Gastrointesinal System

8/14/2019 Gastrointesinal System

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Typhoid FeverTyphoid Fever

(Enteric Fever, Typhus(Enteric Fever, Typhus

Abdominals)Abdominals) -general infxn caused by Salmonella-general infxn caused by Salmonella

typhi involving primarily / lymphoidtyphi involving primarily / lymphoid

tissue (Peyers patches) of / smalltissue (Peyers patches) of / smallintestineintestineCA:CA: S. typhosa, typhoid bacillusS. typhosa, typhoid bacillus

- gm neg rods; facultatively- gm neg rods; facultativelyanaerobic; non-spore forminganaerobic; non-spore forming SI:SI: feces & urine of infected personsfeces & urine of infected persons IP:IP: ave of 2 wks; usual range is 1-3ave of 2 wks; usual range is 1-3

wkswks


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PC:PC: as long as org is excreted or appear in /as long as org is excreted or appear in /excretaexcreta

MOT:MOT: by food & H2O contaminated by stools orby food & H2O contaminated by stools orurine of pt- vehicles are the 5Fsurine of pt- vehicles are the 5Fs

Stages:Stages:

a) prodromal stage: fever. Abdominal pain,a) prodromal stage: fever. Abdominal pain,constipation/ diaarheaconstipation/ diaarhea

b) fastigial stage: 3 cardinal signsb) fastigial stage: 3 cardinal signs

b.1 intermittent ladder like feverb.1 intermittent ladder like fever


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b.2) *rose spots- a rose coloredb.2) *rose spots- a rose coloredmacule that disappears aftermacule that disappears after

applying pressure on abdomen &applying pressure on abdomen &

chestchest

b.3) splenomegaly/hepatomegalyb.3) splenomegaly/hepatomegaly

Dx Test:Dx Test:

1) Widal test- blood serum1) Widal test- blood serumagglutination test; best done duringagglutination test; best done during

88thth day ( 2day ( 2ndnd stage)stage)


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2) blood culture- best done on / 12) blood culture- best done on / 1stst

week or 1week or 1stst stage of dsestage of dse3) urine culture- done during the 13) urine culture- done during the 1stst

2 weeks2 weeks

4) stool culture- best done during /4) stool culture- best done during /33rdrd weekweek

Tx:Tx: chloramphenicol, ampicillinchloramphenicol, ampicillin

Prevention:Prevention:1) immunization with CDT( cholera,1) immunization with CDT( cholera,dysentery & ty)dysentery & ty)


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2) proper disposal of feces2) proper disposal of feces

3) HW3) HW4) proper preparation, storage &4) proper preparation, storage &cooking foodscooking foods

Nursing Care:Nursing Care:- supportive care- fluid/ electrolytes- supportive care- fluid/ electrolytes

- monitor I & O; V/S- monitor I & O; V/S

- increase fluid intake- increase fluid intake- increase calorie; have residue &- increase calorie; have residue &non- irritating foodsnon- irritating foods


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-watch for complications:-watch for complications:

a) perforation of thea) perforation of theintestines= as shown withintestines= as shown with

sudden sharp abdominal pain,sudden sharp abdominal pain,

rigidity & shockrigidity & shock

b) typhoid psychosis stage-b) typhoid psychosis stage-

org goes to the brain= coma vigilorg goes to the brain= coma vigillook, blank stare & dilated pupilslook, blank stare & dilated pupils


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Sample Questions:Sample Questions:

1.1. The other s/s of typhoid fever are:The other s/s of typhoid fever are:

b.b. HA, malaise, splenomegaly, rose spots in theHA, malaise, splenomegaly, rose spots in thetrunktrunk

c.c. Malaise, diarrhea, abdominal painMalaise, diarrhea, abdominal pain

d.d. HA, retino-orbital pains, joint & muscle painsHA, retino-orbital pains, joint & muscle painse.e. Abdominal pain, watery stoolsAbdominal pain, watery stools

2. When is an individual considered as communicable2. When is an individual considered as communicableof typhoid fever?of typhoid fever?

a.a. Up to th convalescent stage of illnessUp to th convalescent stage of illnessb.b. Up to 2 mos after onset of illnessUp to 2 mos after onset of illness

c.c. During the 1During the 1stst week of his illnessweek of his illness

d.d. As long as typhoid bacilli appear in ones excretaAs long as typhoid bacilli appear in ones excreta


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CholeraCholera

Severe GI dse characterized bySevere GI dse characterized byvomiting & massive H2Ory diarrheavomiting & massive H2Ory diarrheawith rapid dehydration & shockwith rapid dehydration & shock

2 toxins produced by Vibrio species:2 toxins produced by Vibrio species:- enterotoxin- causes- enterotoxin- causes

hypersecretion of H2O & Na ofhypersecretion of H2O & Na of

intestinal mucosaintestinal mucosa- endotoxin causes denudation of- endotoxin causes denudation of

intestinal epitheliumintestinal epithelium


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Can occur in epidemics & caused by:Can occur in epidemics & caused by:

V. comma- Ogawa, Inaba,V. comma- Ogawa, Inaba,HirojimaHirojima

V. cholera- classic, El torV. cholera- classic, El tor

Spirillum choleraeSpirillum choleraeSpirillum cholera asiaticaSpirillum cholera asiatica

MOT:MOT: fecal- oral thru contaminatedfecal- oral thru contaminated

food & H2Ofood & H2O

PC:PC: not known but presumed till + stoolnot known but presumed till + stool

cultureculture

IP:IP: from few hours- 5 days; usually 3 daysfrom few hours- 5 days; usually 3 days


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Clinical Manifestations:Clinical Manifestations:

a) mild cases- undetectablea) mild cases- undetectableb) severe cases- starts with colickyb) severe cases- starts with colickypain in abdomen& mild diarrheapain in abdomen& mild diarrhea

- yellow stool at 1- yellow stool at 1stst

- marked mental depression- marked mental depression

- HA, continuous vomiting- DHN- HA, continuous vomiting- DHN

- thirst is terrible; violent cramps- thirst is terrible; violent crampsof lower extremitiesof lower extremities

- temp 104F- temp 104F

- *rice watery stool- *rice watery stool


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Dx:Dx: culture of stool & vomitusculture of stool & vomitus

Prevention:Prevention:a) immunization with CDTa) immunization with CDT

b) control of flies breeding placesb) control of flies breeding places

c) water sterilizationc) water sterilizationd) proper disposal of wasted) proper disposal of waste

e) all contacts of cases should submite) all contacts of cases should submitstool for examstool for exam

Tx:Tx: IV fluids; antibiotics- penicillin orIV fluids; antibiotics- penicillin or

tetracyclinetetracycline


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Nursing Care:Nursing Care:

1) isolation & personal hygiene1) isolation & personal hygiene2) monitor I & O2) monitor I & O

3) proper disposal of feces3) proper disposal of feces

4) precaution of 5 Fs ( food, flies,4) precaution of 5 Fs ( food, flies,feces, fingers & fomites)feces, fingers & fomites)

5) for infants, continue BF5) for infants, continue BF

6) give additional fluids, am6) give additional fluids, am7) coconut H2O is rich in K+, found7) coconut H2O is rich in K+, found

in choleric stoolin choleric stool

8) give oresol8) give oresol


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Bacillary DysenteryBacillary Dysentery

( Shigellosis, Bloody Flux)( Shigellosis, Bloody Flux)Caused enteric infxn by bacillusCaused enteric infxn by bacillus

dysentery strainsdysentery strainsAcute bacterial infxn of / lining of /Acute bacterial infxn of / lining of /

small & large intestine; diarrhea withsmall & large intestine; diarrhea withblood, mucus, pus & nauseablood, mucus, pus & nausea

4 major serologic groups:4 major serologic groups:

- S. dysenteria- S. dysenteria- S. flexneri- S. flexneri

- S. boydie- S. boydie

- S. sonnei- S. sonnei


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IP:IP: 1 day, usually < 4 days1 day, usually < 4 days

MOT:MOT: ingestion of contaminated foodingestion of contaminated food& H2O or by hand to mouth transfer;& H2O or by hand to mouth transfer;by flies; by objects soiled with fecesby flies; by objects soiled with fecesof a pt or carrierof a pt or carrier

Clinical Manifestation:Clinical Manifestation: fever,fever,vomiting & HA; colicky or crampingvomiting & HA; colicky or crampingabdominal pain & tenderness withabdominal pain & tenderness withanorexia, malaise & weakness; bowelanorexia, malaise & weakness; bowelmovement numerous with abdominalmovement numerous with abdominalcramps & tenesmuscramps & tenesmus

Tx:Tx: fluoroquinolones (norfloxacin)fluoroquinolones (norfloxacin)


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Prevention:Prevention:

1) fly control program1) fly control program

2) surveillance of H2O sanitation2) surveillance of H2O sanitation

3) HW after defecation3) HW after defecation

4) sanitary disposal of human feces4) sanitary disposal of human feces

5) sanitary supervision of processing,5) sanitary supervision of processing,

preparation& serving of foodpreparation& serving of food

Nursing Care:Nursing Care:

1) maintain fluid & electrolyte1) maintain fluid & electrolyte

balancebalance


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2) assess weight loss, skin turgor,2) assess weight loss, skin turgor,

mucous membranemucous membrane3) weigh daily3) weigh daily

4) restrict food till N/V subsides4) restrict food till N/V subsides

5) HW5) HW

6) supervision on food storage,6) supervision on food storage,

cooking & preparationcooking & preparation

DIET: low fiber, plenty of fluid, easilyDIET: low fiber, plenty of fluid, easily

digestible foodsdigestible foods

L t i iL t i i


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LeptospirosisLeptospirosis

(Weils Dse, Mud Fever, Trench,(Weils Dse, Mud Fever, Trench,

Flood, Japanese 7 Days, CanicolaFlood, Japanese 7 Days, CanicolaFever)Fever)

Infxn carried by animal bothInfxn carried by animal both

domesticated or wild whose excretadomesticated or wild whose excretais contaminated with food where it isis contaminated with food where it is

ingestedingested

-inoculated thru skin or mucous-inoculated thru skin or mucousmembranemembrane

CA:CA: Leptospira interrogans, spiralLeptospira interrogans, spiral


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RAT is the main host to leptospirosis (pigs,RAT is the main host to leptospirosis (pigs,

cattle, rabbits & other animals) -cattle, rabbits & other animals) -RESERVOIR HOSTSRESERVOIR HOSTS

IP:IP: 7-19 days, ave 10 days7-19 days, ave 10 days

PC:PC: none but leptospires are found in thenone but leptospires are found in thepts URINE between 10-20 days afterpts URINE between 10-20 days after

onsetonset

MOT:MOT: thru contact of the skin with H2O,thru contact of the skin with H2O,

moist soil or vegetation contaminated withmoist soil or vegetation contaminated withurine of infected hosturine of infected host

- contaminated food is ingested- contaminated food is ingested


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3 Stages of Clinical Manifestations:3 Stages of Clinical Manifestations:

1)1) Septicemic stage- fever lasting 4-7Septicemic stage- fever lasting 4-7days which is abrupt & remittentdays which is abrupt & remittentwith chills, HA, anorexia, N/Vwith chills, HA, anorexia, N/V

2)2) Immune or toxic stage- with orImmune or toxic stage- with orwithout jaundice lasting 4-30 days;without jaundice lasting 4-30 days;if severe, death may occur on 9if severe, death may occur on 9 thth--1616thth dayday

3)3) Convalescence- recovery may occurConvalescence- recovery may occurbut if not: renal & hepatic failure-but if not: renal & hepatic failure-

causes of deathcauses of death


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Dx Test:Dx Test:

1) culture of the org1) culture of the org

- blood during the 1- blood during the 1stst weekweek

- CSF- 5- CSF- 5thth-12-12thth dayday

- Urine- after the 1- Urine- after the 1stst week toweek to

convalescenceconvalescence

2) agglutination test2) agglutination testa) Leptospira Agglutination Testa) Leptospira Agglutination Test

b) Leptospira Antigen-Ab Testb) Leptospira Antigen-Ab Test

( LAAT)( LAAT)


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Tx:Tx: penicillin, tetracycline,penicillin, tetracycline,

erythromycinerythromycinNursing Care:Nursing Care: SymptomaticSymptomatic Prevention & Control:Prevention & Control:

1) Improve education of people- risk1) Improve education of people- risk2) use of protective clothing boots &2) use of protective clothing boots &gloves esp by workers withgloves esp by workers with

occupational hazardsoccupational hazards

3) strengthen community-wide rat3) strengthen community-wide rateradication programeradication program

4) investigation of contacts & source4) investigation of contacts & source

of infxnof infxn

H titi AHepatitis A


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Hepatitis AHepatitis A

( Infectious Hepatitis, Epidemic( Infectious Hepatitis, Epidemic

Hepa, Catarrhal Jaundice)Hepa, Catarrhal Jaundice) -caused by virus introduced by-caused by virus introduced by

fecally contaminated H2O or foodfecally contaminated H2O or food

CA:CA: Hepatitis A virusHepatitis A virus

Predisposing Factors:Predisposing Factors: poorpoor

sanitation, contaminated H2Osanitation, contaminated H2O

supplies, unsanitary mtd of preparingsupplies, unsanitary mtd of preparing& serving of food malnutrition,& serving of food malnutrition,

disaster & wartime conditionsdisaster & wartime conditions

IP:IP: 15-50 days, ave 28-30 days15-50 days, ave 28-30 days


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S/S:S/S: influenza like such as HA,influenza like such as HA,

malaise & easy fatigability, anorexiamalaise & easy fatigability, anorexia& abdominal pain, N/V, fever,& abdominal pain, N/V, fever,

lymphadenopathy, jaundicelymphadenopathy, jaundice

Diagnostic test:Diagnostic test:-liver function test-liver function test

- serum antigen antibody test for- serum antigen antibody test for

hepatitishepatitis

- liver biopsy- liver biopsy


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Management:Management:

1) prophylaxis IM injection of1) prophylaxis IM injection of

gamma globulingamma globulin

2) CBR to facilitate liver regeneration2) CBR to facilitate liver regeneration

3) diet to promote tissue repair3) diet to promote tissue repair

-low fat, high CHO (sugar) &-low fat, high CHO (sugar) &

CHONCHON


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Prevention & Control:Prevention & Control:1) ensure safe H2O for drinking1) ensure safe H2O for drinking

2) sanitary mtd in preparing,2) sanitary mtd in preparing,

handling & serving foodhandling & serving food3) washing hands very well b4 eating3) washing hands very well b4 eating

& after using / toilet& after using / toilet

4) proper disposal of feces & urine4) proper disposal of feces & urine


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Paralytic Shellfish PoisoningParalytic Shellfish Poisoning

(PSP/ Red Tide Poisoning)(PSP/ Red Tide Poisoning)A syndrome of characteristicA syndrome of characteristic

symptoms predominantlysymptoms predominantlyNEUROLOGIC which occur withinNEUROLOGIC which occur within

minutes or several hours afterminutes or several hours afteringestion of poisonous shellfishingestion of poisonous shellfish

CA:CA: singles celled org calledsingles celled org calledDinoflagellates- PlanktonDinoflagellates- Plankton

Pyromidium bahamense varPyromidium bahamense varcompressum- org that causes redcompressum- org that causes redtide in / seas and Manila Bay, Samar,tide in / seas and Manila Bay, Samar,

Bataan & ZambalesBataan & Zambales


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MOT:MOT: ingestion of raw or inadequatelyingestion of raw or inadequatelycooked seafood, bi-valve shellfish orcooked seafood, bi-valve shellfish or

mollusks during the red tide seasonmollusks during the red tide season IP:IP: varies from about 30 min to severalvaries from about 30 min to several

hours after ingestion of previous shellfishhours after ingestion of previous shellfish S/S:S/S: numbness of the face ( around /numbness of the face ( around /

mouth), vomiting & dizziness, HA, tinglingmouth), vomiting & dizziness, HA, tinglingsensation, paresthesia, difficulty of speechsensation, paresthesia, difficulty of speech& difficulty of swallowing& difficulty of swallowing

- total muscle with respiratory arrest &- total muscle with respiratory arrest &

death occurdeath occur Poison victims who survive the 1Poison victims who survive the 1stst 12 hours12 hours

after ingestion of the toxic shellfish haveafter ingestion of the toxic shellfish havethe greater chance of survivalthe greater chance of survival


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Management & Control Measures:Management & Control Measures:

No definite medication indicatedNo definite medication indicated

Induce vomitingInduce vomiting

HEHE

Dinking pure coconut milk- weakens / toxicDinking pure coconut milk- weakens / toxic

effect of red tide ( Nabicarbonate soln 25effect of red tide ( Nabicarbonate soln 25gms in glass of H2O)gms in glass of H2O)

** drinking of coconut milk & Nabicarb** drinking of coconut milk & Nabicarb

soln is advised during / EARLY STAGEsoln is advised during / EARLY STAGE

of Poisoning ONLY- if given during /of Poisoning ONLY- if given during /LATE STAGE, they make / condition of /LATE STAGE, they make / condition of /

pt worsenpt worsen


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Shellfish affected by red tide mustShellfish affected by red tide must

NOT BE COOKED with VINEGAR as /NOT BE COOKED with VINEGAR as /toxin of Pyromidium increases (15 xtoxin of Pyromidium increases (15 x

>) when mixed with acid>) when mixed with acid

Toxin of Red tide is not totallyToxin of Red tide is not totallydestroyed upon cookingdestroyed upon cooking

Consumers must be educated toConsumers must be educated to

avoid bi-valve mollusks ( tahong,avoid bi-valve mollusks ( tahong,talaba, kabiya, abaniko) when Redtalaba, kabiya, abaniko) when Red

Tide Warning has been issued by /Tide Warning has been issued by /

proper authoritiesproper authorities


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Soil Transmitted HelminthiasesSoil Transmitted Helminthiases

/ 3/ 3rdrd most prevalent infectionmost prevalent infection

worldwide, 2worldwide, 2ndnd to / diarrheal dses &to / diarrheal dses &

TBTB

Ascaris lumbricoides ( GiantAscaris lumbricoides ( Giant

Roundworm)Roundworm)

Trichuris trichiura ( Whipworm)Trichuris trichiura ( Whipworm)

Hoorkworm ( Ancylostoma duodenaleHoorkworm ( Ancylostoma duodenale

& Necator americanus)& Necator americanus)


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Develop in the soilDevelop in the soil

Man is the only hostMan is the only hostEnter the body through theEnter the body through the

mouth and soles of the feetmouth and soles of the feet


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HABITATHABITAT

INTESTINESINTESTINES

SMALL LARGESMALL LARGEASCARIS HOOKWORMASCARIS HOOKWORM

TRICHURISTRICHURIS


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SOIL TRANSMITTEDSOIL TRANSMITTED

EGGS (FECES)EGGS (FECES)

ENVIRONMENTENVIRONMENT

(SOIL)(SOIL)

EMBRYONATED LARVAEEMBRYONATED LARVAE

Eff f STHEff t f STH


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Effects of STHEffects of STH

Decreased physical activityDecreased physical activity

Impaired cognitive processesImpaired cognitive processes

Poor physical developmentPoor physical development


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Signs & Symptoms of STHSigns & Symptoms of STH

Abdominal pain and enlargementAbdominal pain and enlargement

Weight lossWeight loss

AnemiaAnemiaMalnutritionMalnutrition

Loss of appetiteLoss of appetite


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ASCARIS LUMBRICOIDESASCARIS LUMBRICOIDES

GIANTGIANT

INTESTINALINTESTINAL

ROUNDWORMROUNDWORM


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Lays about 200,000-240,000Lays about 200,000-240,000

eggs/dayeggs/day

1 female worm produces approximately1 female worm produces approximately

65,000,000 eggs in 9 months65,000,000 eggs in 9 months Infective stage is embryonated eggInfective stage is embryonated egg

Life span is 12-24 monthsLife span is 12-24 months


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LIFE CYCLELIFE CYCLE


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ASCARIASISASCARIASIS

LARVAL MIGRATIONLARVAL MIGRATION

RESPIRATORY SYMPTOMSRESPIRATORY SYMPTOMS

LOEFFLERS SYNDROMELOEFFLERS SYNDROME

ADULTSADULTSOBSTRUCTIONOBSTRUCTION

INTESTINESINTESTINES

PHARYNGEALPHARYNGEALCOMMON BILE DUCTCOMMON BILE DUCT


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INTESTINAL OBSTRUCTIONINTESTINAL OBSTRUCTION


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ASCARIASISASCARIASIS


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TRICHURIS TRICHIURATRICHURIS TRICHIURA

WHIPWORMSWHIPWORMS


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Lives in the large intestineLives in the large intestine

Transmitted thru oral-fecal routeTransmitted thru oral-fecal route

Life span is 5 yearsLife span is 5 yearsAnterior 2/3 of the body isAnterior 2/3 of the body is

slender & attached to theslender & attached to the

mucosa of cecummucosa of cecum


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Lays 2,000-5,000 eggs/dayLays 2,000-5,000 eggs/day

Infective stage is embryonated eggInfective stage is embryonated egg

No migration phase in the lungs,No migration phase in the lungs,liver or heartliver or heart

Posterior end is thick giving aPosterior end is thick giving a

whiplike shapewhiplike shape


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TRICHURIASISTRICHURIASIS

HEAVY INFECTIONHEAVY INFECTION

ABDOMINAL PAINSABDOMINAL PAINS

DIARRHEA/DIARRHEA/

DYSENTERYDYSENTERYANEMIAANEMIA

RECTAL PROLAPSERECTAL PROLAPSE

DIAGNOSIS:DIAGNOSIS:STOOLSTOOL

EXAMINATIONEXAMINATION


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RECTAL PROLAPSERECTAL PROLAPSE


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HOOKWORMSHOOKWORMS

HUMANHUMAN

NECATOR AMERICANUS (New World)NECATOR AMERICANUS (New World)

ANCYLOSTOMA DUODENALE (Old World)ANCYLOSTOMA DUODENALE (Old World)

ANCYLOSTOMA CEYLANICUMANCYLOSTOMA CEYLANICUM

ANIMAL:ANIMAL:

ANCYLOSTOMA BRAZILIENSE (Cat)ANCYLOSTOMA BRAZILIENSE (Cat)

ANCYLOSTOMA CANINUM (Dog)ANCYLOSTOMA CANINUM (Dog)

BUCCAL CAPSULE ANDBUCCAL CAPSULE AND


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BUCCAL CAPSULE ANDBUCCAL CAPSULE AND

COPULATORY BURSAECOPULATORY BURSAE


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MOUTH BUCCAL CAPSULEMOUTH BUCCAL CAPSULE


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Adult worms are identified based onAdult worms are identified based on

the presence of cutting plates orthe presence of cutting plates or

teethteeth

Infective stage is 3Infective stage is 3rdrd stage larvastage larva

known as filariformknown as filariform

Lives in the large intestineLives in the large intestine

Life span is up to 8 yearsLife span is up to 8 years


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HOOKWORM INFECTION/HOOKWORM INFECTION/


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HOOKWORM INFECTION/HOOKWORM INFECTION/

DISEASEDISEASE

SKIN PENETRATIONSKIN PENETRATION

HUMAN FILARIFORMHUMAN FILARIFORM

-- GROUND ITCHGROUND ITCH

ANIMAL FILARIFORMANIMAL FILARIFORM

- CREEPING- CREEPINGERUPTIONERUPTION

(CLM)(CLM)

CUTANEOUS LARVACUTANEOUS LARVA

MIGRANSMIGRANS


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HOOKWORM DISEASEHOOKWORM DISEASE

LARVAL MIGRATIONLARVAL MIGRATION

RESPIRATORY SYMPTOMSRESPIRATORY SYMPTOMS

(WAKANA DISEASE)(WAKANA DISEASE)

ADULTS SUCKS OUT BLOODADULTS SUCKS OUT BLOOD

CONSTANT BLOOD LOSSCONSTANT BLOOD LOSS

MICROCYTIC HYPOCHROMICMICROCYTIC HYPOCHROMICANEMIAANEMIA


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Age 2-5 yrs old are easily infectedAge 2-5 yrs old are easily infected

Age 6-14- harbor the greatest localAge 6-14- harbor the greatest local

infection & reservoirinfection & reservoir

Frequency of treatment= 2x a yearFrequency of treatment= 2x a year

for 3 yearsfor 3 years


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Prevention & Control:Prevention & Control:

a) HE- teaching on personal hygienea) HE- teaching on personal hygiene

b) properb) proper disposaldisposal of excretaof excreta

c) early dx thru stool exam &c) early dx thru stool exam &

deworming with albendazole ordeworming with albendazole or

mebendazolemebendazole

E t bi i l iEnterobius vermicularis


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Enterobius vermicularisEnterobius vermicularis

(pinworm/ seatworm)(pinworm/ seatworm)

Adults worms are small, whitish in colorAdults worms are small, whitish in color

Anterior end- cephalic wingsAnterior end- cephalic wings

Lays about 11,000 eggs/dayLays about 11,000 eggs/day

MOTMOT: direct contact to mouth by finger: direct contact to mouth by finger

contamination, sleeping in the bed withcontamination, sleeping in the bed with

carriers, door knobs, table topscarriers, door knobs, table tops

- inhalation of airborne eggs dislodged from- inhalation of airborne eggs dislodged frombed linens & clothesbed linens & clothes


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-gravid female worm will crawl to the-gravid female worm will crawl to the

anus and lay eggs @ the peri-anal oranus and lay eggs @ the peri-anal or

perineal regionsperineal regions

- After egg deposition, gravid femaleAfter egg deposition, gravid female

worm will die & eggs after 5 hours-worm will die & eggs after 5 hours-

infective stageinfective stage

Dx TestDx Test: peri-anal scotch tape swab: peri-anal scotch tape swabstool examstool exam


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Treatment:Treatment: Albendazole orAlbendazole or

mebendazolemebendazole

Prevention:Prevention:

- Personal hygienePersonal hygiene

- Bed linens/ clothing should beBed linens/ clothing should be

sterilized by boilingsterilized by boiling

- Finger nails should be cut shortFinger nails should be cut short

- All members undergo dewormingAll members undergo deworming


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Sample Questions:Sample Questions:

1.1. Pt passes large worm superficiallyPt passes large worm superficiallyresembling an earthworm:resembling an earthworm:

b.b. whipwormwhipworm c. ascarisc. ascaris

c.c. hookwormhookworm d. pinwormd. pinworm

2. Using choices above, the nurse describes2. Using choices above, the nurse describesthis parasite that enters the intestinalthis parasite that enters the intestinalmucosa & could be spread thrumucosa & could be spread thru

autoinfection. This is typically exemplifiedautoinfection. This is typically exemplifiedby:by:


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3. The feces of children suffering from3. The feces of children suffering from

ascariasis can have the following except:ascariasis can have the following except:a.a. fertilized ovafertilized ova c. unfertilized ovac. unfertilized ova

b.b. embryonated ova d. adult wormembryonated ova d. adult worm

4. Heavy infection with ascaris may give rise4. Heavy infection with ascaris may give rise

to:to:

a.a. Intestinal bleedingIntestinal bleeding

b.b. Intestinal blockageIntestinal blockage

c.c. ParalysisParalysisd.d. All of the aboveAll of the above


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5. Man acquires the adult Taenia solium by5. Man acquires the adult Taenia solium by

ingestion of porkingestion of pork

a. eggsa. eggs c. cysticercusc. cysticercus

b. scolexb. scolex d. proglottidsd. proglottids6. Infection with worm parasites is6. Infection with worm parasites is

frequently accompanied by:frequently accompanied by:

a.a. BasophiliaBasophilia c. polycytemiac. polycytemiab.b. EosinophiliaEosinophilia d. neutrophiliad. neutrophilia


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7. Which of the following neither lays eggs nor7. Which of the following neither lays eggs nordeposits larvae in the intestinal canal?deposits larvae in the intestinal canal?

a.a. hookwormhookwormc. pinwormc. pinworm

b.b. ascarisascaris d. trichurisd. trichuris

8. Microcytic hypohromic anemia is common in8. Microcytic hypohromic anemia is common inparasitic infection of:parasitic infection of:

a.a. AscarisAscaris c. pinwormc. pinworm

b.b. HookwormHookworm d. trichurisd. trichuris


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MOT:MOT: ingestion of raw/ insufficientlyingestion of raw/ insufficiently

cooked crabscooked crabs- contamination of food or utensils- contamination of food or utensils

with metacercaria during foodwith metacercaria during food

preparationpreparation- drinking of H2O contaminated with- drinking of H2O contaminated with

infective larvainfective larva

S/S:S/S: cough of long durationcough of long duration- hemoptysis, chest & back pain,- hemoptysis, chest & back pain,

low grade afternoon feverlow grade afternoon fever


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Dx:Dx: sputum exam- eggs in brownsputum exam- eggs in brown

spots ( NaOH )spots ( NaOH )

-stool-stool Tx:Tx: Praziquantel- 25 mg/Kg BW 3xPraziquantel- 25 mg/Kg BW 3x

daily for 3 daysdaily for 3 days Prevention & Control:Prevention & Control:

a) Early dx & prompt tx (EDPT)a) Early dx & prompt tx (EDPT)

b) proper disposal of excretab) proper disposal of excreta

c) HE- as to MOT, KAPc) HE- as to MOT, KAP

d) anti-mollusk campaignsd) anti-mollusk campaigns

AnthraxAnthrax


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( Malignant pustule, woolsorter dse,( Malignant pustule, woolsorter dse,

ragpicker dse)ragpicker dse)An acute bacterial dse usuallyAn acute bacterial dse usually

affecting the skin & involve theaffecting the skin & involve the

oropharynx, lower respiratory tract,oropharynx, lower respiratory tract,mediastinum or intestinal tractmediastinum or intestinal tract

CA:CA: Bacillus anthracis, encapsulated,Bacillus anthracis, encapsulated,

spore-forming ( found in soil, animalspore-forming ( found in soil, animalhair or wool)hair or wool)

IP:IP: a few hours to 7 days; mosta few hours to 7 days; most

occur within 48 hours of exposureoccur within 48 hours of exposure


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b) pulmonary (woolsorters dse)-b) pulmonary (woolsorters dse)-

contracted by inhalation of B.contracted by inhalation of B.anthracis spores, after 3-5 days, /anthracis spores, after 3-5 days, /

symptoms become acute with fever,symptoms become acute with fever,

shock & death resultsshock & death results

c) GIT anthrax- contracted byc) GIT anthrax- contracted by

ingestion of meat from infectedingestion of meat from infected

animals, manifested as violentanimals, manifested as violent

gastroenteritis with vomiting &gastroenteritis with vomiting &

bloody stools; rapidly developingbloody stools; rapidly developing

ascitisascitis


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Cutaneous AnthraxCutaneous Anthrax


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Lab. Dx:Lab. Dx: fluid or pus from lesions, blood,fluid or pus from lesions, blood,

sputumsputum

1) culture1) culture 2) animal Inoculation test2) animal Inoculation test

Treatment:Treatment:

1.1. Parenteral penicillin G-2 million unitsParenteral penicillin G-2 million unitsevery 6 hrs, until edema subsides withevery 6 hrs, until edema subsides with

subsequent administration of oralsubsequent administration of oral

penicillin to complete 7-10 days coursepenicillin to complete 7-10 days course

2.2. Pts who are sensitive to penicillin can bePts who are sensitive to penicillin can be

treated with erythromycin, tetracycline,treated with erythromycin, tetracycline,

chloramphenicolchloramphenicol


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Mtds of Control:Mtds of Control:

1)1) Immunization of high- risk peopleImmunization of high- risk people

2)2) Educate employees handling potentiallyEducate employees handling potentially

contaminated articlescontaminated articles

3)3) Control dusts & proper ventilation inControl dusts & proper ventilation inhazardous industrieshazardous industries

4)4) HW; disinfect hair, woolHW; disinfect hair, wool

Nursing Management:Nursing Management:1.1. Careful history taking; thorough PECareful history taking; thorough PE

2.2. Skin care, psychological & emotionalSkin care, psychological & emotional

tsupport

Gastrointesinal System

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