IV- THE PATIENTS ILLNESS

a) Schematic Diagram (Pathophysiology)- Book Based

Non-modifiable Factor: Age & Sex Modifiable Factors:
Lifestyle; Diet; Hygiene

Etiology:
E. Hystolytica

Person to person
(direct contact, through sexual contact) contaminated water and/or food

Ingestion of Cyst

Cyst breaks down by Digestive Secretions

Trophozoites Multiplication

Direct invasion and ulceration of the bowel wall

Stimulation and destruction of Release of endotoxin irritation of GI

mucosal lining of the bowel wall
Abdominal Pain

Digestive and absorptive malfunction

Secretion of fluid & Excessive Gas Formation

electrolytes in the
intestinal lumen
GI Distention

Abdominal
Fullness
Increased Peristaltic
Movement Nausea and Vomiting

Anorexia
Hyperactive Bowel sounds
Diarrhea Fluid & Electrolyte Imbalance
 Dehydration
Inflammation of the intestinal mucosa

Dry lips, dry mouth,

fatigue, irritability,
Bleeding Inflammatory response Dizziness, weakness at the
Lethargy, poor skin turgor penetration sight

Release of chemical mediators Occult Blood

formation of mouth sores
Stimulates hypothalamus

Fever or hyperthermia RAAS stimulation altered pH

balance

Aldosterone metabolic
Secretion acidosis

Na+ & H2O Death

retention

Decreased Urine output

Patient Centered

Non-modifiable Factor: Age & Sex Modifiable Factors:

Lifestyle; Diet; Hygiene

Etiology:
E. Hystolytica
(Based on fecalysis : 09-12-10)

Person to person contaminated water and/or food

Ingestion of Cyst

Cyst breaks down by Digestive Secretions

Trophozoites Multiplication

Direct invasion and ulceration of the bowel wall

Stimulation and destruction of Release of endotoxin irritation of GI

mucosal lining of the bowel wall
Abdominal Pain
(Felt by pt. on Sept 11-14 )
Digestive and absorptive malfunction

Secretion of fluid & Excessive Gas Formation

electrolytes in the
intestinal lumen
GI Distention

Abdominal
Fullness
Increased Peristaltic Movement Nausea and Vomiting
(manifested by pt. on 09-11-10)

Hyperactive Bowel sounds

(assessed on 09-14-10)
Diarrhea Fluid & Electrolyte
(manifested by the patient before Imbalance
admission 09-11-10 & during the stay in hospital)
 Dehydration

Inflammation of the intestinal mucosa

fatigue, irritability,
Inflammatory response weakness Bleeding on
(experienced by pt. on 09-12-10)

penetration sight

Release of chemical mediators

Occult Blood (present in
fecalysis Stimulates hypothalamus dated 09-12-10 and 09-
13-10)

Fever or hyperthermia
(Manifested by pt. on 09-12-10 with temperature of 38.2oc)

B. Synthesis of the Disease

1. Definition of the Disease

Amebiasis, also known as amebic dysentery, Is an acute or chronic protozoal
infection caused by Entamoeba histolytica (protozoan parasites). This infection produces varying
degrees of illness, from no symptoms at all or mild diarrhea to fulminant dysentery. Extraintestinal
amebiasis can be induce hepatic abcess and infection of the lungs, pleural cavity, pericardium,
peritoneum and, rarely, the brain.

2. Predisposing and Precipitating Factors

Entamoeba histolytica can live in the large intestine (colon) without causing disease. However,
sometimes, it invades the colon wall, causing colitis, acute dysentery, or long-term (chronic) diarrhea.
The infection can also spread through the blood to the liver and, rarely, to the lungs, brain or other
organs.

This condition can be seen anywhere in the world, but it is most common in tropical areas with
crowded living conditions and poor sanitation. Africa, Mexico, parts of South America, and India
have significant health problems associated with this disease.
Entamoeba histolytica is spread through food or water contaminated with stools. This is common
when human waste is used as fertilizer. It can also be spread from person to person -- particularly by
contact with the mouth or rectal area of an infected person.

Risk factors for severe amebiasis include:

 Alcoholism
 Cancer
 Malnutrition
 Old age
 Pregnancy
 Recent travel to a tropical region
 Use of corticosteroid medication to suppress the immune system

In the United States, amebiasis is most common among those who live in institutions and people who
have anal intercourse.

3. Signs and Symptoms

The clinical effects of amebiasis vary with the severity of infestation. Acute amebic
dysentery causes sudden high temoerature of40-40.6oc accompanied by chills and abdomnala
cramping: profuse, blood, mucoid diarrhea with tenesmus; and diffuse abdominal tenderness due to
extensive rectosigmoid ulcers. Chronic amebic dysentery produces intermittent diarrhea that lasts 1-4
weeks and recurs several times a year.Such diarrhea produces 4 to 8 foul smelling mucus and blood
tinged stools daily in patient with a mild fever vague abdominal cramps, possible weight loss,
tenderness over the cecum and ascending colon and, occasionally, hepatomegaly.

4. Health Promotion and Preventive Aspects of the Disease

 Wash hands thoroughly after toileting and before handling or eating food.
 Protect public water supplies from contamination with human waste.
 Dispose of human feces in a sanitary manner to avoid water supply contamination.
 Antidiarrheals aren’t prescribed and make the condition worse/
 Boil potentially contaminated water for at least 5 minutes.
 Wash fruits and vegetables in potable water and keep dry