Diseases affecting the Gastrointestinal Tract

Amoebiasis (Amoebic Dysentery)

A protozoal infection of man initially involving the colon but may spread to soft tissues by contiguity or hematogenous or lymphatic dissemination most commonly to the liver or lungs.Is the third leading cause of death from parasitic disease worldwide.

Etiologic Agent(Entamoeba Hystolitica)

Prevalent in ill-sanitated areas

Common in warm climate

Acquired by swallowing

Cyst survive a few days outside the body

Cyst pass to the large intestine and hatch into trophozites. Pass into mesenteric veins, to the portal vein, to the liver, thereby forming amoebic liver abscess.

Two developmental stages

1. Trophozoites/vegetative form

A facultative parasite that may invade tissue or they are found in the parasitized tissues and liquid colonic contents.

2. Cyst Are passed out with

forms or semi-formed stools and are resistant to environmental conditions.

Considered as the infective stage in the life cycle of Entamoeba Hystolitica

Incubation period:

3 days in severe infection; several months in sub-acute and chronic form. In average case vary from 3-4 weeks.

Period of communicability:

For duration of the illness.

Mode of transmission

™Fecal-oral transmission™Direct contact™Indirect contact- by ingestion of food

especially uncooked leafy vegetables or contaminated with fecal material containing E. Hystolitica cycts.

Clinical manifestationA. Acute amoebic dysentery

Slight attack of diarrhea, altered with periods of constipation and often accompanied by tenesmus.

Diarrhea, watery and foul-smelling stools often containing blood-streaked mucus.

Diarrhea, watery and foul-smelling stools often containing blood-streaked mucus.

Nausea, flatulence and abdominal distension, and tenderness in the right iliac region over the colon.

B. Chronic amoebic dysentery Attack of dysentery lasting for several

days, usually succeeded by constipation. Tenesmus accompanied by the desire to

defecate. Anorexia, weight loss and weakness. Liver maybe enlarged. The stools at first are semi-fluid but soon

become watery, blood, and mucoid. Vague abdominal distress, flatulence,

constipation or irregularity of the bowel. Mild anorexia, constant fatigue and

lassitude Abdomen lost its elasticity when

picked---up between fingers. On sigmoidoscopy, scattered ulceration

with yellowish and erythematous border. Gangrenous type of stool

Extra intestinal forms• HepaticPain at the upper right

quadrant with tenderness of the liver.

Jaundice Intermittent feverLoss of weight or

anorexiaAbscess may break

through the lungs, patient coughs anchovy-sauce sputum

Diagnostic exam

Stool examBlood examProctoscopy/sigmoidoscopy

Treatment modalities

MetronidazoleTetracyclineAmpicillin, quinolones, sulfadiazineStreptomycinFluid and electrolytes lost should be replaced

Nursing management

1. Isolation, enteric precaution2. Health education Boil water for drinking or use

of purified water Avoid washing food from

open drum or pail Cover leftover food Wash hands after defecation

or before eating Avoid eating raw ground

vegetables (lettuce, carrots, etc.)

Methods of PreventionΘ Health educationΘ Sanitary disposal of fecesΘ Protect, chlorinate and

purify drinking waterΘ Use scrupulous

cleanliness in food preparation, handling, and storage

Θ Detection and treatment of carriers

Θ Fly control

Bacillary Dysentery(shigellosis; bloody flux)

An acute bacterial infection of the intestine characterized by diarrhea, and fever associated with the passing out of bloody-mucoid stools with tenesmus.

Etiologic agent

Four serologic groups

Shigella flesneri Shigella boydii Shigella connie Shigella dysentery The most infectious Habitat is the GIT of man Develop resistance against antibiotics Invade in the blood stream

INCUBATION PERIOD:7 hours to 7 days with the average of 3-5 daysPERIOD OF COMMUNICABILITY: The patient is capable of transmitting the

microorganism during the acute infection until feces is negative for the microorganism. Some patient remain a carrier for a year or two.

MODE OF TRANSMISSION: Ingestion of contaminated food, or drink Transmitted by flies Fecal-oral transmission

Clinical manifestation

• Fever• Tenesmus, nausea,

vomiting and headache• Colicky or cramping

abdominal pain with anorexia and body weakness

• Diarrhea with bloody-muciod stools

• Dehydration and loss of weight

Complications

• Rectal prolapse• Respiratory

complication• Non-suppurative

arthritis and peripheral neuropathy

CYCLE SHIGELLA FLESNERE SHIGELLA BOYDII SHIGELLA CONNEI

SHIGELLA DYSENTERY

HUMAN FACEAL POLLUTION

FECES

FECAL-ORAL

INGESTION OF MICROORGANISM

MAN

Diagnostic procedure

Fecalysis Isolation of the causative

microorganism from rectal swab

Peripheral blood examination

Blood culture Sheets of

polymorphoneuclear leukocytes

Modalities of treatment

Antibiotics IV infusion with NSS Low residue of diet Anti diarrheal drugs

NURSING MANAGEMENT: Maintain fluid and

eletrolyte balance Restrict food until

nausea and vomiting subsides

Isolation Maintain personal

hygiene Proper disposal of

excreta Concurrent and terminal

disinfection

METHODS OF PREVENTION AND CONTROLSanitary disposal of human fecesSanitary supervision of processing, preparation of foodFly controlIsolation of patient