Medicine Marrow Pg 41-50 (GIT)
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Medicine Marrow Pg 41-50 (GIT)

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Questions and Answers

Which of the following is a common cause of infectious diarrhea?

  • Viral infections (correct)
  • Food preservation
  • Allergic reactions
  • Stress

    • What is a known complication associated with Campylobacter jejuni?

  • Ileal perforation
  • Guillain Barre syndrome (correct)
  • Chronic kidney disease
  • E. coli infection

    • Infectious diarrhea can be caused by consuming contaminated food or water.

    True

    Name a common symptom of infectious diarrhea.

    <p>Dehydration</p> Signup and view all the answers

    Azithromycin 500mg is routinely indicated for treatment in cases of small bowel diarrhea.

    <p>False</p> Signup and view all the answers

    Infectious diarrhea is typically characterized by __________ and abdominal cramping.

    <p>frequent watery stools</p> Signup and view all the answers

    What type of toxin is Toxin B produced by Clostridium difficile?

    <p>Cytotoxic</p> Signup and view all the answers

    The incubation period for Campylobacter jejuni infection is __________ days.

    <p>2-4</p> Signup and view all the answers

    Match the following terms related to infectious diarrhea with their definitions:

    <p>Dehydration = Loss of body fluids leading to serious health issues Pathogens = Microorganisms that can cause disease Acute diarrhea = Diarrhea that lasts for a short duration Electrolytes = Minerals essential for bodily functions that can be lost during diarrhea</p> Signup and view all the answers

    Match the following conditions with their associated factors:

    <p>Campylobacter jejuni = Feco-oral Pseudomembranous Enterocolitis = Clostridium difficile Toxin A = Enterotoxin Toxin B = Cytotoxic</p> Signup and view all the answers

    What is the recommended induction therapy for mild to moderate gastroenterology management?

    <p>Oral Budesonide 9mg/day</p> Signup and view all the answers

    Maintenance therapy is required for all patients in gastroenterology management.

    <p>False</p> Signup and view all the answers

    Name one newer drug used in gastroenterology management.

    <p>Natalizumab or Ustekinumab or Vedolizumab</p> Signup and view all the answers

    In the case of fistulizing disease, the recommended therapy includes Anti-TNFα plus _____ followed by surgery.

    <p>Immunomodulators</p> Signup and view all the answers

    Match the following medications with their respective classifications:

    <p>Budesonide = Oral steroid Methotrexate = Immunomodulator IV Anti-TNF-α = Biologic therapy Corticosteroids = Anti-inflammatory</p> Signup and view all the answers

    What is the mainstay treatment for mild ulcerative colitis?

    <p>5-ASA (Aminosalicylic acid)</p> Signup and view all the answers

    Oral mesalamine is the drug of choice for mild ulcerative colitis.

    <p>True</p> Signup and view all the answers

    What is the recommended treatment for moderate ulcerative colitis?

    <p>Oral mesalamine + Oral steroids</p> Signup and view all the answers

    In severe ulcerative colitis, the treatment includes IV steroids and IV ______.

    <p>anti-TNF-α</p> Signup and view all the answers

    Match the following ulcerative colitis treatment strategies with their severity:

    <p>5-ASA = Mild UC Oral mesalamine + Oral steroids = Moderate UC IV steroids + IV anti-TNF-α = Severe UC Topical 5-ASA + Azathioprine = Maintenance</p> Signup and view all the answers

    Which of the following is a source of Vibro parahaemolyticus?

    <p>Raw fish</p> Signup and view all the answers

    Bacillus cereus produces a heat labile toxin that is preformed.

    <p>False</p> Signup and view all the answers

    What is the primary treatment for dehydration caused by cholera?

    <p>Ringer lactate</p> Signup and view all the answers

    The incubation period for the heat stable toxin of Bacillus cereus ranges from _____ hours.

    <p>1-6</p> Signup and view all the answers

    Which organism is most commonly associated with secretory diarrhea?

    <p>ETEC (Enterotoxigenic Escherichia coli)</p> Signup and view all the answers

    Non-typhoid salmonella is an invasive organism associated with large bowel diarrhea.

    <p>True</p> Signup and view all the answers

    Match the following clinical feature with its associated pathogen:

    <p>Watery diarrhea = Vibrio cholera Acute diarrhea = Vibrio parahaemolyticus Vomiting = Bacillus cereus Traveler's diarrhea = Enterotoxigenic E. coli</p> Signup and view all the answers

    What is the incubation period for Staphylococcus aureus food poisoning?

    <p>1-6 hours</p> Signup and view all the answers

    Which malignancy is specifically associated with Ulcerative Colitis due to primary sclerosing cholangitis?

    <p>Cholangiocarcinoma</p> Signup and view all the answers

    The most common cause of shigellosis is __________.

    <p>Shigella flexneri</p> Signup and view all the answers

    Which serological marker correlates with disease activity in ulcerative colitis?

    <p>Atypical P-ANCA</p> Signup and view all the answers

    The age of onset for IBD-related colorectal carcinoma is generally older than that of sporadic colorectal carcinoma.

    <p>False</p> Signup and view all the answers

    Primary sclerosing cholangitis is more common in patients with ulcerative colitis than in patients with Crohn's disease.

    <p>True</p> Signup and view all the answers

    What is the common pathological feature of IBD-related colorectal carcinoma?

    <p>Signet ring cell carcinoma</p> Signup and view all the answers

    Match the following organisms with their type of diarrhea:

    <p>ETEC = Secretory Shigella flexneri = Invasive Clostridium perfringens = Preformed toxin Entamoeba histolytica = Invasive</p> Signup and view all the answers

    What are the two fecal markers that help differentiate IBD relapse from infectious diarrhea?

    <p>Fecal calprotectin and lactoferrin</p> Signup and view all the answers

    The genetic sequence followed in sporadic colorectal carcinoma is the __________ sequence.

    <p>adenoma-carcinoma</p> Signup and view all the answers

    Patients with ulcerative colitis have a ___% chance of developing primary sclerosing cholangitis.

    <p>5</p> Signup and view all the answers

    Match the types of malignancy associated with Crohn's Disease and Ulcerative Colitis:

    <p>Crohn's Disease = Non-Hodgkin's lymphoma Ulcerative Colitis = Cholangiocarcinoma</p> Signup and view all the answers

    Match the type of inflammatory bowel disease with its associated serological marker:

    <p>Ulcerative colitis = Anti-goblet cell antibody Crohn's disease = Anti-saccharomyces cerevisiae antibody Both = ASCA</p> Signup and view all the answers

    What are some side effects associated with sulfasalazine?

    <p>Hypersensitivity</p> Signup and view all the answers

    Procto-colectomy with ileoanal anastomosis is indicated for medically refractory disease.

    <p>True</p> Signup and view all the answers

    Name a biologic agent used in the treatment of Crohn's Disease.

    <p>Infliximab</p> Signup and view all the answers

    Which organism is most commonly associated with Hemolytic Uremic Syndrome (HUS)?

    <p>Enterohemorrhagic E. coli 0157:H7</p> Signup and view all the answers

    The __________ level of Crohn's Disease is characterized by fever, cachexia, and obstruction.

    <p>Severe - Fulminant</p> Signup and view all the answers

    Reactive arthritis can be caused by a Shigellosis infection.

    <p>True</p> Signup and view all the answers

    Match the following drugs to their side effects:

    <p>Sulfasalazine = Hypersensitivity and G6PD deficiency Azathioprine = Hepatotoxicity and pancreatitis Corticosteroids = High risk of dependency</p> Signup and view all the answers

    What is the drug of choice for treating Shigellosis?

    <p>Ciprofloxacin</p> Signup and view all the answers

    The main toxin produced by Shigella dysenteriae is called __________.

    <p>Shiga toxin</p> Signup and view all the answers

    Match the type of bacteria with their associated toxins:

    <p>Enterohemorrhagic E. coli 0157:H7 = Shiga-like toxin Streptococcus pneumoniae = Neuraminidase toxin Shigella dysenteriae = Shiga toxin Non-typhoid Salmonella = Invasive enterotoxin</p> Signup and view all the answers

    Study Notes

    Gastroenterology Management

    • Avoid smoking and NSAIDs.
    • Mild to Moderate Ulcerative Colitis: Oral Budesonide 9mg/day
    • Moderate to Severe Ulcerative Colitis: Oral steroids, Methotrexate
    • Severe to Fulminant Ulcerative Colitis: IV Steroids, IV anti TNF-α
    • Maintenance Therapy: Not required for Ulcerative Colitis
    • Medications to Avoid in Ulcerative Colitis Maintenance: Oral 5-ASA, Corticosteroids, Budesonide
    • Newer Drugs for Ulcerative Colitis: Natalizumab, Ustekinumab, Vedolizumab
    • Fistulizing Disease: Anti-TNFα ± Immunomodulators followed by surgery.

    Infectious Diarrhea

    • Acute Diarrhea: Diarrhea that lasts less than 14 days.
    • Campylobacter Jejuni: Source: Feco-oral, Incubation period: 2-4 days, Complications: Risk factor for Inflammatory bowel disease, Trigger for GBS (Guillain Barre syndrome), Associated with immune proliferative small intestinal disease (IPSID)/lymphoma.
    • Campylobacter Jejuni Management: Indications: >70 years, Fever, Abdominal pain, Hypovolemia, ≥6 stools/day, Investigation: Culture (Shigella, Salmonella, Campylobacter), Treatment: Azithromycin 500mg
      • Note: Not routinely indicated in small bowel diarrhea.

    Pseudomembranous Enterocolitis

    • Genesis: Clostridium difficile
    • Toxins: Toxin A: Enterotoxin, Toxin B: Cytotoxic (most potent)
    • Incubation period: 2 days

    Treatment of Ulcerative Colitis

    TrueLove & Witt's Classification

    • Mild Ulcerative Colitis: 37.5°C temperature, HR >90 bpm, Anemia with Hb level 30 mm/hr

    Medical Management

    • 5-ASA (Aminosalicylic acid): Mainstay Rx, Disadvantage: Absorbed at small intestine → Does not reach rectum (site of active disease).
    • Mesalamine: Delayed/controlled release 5-ASA, DOC for mild UC.

    Management

    Induction Therapy
    UC Severity Treatment
    Mild UC Topical 5-ASA / Oral mesalamine
    Moderate UC Oral mesalamine + Oral steroids / Steroid resistant/refractory: Azathioprine/6-mercaptopurine
    Severe UC IV steroid + IV anti-TNF-α / IV Cyclosporine
    Maintenance
    UC Severity Treatment
    All UC Topical 5-ASA + Azathioprine/6-mercaptopurine No role of steroids

    Inflammatory Bowel Disease: Part 2

    Others

    • Primary sclerosing cholangitis (PSC): Most common in ulcerative colitis, Fibrosing destruction of intra and extrahepatic bile ducts, Two-thirds of patients with PSC have ulcerative colitis, 5% of patients with ulcerative colitis have PSC.
    • Stones: Cholelithiasis, Nephrolithiasis (Oxalate).

    Other Investigations

    • Fecal Calprotectin and Lactoferrin: Helps differentiate IBD relapse from infectious large bowel diarrhea, Levels increase in IBD relapse. Relapse identified by:
      • a.Fecal calprotectin & lactoferrin
      • b.Correlation with extraintestinal manifestations
    • Ulcerative colitis: Atypical P-ANCA: Correlates with disease activity, Anti-goblet cell antibody
    • Crohn's disease: ASCA: Anti-saccharomyces cerevisiae antibody, OmP-C: Outer membrane porin C antibody, APB: Anti-pancreatic antibody, Anti-la: Elevated → Bad prognosis, need for surgery, Anti-flagellin
      • Note: ASCA is common to Crohn's disease and Behçet's disease.

    Musculoskeletal

    • Osteopenia, osteoporosis, Most common (>40% of patients) due to long-term drug use

    Liver Steatosis

    ↑ Risk of thromboembolism

    Malignancy In IBD

    • The risk of malignancy is present in both UC and CD.

    Crohn's Disease

    • Non Hodgkin's lymphoma, Leukemia, Myelodysplastic syndrome

    Ulcerative Colitis

    • Cholangiocarcinoma (d/t association with primary sclerosing cholangitis)
    Feature Sporadic Colorectal Carcinoma IBD related carcinoma
    Age of onset >50yrs 10-15yrs younger
    5-yr survival rate 50% for both 50% for both
    Genetic sequence Adenoma-carcinoma sequence Inflammation-Dysplasia-Carcinoma sequence
    Site of lesion Common on left side Any segment of diseased colon
    Pathological feature Adenocarcinoma Signet ring cell carcinoma
    Genetics P53 mutation: Late APC mutation: Early P53 mutation: Early APC mutation: Late

    Gastroenterology

    BACILLUS CEREUS

    Feature Heat stable toxin Heat labile toxin
    Toxin Preformed Formed
    Incubation Period 1-6 hours 6-12 hours
    Clinical Features Vomiting Diarrhea (↑ CAMP)
    Source Undercooked fried rice meat, pudding, dried potato

    VIBRIO CHOLERA

    • Pathogenesis: Non-invasive, Enterotoxin → Activates adenyl cyclase, Toxin co-regulated pilus: mediates attachment to intestinal mucosa
    • Clinical Features: Watery diarrhea: Large volume, Dehydration, Hypokalemic acidosis (Normal anion gap metabolic acidosis).
    • Treatment: Ringer lactate (Fluid of choice), Drug of choice: Doxycycline, Azithromycin (In pregnancy).

    VIBRIO PARAHEMOLYTICUS

    • Source: Raw fish
    • Clinical Features: Acute diarrhea
    • Diagnosis: Kanagawa phenomenon
    • Treatment: No role of antibiotics.

    Large Bowel Diarrhea

    ENTEROTOXIGENIC E.COLI (ETEC)

    • m/c cause of community acquired diarrhea, traveler's diarrhea
    • Toxin: Heat labile toxin (LT) →↑ CAMP.
    • Note: The table format for the Bacillus Cereus section may not entirely reflect the intended original layout.The layout formatting isn't consistent.

    Infectious Diarrhea

    Small Bowel

    • Secretory diarrhea: In vivo toxin production (↑CAMP → ↑water absorption → Secretory diarrhea), ETEC (Enterotoxigenic Escherichia coli): m/c, Vibrio cholera, Preformed toxins (Food poisoning): Staphylococcus aureus, Bacillus cereus, Clostridium perfringens, Cryptosporidium, Microsporidium, Giardia lamblia

    Large Bowel

    • Invasive organisms: Shigella flexneri (0a organisms): Causes shigellosis (m/c), Campylobacter, Non-typhoid salmonella, EIEC (Enteroinvasive Escherichia coli), Vibrio parahemolyticus, Entamoeba histolytica
    • Note: Salmonella typhi: Typhoid (Small bowel invasion → Fever with chills, pain abdomen, no diarrhea).

    Small Bowel Diarrhea

    STAPHYLOCOCCUS AUREUS

    • Preformed toxin: Heat stable enterotoxin
    • Incubation period: 1-6 hours
    • Source: Custard, pork, canned meat
    • Clinical features: Vomiting (most prominent) : D/t 5-HT3 stimulation, Abdominal cramps
    • Note: Organisms producing heat stable enterotoxin: Staphylococcus aureus, Bacillus cereus, Clostridium perfringens, Yersinia, E.coli

    Inflammatory Bowel Disease: Part 2

    • Note: Sulfasalazine: 5-ASA + Sulfapyridine (Carrier) → Absorbed at rectum, S/E (D/t sulfapyridine): Hypersensitivity, bone marrow suppression, G6PD deficiency → No longer used, S/E of azathioprine: Hepatotoxicity, bone marrow toxicity, pancreatitis.

    SURGICAL MANAGEMENT

    • Procto-colectomy with ileoanal anastomosis.
    • Indications: Colonic dysplasia or carcinoma, Uncontrollable colonic hemorrhage, Colonic perforation, Toxic megacolon, Medically refractory disease.

    Crohn's Disease

    GRADING OF SEVERITY

    Severity Level Features
    Mild - Moderate No dehydration, No obstruction, No weight loss, No systemic features
    Moderate - Severe Between mild and severe
    Severe - Fulminant Despite steroid intake, patient has: Fever, Cachexia, Obstruction, Peritoneal signs

    MEDICAL MANAGEMENT

    • Objectives: Endoscopic mucosal healing, Prevent complications (Strictures, fistulae etc).
    • Drugs: Antibiotics, Corticosteroids (High risk of dependency and/or resistance), 5-ASA, Immunomodulators.
    • Biologics- Anti TNF agents: Infliximab, Adalimumab, Certolizumab pegol. Play an important role in the treatment of continuously active disease/prolonged symptomatic remission.

    Infectious Diarrhoea

    Clinical features: Hemolytic Uremic Syndrome (HUS)

    • 90%: Enterohemorrhagic E.coli 0157:H7 (most common)
      • Shiga-like toxin (verocytotoxin)
    • 10%: Streptococcus pneumoniae
      • Neuraminidase toxin
    • Shigella dysenteriae: Shiga toxin
    • Note: Heat stable toxin of ETEC ↑cGMP.

    SHIGELLA

    Pathogenesis

    • Invasion by plasmid antigen (affects all 4 layers of intestinal wall)
    • Shigellosis (severe inflammatory diarrhea)
    • Reactive arthritis

    Treatment

    • Ciprofloxacin (DOC)
    • Azithromycin

    Note: Differential Diagnosis for Diarrhea with Arthritis

    • IBD (Inflammatory Bowel Disease)
      • Identified by:
        • Elevated fecal lactoferrin/calprotectin
        • Extraintestinal manifestations
          • Erythema nodosum
          • Episcleritis
          • Type-1 (peripheral) arthritis

    NON-TYPHOID SALMONELLA

    • Source: Fecal-oral
    • Incubation: 6-72 hours
    • Pathogenesis: Invasive enterotoxin
    • Complications:
      • Aortoarteritis (most severe)
      • Endovascular infection

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    Description

    This quiz covers key concepts in gastroenterology management, focusing on ulcerative colitis treatment protocols and the handling of infectious diarrhea. You will learn about various medications, therapeutic approaches, and specific pathogens associated with acute diarrhea. Test your knowledge on the latest guidelines and management strategies in gastroenterological health.

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