DISEASES AFFECTING THE GASTROINTESTINAL TRACT

Hepatitis

Hepatitis can be caused by: Immune cells in the body attacking the liver and causing autoimmune hepatitis Infections from viruses (such as hepatitis A, B, or C), bacteria, or parasites Liver damage from alcohol, poisonous mushrooms, or other poisons Medications, such as an overdose of acetaminophen, which can be deadly

Hepatitis

The symptoms of hepatitis include: Abdominal pain or distention Dark urine and pale or clay-colored stools Fatigue Fever, usually low-grade General itching Jaundice (yellowing of the skin or eyes) Loss of appetite Nausea and vomiting Weight loss

Hepatitis

A physical examination may show

Enlarged and tender liver Fluid in the abdomen (ascites) that can become infected Yellowing of the skin

VIRAL HEPATITIS
Points of Difference Other names Causative agents Incubation period Source of Infection Mode of transmission HEPATITIS A HEPATITIS B HEPATITIS C Infectious HAV 2-6 weeks Serum HBV 6 weeks-6 months Non-A, Non-B or post-transfusion Other viruses 2 weeks-6 months

Feces
Fecal-oral

Age

Children and elderlies

Blood, semen, vaginal secretions Percutaneous inoculation including sexual contact All ages

Blood
Blood transfusion

All ages

VIRAL HEPATITIS
Point of Difference
7. Season 8. Risk

HEPATITIS A
Rainy Poor environmental sanitation Food handlers Those who practice oral-anal sex

HEPATITIS B
All season Members of health team Drug addicts Client undergoing hemodialysis Promiscuity-love to do sex always Yes

HEPATITIS C
All season Blood recipient a.1. client with blood disorder a.2. client undergoing major surgery

9. Carrier
10. Prognosis

None
5% mortality

1-10%

Yes
1-2% mortality

VIRAL HEPATITIS
Point of Difference 11. Prevention HEPATITIS A Immunization Proper environmental sanitation Screening of food handler Avoid oral-anal sex HEPATITIS B HEPATITIS C Immunization Screening of blood Use sterile donors syringes, needles and instruments Screening of blood donors Be faithful to your partner

Medical Treatment
1. Bed rest 2. Immunization - CDC recommends that all neonates should be given Hepatitis immunization 3. Medications Ex. Moriamin Sulfate Essentiale

MUMPS

Mumps (epidemic parotitis) is a viral disease of the human species, caused by the mumps virus

MUMPS

Epidemiology Peak Age 10-19 years

MUMPS Pathophysiology A. Caused by a paramyxovirus B. Transmission Infected Salivary secretions or urine A. Infectious: Start: 6 days before Parotitis Ends: 2 weeks after symptom onset B. Incubation: 12-25 days (typically 16-18 days)

MUMPS Symptoms A. Subclinical presentation in 20% of cases B. Prodromal stage 1. Fever 2. Malaise 3. Headache 4. Anorexia 5. Myalgia C. Sudden onset pain in cheeks lasting >2 days 1. Unilateral or bilateral 2. Provoked by chewing or swallowing 3. Worse with sour foods

MUMPS Labs A. Complete Blood Count 1. Parotitis: Relative Lymphocytosis 2. Orchitis: Marked Leukocytosis B. Serum Amylase increased C. Cerebrospinal Fluid A. White Blood Cells: 1000-2000 with Neutrophils

Typhoid Fever

also known as enteric fever Fatal multisystemic illness Caused primarily by salmonella typi

Typhoid Fever
Transmission

fecal-oral route
close contact with patients or carriers

contaminated water and food

flies and cockroaches.

Typhoid fever 5 F's 1.Feces 2.Foods 3.Flies 4.Fingers 5.Fomites

Typhoid Fever
Small intestines

Inflammation and ulceration of Peyers patches

Mesenteric lymph nodes

Gallbladder

Bacteremia

Multiplication of Microphages in liver, spleen and bone marrow

Transient (primary) bacteremia

Clinical manifestations Incubation period: 10-14 days STAGES

A. Prodromal Period (early stage) first week of disease insidious onset fever up to 39~400C in 5~7 days chillsailmenttiredsore throat cough ,abdominal discomfort and constipation et al.

B. Fastigium Period second and third week 3 cardinal signs and symptoms 1.Ladder-liked fever. Last 1014 days. 2.Rose spot 3.Splenomegaly Typhoid state/ Typhoid psychosis S/sx 1. restless 2. carphologia 3. subsultustendinum

fatal complications:
intestinal hemorrhage intestinal perforation severe toxemia

C. Defervescence Period
fever and most symptoms resolve by the forth week of infection. Ulceration of peyers patches that causes GI bleeding thru the stool

Fever come down, gradual improvement in all symptoms and signs, but still danger.

D. Convalescence Period
the fifth week. disappearance of all symptoms, but can relapse

TREATMENT General treatment 1.isolation and rest 2.good nursing care and supportive treatment (a)close observation T,P,R,BP,abdominal condition and stool (b)suitable diet include easy digested food or half-liquid food drink more water (c)intravenous injection to maintain water and acid-base and electrolyte balance 3.Immunization 4.Avoid the 5 Fs

Drug of choice
1.Quinolones: o o

first choice. its highly against S.typhi penetrate well into macrophages,and achieve high

concentrations in the bowel and bile lumens 2. Norfloxacin 3. Ofloxacin 4. Ciprofloxacin caution: not in children and pregnant Diagnostic test: Typhidot Widal test

BACILLARY DYSENTERY

Definition
Acute infectious disease of intestine caused by dysentery bacilli Place of lesion: sigmoid & rectum Pathological feature: diffuse fibrous exudative inflammation

Clinical manifestation: fever, abdominal pain, diarrhea, tenesmus , stool mixed with blood, mucus & pus. Even companied with marked toxicity and shock,toxic-encephalopathy

Etiology
Causative organism: dysentery bacilli, genus shigella, gramstain negative, short rod,non-motile

Groups: 4 groups & 50 serotypes - S. Dysenteriae-the most severe

Etiology
Pathogenicity: - virulence (endotoxin) - interotoxin (exotoxin) - invasiveness (attach-penetrate-multiply)

Epidemiology
Source of infection: Humans Carriers Route of transmission:
fecal-oral route

Epidemic features:
season: summer & fall age: younger children

Pathogenesis
Number of bacteria toxicity immunity invasiveness - attachment
- penetration - multiplication

Pathogenesis-common
Bacteria intestine Penetrate mucus Multiply in epithelial cell & proper lamina Inflammation vessel contraction Normal bacteria flora sIg A Prevent attaching

endotoxin
fever

Endogenous pyrogen Superficial mucosal necrosis and ulceration Diarrhea mixed with blood & pus, abdominal ache

Laboratory Findings
Blood picture: total WBC count increase,
neutrophils increase

Stool examination:
direct microscopic exam.: WBC, RBC, pus cells bacteria culture: Sigmoidoscope: shallow ulcer,scar, polyps

Treatment
General treatment: 1.Fluid and electrolytes replacement 2. peri-anal care 3. Observe s/sx of dehydration Drug treatment :cotrimoxazole, ciprofloxacin, Bactrim Symptomatic treatment: Control high fever, convulsion

Prevention: same with typhoid fever

Prevention
Control the source of infection: until culture negative Interruptted the route of transmission

Overview
Epidemiology V. cholerae Biology Model of V. cholerae Pathogenicity Acquisition Toxin Co-Regulated Pilus Vaccine Development

Image from: http://microvet.arizona.edu/Courses/MIC420/lecture_notes/vibrio/vibrio_cholera_em.gifElectron microscopic image of Vibrio cholerae: curved rods with polar flagellum

Modes of Transmission

Water (infectious dose = 109) Food (infectious dose = 103) Person-to-person

The 19th-century illustration depicting the spirit of death at a pump was taken from http://news.nationalgeographic.com/news/2004/06/0614_040614_tvcholera.html

Clinical Manifestations

www.who.int/entity/water_sanitation_health/dwq/en/admicrob6.pdf

Treating Cholera

Sack, David, et al. 2004. Seminar: Cholera. The Lancet. 363: 223-233.

Epidemic Control Measures

Hygienic disposal of human waste Adequate supply of water Good food hygiene

Thoroughly cooking food Eating food while its hot Preventing cooked foods from contacting raw foods (including water or ice) Avoiding raw fruits or vegetables Washing hands after defecation & before cooking
Sack, David, et al. 2004. Seminar: Cholera. The Lancet. 363: 223-233.

http://www.who.int/mediacentre/factsheets/fs107/en/print.html

DEFINITION
Leptospirosis is a kind of zoonotic infectious disease caused by pathogenic leptospires; rats and swine are cardinal source of infection.

Causative Agent: Bacteria of the Genus Leptospira

DEFINITION
clinical features: three symptoms, three signs, internal organ damage, seguelae of eyes and nerve system treatment: penicillin.

Routes of transmission: (1) water borne (indirect contact transmission): by skin, mucosa, when skin is injured. (2) direct contact transmission: (3) food borne

PATHOGENESIS
Initial stage
(1~3days)

leptospira skin, mucosa leptospiremia (toxic symptoms)

three symptoms: fever,myalgia,headache three signs: conjunctival suffussion; muscle tenderness; enlargement of the
lymphnodes

PATHOGENESIS
severe toxic symptoms
lesion of organs: - influenza form - pneumorrhagic form - icterohemorrhagic form - meningoencephalitis renal failure form.

middle stage (3~10d)

Leptospirosis

Leptospirosis
Diagnostic test:
1.MAT (Microscopic Agglutination Test) 2.ELISA Drugs: 1.Oral doxycycline 2.Ampicillin 3.Streptomycin 4.Intravenous Penicillin G

Leptospirosis
Health Teachings 1.Provide education to clients telling them to avoid swimming in potentially contaminated water or flood water. 2. Use of proper protection like boots, gloves when work requires exposure to contaminated water. 3. Drain potentially contaminated water when possible.

Leptospirosis
Nursing Management 1. Isolate the patient and concurrent disinfection of soiled articles. 2. Report all cases of leptospirosis. 3. Investigation of contacts and source of infection.

PATHOGENESIS
immunopathological reaction after fever; sequelae of eyes; reactive meningitis; cerebro arteritis obliterans.

convalescent stage