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Flashcards in Michelle GI Deck (63)
1

criteria for traveller's diarrhoea?

at least 3 losse/watery stools in 24hrs +/- abdo cramps, fever, nausea, vomit or blood in the stool

2

most common cause of traveller's diarrhoea?

E. coli

3

classic staph aureus picture?

vomiting 1-6 hrs after eating contaminated leftovers

4

classic bacillus cereus picture?

ill 1-6 hrs after eating non-refrigerated rice

5

classic E. Coli picture?

ill 12-48 hrs after ingesting food
Travel
Dodgy BBQ
peak diarrhoea 7-10 days after

6

classic clostridium perfringens picture?

ill 6-24 hrs (usually between 10-12) after ingesting re-heated gravy or poorly refrigerated food
only lasts 24 hrs

7

classic salmonella enterica picture?

ill 12-48 hrs after poultry, egg, poor sanitation/water

8

how is salmonella enterica infection treated?

usually self limiting
ceftriaxone or ciprofloxacin if severe

9

classic shigella picture?

"3 day history of dysentery"
diarrhoea for 1-9 days

10

how is shigella treated?

ciprofloxacin

11

classic campylobacter picture?

Ill 48-72 hrs after contact
flu like symptoms first
can mimic appendicitis
farm animals, raw milk, poultry, bad food prep

12

complication of campylobacter infection?

guillian barre syndrome

13

how is campylobacter treated?

usually self limiting
ciprofloxacin if systemic (flu like)

14

classic giardiasis picture?

ill 7 days after swimming in contaminated pond/swimming pool

15

how is giardiasis treated?

metronidazole

16

classic salmonella typhi picture?

Flu and diarrhoea up to 3 weeks after travel to india/asia

17

what are some complications of salmonella typhi?

bones
joints
encephalopathy
GI perforation

18

how is salmonella typhi treated?

azithromycin
ceftriaxone (if sepsis)

19

definition of intestinal failure?

inability to maintain adequate nutrition or fluid status via intestines due to:
- obstruction
- dysmobility
- congenital defect
- surgical resection
- disease

20

type 1 intestinal failure?

days/weeks duration
can be post op or paralytic ileus

21

treatment for type 1 intestinal failure?

often self limiting
fluid and electrolytes
PN if cant oral or enteral feed

22

type 2 intestinal failure?

< 4 weeks duration
can be due to:
- fistula
- sepsis
- abdo surgery complications

23

treatment for type 2 intestinal failure?

PN +/- enteral feeding
HDU or ITU

24

type 3 intestinal failure?

chronic but stable

25

treatment for type 3 intestinal failure?

home PN feeding
may need intestine transplant or bowel lengthening

26

what are the 3 brush border enzymes and what are they made of?

maltase = glucose + glucose
Sucrase = glucose + fructose
Lactase = Glucose + galactose

27

what is rosving's sign?

push on LLQ causes pain in RLQ
sign of appendicitis

28

russel's sign?

calluses on back of hands due to induced vomiting
sign of bulimia nervosa

29

what can long term laxative use cause?

hypokalaemia

30

list some retroperitoneal structures ("SAD PUCKER")

suprarenal (adrenal) gland
Aorta/IVC
Duodenum
Pancreas
Ureters
Colon (ascending and descending)
Kidneys
Oesophagus
Rectum

31

what test is used for bowel screening?

faecal occult blood test every 2 years

32

BUFALO?

Bloods (cultures)
Urine output (hourly)
Fluids
Antibiotics
Lactate (> 4 = fucked)
Oxygen

33

antibiotic for gram +ve cocci?

amoxicillin

34

antibiotic for gram -ve coliforms?

gentamicin

35

antibiotic for gram -ve anaerobes?

metronidazole

36

pathogenesis of sepsis?

colonisation > infection > SIRS > sepsis > severe sepsis > septic shock

37

what is SIRS?

full body inflammation due to trauma, burns, pancreatitis, PE, surgery insults

38

what diseases can cause malabsorption?

Tropical sprue
disaccharide deficiency
Crohns/UC
A-Beta-lipoproteinaemia
Pancreatic insufficiency

39

what causes vit B1 deficiency?

alcohol excess
high diuretic doses
dialysis

40

what is whipple's disease?

infection of Tropheryma whipplei bacteria
HLAB7
multi system involvement: heart, GI, joint pain, steatorrhoea, neuro, wt loss

41

how is whipples disease diagnosed?

PAS granules/macrophages on duodenal biopsy

42

how is tropical sprue diagnosed?

biopsy

43

how is lactose deficiency diagnosed?

lactose breath H2 test
oral lactose intolerance test

44

is crohns TH1 or TH2 mediated?

TH1

45

how is small bowel bacterial overgrowth diagnosed?

jejunum aspirate: (low vit B12, high folate)
schilling test

46

whatcan cause small bowel bacterial overgrowth?

trauma (puncturing injury)
fistula, diverticula, stricture, crohns

47

diverticulitis risk factor?

low fibre

48

what is Meckel's diverticulum?

remnant of omphalo-mesenteric duct (AKA vitello-intestinal duct) and can contain ileal, gastric or pancreatic mucosa

49

where does Meckel's diverticulum occur and what artery supplies it?

2 feet above ileocaecal valve on small intestine side
supplied by vitelline artery

50

what are the symptoms of Meckel's diverticulum?

malaena
acute appendicitis
acute abdo pain (due to increased HCl secretion)

51

what is ischaemic colitis and how may it present?

acute transient loss of blood flow to large intestine
thumb printing on AXR, inflammation, ulceration and haemorrhage

52

where is ischaemic colitis common, who is it assoc with?

in flexures
people using cocaine

53

what is gilbert's disease?

autosomal recessive decreased activity of UDP glucoronyl transferase (UGT) causing increased unconjugated bilirubin

54

what are the symptoms of gilberts disease?

intermittent jaundice brought on by physical stress (eg. exercise or fasting)

55

physical complications of C. Diff?

pseudomembranous colitis > yellow easily disloged plaques on colonoscopy

56

how is C. Diff diagnosed and treated?

Dx = toxins in stool
Tx = metronidazole

57

classic presentation of intussusception?

2 yr old boy with RLQ pain, pulling knees up to chest during pain
red currant jelly stools
sausage shaped mass

58

how is intussusception diagnosed and managed?

Dx = US
Tx = air insufflation (radiological)

59

what causes pernicious anaemia?

autoimmune causes by autoantibodies against parietal cells or intrinsic factor

60

what are the symptoms of pernicious anaemia?

Vit B12 deficiency (need intrinsic factor to absorb B12)
predisposes to gastric cancer

61

how does oesophageal candidiasis present and what does it indicate?

white spots in throat
pain
dysphagia
indicates immunosuppression (HIV< chemi, steroids, broad spectrum antibiotic use)

62

signs of starvation?

- decreased metabolic rate
- small increase in cortisol/GH
- decreased insulin
- initial loss of Na/H2O then retention

63

signs of injury?

increased metabolism
increased cortisol/GH and increased insulin (but deficient)
Na/H2O retention