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Disease

Causative Agent

Mode of Transmission
Break in skin integrity (wound)

Incubation

Manifestations

Diagnostics

Medical/objectives Management
Neutralize toxin: - Anti-tetanus serum - Tet anti-toxin - Tet Ig Kill the organism - Antibiotic: Penicillin - Cleanse wound (thin dressing) Control spasm - Muscle relaxant: diazepam, valium, methocarbamol, lioresal (Baclofen), eperisone (Myonal) -

Nursing Care

Prevention

CNS INFECTIONS
Tetanus (Bacterial) Clostridium Tetani Spore Destroyed by O2 Inflammatory Process (RCDTF) Inc. Muscle tone near wound Tachycardia, diaphoresis Low grade fever Spasm: trismus, risussardonicus, opisthotonus, abdominal Clinical observation: LOCK JAW Hx of wound or tooth decay Maintain airway Maintain IV line Decrease stimuli Gentle handling, turn 1x per shift - Minimal handling: cluster care - Protect from injury: padded rails, call light - Provide comfort measures Immunization DPT: 6 wks after birth (3doses, 1mo interval) 0.5cc, IM Expect fever Give warm compress h24 first then cold Tetanus Toxoid: st nd 1 : 2 trim nd 2 : 1mo. rd 3 : 6mos th 4 : 1 yr th 5 : 1 yr Booster: q10 yrs 0.5cc, IM Heaviness at injection site Immunization Proper disposal of nasopharyngeal secretions Do not swallow CMV/TB Cover nose and mouth when sneezing mask

Meningitis (Bacterial)

Viral: Aseptic Meningitis CMV Fungal Cryptococcus neoformans Immunocomp Bacterial TB nd Streptococcal (2 to respi infection) Staph (skin infection) Meningococcal

Droplet via respiratory tract

210 days

- Nasopharyn URTI enters bloodstream vascular sys affectedpathologic vascular changes - Petichae (meningo) - Ecchymosis (meningo) - Abnormal reflexes: kernigs (leg), brudzinskis (neck) - Inc ICP

Lumbar Puncture Bacterial: yellowish, turbid, cloudy, inc CHON, WBC, normal sugar Viral: Clear, Increased CHON, WBC, normal sugar C&S, Counter Immuno Electrophoresis (protozoan or viral), blood culture

Antimicrobal - Neuro fnx Corticosteroid - Adequate nutri (Dexameth, and elimination hydrocort) - Ensure comfort: NOT Prednisone diversional (Na retention, therapy, noncant cross BBB) stimulating envt, Osmotic elevate HOB 30, Diuretic: nursing massage Mannitol (Petrissage) Anticonvulsant: Phenytoin (IV/PO), flush before and after, POgingival hyperplasia

Encephalitis (Viral) Brain Fever

Arbovirus Primary: affects brain directly Secondary: previous infection Measles, chx pox Post vaccine anti-rabies Toxic: metal poisoning

Primary: Vector mosquito, ticks, birds

- Same as Meningitis - Fever, HA, sore throat - Convulsions - Behavioral changes (initial symp) Altered LOC (Lethargy)

Lumbar punctureinc CHON, WBC, clear Counterimmunophoresis EEGextent of brain damage

Symptomatic

- Same as meningitis : Neuro fnx, nutri and elim

Polio Myelitis (Viral) Acute Flaccid Paralysis Infantile Paralysis

Polio Virus (Legio Debiletans) Type1: Brunhilde permanent immunity Type2: Lansing Type3: Leon

Early (1-4days) Droplet LateFecal-oral

Invasive/Abortive Stage - Time Virus infects individual - s/sx disappear - respi: sore throat, fever, HA, Body Malaise

Lumbar puncturesame as enceph Throat washing/swab within 1-4days Stool exam/fecalysisafter 5 days

Analgesic (Narcotic)Codeine (not causes respi dep) Symptomatic Mech VentIron Lung machine (neg P)

- Symptomatic / supportive - Hot compress for pain

Viral: permanent immunity but caused by diff. microorganis m Eradicate source of infection Insecticides Repellant Screen doors and windows C-hemically treat mosquito nets (Permethrin solnSoak 1-2days, dry 23-days, use 3-6mos) L-arvivarous fishes E-nvt sanitation A-nti mosquito soap N-eem tree/euchaly ptus Immunizatio n (OPV): 6wks after birth, 3 doses 1 mo interval; 2gttsPO; NPO 30 mins; if

- GI: Abd pain, anorexia, N/V, Diarrhea/Consti Pre-Paralytic Stage CNS involved without paralysis - Severe muscle pain - Siff hamstring - Hoyne sign (head drop) - Poker Spine opisthotonus with head retracted - Tri-pod position *Paralytic stage - Flaccid paralysis - Bulbar typeCN 910 affected - Spinal typeanterior horn cell (motor fnx): extremities, intercostal muscle Animal:3-8 Animals weeks Dumb stage: change in Human:10days- disposition, 21 years (1withdrawn, stays in a 3mos) corner, quiet, depressed, overly affectionate, walks to and fro, hyperactive Furious stage: easily agitated, easily bites, vicious or fierceful look, drooling, Humans - not transmissible without s/sx

with diarrhea, give but do not count, careful handling stools Inactivated Polio Virus: Salk vaccine, 6wks after birth, 3 doses 1 mo. Interval, 0.5ccIM, if immunocom p Avoid MOT do not put anything in mouth Proper waste disposal Responsible pet owner Keep away from strays Keep animals chained or caged When bitten, wash with water and soap, apply antiseptic soln, Can be destroyed by heat 60c for 35 secs.

Rabies (Viral) Rhabdo Virus Lyssa La Rage

Rhabdo Virus

Contact with saliva of rabid animal - Peripheral nervesCNS--> multiply will be behind inclusion bodies negri bodies (pathologic bodies formed as microorg multiplies) - Efferent nervessalivary gland of animals virus

Brain biopsy of animals negri bodies DFAdirect fluorescent antibody test Observe animal for 10 days 3 factors to consider site of bite (waist up- give vaccine) extent of bite reason for bite

Post exposure prophylaxis: Active immunization anti-rabies vaccine, purified vero cell vaccine (Verorab), Purified duck embryo (Kyssavac), purified chich embryo (Rabipur) IM/ID Passive Immunization: Equine rabies Ig (ERIg) 0.2cc/kgbw Human Rabies Ig (HRIg)

- Supportive/ symptomatic - Dim and quiet envt - Room away from subutility room - Restrain before maniacal behavior - Provide comfort measures

goes to saliva Invasive stage: itchiness, numbness and pain at site of bite, flulike, marked insomnia, restless, irritable, apprehensive, photosensitivity, saliva has virus Excitement Stage: Aerophobic, hydrophobic, pharyngolaryngeal spasm, drooling, photophobia, maniacal behaviorviolent Paralytic stage: spasm stops, ascending paralysis, 24-72hrs

0.133 cc/kgbw Within 7days Single dose Ventroglutea Multiple bites: Half IM, half on bites Haloperidol (Haldol): antipsychotic, normalize behavior of pt. Benadryl: anti-histamine, sedative hypnotic to dec anxiety, IM, q6h -

CIRCULATORY
Dengue Hemorrhagic Fever Arbo Virus Onyong-nyong virus Chikungunya virus West nile virus Flavivirus (Philippines) Vector Borne: Mosquito bite Aedes Aegypti Aedes Albopictus Culex fatigan: after biting an infected person, it will be the only one acquiring the disease Day biting Low flying Breeds in clear, stagnant H2O Without Warning Sx: Like gr1 High grade fever: 3-5 days, antipyretics not effective (RTC may decrease) Pain: HA, retrorbital, joint and bone, abdominal N/V Peticahe/herman s sx With Warning Sx: Epistaxis, gum bleed Hematemesis, Rumpel Leede-Test Tourniquet test Capillary rigidity PRESUMPTIVE BP=S+D/2 Inflate 5-children and 10-adults 1sq in.=20 formation Criteria: 6mos or older, fever for more than 3 days, no other signs of DHF Platelet Count CONFIRMATORY N:150,000-400,000 mm3 Below 150K Symptomatic Fluids to maintain concentration of the blood and intravascular vol (200mL/hr) Coagulants Vit K (aquamephyton) NO protamine sulfateanti-coag effect Antipyreticno ASA Vit Ccapillary resistance Prevention and control of bleeding: - gentle nasal care (avoid picking, use cotton buds with NSS) Nose bleed - Position upright, lean forward and compress nose - Cold compress Vomiting of blood Eradicate Mosquito: 4S - Search and Destroy - Selfprotection - Stop AMD Fumigation - Seek early consultation

melena Hematochezia Severe DHF Evidence of circu failure Cold and clammy Cold extremities Prolonged capillary refill (hemoconcentrati on) Altered VS- dec BP, inc RR and PR (thready, weak) Dengue shock syndrome: hypovolemic shock (excessive blood loss from prolonged bleeding)

Hematocrit Determination Above 0.54 (54%)

- Keep NPO - Ice packs over epi region - Refer to MD Melena - Avoid dark colored food - Avoid red meatfor 3 daysoccult blood test Provide fluids Increase resistance Supportive

Malaria

Protoza - P. Falciparum: most deadly, multiplies rapidly, common in Phil - P. Oval - P. Vivax: common in Phil - P. Malariae

Vector Borne: Mosquito Bite (Anopheles Mosquito) BT, Needle prick Night biting Mountainous, forested (Palawan, Davao, Mt. Province, Ifugao, Cagayan Valley) Clear flowing water Capable of transferring to blood stream

CNS Respi: Cough, hemoptysis GI: N/V, Melena, Hematemesis GU: Oliguria, Anuria, Uremia, Black water fever Stages: Cold Stage- Shivering of body; 10-15mins Hot Stage- fever, Ham Abd pain, vomiting; 4-6h Wet Stage- profuse swearing with weakness Chills before fever rupturing of membranes Severe anemia Cerebral hypoxia (restless, confused, delirium, convulsions, loss of consciousness, coma) Black water feverdark urine bec of rapid destruction of RBC

Malarial Smear: extracted during fever (parasite in the blood) Quantitative Buffy Coat: rapid test, no need to wait

Antimalarial agents Artemether first line Chloroquine mainstay drug Quinine reserve drug Primaquine Atabrine Fansidar Antimalarial caution with pregnant abortifacient; untreated can cause severe anemia to baby No permanent immunity Remission and exacerbation for 3-5 yrs

Cold stage - Keep warm: blankets, warm drink, drop light, hot water on soles of feet Hot Stage - Lower temp: cold compress, provide fluids, light loose clothing, If with neuro symptoms do not inc. fluid intake Wet Stage - Keep comfy, warm and dry, fluids for dehydration

Eradication of mosquitoes

INTEGUMENTARY
Leprosy Hansens disease Hansenosis Mycobacterium Lebrae Prolonged Intimate Skin contactbacteria in skin lesion Dropletconc. In respi tract 5.5months 8yrs
Cardinal Sx: Peripheral nerve enlargement Loss of sensation on affected partloss of hair, anhydrosis (absent sweating) (+) skin smear mycobacterium leprae 2 types based on lesions PaucibacillaryGood Prog 1-5 skin patches or nodules Non-infectious type Tuberculoid, Benign Mild manifestations Multibacillary Lepromatous type Infectious >5 lesions Severe manifestations Changes of recovery but with complications Early sign: skin changes Color changedoes not disappear with tx Skin lesions that wont heal Late Signs Lagopthalmus- cant close eyelids Madarosis- loss of brows and lashes Saddle nose deformitysinking of bridge of nose, absorption of small bones Natural amputation Leonine face- lion Contracturesclaw fingers and toes Chronic skin ulcers Gynecomastia Active, neglected nodolous, lepromatous

Skin smear test Skin lesion biosy Lepromin testpauci or multi Wassermann reaction testblood exam Pregnancywait for delivery before tx Dapsone: single drug, many with resistance Multiple Drug Therapy: prevent resistance, hasten recovery, lessen period of communicability 2 approaches Pauci: 6-9mos, rifampicin 1x a month, dapsone 1x a day Multi: 1218months, rifampicin 1x a mo, dapsone and lamprene 1x a day (hyperpigment skin) Pscyh aspect Skin care prevent skin infection Provide physical exercise strengthen muscle and prevent contracture Provide adequate drug info Immunization BCG Avoid MOT

leprosy lesions on face

Measles Rubeoloa

Paranyxovirus (Rubeola Virus)

Airborne Communicable: 4 days before appearance of rash 5 days after appearance of rash

German Measles Rubella

Psydoparamyxo virus (Toga/Rubella Virus)

Direct (Droplet)

Stages Pre-eruptive High fever 3-4days Cough, Coryza (colds), conjunctivitis Photosensitivity Kopliks spots (hallmark) fine red spots with bluish gray spots at center, within inner cheek Eruptive Maculo-papular rash (reddish, blotch; cephalocaudal, starts behind earsface necktrunkextremities) rd 3 day of illness 2-3days whole body coeAHvered with rashes Post-eruptive Rashes start to disappear from ears Fine barry desquamination (brown first, rashes peel not skin); Road to recovery Pre-eruptive Absent fever 1-2days Cough, Colds Forscheimers spots: enanthem, fine red spots, petechial on soft palate Eruptive Rash formation; maculopapularpinkish, discrete, finer and smaller than measles Cephalocaudalface first 24hrscompletely covered Enlargement of lymph nodesdifferentiating

Clinical observation

Symptomatic Mx

Symptomatic/supportive Prevent acquiring secondary infection Prevent patients exposure to draft pulmonary complication Keep warm and dry

Permanent immunity Immunization: AMVat 9 mos., 0.5ccIMm may have fever, mild rash after 3-4days MMRat 1215mos, 0.5ccSQ, can be given to adults (no pregnancy for 3mos) Epidemic- give immunization at 6mos but revaccinate at 15mos Proper disposal of nasopharyngeal secretions

Clinical observation

Same as measles

Same as Measles

Same as Measles

Chicken Pox Varicella

Varicella-zoster virus

Airborne (nasopharyngeal secretions, secretions of rashes)

Herpes Zoster Shingles Zona

Varicella-zoster virus

Direct (Droplet) Acute posterior ganglionitis: posterior nerve roots affected Dormant chx pox Inactive chx pox Cant have

factor, sub-occipital, posterior auricular, posterior cervical Post-eruptive rd Rash disappears3 day of illness Enlarged lymph nodes gradually subside Pre-eruptive Presence or absence of low grade fever HA, body malaise, muscle pain 1-2days Eruptive Vesiculo-pustular rashes Macule, papule, vesicle, pustule Take a bath daily (tepid) Might develop boilscarbuncle cellulitisgangrene Rupture scar (Pock Marks) Generalized distribution first on the covered part of body (trunk, scalp) Unifocular appearance one at a time, never fuses Post-eruptive Crusts (dry), falls off (peels off) Vesiculo-papular rash Painful-persists for 2 mos after recovery Unilateral distribution follows nerve pathway Appears in cluster

Clinical observation

Symptomatic Anti-viral agents (acyclovirZovirax) Antipuritic agentsantihistamin, calamine lotion

Skin care Increase body resistanceadequate rest and nutrition

Communicable until all have dried Immunization (Viravax): at 1218mos, 0.5ccSQ, may have feverm may have rash 3-4days afterm below 13 single dose, above 13 2 doses with 1mo interval Same as measles

Clinical observation

Symptomatic May be given analgesics

Symptomatic

Temporary immunity

without chx pox

RESPIRATORY
Diptheria Corynebacterium dipheriae (Klebsloeffler baccilus) Direct (Droplet)

Pertusis Whooping cough Chin cough

Bordatella Pertussis Hemophilus pertussis

Direct (Droplet)-<6yrs of age

710 days

Irritating nasal discharge serosanguinous, foul smell - Sore throat, dysphagia - Bull-neck appearance neck edema, anterior aspect of neck, inflammation of cervical lymph node - Hoarseness, loss of voice (temporary) - Coughing (barking, croupy) - (+)pseudomembrane grayish white appearance, characteristic sign, found on nasal septum, uvula, soft-palate, tonsils, pharyngeal - Myocarditis:marked facial pallor, very irregular PR, Hypotension, chest pain, epigastric pain Catarrhal stage Highly communicable Lasts 1 wk Colds, fever, nocturnal coughing, tiredness and listlessness Paroxysmal/spasmodic 5-10 successive force of coughing that ends in a prolonged inspiratory phase or a whooptoo much pressure exerted Congested face Congested tongue (purple)

Nose and throat swabconfirms Schick test determine immunity and susceptibility Moloney test hypersensitivity to diphtheria toxin

Anti-deptheria serumneutralize toxin Antibioticpenicillinkill microorganism

CBR (prevents myocarditis) Maintain patent air way I: upright position, Inc fluids, Encourage DBCE, chesty physiotherapy, turn to side q2 to prevent pooling D: suction, inhalation therapy (O2, neb, steam), postural drainage Provide adequate nutria Provide comfort measures

Immunization Proper disposal of nasopharyngeal secretions Covering of the nose and mouth when sneezing or coughing Never kiss

Nasal swab during cararrhal stage Nasopharyngeal culture confirmatory test; bordet-gengou test; agar plate; cough plate

Antibiotic Antibodies pertussis Ig F&E replacement Codeine with mild sedation antitussive effect

Provide adequate rest to dec O2 demand Adequate nutrition with SAP (once coughing, withhold feeding, bottle feeding should have small hold, apply abd binders) No permanent immunity but second attacks are rare

Proper disposal of nasopharyngeal secretions Cover mouth and nose when coughing

Pneumonia

Virus: CMV, opportunistic microorganism Protozoa: Pneumocystis carnil pneumonia, OM Bacteria: Most common, CAP (strep pneumoniae) HAP: Staph aureus, Gram (-) (pseudomonas) Noxious substances: Lipid pneumonia (oilbased lubricants); Aspiration Pneumo Mycobacterium Tuberculosis hominisfrom humans

Direct (Droplet)

Teary red eyes with eyeball protusion Distended face and neck veins Involuntary micturition and defacation Abdominal hernia Chokes on mucus (vomiting) Convalescent No longer communicable Signs and symptoms start to subside Cardinal Sx: Feverm shaking chills/rigor, productive cough Sputum production rusty colored (CAP), Creamy yellow (Staph), Currant Jelly (Klebsiella), Greenish (Pseudomonas), Clear (None) Chest pain/pleuritic pain: friction between pleural layers, apply chest binders, splint chest wall, turn to affected side Fast breathing, chest indrawing (subcoastal retraction), stridor, wheezes

Chest x-ray (definitive, lung consolidations, patchy infiltrates) Sputum exam (first thing in the morning, 5-10mL, DBCE- breathe through nose and release through pursed lips; after 3 th DB, cough on 4 , put tongue behind lower teeth)

Antibiotic Inhalation therapy Expectorants Atitusives

Maintain patent airway Provide adequate rest Provide nutrition Provide comfort

Immunization Proper disposal of secretions

Tuberculosis Kochs infection

Airborne

1 wk 2mos

Asymptomatic Low grade feverm night sweats, anorexia, weight loss, fatigability, body malaise, chest and back

Tuberculin test Screening only (+) if with TB exposure Consistently (+)-

Rifampicin: hepatotoxic, orange secretions Isoniazid: hepatotoxic, avoid

Provide adequate rest: do activities gradually, provide adequate nutrition (SFF, high cal), drug

Immunization (BCG)ID, Right deltoid, 0.05cc abscessformation on site of

Bovis- TB of cattlesfrom contaminated milk Avis- TB of birds pet owners, mycobacterium Avium Complex

pain, productive cough, hemoptysis (erosion of lung capillaries, no CPT), dyspnea

may have developed sensitivity to microorganism Purified protein derivative (PPD) After 48-72h (+) >10mm if with HIV >5mm (+) Mantoux test Tine test/multipuncture test Vollmer and Pirquet (skin scratch/patch) X-ray - Extent of disease - Minimal, moderately advanced, far advanced TB Blood examconfirms Blood culturefirst wk of infection Widal test Presence of antigen left by microorganism Antigen Osomatic antigen H- flagellar antigenpreviously exposed to TF or had immunization Typhidot Presence of antibodies

alcohol, monitor liver enzymes, peripheral neuritis, Give B6 (Pyrodoxine) Pyrazinamide: hyperurecemia, alkalinize urine Ethambutol: optic neuritis, sx of visual disturbance, color blindness Streptomycin: nephrotoxic, ototoxic

compliance

injection (longer than 3 mos indolent abscess; kochs phenomenon) Prophylaxis (INH)- 6 months; children-9mos; immunocom12months

GASTROINTESTINAL
Typhoid Enteric Fever Salmonella typhosa Fecal-oral 5Fs Feces, Fingers, Food, Flies, Fomites While on Blood stream - Fever, dull HA, abd pain, vomiting, diarrhea, constipation Peyers patches (target) - Ladder-like fever - Rose spotscharacter sign, small spots like petichate, trunk, face (child) - Splenomegaly Intestinal perforation peritonitis -

chloramphenicol antibiotic F&E replacement -

Maintain F&E, I&O, sx of dehydration (<48h, wt loss) Provide adequate nutrition: avoid fatty, spicy and irritating food, vomiting-SFF, Children on NPO initially to rest GI Give clear liquid to gen liquids to soft and full Provide comfort measures -

Gives temporary immunity Immunization Avoid sources: proper disposal of excreta, proper prep, storage and handling of food, eradicate flies, hand washing, dont put anything in mouth

IgM presently infected igG recovering

Leptospirosis

Leptospira (Spirochete)

Skin penetration Need not wounded Enters pores

2day 1mo (56days )

Flulike: fever, HA, Vomiting, muscle tenderness and pain (calf muscles) Jaundice with hemorrhage Orange eyes and skin Anuria Uremia kidney failure Mucoid stool, blood streakes if severe Endotoxin affects intestines Rice watery stools one after another Releases vibrio substance stimulate peristalsisdiarrhea Microorganism will not destroy intestinal wall, only stimulate Rapid dehydration Washer womans hands (dry and wrinkled, poor skin turgor) Walten Bed (hole and pale underneath) Stool with fishy odor Mucopurulent blood streaked stool Trophozoites dissolves intestinal tieeues mucus, pus in blood

Leptospira agglutination test (LAT) Leptospira Antigenantibody test (LAAT) Microscopic Agglutination Test (MAT) Stool exam submitted fresh (trophozites for 30mins only, after 30 stool cyst) Stool exam submitted fresh (trophozites for 30mins only, after 30 stool cyst)

Antibiotic Tetracycline

Symptomatic/ supportive Monitor UOconsistency, frequency, amt

Eradicate rates: poison, envt sanitation

DYSENTRY Bacillary Shigellosis Bloddy Flux Violent Cholera Eltor

Shigella Dysenteriae Flexneri Boydii Sonnei Vibrio cholera Comma shaped Ogawa Inaba Eltor

Fecal-oral

Antibiotic (Cotrimoxazole) ORT Antibiotic (tetracycline) IVT

Same with Typhoid

Same with Typhoid

Fecal oral

Same with Typhoid

Same with Typhoid

Amebic Amebiasis

Inactive (Cyst) Active (Trophozoites)

Fecal oral

Stool exam submitted fresh (trophozites for 30mins only, after 30 stool cyst)

Anti-amebic (metronidazole) ORT Chloroquine (antiprotozoan)

Same with typhoid

Same with typhoid

HEPATITIS

A - Infectious hepatitis

Alcoholism Drug intoxication Chemical intoxication (arsenic) Microorganism, viral hepatitis, liver is directly affectedcommunicable Hepatitis A Virus (RNA)

Fecal-oral

2wks6mos

B Serum Hepatitis

Hepatitis B Virus (DNA)

C Post transfusio n hepatitis D Dormant HepB Cannot have D without B E G Hepatitis D Virus/Delta virus

Parenteral; oral to oral (6-8gal of saliva), sexual contact, verticalchild birth, blood and other fluids Parenteral

6wks6mos

5-12 wks

Parenteral

3-13 wks

Hepatitis E Hepatitis G Virus

Fecal-oral Parenteral

3-6wks Unknown

Pre-icteric Before Jaundice Arises Fever RUQ pain Wt. loss and malaise liver unable to convert glucose to glycogen Anorexia, n/vliver cant deaminase Anemiadecreased lifespan of RBC (<120d) Icteric Jaundice: inability of the liver to remove normal amt of bilirubin goes to sweat bile salts on skin pruritus Tea-colored urine Excess bilirubin thrown out by kidney into urine Acholic stoolclay color Pre-icteric symptoms but less degree Post-icteric Jaundice disappers s/sx subside inc energy 3-4mos liver regeneration Avoid alcohol and OTC

Liver enzyme test Determine extent of liver damage ALT- Alanine aminotransferase-#1 indicator of CHON AST- Aspartate aminotransferase inc upon onset of jaundice ALP- Alkaline phosphateinc with obstructive hepa; tumor or bile stones obstructing biliary tree GGT- Gamma Glutamyl Transferasetoxic hepa: alcohol, meds, chemical LDG- Lactic dehydrogenase liver damage Serum AntigenAntibody Test Hepa A: HAgAB (-)Anti-HBS= infected (+) both carrier

Symptomatic Hepatic protector: phospholipids, vitamins and mineralsallows to relax but not tx, essentiale, silimarin, Jetipar (kids) Carriers and Chronic Hep B (antiviral): Larnivodine table OD x 1yr Immune stimulant: interferon 2-3x a week for 3 mos

Provide adequate rest dec. metab

liver relax Nutrition: Low Fat (not enough bile), Hi CHO (spare protein metab to prevent Ammonia formationhepati c enceph) Butterball diet prevent protein breakdown, any hard candy CHON- modify based on condition; infectedmoderate, recovering high, complications- low

No permanent immunity Immunization: (-) antigen and antibody; at birth 3 doses 0.5ccIM; st nd 1 at birth, 2 at th rd 2-6 wk, 3 at 3th 14 week; if BW is <2kg, extra dose th on 10 wk Avoid MOT

meds for 1 yr

SEXUALLY

TRANSMITTED
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INFECTIONS

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