Gastrointestinal Diseases PDF

GASTROINTESTINAL Incubation Period DISEASES At least 2 months Clinical Manifestations SCHISTOSOMIASIS 1st Stage (BILHARZIASIS OR SNAIL FEVER) Pru...

GASTROINTESTINAL Incubation Period DISEASES At least 2 months Clinical Manifestations SCHISTOSOMIASIS 1st Stage (BILHARZIASIS OR SNAIL FEVER) Pruritic rash known as ‘swimming Bilharzia is a common name for itch’ occurs24 hours after schistosomiasis infection. penetration of cercariae in the It is named after Theodor Bilharz, skin a 19th century German zoologist. 2nd Stage Description Bloody mucoid stools (on and off Tropical disease for 2 weeks) Caused by blood fluke, Katayama fever- clinical Schistosoma Japonicum that is constellation of the following transmitted by a tiny snail ○ Fever, headache oncomelania quadrasi ○ Cough, chills and sweating (intermediary host) ○ Lymphadenopathy and High prevalence of hepatosplenomegaly schistosomiasis in ○ Region 5 (Bicol), Region 8 3rd Stage (Chronic Stage) (Samar and Leyte), Granulomatous reactions to egg ○ Region 11 (Davao) deposition in the intestine, liver, bladder Causative Agent Inflammation of the liver icteric Schistosoma Japonicum- and jaundice endemic in the Philippines and Bulging of the abdomen China Enlargement of the spleen Schistosoma Mansoni- South Sometimes the brain is affected America, the Middle East and that caused epilepsy Caribbean Eggs are deposited in the bladder Schistosoma Haematobium- wall leading to hematuria, bladder Africa and Middle East obstruction Hydronephrosis and recurrent Sources of Infection urinary tract infections Stool and urine of the infected Pale and marked muscle wasting persons or animals Complications Liver cirrhosis and portal Mode of Transmission hypertension Infection occurs when skin comes Bleeding esophageal varices in contact with contaminated Bladder cancer fresh water in which certain types Pulmonary hypertension of snails that carry schistosomes Heart failure are living Ascites (abnormal accumulation It is a free-swimming larval forms of fluid in the abdominal (cercariae) of the parasite that –peritoneal cavity) penetrate the skin Renal failure Ingestion of contaminated water Cerebral schistosomiasis Diagnostic Procedure to reduce transmission by Fecalysis reducing egg passage. Liver and rectal biopsy Travelers visiting endemic areas ELISA should be advised of the risks and Circumoval precipitation test informed about preventing (COPT)confirmatory test measures. ○ The circumoval precipitin test (COPT) is based on b. Control of patient, contacts and patient serum the immediate environment. precipitation with Isolation: none lyophilized eggs or purified Report to local health authority in live eggs identified under selected endemic areas microscope. This method Concurrent disinfection: sanitary is useful for the diagnosis disposal of feces and urine of S. mansoni and S. Quarantine: none japonicum due to its high Immunization of contacts: None sensitivity (92-100%) and specificity (96-100%) c. Investigation of contacts and source of infection Nursing Interventions Specific treatment: Praziquantel TSB (Biltricide) is the drug of choice Skin Care against all species. Alternative Provide comfort drugs are Oxamniquine for S. Proper nutrition Preventive mansoni and Metrifonate for haematobium. Methods and Control Epidemic measures: examine for a. Measures schistosomiasis and treat all who Educate the public in endemic are infected, but especially those areas regarding the mode of with moderate to heavy transmission and methods of intensities of egg passage; pay protection particular attention to children Dispose of feces and urine so that Motivate people in these areas to viable eggs will not reach bodies have an annual stool exam. of fresh water containing PHN in endemic areas intermediate snail host participates actively in the above improve irrigation and agriculture preventive and control measures. practices: reduce snail habitats by removing vegetation or by draining and filling CHOLERA (EL TOR) Treat snail-breeding sites with molluscicides. Description Provide water for drinking, It is an acute bacterial enteric bathing and washing clothes disease characterized by profuse from sources free of cercariae or diarrhea, vomiting, massive loss of treatment to kill them. Water fluid and electrolytes that can treatment using chlorine and result to hypovolemic shock, iodine. acidosis and death Treat patients in endemic areas to prevent disease progression and Etiologic Agent ○ Tetracycline Vibrio El Tor ○ Furazolidone ○ Chloramphenicol Sources of Infection ○ Cotrimoxazole Vomitus and feces of infected persons and feces of convalescent Nursing Management or healthy carriers Hand washing Contacts may be temporary Enteric isolation carriers Vital signs I and O monitoring Mode of Transmission Personal hygiene Food and water contaminated Proper excreta disposal with vomit and stools of patients Environmental sanitation and carriers Susceptibility, Resistance and Incubation Period Occurrence From few hours to 5 days; usually Susceptibility and resistance 3 days general although variable. Frank clinical attack confers a temporary immunity which may afford some Period of Communicability protection, for several years. 7-14 days after onset, occasionally Immunity artificially induced by 2-3 months vaccines of variable and uncertain duration. Clinical Manifestations Appears occasionally in epidemic Rice-watery stools form in the Philippines Washer-woman’s hands Vomiting Methods of Prevention and Control Diarrhea Food and water supply must be Deep rapid breathing protected from fecal Oliguria contamination Water should be boiled and Diagnostic Tests chlorinated Rectal swab Milk should be pasteurized Darkfield orphase microscopy Sanitary disposal of human Stool exam excreta is a must Blood test Report case at once to Health ○ Elevated BUN and Officer creatinine level Bring patients to hospital for ○ Increase in serum lactate, proper isolation and prompt and protein and phosphate competent medical care. levels All contacts of the cases should submit themselves for stool Treatment Modalities examination and be treated IV Treatment accordingly if found or discovered Oral Therapy Rehydration positive. Coconut water Give ORESOL Antibiotics PHN Responsibilities Contamination is usually by hands Assist family and patient to make of carrier arrangement for immediate Flies are vectors hospitalization Give necessary measures to Incubation Period control spread of disease Variable; average 2 weeks, usual Share with patient and family the range 1 to 3 weeks nature of the treatment Rehydration/ replacement of lost Period of Communicability fluids and electrolytes (Sodium As long as typhoid bacilli appear chloride, bicarbonate and in excreta; usually from potassium) appearance of prodromal symptoms from first week throughout convalescence TYPHOID FEVER Clinical Manifestations Onset Description ○ Headache A systemic infection characterized ○ Ladder-like fever by continued fever, malaise, ○ Rose spots on the anorexia, slow pulse, involvement abdomen of lymphoid tissues, especially Typhoid state ulceration of Peyer’s patches, ○ Coma vigil – is state of enlargement of spleen, rose spots coma in which the patient on trunk and diarrhea. lies unconscious but with Many mild typical infections are eyes open often unrecognized. ○ Subsultus tendinum - an A usual fatality of 10% is reduced involuntary twitching of to 2 or 3% by antibiotic therapy the muscles esp. of those of the arms and feet Etiologic Agent causing movement of the Salmonella Typhosa tendons (Hallmark of Typhoid bacillus Typhoid fever) ○ Carphologia – the action Sources of Infection of picking or grasping at Feces and urine of infected imaginary objects, as well persons as the patient’s own Family contacts may be transient clothes or bed linens. carrier ○ Delirium- is a serious Carrier state is common among disturbance in mental persons over 40 years of age abilities that results in especially females confused thinking and reduced awareness of the Mode of Transmission environment Direct or indirect contact with patient or carrier Principal vehicles are food and water  Complications Maintain standard precautions or Hemorrhage/ perforation (most in diapers or if an outbreak dreaded complication) develops in an institution Peritonitis Prevent further injury Bronchitis and pneumonia Provide good skin and mouth Typhoid spine care Septicemia Reiter’s syndrome- joint pains Prevention and Control and eye irritation Sanitary and proper disposal of excreta Diagnostic tests Proper supervision of food Typhidot- confirmatory sanitation ELISA Enteric precaution Widal Provision of safe water supply Rectal swab Detection and supervision of Bone marrow aspiration typhoid carriers (identifies S. Typhi) Susceptibility, Resistance and Treatment Modalities Occurrence Chloramphenicol- drug of choice Susceptibility is general although Ampicillin many adults appear to acquire Co-trimoxazole immunity through unrecognized Ciprofloxacin infections Cefixime/ Azithromycin Attack rates decline with age after Ceftriaxone (recommended for the second or third decades. complicated cases) A high degree of resistance Fluoroquinolones - are a class of usually follows recovery. broad spectrum antibiotic and are the direct inhibitors of bacterial BACILLARY DYSENTERY DNA synthesis Ciprofloxacin and ofloxacin are (SHIGELLOSIS, BLOODY currently the drugs of choice for FLUX) most cases of typhoid fever These fluoroquinolones have Description become affordable for use in An acute bacterial infection of the many resource-limited areas. intestine characterized by FDA - approved fluoroquinolones diarrhea, fever, tenesmus and in include levofloxacin (Levaquin), severe cases bloody and mucoid ciprofloxacin (Cipro), ciprofloxacin stools. extended-release tablets, Patients with mild undiagnosed moxifloxacin (Avelox), ofloxacin, infections have only transient gemifloxacin (Factive) and diarrhea or no intestinal delafloxacin (Baxdela). symptoms. Severe infections are frequent in Nursing Management infants and in elderly debilitated Isolation persons Monitor V/S Give nourishing fluids in small quantities at frequent intervals Etiologic Agent Colicky or cramping abdominal Shigella sonnei (most common pain associated with anorexia and specie in western Europe body weakness Shigella flexneri -is a species of Bloody - mucoid stool Gram Negative bacteria in the Rapid dehydration genus Shigella that can cause diarrhea in humans. Diagnostic Tests Shigella boydii - is a Microscopic examination of fresh Gram-negative bacterium of the stool specimen may reveal mucus, genus Shigella. Like other red blood cells, and members of the genus, S. boydii is polymorphonuclear leukocytes a nonmotile, non spore forming, Direct immunofluorescence with rod-shaped bacterium which can specific antisera will demonstrate cause dysentery in humans shigella Sigmoidoscopy or through fecal-oral contamination. proctoscopy may reveal typical Sh-dysenteriae - spreads through superficial ulcerations contaminated water and food, Stool cultures must rule out other causes minor dysentery because causes of diarrhea of its Shiga toxin, but other species may also be dysentery Treatment Modalities agents. Antibiotics ○ Ampicillin Incubation Period ○ Ceftriaxone 1 day, usually less than 4 days ○ Trimethoprim-sulfametho xazole Sources of Infection ○ Ciprofloxacin Feces of infected persons, many IV therapy in apparent mild and Low residue diet unrecognized infections Contraindicated: antidiarrheal drugs (they may delay fecal Mode of Transmission excretion that can lead to prolong Ingestion of contaminated food fever) Drinking contaminated water and milk Nursing Management Fecal-oral transmission Maintain fluid and electrolyte balance Period of Communicability Keep the patient warm and During acute infection and until comfortable microorganism is absent from Restrict food until nausea and feces usually within a few weeks vomiting subsides even without specified therapy. Isolation precaution A few individuals become carriers Low fiber, plenty of fluids; easily for a year or two and rarely longer digestible foods Use a disposable warming pad to relieve abdominal discomfort, and Clinical Manifestations schedule care to conserve patient Fever strength Tenesmus- straining to defecate Headache Susceptibility, Resistance and Incubation Period Occurrence 15 to 50 days, depending on dose Disease is more common and more severe in children than in Signs and Symptoms adults. Influenza-like such as headache A relative and transitory Malaise and easy fatigability strain-specific immunity follows Anorexia and abdominal recovery discomfort/ pain Nausea and vomiting Methods of Prevention and Control Fever Sanitary disposal of human feces Lymphadenopathy Sanitary supervision of Jaundice accompanied by processing, preparation and pruritus and urticaria serving of food particularly those Bilirubinemia with clay-colored eaten raw stools Adequate provision of safe washing facilities Management/ Treatment Fly control and screening to Prophylaxis –”IM” injection of protect foods against fly gamma globulin contamination Complete bed rest Protection of purified water Low fat diet but high in sugar supplies and construction of safe privy Prevention and Control Control of infected individual Ensure safe water for drinking contacts and environment Sanitary method in preparing, Reporting to local health officer handling and serving food Isolation of patient during acute Proper disposal of feces and urine illness Washing hands very well before Rigid personal precautions by eating and after using the toilet attendants Separate and proper cleaning of articles used by patient HEPATITIS A (INFECTIOUS HEPATITIS, EPIDEMIC EPIDEMIC PAROTITIS (MUMPS HEPATITIS, CATARRHAL INFECTIOUS PAROTITIS) JAUNDICE) Description Etiology It is an acute viral disease Hepatitis A virus manifested by swelling of one or both parotid glands, with Predisposing Factors occasional involvement of other glandular structures, particularly Poor sanitation the testes in male. Contaminated water supplies Unsanitary method of preparing and serving food Etiologic Agent Malnutrition Mumps virus, a member of the Disaster and war time conditions family Paramyxoviridae, genus paramyxovirus, is antigenically  related to the parainfluenza Complement Fixation test- is a viruses blood test in which a sample of serum is exposed to a particular Source of Infection antigen and complement in order Secretion of the mouth and nose to determine whether or not antibodies to that particular Mode of Transmission antigen are present. The nature of complement is to react in Direct contact combination with Indirect contact with the articles antigen–antibody complexes. freshly soiled with secretion from Hemo-agglutination Inhibition the nasopharynx Test- Used to determine the immune status Incubation Period Neutralization Test - Determines 12- 26 days, usually 18 days immunity to mumps Viral culture Period of Communicability Cases are infectious for up to a Treatment Modalities week (normally 2 days) before Analgesics for pain parotid swelling until 9 days after Antipyretics for fever 48-hour period immediately IV fluid replacement preceding onset of swelling is Hot and cold application considered the time of highest communicability Nursing Management Medical aseptic protective care Clinical manifestations ○ Single-occupancy room Painful swelling in front of the ear, ○ Oral care and personal angle of jaws and down the neck hygiene Fever ○ (warm salt-water gargles) Malaise General management of the Loss of appetite disease Swelling of one or both testicles ○ Bed rest (orchitis) in some boys ○ Diversional activities ○ Eye care Complications ○ Provide extra fluids OrchitisOophoritis Diet Mastitis ○ No restriction of food Nuchal rigidity ○ Soft bland and semi-solid Deafness is easily managed Meningoencephalitis ○ Acid foods (fruit juices) Pancreatitis increases discomfort Myocarditis Nephritis Prevention and Control Active immunization (MMR) Diagnostic Tests Reporting cases to health Serum Amylase Determination authorities (most useful test) in making early Isolation of patient presumptive diagnosis for mumps): elevated amylase level Disinfection All materials contaminated by Incubation Period nose and mouth secretions Varies from about 30 minutes to should be properly boiled. several hours after ingestion of Paper handkerchiefs should be poisonous shellfish burned Signs and Symptoms Terminal Disinfection Numbness of the face especially The usual method of cleaning a around the mouth room or unit should be used. Vomiting and dizziness The room should be aired for 6 to Headache 8 hours Tingling sensation, paresthesia and eventual paralysis of hands PARALYTIC SHELLFISH and feet Floating sensation and weakness POISONING (PSP I RED Rapid pulse TIDE POISONING) Difficulty of speech (aphasia) and difficulty of swallowing A syndrome of characteristic (Dysphagia) symptoms predominantly Total muscle paralysis with neurologic which occur within respiratory arrest and death occur minutes or several hours after in several cases ingestion of poisonous shellfish Poison victims who survive the first 12 hours after ingestion of the Causative Organism toxic shellfish have a greater Single celled organism called chance of survival dinoflagellates It is commonly referred to as Management and Control Measures plankton No definite medication indicated Pyromidium bahamense var. Induce vomiting compressum (Manila Bay, Samar, Drinking pure coconut milk Bataan and Zambales) weakens the toxic effect of red Plankton (singular plankter) are tide. the diverse collection of Sodium bicarbonate (25 grams in organisms that live in the water ½ glass of water may be taken) column of large bodies of water Drinking of coconut milk and and are unable to swim against a sodium bicar sol. Is advised current. during the early stage of These organisms include bacteria, poisoning only. If given during the archaea, algae, protozoa and late stage, they may make the drifting or floating animals that condition of the patient worse. inhabit the seas and ocean Shellfish affected by red tide must NOT be cooked with vinegar as Mode of Transmission the toxin of Pyromidium increases Ingestion of raw or inadequately when mixed with acid cooked seafood usually bivalve shellfish or mollusks during red tide season (clams, mussels, oysters, and scallops)  BOTULISM Deep tendon reflexes are decrease or absent Initial vomiting or diarrhea Description followed by constipation Rare but severe form of poisoning ○ Botulism toxin inhibits caused by gram-positive, acetylcholine release from anaerobic bacteria. the presynaptic nerve It is an illness of descending terminal, causing flaccid paralysis and autonomic paralysis. dysfunction due to neurotoxin ○ Death in botulism exposure is generally due Causative Agent: Clostridium botulinum to respiratory failure. Foodborne botulism ○ Tonic paralysis is the cause Wound botulism of respiratory arrest in Infant botulism other toxicity exposures, such as exposure to Sources of Infection tetanus toxin. Untreated water Undercooked and improperly Diagnostic Tests preserved canned foods, A toxicology screen may identify especially those with a low acid C. Botulinum content Stool culture may identify C. Home-canned vegetables Botulinum Cured pork and ham The suspected food may also be Smoked and raw fish cultured to isolate C. botulinum Honey and corn syrup Electromyography will show little response to nerve stimulation in Mode of Transmission the presence of botulism Ingestion (or injection) of Diagnostic tests should be preformed toxin conducted as needed to rule out Spores may resist 100 degrees diseases that maybe confused Celsius for many hours with botulism, such as Inhalation of toxin may also cause myasthenia gravis and disease Guillain-Barre syndrome Ingestion of spores A mouse- inoculation test will be Introduction of spores into the positive and is the most direct wound way to confirm a diagnosis of botulism Incubation Period 12 to 72 hours but extremes of 2 Myasthenia gravis Myasthenia hours to 10 days are reported gravis (MG) is a long-term neuromuscular Clinical Manifestations disease that leads to varying degrees of skeletal muscle Double or blurred vision weakness. The most commonly Droopy eyelids affected muscles are those of the Dry mouth eyes, face, and swallowing. It can Difficulty swallowing or talking result in double vision, drooping Difficulty breathing Flaccid paralysis (Descending)  eyelids, trouble talking, and Teach patient and families to see trouble walking. their doctors promptly for infected wounds and to avoid Guillain-Barre syndrome injectable street drugs is a rare disorder in which your body's immune system attacks Suggested on-call action your nerves. Weakness and Ensure that the case is admitted tingling in your extremities are in the hospital usually the first symptoms. These Obtain food history as a matter of sensations can quickly urgency spread, eventually paralyzing your Obtain suspect food whole body. Identify others at risk Inform appropriate local and Complications national authorities Aspiration Weakness and nervous system AMOEBIASIS problems can be permanent Death Description Treatment Modalities Protozoal infection that initially Botulinus antitoxin- IV, IM involves the colon but may spread Infants- inducing vomiting or into the liver and lungs by giving enema lymphatic dissemination IV fluid can be administeredNasogastric tube Etiologic Agent Endotracheal intubation- Entamoeba Histolytica respiratory distress Nursing Considerations 2 stages Obtain a careful history of foods Cyst- considered to be the eaten in the past few days infective stage and the resistance Monitor respiratory and cardiac to environmental conditions and function carefully can survive for few days outside of Perform frequent neurologic the body checks Trophozoites/ vegetative form- Purge the GI tract as ordered facultative parasites that invade If giving the botulinus antitoxin, the tissue check the patient’s allergies, perform a skin test first Sources of Infection Educate the patient and family Contaminated food and water about the importance of proper Flies hand hygiene Teach the patient and family to Mode of Transmission cook food thoroughly before Fecal-oral ingesting Oral-anal Instruct the patient who eats home canned food to boil the food for 10 minutes before eating Incubation Period to ensure that it is safe to Severe infection-3 days consume Average 2-4 weeks Period of Communicability Nursing Interventions Communicable for the entire Observe isolation and enteric duration of the illness or until precautions cysts are present in the stool Proper collection of stool specimen Clinical Manifestations No oil prep for 48 hours Acute amoebic dysentery Large portion of stool containing ○ Slight attack of diarrhea blood mucus altered with constipation Label specimen properly ○ Watery foul-smelling Send specimen immediately to stools containing the laboratory blood-streaked mucus Provide skin care and hygiene ○ Gaseous distention of the Provide optimum comfort- lower abdomen dysenteric patient should never ○ Nausea, flatulence be allowed to feel cold ○ Tenderness in the right Diet-fluids should be forced iliac region Cereal and strained meat broths ○ Chronic amoebic without fats dysentery Bland diet without cellulose of ○ Diarrhea for several days, bulk producing foods succeeded by constipation Chicken and fish may be added ○ Anorexia, weight loss, when convalescence is weakness and fatigue established. ○ Watery, bloody, mucoid stool Prevention ○ Flatulence and irregular Health education and fly control bowel movement Sanitary disposal of feces ○ Abdomen loses its Safe drinking water elasticity Proper food preparation and food ○ Severe cases- scattered handling ulceration is seen through Detection and treatment of sigmoidoscopy carrier Diagnostic Procedures PARAGONIMIASIS Stool exam- cyst (plenty of amoeba on the stool) is an infection with parasitic Blood exams- leukocytosis worms Sigmoidoscopy It is caused by eating undercooked crab or crayfish. Management Paragonimiasis can cause illness Metronidazole (Flagyl) 800 mg. resembling pneumonia or stomach flu. TID for 5 days The infection can last for years. Tetracycline, ampicillin, streptomycin, chloramphenicol Etiologic Agents Lung Fluke ○ Paragonimus westermani ○ Paragonimus siamenses In the lungs After swallowing the tiny (microscopic) ascariasis eggs, they hatch in the small intestine and the larvae migrate through the bloodstream or lymphatic system into the lungs. At this stage, the client may experience signs and symptoms similar to asthma or pneumonia, including: Persistent cough. Shortness and others Mode of Transmission Ingestion of raw/ uncooked crabs Contamination of food Using meat/ juice of infected animals Reservoir of Hosts Cats Dogs Rats Pigs Clinical Manifestations Cough of long duration Recurrent blood-streaked sputum Chest-back pain PTB-like signs and symptoms not responding to anti-TB medications Diagnostic test Sputum examination Immunology Cerebral paragonimiasis Treatment Praziquantel (Biltrizide) Prevention and control Treatment of infected person Anti-mollusk campaigns Education of the population Avoid eating infected foods