A 26 year old male suffered from profuse watery stools,cramping abdominal pain and fever after 5 days after starting a Penicilllin group of Antibiotic.
Endoscopic picture of the colon is shown in the image.Regarding this condition,all of the following statements are true ,except:
A. It is caused by Clostridium Difficile.
B. Vancomycin may be used in the treatment
C. Blood in stools is a common feature
D. Caused by Enterotoxin and Cytotoxin
Show Answer
Correct Answer » C
Explanation
Ans:C. Blood in Stools is a common feature.
The patient is suffering from Pseudomembranous Colitis.Yellowish plaque-like Lesions seen in Colon.
Pseudomembranous colitis
It is an inflammatory disease of the colon.
In mild cases may appear as minimal inflammation or edema of the colonic mucosa.
In more severe cases, the mucosa often is covered with loosely adherent nodular or diffuse exudates.
These raised exudative plaques are 2-5 mm in size. Coalescence of these plaques generates an endoscopic appearance of yellowish pseudomembranes lining the colonic mucosa.
The antibiotic-induced change in the balance of normal gut flora allows overgrowth of Clostridium difficile.
The organism is a normal commensal of gut
Clindamycin, lincomycin, ampicillin, and cephalosporin have been implicated in most of the reported cases.
Colitis results from the bacterial production of large amount of toxins. The most important toxins are toxin A (enterotoxin) and toxin B (cytotoxin).
Symptoms include the following:
Profuse, watery or mucoid, green, foul-smelling, liquid stool may contain small amounts of blood
Cramping abdominal pain may occur
The patient’s temperature may reach 103-105°F.
Diagnosis:
Endoscopic visualization of the pseudomembranes shows classic pseudomembranes visible as raised yellow plaques, which range from 2-10 mm in diameter and are scattered over the colorectal mucosa.. When the pseudomembranes are manipulated, ulcerated mucosa is uncovered.
Direct detection of toxins in the stool.
Treatment:
Immediate cessation of the offending antimicrobial agent.
Maintaining fluid and electrolyte intake.
Oral treatment with antimicrobial agents effective against C difficile:Metronidazole,Vancomycin
Reintroduction of normal flora by ingestion of probiotics
Fulminant colitis, characterized by septicemia and/or evidence of perforation requires emergent laparotomy. A total abdominal colectomy with end ileostomy may be lifesaving
