobacter Shigella Non-tymphoidal salmonella V. parahaemolyticus Viral Protozoal Cholera

Question 31

What are symptoms of traveller's diarrhoea?

Answer 31

Abdominal pain, cramps, nausea, vomiting, dysentry

Question 32

True or false: most strains of E. coli are harmless

Answer 32

True, some serotypes are pathogenic

Question 33

Is cholera found in the UK?

Answer 33

Not really but can be seen in travellers

Question 34

What causes vibrio cholerae?

Answer 34

Vontaminated food/water

Question 35

What are symptoms of cholera?

Answer 35

Profuse watery "rice water" diarrhoea, up to 20 litres a day!! Vomiting Rapid dehydration

Question 36

What is used to treat cholera?

Answer 36

Doxycycline and fluids Oral rehydration therapy

Question 37

What are 3 more common protozoa (parasites)?

Answer 37

Crytpo Giardia Entamoeba

Question 38

What are the 2 more common worms (parasites)?

Answer 38

Schistosomiasis Strongyloides

Question 39

Who is most at risk to both common and rarer infections?

Answer 39

Immunosuppressed patients

Question 40

What are red flags for diarrhoea?

Answer 40

Dehydration Electrolyte imbalance Renal failure Immunocompromise Sever abdominal pain (c. diff can cause toxic megacolon and can perforate) Cancer risk factors: over 50, chronic diarrhoea, weight loss, blood in stool, Fhx cancer, change in bowel symptoms

Question 41

What other infections may cause pain in the Right Upper Quadrant?

Answer 41

Biliary sepsis (aka ascending cholangitis) Liver abscess Pneumonia

Question 42

What other infections may cause lower abdominal pain?

Answer 42

Pelk inflammatory disease

Question 43

Pain in the Left or right upper quadrant may be peptic ulcer disease caused by...

Answer 43

Helicobacter pylori

Question 44

Where does helicobacter pylori live?

Answer 44

Within mucous layer overlying the gastric mucosa

Question 45

How to diagnose peptic ulcer disease

Answer 45

Stool antigen test Breath test Blood test for antibodies (can be positive for a year after) Endoscopy with biopsy

Question 46

How to diagnose a biliary tract infection?

Answer 46

Ultrasound

Question 47

How to treat biliary tract infection

Answer 47

IV fluids, analgesia and antibiotics or cholecystectomy

Question 48

Obstruction of the common bile duct is called...

Answer 48

Ascending Cholangitis

Question 49

What is Charcot's triad?

Answer 49

Fever, abdominal pain and jaundice seen with ascending cholangitis

Question 50

Management of ascending cholangitis

Answer 50

Prompt admission with IV antibiotics ERCP Cholecystectomy (has high mortality)

Question 51

Liver abscess can be seen on...

Answer 51

ultrasound of CT

Question 52

What is the management of a liver abscess?

Answer 52

Antibiotics and drainage

Question 53

What are 3 main causes of liver abscess?

Answer 53

Bacterial (faecal flora eg E. Coli) Amoebic Hydatid (dog tapeworm)

Question 54

What is the other name for enteric fever?

Answer 54

Typhoid

Question 55

What is Enteric fever caused by

Answer 55

Salmonella typhi

Question 56

What are symptoms of enteric fever?

Answer 56

Generalised or right lower quadrant pain, high fever, "relative bradycardia", headache, myalgia, rose spots, constipation/green diarrhoae

Question 57

How is enteric fever diagnosed?

Answer 57

Through blood cultures

Question 58

What are complications of enteric fever?

Answer 58

GI bleed, perforation, myocarditis, abscesses

Question 59

How do you treat enteric fever?

Answer 59

Emergency surgery Antibiotics

Question 60

Biliary sepsis, peritonitis and liver abscess patients all...

Answer 60

get sick quickly!