You are on page 1of 23

Introduct|on

1yphold fever also known as enLerlc fever ls a poLenLlally faLal mulLlsysLemlc lllness caused
prlmarlly by 5olmooello typbl 1he proLean manlfesLaLlons of Lyphold fever make Lhls dlsease a Lrue
dlagnosLlc challenge 1he classlc presenLaLlon lncludes fever malalse dlffuse abdomlnal paln and
consLlpaLlon unLreaLed Lyphold fever ls a gruellng lllness LhaL may progress Lo dellrlum obLundaLlon
lnLesLlnal hemorrhage bowel perforaLlon and deaLh wlLhln one monLh of onseL Survlvors may be lefL
wlLh longLerm or permanenL neuropsychlaLrlc compllcaLlons
5 typbl has been a ma[or human paLhogen for Lhousands of years Lhrlvlng ln condlLlons of poor
sanlLaLlon crowdlng and soclal chaos lL may have responslble for Lhe CreaL lague of ALhens aL Lhe end
of Lhe elopenneslan War

1he name 5 typbl ls derlved from Lhe anclenL Creek typbos an eLhereal
smoke or cloud LhaL was belleved Lo cause dlsease and madness ln Lhe advanced sLages of Lyphold
fever Lhe paLlenLs level of consclousness ls Lruly clouded AlLhough anLlbloLlcs have markedly reduced
Lhe frequency of Lyphold fever ln Lhe developed world lL remalns endemlc ln developlng counLrles
1he lncldence of Lyphold fever ln Lhe unlLed SLaLes has markedly decreased slnce Lhe early
1900s 1oday approxlmaLely 400 cases are reporLed annually ln Lhe unlLed SLaLes mosLly ln people who
recenLly have Lravelled Lo endemlc areas 1hls ls ln comparlson Lo Lhe 1920s when over 33000 cases
were reporLed ln Lhe uS 1hls lmprovemenL ls Lhe resulL of lmproved envlronmenLal sanlLaLlon Mexlco
and SouLh Amerlca are Lhe mosL common areas for uS clLlzens Lo conLracL Lyphold fever lndla
aklsLan and LgypL are also known hlghrlsk areas for developlng Lhls dlsease Worldwlde Lyphold fever
affecLs more Lhan 13 mllllon people annually wlLh over 300000 paLlenLs dylng of Lhe dlsease
ln Lhe hlllpplnes Lyphold fever has rlsen by 60 percenL ln negros CccldenLal Lhls year wlLh
Lhree reporLed deaLhs 1here were 486 Lyphold cases Lhls year compared Lo 302 lasL year or 60 percenL
more 1he Lop Lhree areas wlLh Lyphold fever cases whlch are areas of concern are CalaLrava wlLh 84
kabankalan ClLy 38 and San Carlos ClLy 43 CLher areas hlL wlLh Lyphold fever are lsabela 31 cases
Sllay ClLy 27 LscalanLe ClLy Plmamaylan ClLy Sagay ClLy and 1allsay ClLy wlLh 21 each Molses adllla
20 Cadlz ClLy 17 La CarloLa ClLy 13 vlcLorlas ClLy 12 uon Salvador 8enedlcLo 11 1oboso 10
Cauayan and La CasLellana 9 each L8 Magalona llog and Murcla 8 each 8lnalbagan and Plnlgaran
7 each 8ago ClLy 6 Manapla 4 onLevedra 3 and Candonl Plnobaan San Lnrlque Slpalay and
valladolld 1 each
Cur group chose Lyphold fever as our case sLudy because of lLs lncreaslng cases here ln our
counLry 1hrough Lhls sLudy we wlll be able Lo lnform more people especlally our conurses of Lhe
naLure of Lhe dlsease and lLs effecL Lo Lhe people who have lL We also wanL Lhem Lo know Lhe causes
and rlsk facLors of Lyphold fever so LhaL cerLaln precauLlons and healLh Leachlngs would be done Lo
allevlaLe Lhe number of cases all over Lhe world especlally Lo Lhe developlng counLrles llke Lhe
hlllpplnes







9ft|ent's prof||e
name Mrs C8
Age 34 years old
8lrLhday May 23 1977
Address Area 1 SlLlo Llb[o 8arangay SLo nlno ClLy of aranaque
naLlonallLy llllplno
8ellglon CaLhollc
Admlsslon daLe CcLober 30 2011
Admlsslon Llme 1104 pm
AdmlLLlng hyslclan Marle Clalre M 8oqulllo Mu
Chlef compllanL fever
AdmlLLlng ulagnosls vlral PepaLlLls C63
llnal ulagnosls 8evlsed dx L/c 1yphold fever C63 u 18 weeks ACC



















9ft|ent's h|story
resenL medlcal hlsLory
LM !une 22 2011
11 days prlor Lo admlsslon (+) fever (+) dysurla (on and off) clalms Lo have no bowel
movemenL for 11 days () abdomlnal paln
1 day prlor Lo admlsslon has yellowlsh sclera
asL medlcal hlsLory
(+) measles and chlcken pox (chlldhood)
WlLh famlly hlsLory of
PyperLenslon (moLher slde)
() smoker and alcohol drlnker
CbsLeLrlcal PlsLory
O LM !une 22 2011
O Luu March 29 2012
O ACC 21 weeks and 2 days
Socloeconomlc SLaLus
O no [ob a housewlfe
O Per husband works as a Lrlcycle drlver
O no oLher source of lncome
8ehavloural SLaLus
O Pas a hablL of buylng readyLoeaL food
O uoesn'L have a hablL of washlng hands
LnvlronmenLal SLaLus
O 2 days before paLlenL had fever Lhere ls flood ln Lhelr place
O Llves ln a squaLLers' area



IN1AkL AND CU19U1
NCVLM8Lk 18 2011
IN1AkL 6 2
IVI 120
CkAL 1000
C1nLkS
SU81C1AL 900 cc

CU19U1
UkINL 430 cc
S1CCL 0
VCMI1US
C1nLkS
GkAND 1C1AL 430 cc

NCVLM8Lk 17 2011
IN1AkL 62 210 106
IVI 120 300 300
CkAL 320 330 430
C1nLkS
SU81C1AL 640 830 730

CU19U1
UkINL 300 440 330
S1CCL 0 1 1
VCMI1US
C1nLkS
GkAND 1C1AL 140 410 200


LA1LS1 VI1AL SIGNS NCVLM8Lk 18 2011
V|tf| S|gn kesu|t
1LM9LkA1UkL 368
9ULSL kA1L 88 bpm
kLS9IkA1Ck kA1L 19 cpm
8LCCD 9kLSSUkL 100/70 mmPg









9hys|cf| Assessment
BUDY PART FINDINCS NURMAL FINDINCS INTERPRETATIUNS
Ceneral Survey consclous and coherenL
helghL
welghL
8Ml
conscious ond coherent normal
Skin Warm Lo Louch
brown ln color
Skln feels rough
good skln Lurgor


Normo//y skin is uniform
whitish pink or brown No
skin /esion shou/d be present
except for freck/es
8irthmork or mo/es which
moy be f/ot or e/evoted
normal
5cors ore usuo//y present
since chi/dhood 5kin shou/d
normo//y fee/ smooth even
firm except where there is
siqnificont hoir qrowth 4
certoin omount of rouqhness
is normo/
n4u
air 8lack ln color and Lhln noir vories from dork brown
to po/e brown
normal
Face Cval shaped
no edema
dlsproporLlonaLe
sLrucLures or lnvolunLary
movemenL
smooLh and unlform ln
conslsLency
no nodules and masses
1he shope of the foce con be
ovo/ round or s/iqht/y
squore 1here shou/d be no
edemo disproportionote
structures or invo/untory
movement 5hou/d be
smooth ond uniform in
consistency 4bsence of
nodu/es ond mosses
normal
Eyes Move smooLhly and
symmeLrlcal
yellowlsh sclera
8oth eyes shou/d move
smooth/y ond symmetrico/
ellowlsh sclera
[n|unctiva plnk palpebral con[unclva 5hiny moist so/mon pink in
co/or
normal
Pupils equally round reacLlve
Lo llghL and
accommodaLlon
Pupi/s equo//y round
reoctive to /iqht ond
occommodotion 4veroqe
pupi/ site l7mm
normal
isual Acuity 20/20 20/20 normal
N[se and Sinuses symmeLrlcally ln Lhe
mldllne of Lhe face and ls
wlLhouL swelllng
bleedlng leslons and
masses
no nasoanal dlscharge
1he shope of the externo/
nose con vory qreot/y omonq
individuo/s Locoted
symmetrico//y in the mid/ine
of the foce ond is without
swe//inq b/eedinq /esions
ond mosses 4bsence of
dischorqes
normal
Neck and Lympb n[des neck ls symmeLrlc
wlLhouL Lenderness or
llmlLaLlon of movemenL
nodes are nelLher
palpable nor Lender
no Lonsllopharyngeal
congesLlon
Neck hos no /esions ond
tenderness 4bi/ity to move
f/exion extension /otero/
rototion ond ti/tinq 1hyroid
is nonpo/pob/e ond po/pob/e
nor tender
normal
Lips and M[utb smooLh and molsL
no leslons bleedlng
4ppeors smooth ond with
moist 1eeth ore present ond
in qood dentition 1onque
hos no /esions 6ums ond
mucoso hos no siqns of
swe//inq b/eedinq ond
infections
normal
Ear maLch Lhe flesh color of
Lhe resL of Lhe body
poslLloned cenLrally and
ln proporLlon Lo Lhe head
no forelgn bodles
redness dralnage
deformlLles nodules or
leslons
1he eors shou/d motch the
f/esh co/or of the rest of the
body ond shou/d be
positioned centro//y ond in
proportion to the heod
cerumen shou/d be moist
ond not obstruct the
tymponic membrone 1here
shou/d be no foreiqn bodies
redness droinoqe
deformities nodu/es or
/esions
normal
1kuNk
best normal chesL expanslon
resonance upon
percusslon
4bsence of odventitious
sounds Percussion ond
po/potion ore resonont
normal
Abd[men same color as Lhe resL of
Lhe body
globular and sofL
nonLender
Llver ls noL be palpable
decreased bowel sounds
palpable masses aL Lhe
lefL lower quadranL
5hou/d hove the some co/or
os the rest of the body No
/esions ond mosses Liver
shou/d not be po/pob/e
bowe/ sounds ore usuo//y
hiqhpitched occurrinq ot 5
l0times /minute
Clobular shape due Lo
pregnancy
decreased bowel sound
and palpable masses aL
LLC due Lo consLlpaLlon
uPPk 4Nu LOwk x1kMl1l5
Nails plnklsh
caplllary reflll reLurn Lo
normal wlLhln 23 seconds
Normo//y the noi/s hove o
pink cost for /iqhtskinned
individuo/s copi//ory refi//
moy vory with oqe but co/or
shou/d return to normo/
within 2l seconds
normal
ands Able Lo do range of
moLlon
4b/e to do konqe of motion normal
Legs knees are ln allgnmenL
wlLh each oLher and feeL
are ln allgnmenL wlLh Lhe
lower legs
able Lo flex and exLend
Lhe legs wlLh no audlble
cllcks wlll be heard
knees ore in o/iqnment with
eoch other 1he foot is in
o/iqnment with the /ower
/eq 1he potient wi// be ob/e
to f/ex ond extend the /eqs
with no oudib/e c/icks wi// be
heord durinq joint
movement
normal












Med|cf| mfnfgement
DA1L]1IML DCC1Ck'S CkDLk kA1ICNALL NUkSING
kLS9CNSI8ILI1
10]30]11 lease admlL Lo av 2

Speclal room for a
speclflc dlsease
AsslsL Lhe paLlenL ln
admlLLlng Lo Lhe room
Secure consenL for
admlsslon
lor legal purposes AsslsL ln preparlng
consenL form
uleL uA1 Advlsed Lhe paLlenL
abouL her dleL
lvl nSS 1L x 8 hours 1o replace fluld
lmbalance
MonlLor and regulaLe
lv fluld
ux
C8C wlLh c
urlnalysls
8lood 1yplng
SC1SCC1 ALk hos
18 81 82
lor Lransvaglnal u1Z
lor u1Z of Lhe llver and
gallbladder
lor An1lPAv/ 1CA
lor conflrmaLory or
look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
1x
repare 2 unlLs of 88C

lor blood Lransfuslon Advlsed Lhe paLlenL Lo
secure needs
lease refer
1130 pm

89120]80
1 382
kk 38
9k132

G69 18 weeks of ACG

CC fever
(+) hefdfche
() cough]co|ds
(+) d|zz|ness
() DC8
() fd pf|n
(+) dysur|f
() |ow fck pf|n
(+) |oss of fppet|te
(+) ody wefkness
() vfg|nf| d|schfrge]
|eed|ng


MalnLaln lvl raLe aL 8
hours
1o replace fluld
lmbalance
MonlLor and regulaLe
lv fluld
MonlLor l and C q shlfL 1o monlLor lf Lhere ls
fluld overload
MonlLor l and C
accuraLely
MonlLor 18 q shlfL lor basellne daLa and
Lo be acqualnLed wlLh
posslble compllcaLlons
MonlLor 18 accuraLely
8evlse dx above
ux
lor blood Lyplng
8un Crea na k Cl
SCC1 SC1Alk phos
Pold u1Z of llver and
gallbladder 18 81 82
An1lPAv
lor Cx8 wlLh abdomlnal
shleld
lor malarlal smear
lor blood CCS x 2
dlfferenL slLe
lor conflrmaLory or
look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
1x
SLarL Lhe ff meds
1 araceLamol
300mg 1lv now
Lhen araceLamol
300 mg Lab/ 1
Lab q4 lf Lemp
378 C 81C
2 lerrous sulphaLe
+ lollc acld 1 cap
Cu
3 MulLlvlLamlns 1
cap Cu
4 CefLrlaxone 2 g
1lv now Lhen Cu

1o cure speclflc dlsease

AsslsL Lhe paLlenL ln
Laklng medlcaLlons
Pold blood Lransfuslon
v/S q4 lor basellne daLa and
Lo be acqualnLed wlLh
posslble compllcaLlons
MonlLor v/S accuraLely
8efer Lo C8 Cyne servlce lor gyne servlces 8efer accuraLely
10]31
7 fm

W|th ep|sodes of fever
(+) hefdfche
() cough fnd co|ds
lease faclllLaLe all
pendlng labs
lor conflrmaLory or
look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe pendlng labs
ConLlnue meds and
presenL managemenL
lor conLlnuous care
lease monlLor Lemp q4
and record
lor basellne daLa and
Lo be acqualnLed wlLh
posslble compllcaLlons
MonlLor Lemp
accuraLely
11]1]11

St||| w|th fever
lvl raLe Lo 1l x 12 hours 1o replace fluld
lmbalance

ConLlnue presenL
managemenL
lor conLlnuous care AsslsL Lhe paLlenL ln
Laklng medlcaLlons
8efer
11]2
809 fm

St||| w|th fever


lvl Lo follow u3L8 1L x
120 cc/hr
1o replace fluld
lmbalance
MonlLor and regulaLe
lv fluld
laclllLaLe blood culLure lor conflrmaLory lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
lollow up referral Lo C8
May glve kallum durule
Lab/ 1 Lab 1lu
lor oLasslum
supplemenL
AsslsL Lhe paLlenL ln
Laklng medlcaLlon
araceLamol 300mg/ Lab
81C q4
1o lower paLlenL's
Lemp when febrlle
AsslsL Lhe paLlenL ln
Laklng medlcaLlon
refer
11]2
1030 fm

(+) |cter|c sc|erf
In 132
II cx soft c|osed
uterus en|frged to 4
months
() |eed|ng

C8 Gyne notes
Dx G69 (00) 9U 18
6]7 wks
t]c 1ypho|d Iever
t]c nepf A

lor pelvlc u1Z 8asellne daLa and Lo
vlsuallze Lhe pelvls lf lL
ls compaLlble Lo
dellvery
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
lollow up all lab resulLs lor conflrmaLory or
look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe pendlng labs
ConLlnue oral meds and
lv CefLrlaxone
lor conLlnuous care AsslsL Lhe paLlenL ln
Laklng medlcaLlons
8efer accordlngly
11]3

Grfm stf|n
W|th grfm () rods
St||| w|th ep|sodes of
fever
() cough fnd co|ds
() hefdfche

D4 ceftr|fxone
lf up blood culLure Loday lor conflrmaLory or
look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
add 2 egg whlLe ln
meals
lnsLrucL Lhe paLlenL
abouL Lhe dleL
ConLlnue presenL
medlcaLlons
lor conLlnuous care AsslsL Lhe paLlenL ln
Laklng medlcaLlons
lease carry ouL C8 noLes 1o have lnformaLlon
abouL paLlenL's
pregnancy
Carry ouL accuraLely
11]4
93 fm

In1 142
ConLlnue meds lor conLlnuous care AsslsL Lhe paLlenL ln
Laklng medlcaLlons
8efer accordlngly
11]
1006 fm

St||| w|th fever
Ceftr|fxone IV
(gener|c)

uc cefLrlaxone lv lor medlcal purposes Carry ouL order
properly
May glve Amoxlclllln
300mg/cap 2 cap 3 x a
day
lor anoLher llne of
anLlbloLlcs
AsslsL Lhe paLlenL ln
Laklng medlcaLlons
8efer accordlngly
11]6
929 fm

W|th |cter|c sc|erf
Afer||e

D1 fmox|c||||n h|gh
dose

ConLlnue presenL
managemenL
lor conLlnuous care AsslsL Lhe paLlenL ln
Laklng medlcaLlons
and conLlnue care
lor repeaL serum k now lor conflrmaLory or
look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
lvl Lo follow u3L8 1L x
100 cc/hr
1o replace fluld
lmbalance
MonlLor and regulaLe
lv fluld
refer
11]6
7pm
Add azlLhromycln
300mg/Lab Cu x 3 days

8efer
used Lo LreaL lnfecLlons AsslsL Lhe paLlenL ln
Laklng medlcaLlons
11]7
1000 fm
Pold azlLhromycn ShlfL Lo anoLher drug Carry ouL docLor's
order accuraLely
Pold amoxlclllln ShlfL Lo anoLher drug Carry ouL docLor's
order accuraLely
8esume cefLrlaxone 2g
1lv q 24 hours
used Lo LreaL lnfecLlons Clve Lhe medlcaLlons
properly
18 q shlfL and record lor basellne daLa and
Lo be acqualnLed wlLh
posslble compllcaLlons
MonlLor 18 accuraLely
lncrease Cll 1o prevenL dehydraLlon
due Lo fever
Advlse Lhe paLlenL
abouL Lhe sald order
lvl Lo ff u3L8 1L x 100
cc/hr
1o replace fluld
lmbalance
MonlLor and regulaLe
lv fluld
8efer accordlngly
11]8
74 fm

D ceftr|fxone
1x ep|sode of fever
() chfnge |n ur|ne fnd
owe| hf|ts
Good fppet|te
() cough
() vfg|nf| d|schfrge

8elnserL lvl Lo oLher slLe
uue Lo phleblLls and
prevenL furLher
compllcaLlons
roperly lnserL Lhe
needle prevenL furLher
compllcaLlons
ConLlnue cefLrlaxone 2 g
1lv q24 hours
lor conLlnuous care AsslsL Lhe paLlenL ln
Laklng medlcaLlons
11]9
7 fm
d/c lvl

refer
1o replace Lhe prevlous
lvl
Carry ouL Lhe order
accuraLely
11]10
11 fm

(+) st||| w|th fever
ep|sodes
() ph|e|t|s
8elnserL lvl uslng u3L8 x
30 cc/hr
1o replace fluld
lmbalance
MonlLor and regulaLe
lv fluld
ConLlnue glvlng
cefLrlaxone lv
lor conLlnuous care AsslsL Lhe paLlenL ln
Laklng medlcaLlons
refer
4pm ShlfL cefLrlaxone Lo
Amplclllln 2 g 1lv q6 ()
AnS1
lor medlcal purposes Carry ouL docLor's
order accuraLely
11]11
84 fm

Ier||e ep|sode |fst
n|ght (38C)
Afer||e
C8S
An|cter|c
() vfg|nf| |eed|ng
Iood fetf| movement
ConLlnue meds

refer
lor conLlnuous care AsslsL Lhe paLlenL ln
Laklng medlcaLlons
11]12
8 fm

D2 fmp|c||||n
1x ep|sode of fever
(38C)
9f|e pf|perf|
con[uct|v|t|s
8epeaL C8CC Loday lor conflrmaLory or
look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
lncrease ferrous sulfaLe +
lollc acld 1 cap 8lu
used Lo LreaL lron
deflclency
AsslsL Lhe paLlenL ln
Laklng medlcaLlons
11]13
1049 fm

St||| w|th fever
lor repeaL urlnalysls

refer
1o look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
11]14

D1 ffer||e (366C)
ng 78
nct 23
k8C 27

D3 fmp|c||||n
lor blood Lransfuslon of
aL leasL 2 unlLs 88C
properly Lyped and cross
maLch
1o correcL anemla lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
lncrease leSC4 + follc
acld 1 cap 1lu
used Lo LreaL lron
deflclency
AsslsL Lhe paLlenL ln
Laklng medlcaLlons
11]1

Dx typho|d
Afer||e
9f||or
SLlll for blood Lransfuslon 1o correcL anemla lnsLrucL Lhe paLlenL
abouL pendlng labs
11]16

D fmp|c||||n w|th 1x
ep|sode of fever
C|efr refth sounds
lease refer paLlenL Lo
MSW for asslsLance of
meds
lor conLlnuous supply
of medlclne Lo prevenL
reslsLance
8efer accordlngly
laclllLaLe blood
Lransfuslon once
avallable
1o correcL anemla lnsLrucL Lhe paLlenL
abouL pendlng labs
11]17
942 fm
lor repeaL blood culLure 1o look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
refer
11]18
930 fm

() fever for 2x
(+) pf|e pf|perf|
con[unct|vf
(+) pf||or
May remove lvl
Lemporarlly
lluld lmbalance ls noL a
problem
Carry ouL order
accuraLely
lnserL heplock for Lhe lv
anLlbloLlc compleLlon
lor Lhe lv anLlbloLlc
compleLlon
Advlsed Lhe paLlenL
abouL Lhe order and
asslsL ln glvlng lv meds
lor repeaL C8C Loday 1o look for posslble
compllcaLlons
lnsLrucL Lhe paLlenL
abouL Lhe procedure Lo
be done
refer






















Anftomy fnd 9hys|o|ogy
Introduct|on to the gfstro|ntest|nf| system
1he gfstro|ntest|nf| trfct (Cl1) conslsLs of a hollow muscular Lube sLarLlng from Lhe oral cavlLy where
food enLers Lhe mouLh conLlnulng Lhrough Lhe pharynx oesophagus sLomach and lnLesLlnes Lo Lhe
recLum and anus where food ls expelled 1here are varlous fccessory orgfns LhaL asslsL Lhe LracL by
secreLlng enzymes Lo help break down food lnLo lLs componenL nuLrlenLs 1hus Lhe sallvary glands llver
pancreas and gall bladder have lmporLanL funcLlons ln Lhe d|gest|ve system lood ls propelled along Lhe
lengLh of Lhe Cl1 by perlsLalLlc movemenLs of Lhe muscular walls

1he prlmary purpose of Lhe gasLrolnLesLlnal LracL ls Lo break food down lnLo nuLrlenLs whlch can be
absorbed lnLo Lhe body Lo provlde energy llrsL food musL be lngesLed lnLo Lhe mouLh Lo be
mechanlcally processed and molsLened Secondly dlgesLlon occurs malnly ln Lhe sLomach and small
lnLesLlne where proLelns faLs and carbohydraLes are chemlcally broken down lnLo Lhelr baslc bulldlng
blocks Smaller molecules are Lhen absorbed across Lhe eplLhellum of Lhe small lnLesLlne and
subsequenLly enLer Lhe clrculaLlon 1he large lnLesLlne plays a key role ln reabsorblng excess waLer
llnally undlgesLed maLerlal and secreLed wasLe producLs are excreLed from Lhe body vla defecaLlon
(passlng of faeces)
ln Lhe case of gasLrolnLesLlnal dlsease or dlsorders Lhese funcLlons of Lhe gasLrolnLesLlnal LracL are noL
achleved successfully aLlenLs may develop sympLoms ofnausea vomlLlng dlarrhoea malabsorpLlon
consLlpaLlon or obsLrucLlon CasLrolnLesLlnal problems are very common and mosL people wlll have
experlenced some of Lhe above sympLoms several Llmes LhroughouL Lhelr llves

8fs|c structure
1he gasLrolnLesLlnal LracL ls a muscular Lube llned by a speclal layer of cells called eplLhellum 1he
conLenLs of Lhe Lube are consldered exLernal Lo Lhe body and are ln conLlnulLy wlLh Lhe ouLslde world aL
Lhe mouLh and Lhe anus AlLhough each secLlon of Lhe LracL has speclallsed funcLlons Lhe enLlre LracL
has a slmllar baslc sLrucLure wlLh reglonal varlaLlons

1he wall ls dlvlded lnLo four layers as follows

Mucosf
1he lnnermosL layer of Lhe dlgesLlve LracL has speclallsed eplLhellal cells supporLed by an underlylng
connecLlve Llssue layer called Lhe lamlna proprla 1he lamlna proprla conLalns blood vessels nerves
lymphold Llssue and glands LhaL supporL Lhe mucosa uependlng on lLs funcLlon Lhe eplLhellum may be
slmple (a slngle layer) or sLraLlfled (mulLlple layers)
Areas such as Lhe mouLh and oesophagus are covered by a sLraLlfled squamous (flaL) eplLhellum so Lhey
can survlve Lhe wear and Lear of passlng food Slmple columnar (Lall) or glandular eplLhellum llnes Lhe
sLomach and lnLesLlnes Lo ald secreLlon and absorpLlon 1he lnner llnlng ls consLanLly shed and replaced
maklng lL one of Lhe mosL rapldly dlvldlng areas of Lhe body! 8eneaLh Lhe lamlna proprla ls Lhe
muscularls mucosa 1hls comprlses layers of smooLh muscle whlch can conLracL Lo change Lhe shape of
Lhe lumen

Sumucosf
1he submucosa surrounds Lhe muscularls mucosa and conslsLs of faL flbrous connecLlve Llssue and
larger vessels and nerves AL lLs ouLer margln Lhere ls a speclallzed nerve plexus called Lhe submucosal
plexus or Melssner plexus 1hls supplles Lhe mucosa and submucosa

Muscu|fr|s externf
1hls smooLh muscle layer has lnner clrcular and ouLer longlLudlnal layers of muscle flbres separaLed by
Lhe myenLerlc plexus or Auerbach plexus neural lnnervaLlons conLrol Lhe conLracLlon of Lhese muscles
and hence Lhe mechanlcal breakdown and perlsLalsls of Lhe food wlLhln Lhe lumen

Serosf]mesentery
1he ouLer layer of Lhe Cl1 ls formed by faL and anoLher layer of eplLhellal cells called mesoLhellum

Ind|v|duf| components of the gfstro|ntest|nf| system

Crf| cfv|ty
1he oral cavlLy or mouLh ls responslble for Lhe lnLake of food lL ls llned by a sLraLlfled squamous oral
mucosa wlLh keraLln coverlng Lhose areas sub[ecL Lo slgnlflcanL abraslon such as Lhe Longue hard palaLe
and roof of Lhe mouLh MasLlcaLlon refers Lo Lhe mechanlcal breakdown of food by chewlng and
chopplng acLlons of Lhe LeeLh 1he Longue a sLrong muscular organ manlpulaLes Lhe food bolus Lo come
ln conLacL wlLh Lhe LeeLh lL ls also Lhe senslng organ of Lhe mouLh for Louch LemperaLure and LasLe
uslng lLs speclallsed sensors known as paplllae
lnsallvaLlon refers Lo Lhe mlxlng of Lhe oral cavlLy conLenLs wlLh sallvary gland secreLlons 1he mucln (a
glycoproLeln) ln sallva acLs as a lubrlcanL 1he oral cavlLy also plays a llmlLed role ln Lhe dlgesLlon of
carbohydraLes 1he enzyme serum amylase a componenL of sallva sLarLs Lhe process of dlgesLlon of
complex carbohydraLes 1he flnal funcLlon of Lhe oral cavlLy ls absorpLlon of small molecules such as
glucose and waLer across Lhe mucosa lrom Lhe mouLh food passes Lhrough Lhe pharynx and
oesophagus vla Lhe acLlon of swallowlng

Sf||vfry g|fnds
1hree palrs of sallvary glands communlcaLe wlLh Lhe oral cavlLy Lach ls a complex gland wlLh numerous
aclnl llned by secreLory eplLhellum 1he aclnl secreLe Lhelr conLenLs lnLo speclallsed ducLs Lach gland ls
dlvlded lnLo smaller segmenLs called lobes SallvaLlon occurs ln response Lo Lhe LasLe smell or even
appearance of food 1hls occurs due Lo nerve slgnals LhaL Lell Lhe sallvary glands Lo secreLe sallva Lo
prepare and molsLen Lhe mouLh Lach palr of sallvary glands secreLes sallva wlLh sllghLly dlfferenL
composlLlons


9ototlJs
1he paroLld glands are large lrregular shaped glands locaLed under Lhe skln on Lhe slde of Lhe face 1hey
secreLe 23 of sallva 1hey are slLuaLed below Lhe zygomaLlc arch (cheekbone) and cover parL of Lhe
mandlble (lower [aw bone) An enlarged paroLld gland can be easler felL when one clenches Lhelr LeeLh
1he paroLlds produce a waLery secreLlon whlch ls also rlch ln proLelns lmmunogloblns are secreLed help
Lo flghL mlcroorganlsms and aamylase proLelns sLarL Lo break down complex carbohydraLes

5obmooJlbolot
1he submandlbular glands secreLe 70 of Lhe sallva ln Lhe mouLh 1hey are found ln Lhe floor of Lhe
mouLh ln a groove along Lhe lnner surface of Lhe mandlble 1hese glands produce a more vlscld (Lhlck)
secreLlon rlch ln mucln and wlLh a smaller amounL of proLeln Mucln ls a glycoproLeln LhaL acLs as a
lubrlcanL

5oblloqool
1he subllnguals are Lhe smallesL sallvary glands covered by a Lhln layer of Llssue aL Lhe floor of Lhe
mouLh 1hey produce approxlmaLely 3 of Lhe sallva and Lhelr secreLlons are very sLlcky due Lo Lhe large
concenLraLlon of mucln 1he maln funcLlons are Lo provlde buffers and lubrlcaLlon

Cesophfgus
1he oesophagus ls a muscular Lube of approxlmaLely 23cm ln lengLh and 2cm ln dlameLer lL exLends
from Lhe pharynx Lo Lhe sLomach afLer passlng Lhrough an openlng ln Lhe dlaphragm 1he wall of Lhe
oesophagus ls made up of lnner clrcular and ouLer longlLudlnal layers of muscle LhaL are supplled by Lhe
oesophageal nerve plexus 1hls nerve plexus surrounds Lhe lower porLlon of Lhe oesophagus 1he
oesophagus funcLlons prlmarlly as a LransporL medlum beLween comparLmenLs

Stomfch
1he sLomach ls a ! shaped expanded bag locaLed [usL lefL of Lhe mldllne beLween Lhe oesophagus and
small lnLesLlne lL ls dlvlded lnLo four maln reglons and has Lwo borders called Lhe greaLer and lesser
curvaLures 1he flrsL secLlon ls Lhe cardla whlch surrounds Lhe cardlal orlflce where Lhe oesophagus
enLers Lhe sLomach 1he fundus ls Lhe superlor dllaLed porLlon of Lhe sLomach LhaL has conLacL wlLh Lhe
lefL dome of Lhe dlaphragm 1he body ls Lhe largesL secLlon beLween Lhe fundus and Lhe curved porLlon
of Lhe !
1hls ls where mosL gasLrlc glands are locaLed and where mosL mlxlng of Lhe food occurs llnally Lhe
pylorus ls Lhe curved base of Lhe sLomach CasLrlc conLenLs are expelled lnLo Lhe proxlmal duodenum vla
Lhe pylorlc sphlncLer 1he lnner surface of Lhe sLomach ls conLracLed lnLo numerous longlLudlnal folds
called rugae 1hese allow Lhe sLomach Lo sLreLch and expand when food enLers 1he sLomach can hold
up Lo 13 llLres of maLerlal 1he funcLlons of Lhe sLomach lnclude
1 1he shorLLerm sLorage of lngesLed food
2 Mechanlcal breakdown of food by churnlng and mlxlng moLlons
3 Chemlcal dlgesLlon of proLelns by aclds and enzymes
4 SLomach acld kllls bugs and germs
3 Some absorpLlon of subsLances such as alcohol
MosL of Lhese funcLlons are achleved by Lhe secreLlon of sLomach [ulces by gasLrlc glands ln Lhe body
and fundus Some cells are responslble for secreLlng acld and oLhers secreLe enzymes Lo break down
proLelns

Smf|| |ntest|ne
1he small lnLesLlne ls composed of Lhe duodenum [e[unum and lleum lL averages approxlmaLely 6m ln
lengLh exLendlng from Lhe pylorlc sphlncLer of Lhe sLomach Lo Lhe lleocaecal valve separaLlng Lhe lleum
from Lhe caecum 1he small lnLesLlne ls compressed lnLo numerous folds and occuples a large
proporLlon of Lhe abdomlnal cavlLy
1he duodenum ls Lhe proxlmal Cshaped secLlon LhaL curves around Lhe head of Lhe pancreas 1he
duodenum serves a mlxlng funcLlon as lL comblnes dlgesLlve secreLlons from Lhe pancreas and llver wlLh
Lhe conLenLs expelled from Lhe sLomach 1he sLarL of Lhe [e[unum ls marked by a sharp bend Lhe
duodeno[e[unal flexure lL ls ln Lhe [e[unum where Lhe ma[orlLy of dlgesLlon and absorpLlon occurs 1he
flnal porLlon Lhe lleum ls Lhe longesL segmenL and empLles lnLo Lhe caecum aL Lhe lleocaecal [uncLlon

1he small lnLesLlne performs Lhe ma[orlLy of dlgesLlon and absorpLlon of nuLrlenLs arLly dlgesLed food
from Lhe sLomach ls furLher broken down by enzymes from Lhe pancreas and blle salLs from Lhe llver
and gallbladder 1hese secreLlons enLer Lhe duodenum aL Lhe Ampulla of vaLer AfLer furLher dlgesLlon
food consLlLuenLs such as proLelns faLs and carbohydraLes are broken down Lo small bulldlng blocks
and absorbed lnLo Lhe bodys blood sLream
1he llnlng of Lhe small lnLesLlne ls made up of numerous permanenL folds called pllcae clrculares Lach
pllca has numerous vllll (folds of mucosa) and each vlllus ls covered by eplLhellum wlLh pro[ecLlng
mlcrovllll (brush border) 1hls lncreases Lhe surface area for absorpLlon by a facLor of several hundred
1he mucosa of Lhe small lnLesLlne conLalns several speclallsed cells Some are responslble for
absorpLlon whllsL oLhers secreLe dlgesLlve enzymes and mucous Lo proLecL Lhe lnLesLlnal llnlng from
dlgesLlve acLlons

Lfrge |ntest|ne
1he large lnLesLlne ls horseshoe shaped and exLends around Lhe small lnLesLlne llke a frame lL conslsLs
of Lhe appendlx caecum ascendlng Lransverse descendlng and slgmold colon and Lhe recLum lL has a
lengLh of approxlmaLely 13m and a wldLh of 73cm
1he caecum ls Lhe expanded pouch LhaL recelves maLerlal from Lhe lleum and sLarLs Lo compress food
producLs lnLo faecal maLerlal lood Lhen Lravels along Lhe colon 1he wall of Lhe colon ls made up of
several pouches (hausLra) LhaL are held under Lenslon by Lhree Lhlck bands of muscle (Laenla coll)
1he recLum ls Lhe flnal 13cm of Lhe large lnLesLlne lL expands Lo hold faecal maLLer before lL passes
Lhrough Lhe anorecLal canal Lo Lhe anus 1hlck bands of muscle known as sphlncLers conLrol Lhe
passage of faeces


1he mucosa of Lhe large lnLesLlne lacks vllll seen ln Lhe small lnLesLlne 1he mucosal surface ls flaL wlLh
several deep lnLesLlnal glands numerous gobleL cells llne Lhe glands LhaL secreLe mucous Lo lubrlcaLe
faecal maLLer as lL solldlfles 1he funcLlons of Lhe large lnLesLlne can be summarlsed as
1 1he accumulaLlon of unabsorbed maLerlal Lo form faeces
2 Some dlgesLlon by bacLerla 1he bacLerla are responslble for Lhe formaLlon of lnLesLlnal gas
3 8eabsorpLlon of waLer salLs sugar and vlLamlns

L|ver
1he llver ls a large reddlshbrown organ slLuaLed ln Lhe rlghL upper quadranL of Lhe abdomen lL ls
surrounded by a sLrong capsule and dlvlded lnLo four lobes namely Lhe rlghL lefL caudaLe and quadraLe
lobes 1he llver has several lmporLanL funcLlons lL acLs as a mechanlcal fllLer by fllLerlng blood LhaL
Lravels from Lhe lnLesLlnal sysLem lL deLoxlfles several meLabollLes lncludlng Lhe breakdown of blllrubln
and oesLrogen ln addlLlon Lhe llver has synLheLlc funcLlons produclng albumln and blood cloLLlng
facLors Powever lLs maln roles ln dlgesLlon are ln Lhe producLlon of blle and meLabollsm of nuLrlenLs
All nuLrlenLs absorbed by Lhe lnLesLlnes pass Lhrough Lhe llver and are processed before Lravellng Lo Lhe
resL of Lhe body 1he blle produced by cells of Lhe llver enLers Lhe lnLesLlnes aL Lhe duodenum Pere
blle salLs break down llplds lnLo smaller parLlcles so Lhere ls a greaLer surface area for dlgesLlve enzymes
Lo acL

Gf|| |fdder
1he gallbladder ls a hollow pear shaped organ LhaL slLs ln a depresslon on Lhe posLerlor surface of Lhe
llvers rlghL lobe lL conslsLs of a fundus body and neck lL empLles vla Lhe cysLlc ducL lnLo Lhe blllary ducL
sysLem 1he maln funcLlons of Lhe gall bladder are sLorage and concenLraLlon of blle 8lle ls a Lhlck fluld
LhaL conLalns enzymes Lo help dlssolve faL ln Lhe lnLesLlnes 8lle ls produced by Lhe llver buL sLored ln Lhe
gallbladder unLll lL ls needed 8lle ls released from Lhe gall bladder by conLracLlon of lLs muscular walls ln
response Lo hormone slgnals from Lhe duodenum ln Lhe presence of food


9fncrefs
llnally Lhe pancreas ls a lobular plnklshgrey organ LhaL lles behlnd Lhe sLomach lLs head
communlcaLes wlLh Lhe duodenum and lLs Lall exLends Lo Lhe spleen 1he organ ls approxlmaLely 13cm
ln lengLh wlLh a long slender body connecLlng Lhe head and Lall segmenLs 1he pancreas has boLh
exocrlne and endocrlne funcLlons Lndocrlne refers Lo producLlon of hormones whlch occurs ln Lhe lsleLs
of Langerhans 1he lsleLs produce lnsulln glucagon and oLher subsLances and Lhese are Lhe areas
damaged ln dlabeLes melllLus 1he exocrlne (secreLrory) porLlon makes up 8083 of Lhe pancreas and ls
Lhe area relevanL Lo Lhe gasLrolnLesLlnal LracL
lL ls made up of numerous aclnl (small glands) LhaL secreLe conLenLs lnLo ducLs whlch evenLually lead Lo
Lhe duodenum 1he pancreas secreLes fluld rlch ln carbohydraLes and lnacLlve enzymes SecreLlon ls
Lrlggered by Lhe hormones released by Lhe duodenum ln Lhe presence of food ancreaLlc enzymes
lnclude carbohydrases llpases nucleases and proLeolyLlc enzymes LhaL can break down dlfferenL
componenLs of food 1hese are secreLed ln an lnacLlve form Lo prevenL dlgesLlon of Lhe pancreas lLself
1he enzymes become acLlve once Lhey reach Lhe duodenum


























9A1nC9nSICLCG






























Non Modifiable
Factors
Race
Culture
Salmonella typhi
Small intestine
Modifiable Factors
Environment
al factors
Behavioral
factors
Food/drinks
intake
Multiplication in the intestinal and mesenteric
lymphoid follicles (Peyer's patches)
Macrophage (Peyer's patch)
Bacteria is within the
macrophages and survives
Bacteria spread via the lymphatic
while inside the macrophages
Multiplication in the reticuloendothelial tissues of
the liver, spleen, bone marrow, and lymph nodes
Transient bacteriaemia
nfected bile
The organism re-enters the
gastrointestinal tract in the bile
and reinfects Peyer patches
Necrosis of the Peyer's patch
Fever, Headache,
Loss of appetite
Abdominal
pain, spleen
enlargement,
and rose
spots
Shed in the stool and
are then available to
infect other hosts
Perforation and bleeding
TYPHOID FEVER
Constipation,
Yellowish sclera
All paLhogenlc 5olmooello specles are engulfed by phagocyLlc cells whlch Lhen pass Lhem
Lhrough Lhe mucosa and presenL Lhem Lo Lhe macrophages ln Lhe lamlna proprla 5 typbl enLers Lhe
hosLs sysLem prlmarlly Lhrough Lhe dlsLal lleum 5 typbl has speclallzed flmbrlae LhaL adhere Lo Lhe
eplLhellum over clusLers of lymphold Llssue ln Lhe lleum (eyer paLches) Lhe maln relay polnL for
macrophages Lravellng from Lhe guL lnLo Lhe lymphaLlc sysLem 5 typbl has a vl capsular anLlgen LhaL
masks AMs avoldlng neuLrophllbased lnflammaLlon 1he bacLerla Lhen lnduce Lhelr hosL
macrophages Lo aLLracL more macrophages
lL coopLs Lhe macrophages cellular machlnery for Lhelr own reproducLlon as lL ls carrled
Lhrough Lhe mesenLerlc lymph nodes Lo Lhe Lhoraclc ducL and Lhe lymphaLlcs and Lhen Lhrough Lo Lhe
reLlculoendoLhellal Llssues of Lhe llver spleen bone marrow and lymph nodes Cnce Lhere Lhe 5
typbl bacLerla pause and conLlnue Lo mulLlply unLll some crlLlcal denslLy ls reached AfLerward Lhe
bacLerla lnduce macrophage apopLosls breaklng ouL lnLo Lhe bloodsLream Lo lnvade Lhe resL of Lhe
body aLlenLs develop sympLoms lncludlng fever headache and loss of appeLlLe when Lhe organlsm
reenLers Lhe bloodsLream
1he gallbladder ls Lhen lnfecLed vla elLher bacLeremla or dlrecL exLenslon of 5 typbl lnfecLed
blle 1he resulL ls LhaL Lhe organlsm reenLers Lhe gasLrolnLesLlnal LracL ln Lhe blle and relnfecLs eyer's
paLches 8acLerla LhaL do noL relnfecL Lhe hosL are Lyplcally shed ln Lhe sLool and are Lhen avallable Lo
lnfecL oLher hosLs LvenLually Lhere wlll be necrosls of Lhe eyer's paLch whlch leads Lo perforaLlon and
bleedlng and lf lefL unLreaLed deaLh ls lmmlnenL




















Lforftory kesu|ts

NAML C8 AGL]SLk34/l

S9LCIMLN u8lnL DA1L 11/14/11

MICkCSCC9IC]CnLMICAL LkAMINA1ICN

kCU1INL 9nSICAL LkAMINA1ICN kLSUL1 kLILkLNCL
CCLC8 LlghLellow LL ellow amber
1u88lul1(CLA8l1) Clear Clear

CnLMICAL ANALSIS
CLuCCSL negaLlve 30mg/dL (1race)
8lLl8u8ln negaLlve 03 mg/dL (+)
kL1CnL negaLlve 3 mg/dL (1race)
SLClllC C8Avl1 1003 1013 1030
8LCCu negaLlve 003 mg/dL (1race)
ASCC88lC AClu negaLlve 20 mg/dL
pP 70 48 77
8C1Lln negaLlve 10 mg/dL (1race)
u8C8lLlnCCLn normal 20 mg/dL (+)
nl18l1L negaLlve 01 mg/dL (+)
LLukCC1LS negaLlve 23 W8Cs/uL (1race)

UkINL SLDIMLN1 ANALSIS 8 AU1C 9Ak1ICLL kLCCGNI1ICN
8ed 8lood Cells 02/hpf (M) 03 (l) 04/hpf
WhlLe 8lood Cells 03/hpf (M) 03 (l) 03/hpf
LplLhellal Cells 8A8L (18) (M) 01 (l) 03/hpf
8acLerla 8A8L (18)
Mucus 1rends 8A8L (18)
























NAML C8 AGL]SLk34/l

S9LCIMLN 8LCCu DA1L 11/12/11

nLMA1CLCG

LkAM NAML kLSUL1 NCkMAL VALULS IN1Lk9kL1A1ICN
W8C 901x10
9
/L 48108 x10
9
/L normal
k8C 237x10
12
/L 4761 x10
12
/L normal
nLMCGLC8IN 782g/L 1317g/L lndlcaLes bleedlng
nLMA1CCkI1 2361 4032 Low 8lood ConcenLraLlon
MCV 9203fl 8298 x10fl normal
MCn 3049pg 2833pg normal
MCnC 3313g/L 3338g/L normal
9LA1LLL1 CCUN1 273x10
9
/L 130200 x10
9
/L normal
kCW 1166 1141463 normal
Neutroph|| 418 4070 normal
Lymphocytes 499 1948 lndlcaLes presenL bacLerlal
lnfecLlon
Los|noph|| 03 28
Monocyte 74 39 normal
8fsoph||s 01 03 normal


RESULT NORMAL VALUES INTERPRETATION
Potassium 4.08 3.5-5.3 mmo/l Normal

kLCN1CLCGICAL AND UL1kASCUND IINDINGS

1here are hazy lnfllLraLes seen aL Lhe lower lobes
PearL and greaL vessels are normal ln slze and conflguraLlon
1he resL of Lhe vlsuallzed chesL sLrucLures are unremarkable
Impress|on
neumonla boLh lower lobes

kLCN1CLCGICAL AND UL1kASCUND IINDINGS
WlLhln an enlarged uLerus Lhere ls a slngle feLus breech presenLaLlon male wlLh Lhe followlng
blomeLrlc measuremenLs 8u 332 PC 2084mm AC 1841mm lL 426mm LlW 626g
8eal Llme examlnaLlon shows acLlve feLal movemenL and regular cardlac pulsaLlon (lP8 149bpm)
lacenLa ls lmplanLed aL Lhe posLerlor uLerlne wall wlLh grade C maLurlLy no evldence of prevlae noLed
AmnloLlc fluld ls wlLhln normal
Impress|on
slngle llve lnLrauLerlne pregnancy breech male of abouL 23weeks and 2 days age of gesLaLlon Luu
03/01/2012
placenLa posLerlor ln locaLlon grade C
normohydramnlos

You might also like