Download DYSENTERY

DYSENTERY
PBL 14
SUPERVISOR : DR SAHAR ZAKARIA
DEFINITION
Dysentery is a form of severe diarrhea
with mucus and blood in the stools
with or without tenesmus.
As the result of intestinal inflammation
mainly in the colon
CAUSATIVE AGENTS
A- INFECTIOUS CAUSES :
Bacterial (shigella, salmonella,
campylobacter, E-coli, colistredium difficile )
Parasitic (Entamoeba histolytica,
Balantedium. coli, Schistosom. mansoni,
Plasmodium. falciparum, Leishmania.
donovani)
Viral (rotavirus, norovirus, adenovirus and
CMV ) uncommon cause of dysentery
B. NON INFECTIOUS CAUSES
Ulcerative colitis
- A chronic inflammatory and ulcerative disease
arising in the colonic mucosa
Ischemic colitis
- Transient reduction in blood flow to the colon
Colorectal tumor
- Malignancy in the colon
CLINICAL
MANIFESTATION
Most common
dysentery
Bacillary dysentery
Amoebic dysentery
Causative
agents
Shigella flexneri, Shigella
dyenteriae, Shigella boydi,
Shigella sonnei
More (up to 20 or 30 watery
bowel movements in 1 day)
Parasite entamoeba histolytica
Frequency of
Diarrhea
Sign & Symptom
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High fever
Dehydration
Bloody + pus stool
Loss of appetite
Flatulence
Painful bowel movement
Abdominal pain
Nausea & vomiting
Less
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Most common
Country
Western Europe & USA
Mild fever
Watery diarrhea, which can
contain blood, mucus or pus
Intermittent constipation and
diarrhea
Painful passing of stools
Fatigue
Abdominal pain
Nausea and vomiting
Developing countries
Presence of fecal leukocytes Presence of E histolytica
on smear stained with
trophozoites or cysts in
methylene blue
faeces with direct saline
smear
Sigmoidoscopy Diffusely erythematous with Shallow skip lesion and
numerous small ulcer
flask shaped or ‘collar –
stud’
Stool culture
N/E
Little- a lot of blood &
mucus
Bulky- little blood- little
mucus
M/E
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 Scanty pus cells
 E. Histolytica
 Macrophage very
few
 RBC is rouleaux
 Present Charcot
Numerous pus cells
Gram negative bacilli
Macrophages numerous
RBC scattered
Absent Charcot Leydon
Crystal
Bacillary dysentery Amoebic dysentery
Complication
Dehydration
Exudative arthritis
Bacteremia
Ulcer colonic lesion
Reiter’s syndrome
Amoeboma
Liver abscess
Perforation of an
amoebic ulcer
Strictures of the
colon
Treatment
Rehydration
By oral or IV
By oral only
(commonly in children)
Antimicrobial
Ciprofloxacin
Metronidazole
Anti diarrheal
Non preferable (can
cause aggravating of
disease)
Preferable
OTHERS INFECTIOUS CAUSES
SALMONELLA
- Common bacterial disease that affects the
intestinal tract. Salmonella live in animal and
human intestines & shed through feces. Humans
become infected most frequently through
contaminated water or food.
ROTAVIRUS
- Most common cause of severe diarrhea among
infants and young children
- The virus is transmitted by the fecal-oral route. It
infects and damages the cells that line the small
intestine and causes gastroenteritis.
DIAGNOSIS
1. Direct stool inspection to check the presence of
blood in the stool
2. Stool culture to find organism that cause
gastroenteritis
3. Immunoassay to detect and identify certain
bacterial toxin, viral and protozoal antigen in blood
4. Sigmoidoscopy with biopsies to screen for
colorectal cancer, rectal bleeding & bowel habits.
5. Colonoscopy and abdominal CT for determine
the cause of colorectal problems & to screen for
colorectal cancer.
GENERAL TREATMENT
1. Drinking fluids
Drinking plenty of fluid to replace the those that have
been lost and to avoid dehydration.
2. Oral rehydration solution (ORS)
Usually come in sachets that are available without
prescription.
Help to replace salt, glucose and other minerals that
the body losses through dehydration
3. Advise about eating
Eat small, light meals and avoid heavy, spicy or heavy
food
PREVENTION &
CONTROL
Environmental sanitation as anti-fly measures,
proper sewage disposal and safe water supply.
Faeces must not be used as fertilizer.
Health education for: washing of green
vegetables, fruits before eating.
Make sure drink only purified water
Wash the hands with antibacterial soap after
using bathroom, before preparing and eating
food
THANK YOU
PBL-mates
Ebrahim
Safwan
Faisal
Irfan
Fatin
Munirah
Amanina
Syahirah
Najihah
Yasmeen
Eika