XI.

PATHOPHYSIOLOGY Medical Diagnosis Typhoid fever, Acute Gastroenteritis (AGE) Definition

Typhoid fever - is a life-threatening illness caused by the bacterium Salmonella typhi. Acute Gastroenteritis (AGE)- Gastroenteritis (also known as gastro, gastric flu, tummy bug in some countries, and stomach flu, although unrelated to influenza) is inflammation of the gastrointestinal tract, involving both the stomach and the small intestine (see also gastritis and enteritis) and resulting in acute diarrhea.

Schematic Diagram
Predisposing Geographical area tropical islands in the Pacific (Philippines) and Asia Young adult(19-45) 40yrs old Precipitating Washing of hands inadequately Sharing of food from the same plate Drinking unpurified water Eating foods from the outside source (carinderia)

Ingestion of foods or fluids contaminated with Salmonella typhi bacteria

Bacteria enter the stomach and survive a pH as low as 1.5

Bacteria invades the Payers patches of the intestinal wall in the small intestines where it attach (incubation period is first 7-14 days after ingestion)

Diagnostic: Hematology: Neutrophils-74 (50-70)

Bacteria will then injects toxins known as the effector proteins into the intestinal cells and interrupts with the cellular proteins & lipids & manipulate their function resulting in phagocytization of the epithelial cell membrane until it is engulf down into the inferior part of the host cells where macrophages is present. Macrophages & intestinal epithelial cells then attract T cells & neutrophils with interleukin 8 (IL-8 causing inflammation of the intestinal wall) The bacteria is within the macrophages and survives

Perforation and destruction of mucosal lining of the intestinal wall can lead to persistent inflammation Ulceration and bleeding in the mucosal lining and leads to necrosis Tissue damage and inflammation causes loss of absorption due to damaged villi causing an increase in water, electrolytes, mucus, blood, and serum to be pulled into the intestine from immature crypt cells Abdominal spasm is induced to limit mucosal injury adding in stimulation of increased peristalsis

Signs/ symptoms: Abdominal pain

Diagnostic: Fecalysis: reddish brown color (brown) RBC:2-4/hpf(0-

Bacteria spread via the lymphatics while inside the macrophages

The bacteria induced macrophage apoptosis, breaking out into the bloodstream and cause systemic infection

Signs/ symptoms: Febrile: T-38.5C Warmth to touch Headache of 3/10, body weakness

Typhoid Fever

Signs/ symptoms: RUQ Abdominal pain of 5/10 pain scale, guarding behavior, facial grimace, tachypnea-RR of 38cpm,

Acute Gastroenteritis

Complications: Bile is infected and typically shed in the stool and are then available to infect other hosts

Complications: Peritonitis Pancreatitis Hepatic and splenic abscesses Disseminated intravascular coagulation Myocarditis Shock Death

Signs/ symptoms: Diarrhea, defecates 5-7 times at night, soft watery stool 2-3 cups per episodes, hyperactive bowel sounds of 16 clocks per minute, dry skin, anorexia, decreased body weight

Legend: - Pathophsiology

- Signs and symptoms

- Diagnostic exams

- Complications

Medical Care

If a patient presents with unexplained symptoms described in Table 1 within 60 days of returning from an typhoid fever (enteric fever) endemic area or following consumption of food prepared by an individual who is known to carry typhoid, broad-spectrum empiric antibiotics should be started immediately. Treatment should not be delayed for confirmatory tests since prompt treatment drastically reduces the risk of complications and fatalities. Antibiotic therapy should be narrowed once more information is available. Compliant patients with uncomplicated disease may be treated on an outpatient basis. They must be advised to use strict handwashing techniques and to avoid preparing food for others during the illness course. Hospitalized patients should be placed in contact isolation during the acute phase of the infection. Feces and urine must be disposed of safely.

Surgical Care
Surgery is usually indicated in cases of intestinal perforation. Most surgeons prefer simple closure of the perforation with drainage of the peritoneum. Small-bowel resection is indicated for patients with multiple perforations. If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder should be resected. Cholecystectomy is not always successful in eradicating the carrier state because of persisting hepatic infection.

http://emedicine.medscape.com/article/231135-treatment#showall http://www.scribd.com/doc/27500491/PATHOPHYSIOLOGY-OF-TYPHOID-FEVER-AND-ACUTE-GASTROENTERITIS http://emedicine.medscape.com/article/231135-treatment#a1128 http://www.brianmac.co.uk/physiold.htm http://www.google.com.ph/imgres? imgurl=http://www.daviddarling.info/images/digestive_tract.jpg&imgrefurl=http://www.daviddarling.info/encyclopedia/D/digestive _system.html&h=360&w=500&sz=35&tbnid=WqICm9_PqHIuhM:&tbnh=94&tbnw=130&prev=/search%3Fq%3Danatomy%2Band %2Bphysiology%2Bof%2Bdigestive%2Bsystem%26tbm%3Disch%26tbo %3Du&zoom=1&q=anatomy+and+physiology+of+digestive+system&hl=tl&usg=__-jThK6FGzlvZzZ8ES6d1NYpVIk=&sa=X&ei=DPcETrWtFqmhmQX69Ym6DQ&ved=0CE4Q9QEwCA http://www.scribd.com/doc/6779644/Discharge-Plan-Gastritis