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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
Precipitating
Predisposing Washing of hands inadequately
Geographical area – tropical islands in the Sharing of food from the same plate
Pacific (Philippines) and Asia Drinking unpurified water
Young adult(19-45) – 40yrs old 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 Payer’s patches of the


intestinal wall in the small intestines where it
attach (incubation period is first 7-14 days
after ingestion)
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 Perforation and
where macrophages is present. destruction of Signs/
Diagnostic: mucosal lining of the symptoms:
Hematology: intestinal wall can Abdominal pain
Macrophages & intestinal epithelial
Neutrophils-74 lead to persistent
cells then attract T cells &
(50-70) inflammation
neutrophils with interleukin 8 (IL-8
causing inflammation of the Diagnostic:
intestinal wall) Ulceration and Fecalysis: reddish
bleeding in the
brown color
(brown)
The bacteria is within the mucosal lining and
macrophages and survives RBC:2-4/hpf(0-
leads to necrosis

Tissue damage and


Bacteria spread via the lymphatics
while inside the macrophages inflammation causes
loss of absorption
due to damaged villi
causing an increase
The bacteria induced macrophage in water,
apoptosis, breaking out into the
electrolytes, mucus,
bloodstream and cause systemic
infection blood, and serum to
be pulled into the
Signs/ symptoms:
intestine from
Febrile: T-38.5C Typhoid immature crypt cells
Warmth to touch
Headache of 3/10, body Fever
Signs/ symptoms:
weakness Abdominal spasm is RUQ Abdominal pain of
induced to limit 5/10 pain scale,
mucosal injury adding guarding behavior,
in stimulation of facial grimace,
increased peristalsis tachypnea-RR of
38cpm,
Signs/ symptoms:
Acute Diarrhea, defecates 5-7
Gastroenteritis times at night, soft
watery stool 2-3 cups
per episodes,
hyperactive bowel
sounds of 16 clocks per
Complications: Complications: minute, dry skin,
Bile is infected and typically Peritonitis anorexia, decreased
shed in the stool and are Pancreatitis body weight
then available to infect Hepatic and splenic
other hosts abscesses Disseminated
intravascular coagulation
Myocarditis
Shock
Death

Legend:

- Pathophsiology

- Signs and symptoms

- Diagnostic exams

- Complications