INTESTINAL INFECTION

CHAN DARA MD, MSC IN TROPICAL MEDICINE,

KHON KAEN UNIVERSITY, THAILAND

E-mail: dr. chan@kkumail.com

 I. Definition.

Infections of the small intestine, including the duodenum, jejunum,

and ileum, generally result from the ingestion of contaminated food
or water.

The majority of infections are caused by Escherichia coli, rotavirus,

Giardia lamblia, and Cryptosporidium parvum. Other microbes have
been associated with small bowel infections including Vibrio
cholerae, Salmonella spp., Shigella spp., and Entamoeba histolytica.
 II. Epidemiology:

Giardiasis has an annual incidence of 2 million

people worldwide.
Enterotoxigenic E. coli (ETEC) is estimated
at 200 million people.
 Enteropathogenic E. coli (EPEC) accounts for around 5–10% of
pediatric diarrheal illnesses in the developing
world.
III. Anatomies of the intestines
 IV. Symptoms of intestinal infection

Intestinal infection can last from few days to 14 days.

• Abdominal cramps and discomfort .
• Diarrhea.
• Nausea
• Vomiting.
• Fever.
• Loss of appetite.
• Muscle aches.
• Dehydration.
• Headache.
• Mucus or blood in the stool .
• Weight loss .
V. Common causes of intestinal infections

 Bacterial : E.coli, Clostridium difficile , Staphylococcus

aureus ,Yersinia enterocolitica , and Vibrio cholera,
Salmonella, and Shigella….
 Viral :Adenovirus , Rotavirus, Enterovirus,
Norovirus…
 Parasite : Giardiasis, Entamoeba histolytica,
Cryptosporidiosis,…
 VI. Diagnosis:

 Stool analysis and culture .

 Blood culture .

 Blood test for electrolyte balance .

 VII. Treatment for intestinal infections:

• Rehydration – oral and sometimes intravenous

•Antibiotics can help in cases of bacterial infection.

(Ceftriaxone ,Oflocet ,Augmentin…..)
•Antibiotics will not help Intestinal infections from
viruses or parasites.
 VIII. Prevention:
keeping your kitchen consistently clean
washing your hands after using the toilet.
Drinking boil water
Traveling abroad and getting recommended vaccines
Thank You
ULCERATIVE COLITIS

CHRUN CHHUNNY MD, Pediatrician and Gastroenterologist

JAYAVARMAN 7 CHILDREN HOSPITAL

 I. Definition

​​ Ulcerative colitis គឺជាជំងឺរលាកពោះវៀនធំ​ដែល

ស្ទាប់ខាងក្នុងនៃពោះវៀនធំនិងរន្ធគូថប្ជាក្ហមនិងហើម។
ក្នុងករណី ភាគច្នការរលាកចាប់ផ្តើមនៅក្នុងរន្ធគូថនិងពោះវៀន
បន្ទា ប់ (The sigmoid colon) ហើយរលាក់ ទៅពោះវៀនធំ
ទាំងមូល។
II. Causes

The exact cause of ulcerative colitis remains unknown.

 Auto-immune system .

 Genetic (ហ្ន)

 Environmental factors . (កត្តា បរិស្ថា ន)

III. colon anatomy
 IV. Clinical Manifestation

 Diarrhea, often with blood or pus.

 Abdominal pain and cramping.
 Rectal pain.
 Rectal bleeding passing small amount of blood with stool.
 Urgency to defecate.
 Inability to defecate despite urgency.
 Weight loss.
 Fatigue
V. Diagnostic
Endoscopic procedures
 Colonoscopy. Biopsy
 Flexible sigmoidoscopy.
Lab tests
 Blood tests.
 Stool studies
Imaging procedures
 X-ray.
 CT scan.
 Computerized tomography (CT) enterography
 Magnetic resonance enterography (MRE) .
VI. Treatment:
Medical Management :
 Drug Therapy
1. Corticosteroid ( Prednisolone …. )
2. Sulfasalazine (Azulfidine) Reduce inflammatory
response and Anti-bacterial activity
3. Anti-diarrhea
 Diet Therapy ( No Milk or Milk product , food with High
protein and high calories )
Surgery Management ( Colon resection , Ileostomy , Ileoanal
anatomosis …. )
VII. Complications :
 Rupture of your colon.
 Sepsis, or blood infection.
 Severe dehydration.
 Toxic mega colon, or a rapidly swelling colon .
 Liver disease (rare).
 Intestinal bleeding.
 Kidney stones.
 Inflammation skin, joints, and eyes .
 Colon Cancer .
Thank You
ACUTE APPENDICTIS

រលាកខ្នែងពោះវៀន

CHRUN CHHUNNY MD, Pediatrician and Gastroenterologist

JAYAVARMAN 7 CHILDREN HOSPITAL

I. Definition:

គឺជាការរលាកខ្នែងពោះវៀន ដំបូង បណ្តា លអោយហើម

ស្ទះសរសៃឈាម និងក្លា យជាខ្ទុះឬ រលួយ បែកខ្នែង។
II. Anatomy

64%

32%
III. Incidence

1:1000 people each year and 7% of the US population.

Mortality 0.2-0.8%.
Perforation rate is higher in young children and elderly
Appendiceal perforation is related to an increase in morbidity and
mortality rates.
 IV. Etiology

• Obstruction by fecolith (ដុំលាមករឹងដែលជួបប្រទះញឹកញាប់ ) , Stricture .

• Foreign body(មានវត្ថុរឹង ធ្លា ក់ចូលក្នុងខ្ងពោះវៀន)
• Enlarged lymphoid follicles
• Intestinal worms
• Traumatic injury
• Tumors
• Bacterial infection មានមេរោគក្នុងពោះវៀន ឬតាមចរន្តឈាមបង្ក
អោយរលាកខ្ងពោះវៀន ( Aerobes & Anaerobes ).
V. Clinical Sign
Movement of Periumbilical pain to RLQ pain 80%.
Anorexia, Nausea (ក្អួតចង្អោ )or Vomiting seen in 50% of cases.
Low grade fever T:38 (ក្តៅ ខ្លួនស្ទិញៗ )
 គ្មា នផោម គ្មា នជុះ តែជួនកាលមានរាគ។

Diarrhea or constipation 18%

Dysuria, hematuria or pyuria,cystitis (inflamed appendix near the
urinary bladder or ureter).
VI. Physical Sign
 RLQ tenderness 80%,
 Rebound tenderness, pain on percussion, rigidity, and guarding.
 Rovsing sign (RLQ pain with palpation of the LLQ),
 Obturator sign (RLQ pain with internal rotation of the flexed right
hip),
 Psoas sign (RLQ pain with hyperextension of the right hip)
 Cough sign (sharp pain in the RLQ resulting from a voluntary
cough).
 លើកជើងស្តាំអ្នកជំងឺទាញអោយត្រង់ រួចគោះកែងជើង ពេលនោះ អ្នកជំងឺឈឺខ្លាំង នៅត្រង់ចំហៀង

ផ្ចិតខាងស្តាំ

 Rectal examination?
 VI. Physical Sign
• Rovsing's sign: RIF fossa pain on palpation of the LIF
 VI. Physical Sign
• Psoas sign: RIF pain with extension of the right hip
VI. Physical Sign
VI. Physical Signs
 VII. Characteristic Score

 1M= Migration of pain to the RLQ

 1A = Anorexia
 1N = Nausea and vomiting
 1T = Tenderness in RLQ
 2R = Rebound pain
 1E = Raised temperature
 1L = Leukocytosis
 2S = Movement of WBC to the left
 Total 10.
VIII. Diagnosis
 Physical exam
 Rovsing's sign
 Psoas sign
 Obturator sign.
 Rebound tenderness
 Digital rectal exam
 Lab (CRP clavate. WBC elevate 70%).

 Imaging
 X-ray of Abdomen
 Ultra sound
 CT scan
 MRI
Abdomen sonography

Abdomen MRI
IX. Differentials diagnosis

Ovarian cyst torsion, PID, Ectopic pregnancy

Gastroenteritis
Intussusception
Renal calculi, UTI
Mesenteric adenitis
Testicular torsion, strangulated hernia
Mesenteric adenitis
Constipation, Cholecystitis, Diverticulitis,
Peptic ulcer
Psoas abscess
X. Treatments

 Surgical Emergency
 Laparoscopy
 Laparotomy
 Antibiotic ( If Possible )
 Ceftriazone
 Metronidazol
XI. Complications

 Intra abdominal Abscess.

Bowel obstruction .
Bowel perforation .
 Appendicular Plastron.
Appendicular Peritonitis Local , Generalized.
Thank you
 Reference
www.emedicine.com
Textbook of surgery: Sabiston 2005
Humes DJ, Simpson J, 2006
GENERALIZED PERITONITIS

រលាកស្រោមពោះ

CHRUN CHHUNNY MD, Pediatrician and Gastroenterologist

JAYAVARMAN 7 CHILDREN HOSPITAL

 គឺជាជំងឺរលាកស្រោមពោះទូទៅពេញពោះ Generalized
peritoneum infection បណ្តា លអោយមានដក់ទឹក, ខ្ទុះ ឬឈាម
ក្នុងពោះ។
II. Anatomy of the peritoneal cavity
 III. Clinical Symptoms
 អ្នកជំងឺមានសញ្ញា ខុសៗគ្នា ទៅតាមមូលហេតុបង្កឡើង
 សភាពអ្នកជំងឺទ្រុឌទ្រោមខ្លាំង(poor general condition)
 ស្កទឹ Thirsty
 គ្មា នជុះ No Stool
 គ្មា នផោម No gaz
 សញ្ញា ជីវិតចុះខ្សោយ(សម្ពា ធឈាម,ជីបចរ, ចង្វា ក់ដង្ហើម, ទឹកនោម).
 ឈឺខ្លាំងក្នុងពោះ Abdominal pain
 មានប្តិកម្មស្មពោះឡើងរឹងពេលស្ទា
ឬចុច បឬចុច Abdomen contracture
 សំលេងខ្ទរ Taimpanism ធ្លា យក្ពះឬពោះវៀន
ឬ ពោះវៀន
 គោះសំលេងណែន Dulness
 បែកសរីរតាន់ ថ្លើម អណ្តើ ក ឬ កូនក្ស្បូន។
 IV. Cause of peritonitis

 Primary peritonitis Aseptic Peritonitis ) Spontaneous

bacterial peritonitis ascites from cirrhosis , heart
failure, systemic lupus and nephrosis…

 Secondary peritonitis(Septic Peritonitis) infection

due to a perforated appendix, perforated
ulcers, diverticulitis….
V. Diagnostic

 CBC Count and Blood Culture

 Peritoneal Fluid Analysis
 Abd X-ray
 Ultrasonography
 CT Scanning
Abd x ray

. Abd sonography
 . Abd MRI

. Abd CT scan
VI. Treatment
Antibiotics : Ceftriaxone , Metronidazole …
Surgery : Emergency Surgical removed all the feces
mater and repair perforation .
Other treatments :
 Pain medications …
 fluids given or blood transfusion …
 Oxygen .
VII. complications of peritonitis

Dehydration,

Sepsis,

Multiple organ infection and/or failure,

Hepatic encephalopathy,

Hepatorenal syndrome (liver disease leading to increasing renal
Failure),

Shock, and death.
REFERENCE
Thank you
INTESTINAL OBSTRUCTION

ជំងឺស្ទះពោះវៀន

CHRUN CHHUNNY MD, Pediatrician and Gastroenterologist

JAYAVARMAN 7 CHILDREN HOSPITAL

I. Definition

 Intestinal obstruction is a blockage that keeps food or

liquid from passing through your small intestine or large
intestine (colon).
 The obstruction could be complete or partial .
 Most obstruction occurs in ileum .
I. Definition

 Intestinal obstruction is a blockage that keeps food or

liquid from passing through your small intestine or large
intestine (colon).
 The obstruction could be complete or partial .
 Most obstruction occurs in ileum .
II. Intestine anatomy
III. Risk factors


Abdominal or pelvic surgery, which often causes adhesions — a
common intestinal obstruction

Crohn's disease, which can cause the intestine's walls to thicken,
narrowing the passageway

Abdomen Cancer
IV. Causes of intestinal obstruction

1 . Mechanical obstruction


Intestinal adhesions(60%) — bands of fibrous tissue in the
abdominal cavity that can form after abdominal or pelvic surgery

Hernias(10%) — portions of intestine that protrude into another part
of your body

Colon cancer,Volvulus

Intussusception (5%)In children, the most common cause of
intestinal obstruction
1 . Mechanical obstruction
1 . Mechanical obstruction
Adhesion and Incarcerated hernia
IV. Causes of intestinal obstruction
2 . Non-Mechanical obstruction
 Paralytic ileus
 Electrolyte disorders
 Lumbar spinal trauma
V. Signs and symptoms of intestinal

Bowel sounds will be absent

No passing stool or gas
Abdominal Colic
Loss of appetite
Vomiting
Swelling of the abdomen .
 Signs of dehydration .
Physical Examination

Inspection
Abdominal distension ,scars ,visible peristalsis
Palpation
Mass ,tenderness, guarding
Percussion
Tympanic ,dullness
Auscultation
Bowel sound are high pitch and increase in frequency
DIGITAL RECTAL EXAMINATION
VI. Diagnosis

 Physical exam.
 Abd X-ray ( Common) .
 Abd CT Scan
 Abd Ultrasound.
 Air or barium enema.
Abd X-ray

Air or barium enema

Abd CT Scan

Abd Ultrasound.
VII. Treatment

 Pain killer medications .

 Evacuation of intestinal contents by intestinal tube
 Nasojejunal tube to decompress intestine
 Surgical repairs for mechanical obstructions .
VIII. Complications
Untreated, intestinal obstruction can cause serious .


Tissue death. Intestinal obstruction can cut off the blood supply to
part of your intestine.

Infection. Peritonitis is the medical term for infection in the
abdominal cavity.
 REFERENCES
1. Cinnamon L. VanPutte, Jennifer L. Regan, Andrew F. Russo. SEELEY’S ESSENTIALS OF
ANATOMY & PHYSIOLOGY, TENTH EDITION. 2019 by McGraw-Hill Education.
2. Erin C. Amerman. Exploring Anatomy & Physiology in the Laboratory: Core Concepts.
2018, by Morton Publishing Company.