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inf & imm > Week 2 GI & ENT > Flashcards

Week 2 GI & ENT Flashcards

1
Q

What are the common GIT infections?

A
  • Bacterial gastroenteritis
  • Viral/Parasitic gastroenteritis
  • Amoebiasis
  • Giardiasis
  • Toxic megacolon
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2
Q

What are the common intra-abdominal infections?

A
  • Peritonitis
  • Cholecytitis
  • Diverticulitis
  • Intra-abdominal, liver or pancreatic abscess
  • Peptic ulcer disease
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3
Q

What are the common ENT infections? (10)

A
  • Pharyngitis
  • Diphtheria
  • Epiglottitis
  • Otitis externa
  • Otitis media
  • Mastoiditis
  • Sinusitis
  • Conjunctivitis
  • Keratitis
  • Endophthalmitis
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4
Q

What are the common organisms causing bacterial GE?

A
  • Salmonella spp (mostly S enteriditis, S typhi & S paratyphi)
  • Shigella spp
  • Campylobacter jejuni
  • Vibrio spp
  • Clostridium difficile
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5
Q

How are the common Salmonella spp transmitted and what GI infection do they cause?

A

Causes bacterial GE

Salmonella enteriditis
- Most common
- Transmitted through food
- Usually self-limiting

Salmonella typhi (typhoid fever) & Salmonella paratyphi
- Causes more dangerous manifestations
- P.t. transmitted by water
- P.p transmitted from person-to-person (eg ingestion of fecal-contaminated food/water)
- Must be treated with antibiotics
- Not endemic in Singapore

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6
Q

How is shigella spp transmitted and what GI infection does it normally cause?

A
  • Can cause bacterial GE
  • Transmitted from person-to-person
  • Disease is usually self-limiting
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7
Q

How is Campylobacter jejuni transmitted and what GI infection does it normally cause?

A
  • Can cause bacterial GE
  • Transmitted through food (mostly chicken)
  • Usually self-limiting
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8
Q

How is Vibrio spp transmitted and what GI infection does it normally cause?

A
  • Can cause bacterial GE
  • Transmitted through raw seafood
  • Usually self-limiting

Note: Vibrio cholera
- Causes the most serious effects, and can cause death
- Transmitted through water
- Common indicator is “rice water stool”

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9
Q

How is Clostridium difficile transmitted and what GI infection does it normally cause?

A
  • Can cause bacterial GE
  • Starts off with antibiotic exposure and then transmitted person-to-person
  • Especially common in hospital environments
  • Treatment involves stopping the current antibiotic and replacing it with one that targets the GI
  • Dangerous as it can lead to colitis, toxic megacolon or death
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10
Q

What is haemolytic uraemic syndrome?

A
  • Serious condition affecting the kidneys
  • Caused by EHEC/E.coli strain 0157
  • Transmitted through contaminated food or water
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11
Q

What samples and tests do you send for to test for Salmonella spp, Shigella spp, Vibrio spp and Campylobacter causing bacterial GE?

A
  • Stool sample
  • Culture and sensitivity test
  • TAT 24-48 hours
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12
Q

What samples and tests do you send to test for C. difficile causing bacterial GE?

A
  • Stool
  • C. diff toxin test
  • C&S not done as C. diff is hard to grow
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13
Q

What are the common viruses that cause viral GE?

A
  • Norovirus
  • Rotavirus
  • Adenovirus

note: all these viruses are common in children and in nurseries

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14
Q

How is Norovirus transmitted and what GI infection can it cause?

A
  • Viral GE
  • Can lead to uncontrolled diarrhea and vomiting (easily spread in hospitals)
  • Transmitted through contaminated food/shellfish/water and fecal-contaminated sources
  • Usually self-limiting
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15
Q

How are Rotavirus and Adenovirus transmitted and what GI infection can it cause?

A
  • Viral GE
  • Commonly causes paediatric diarrhea
  • Transmitted person-to-person
  • Usually self-limiting
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16
Q

What samples and tests do you send to test for rotavirus, adenovirus and norovirus causing viral GE?

A
  • Stool sample
  • Enzyme immunoassay (EIA) test and/or
  • Polymerase chain reaction (PCR) test
  • C&S not done as viral cultures takes too long to grow
17
Q

Cause and diagnosis of Amoebiasis?

A
  • By Entamoeba histolytica parasite

Diagnosis through
- Microscopy of stool specimens (to visualise parasite)
- Blood serology if systemic infection is suspected

Systemic infection
- More dangerous
- Usually abscess in the liver
- Pus will look like anchovy sauce

18
Q

Cause and diagnosis of giardiasis?

A
  • Giardia parasite (G. intestanalis, lambia, duodenalis)
  • Diagnosis through stool microscopy
19
Q

Cause and diagnosis of toxic megacolon?

A
  • Microbe cause: C. difficile
  • PP cause: Inflammatory bowel disease, ischemic colitis, medicinal drugs, other inflammatory conditions
  • Common in elderly due to use of many antibiotics

Impending signs:
- Distended abdomen but no diarrhea/output
- Antibiotics alone is not enough to treat

20
Q

Brief on the other intra-abdominal infections and what microbes can cause them?

A
  • Cholecystitis (infl of gallbladder) leading to cholangitis (infl of bile duct)
  • Diverticulitis (infl of intestines)
  • Abscesses

Caused by:
- Coliforms (eg E. coli, Klebsiella, Enterobacter)
- Anaerobes
- Enterococci
- P. aeruginosa
- Candida

21
Q

What is the pathophysiology of peritonitis?

A
  • Usually due to the perforation of intestines, gallbladder or other organs within the abdomen and spills over into the sterile peritoneum
  • May also be due to C. diff toxins

Primary:
- Liver disease -> ascites -> spontaneous bacterial peritonitis

Secondary:
- Associated with peritoneal dialysis

22
Q

What pathogens can cause peritonitis?

A

Primary:
- Coliforms
- Pseudomonas aeruginosa
- Anaerobes
- Enterococci
- Candida

Secondary:
- Primary +
- Coagulase-negative Staphylococcus (Skin flora)
- Staph aureus
- Other environmental bacteria (due to foreign object)

23
Q

Cause and pathophysiology of peptic ulcer disease?

A
  • Helicobacter pylori
  • Bacteria can survive due to urease production (neutralises stomach acid)
  • Chronic condition may lead to stomach cancer
  • Gastric biopsy may be needed if repeated courses of Abx does not work
24
Q

What is the most common first line of antibiotics?

A

Ceftriaxone

25
Q

Why should frequent use of Ciproflaxin be discouraged?

A
  • One of the few Abx that can be used to treat UTI caused by Pseudomonas aeruginosa
  • If px is resistant to Ciproflaxin, IV Abx needs to be started
26
Q

What are the common pathogens causing Pharyngitis? (IMPT)

A

1) Viruses
- Most common
- eg Rhinovirus, Adenovirus, Parainfluenza, EBV
- Disease is usually self-limiting

2) Group A Streptococcus
- especially Streptococcus pyogenes
- necessary to treat with antibiotics to prevent complications, can give Abx prophylaxis also
- eg rheumatic fever/heart disease, glomerulonephritis, tonsillar abscess

3) Corynebacterium diphtheria
- Fatal due to airway obstruction and/or arrhythmia from exotoxins
- Common in countries w poor vaccination rates

4) Neisseria gonorrhea
5) Fusobacterium necrophorum

27
Q

What are the causes of Diphtheria and their signs?

A
  • Corynebacterium diphtheriae
  • Transmitted through infected droplets or surfaces
  • Incubated for 2-5 days and infectious until at least 14 days of Abx therapy
  • s/s include “bull/thick” neck appearance, thick pseudomembrane in the tonsils, sore throat, fever
  • Arrythmias, myocarditis and heart blocks can occur if toxins are involved
  • Toxigenic strains also cause the pseudomembranes and nerve toxicity
  • Non-toxigenic strains merely colonise the airway
28
Q

What is the diagnosis, treatment and prevention of Diphtheria?

A

Diagnosis:
- Culture from nasopharyngeal swab

Treatment:
- Abx (Erythromycin, Penicillin)
- Antitoxin

Prevention:
- Vaccination
- Abx prophylaxis

29
Q

Epiglottitis?

A
  • Haemophilus influenzae type B
  • Infected epiglottis
  • s/s drooling, difficulty swallowing, airway obstruction and difficulty breathing
  • Do not take throat swab
30
Q

Normal Otitis externa? (OE)

A
  • Staph aureus and Pseudomonas aeruginosa
  • Infected external auditory canal
  • Due to water trapped in ear, or heavy use of hearing aids/ear phones
  • Treatment with antibiotic ear drops
31
Q

Malignant Otitis externa

A
  • Mostly due to pseudomonas aeruginosa
  • Seen in diabetics or immunocompromised
  • More serious as infection may invade the bone, blood vessels and nerves
  • Treatment is for at least 6 weeks and IV Abx
32
Q

Otitis media? (OM)

A
  • Usually viral but
  • Common bacteria include Streptococcus pneumoniae and Haemophilus influenza
  • Obstruction of eustachian tube
  • Treat with antibiotics is due to bacteria
  • Complication may include mastoiditis leading to brain abscess
33
Q

Mastoiditis?

A

Mastoiditis is an infection of your mastoid bone, the large bone behind your ear.

34
Q

What pathogens commonly cause Sinusitis?

A
  • Streptococcus pneumoniae
  • Haemophilus influenzae
35
Q

Causes and s/s of Conjunctivitis? (IMPT)

A
  • Mostly viral:
    ~ Adenovirus
    ~ Enterovirus
  • Bacteria:
    ~ Staph aureus
    ~ Strep pneumoniae
    ~ Pseudomonas aeruginosa (contact lens)
  • s/s:
    ~ Thick purulent exudate if bacterial in origins
    ~ Red eyes
    ~ Usually in children
36
Q

Causes and s/s of Keratitis?

A
  • Mostly bacterial
    ~ Similar to conjunctivitis
    ~ coliforms
    ~ Group A Strep

s/s:
- May lead to blindness
- Not so much discharge, more watery eyes

37
Q

Causes of Endophthalmitis?

A
  • Staph aureus
  • Streptococcus
  • Candida

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