GastroIntestinal / GastroenterologyDysentery

[ Bacterial ]

Dysentery is an intestinal inflammation, especially in the colon, that can lead to

severe diarrhea with mucus or blood in the feces.

Patients typically experience mild to severe abdominal pain or stomach cramps. In some
cases, untreated dysentery can be life-threatening, especially if the infected person
cannot replace lost fluids fast enough.

When people in industrialized nations have dysentery, signs and symptoms tend to be
mild. Many won't even see their doctor, and the problem resolves in a few days. Even
so, if a doctor in Western Europe, North America and many other countries comes
across a case of dysentery, local authorities need to be told - it is a notifiable disease
 Symptoms of dysentery

A symptom is something the patient feels and reports, while a sign is something other people,
such as the doctor notice. For example, pain may be a symptom while a rash may be a sign.

Abdominal pain, diarrhea and fatigue are possible symptoms of dysentery.

In developed countries signs and symptoms of dysentery tend to be much milder than in
developing nations or tropical areas. Patients with mild symptoms will have a slight stomach
ache (cramping), and will frequently go to the toilet because of diarrhea.

Symptoms usually appear from one to three days after the person has become infected - this is
called the incubation period. In most cases the patient recovers completely within a week. How
often the individual goes to the toilet and has mucus or blood in feces usually depend on what is
causing the disease.

In some cases people who get dysentery also develop lactose intolerance, which can take a
long time to go away, sometimes even years.

Symptoms of amoebic dysentery include:

 abdominal pain

 fever and chills

 nausea and vomiting

 watery diarrhea, which can contain blood, mucus or pus

 painful passing of stools

 fatigue

 intermittent constipation.

The amoeba can tunnel through the intestinal wall and spread into the bloodstream and infect
other organs; ulcers can develop, these ulcers may bleed, causing blood in stools.

In some cases symptoms may persist for several weeks, but usually only last a few days. The
amoebas may continue living within the host (the human) even after symptoms have gone,
increasing the likelihood of a recurrence when the person's defenses are down. The amoebas
are less likely to survive if the patient receives treatment.

Signs and symptoms of bacillary dysentery - as in other types, symptoms tend to appear
from one to three days after the person has been infected. Most typically, there is just mild
stomachache and diarrhea, and no blood or mucus in the feces. For many, symptoms are so
mild they do not even bother going to the doctor, and the problem resolves in a few days.
Initially, the infected person goes to the toilet frequently with diarrhea.

Although much less common, some people with bacillary dysentery may have blood or mucus in
their feces, abdominal pain may be intense, there may be an elevated body temperature (fever),
nausea and vomiting.

Diagnosis of dysentery

The doctor, initially usually a GP (general practitioner, primary care physician) will ask the
patient about symptoms and carry out a physical examination. A stool sample may be ordered,
especially if the patient has been abroad in the tropics.

In rare cases, if symptoms are severe, other diagnostic tests may be recommended, such as
an ultrasound scan or an endoscopy.
 Treatments for dysentery

Rehydration therapy - initially this is done using oral rehydration; the patient is encouraged to
drink plenty of liquids. Diarrhea, as well as vomiting results in loss of fluids that have to be
replaced to prevent dehydration. If the diarrhea and/or vomiting is profuse the medical team
may recommend intravenous fluid replacement - the patient will be on a drip.

Antibiotics and amoebicidal drugs - experts say that if possible, the administration of
medications to kill the cause of the dysentery should be held back until lab tests determine
whether the illness is being caused by a bacterium or amoeba. If this is not possible, depending
on the severity of symptoms, the patient may be given a combinations of antibiotic and
amoebicidal medication.

If symptoms are not severe and the doctor determines it is Bacillary dysentery (Shigella), the
patient most likely will receive no medication - in the vast majority of cases the illness will
resolve within a week. Oral rehydration is important.

If amoebic dysentery is diagnosed the patient will probably start with a 10-day course of an
antimicrobial medication, such as Flagyl (metronidazole). Diloxanide furoate, paromomycin
(Humatin), or iodoquinol (Yodoxin) may also be prescribed to make sure the amoeba does not
survive inside the body after symptoms have gone.

Antirheumatic drug Ridaura (auranofin) may offer a cheap, low-dose treatment for the
amoebic infections that cause dysentery in humans globally. The drug has only been tested in
the laboratory and in animal studies, researchers from the University of California in San Diego
and the University of California in San Francisco reported in Nature Medicine (May 2012 issue).

Prof. James McKerrow and team had been screening already approved medications to see
whether any of them could be used in the developing world when they made their discovery.

Prof McKerrow said "When we're looking for new treatments for the developing world, we start
with drugs that have already been approved."
They found that auranofin, which is already FDA-approved for the treatment of arthritis,
was ten times more potent than metronidazole against the parasite Entamoeba
histolytica.

According to the researchers, the combination of an off-patent medication plus many years of
clinical safety data means we may well have a worldwide lower-cost solution, with fewer side
effects or risk of drug resistance than the therapies currently available.

Complications of dysentery

Dehydration - diarrhea and vomiting can quickly lead to dehydration. This can happen
especially quickly with infants and young children. Dehydration can be life-threatening.

Liver abscess - if the amoeba spreads to the liver.

Prevention of dysentery

In most cases, dysentery is caused by poor hygiene. Individuals can take measures to reduce
their risk of infection by regularly washing their hands, especially before and after going to the
toilet and preparing food.

If you are in an area where the risk of dysentery is higher, only drink water from reliable sources
(bottled water). If you drink from the bottle, make sure it is opened in front of you and clean the
top of the rim. Make sure the food you eat is thoroughly cooked and beware of ice cubes; you
may not know what type of water was used to make them. Use purified water to clean your
teeth.
 Nursing Management
Assessment

1. Identity

Noteworthy is the age. Episodes of diarrhea occurred in the first 2 years of life. Highest incidence is
the age group 6-11 months. Most bacteria stimulate gut immunity against infection, it helps explain
the decline insidence disease in older children. At the age of 2 years or more of active immunity
begins to form. Most cases are due to an intestinal infection and asymptomatic enteric bacteria
spread mainly clients are not aware of the infection. Economic status also influential, especially from
the diet and treatment.

2. Main complaint
Defecation is more than 3 x

3. History of present illness

Defecation greenish yellow color, mixed with mucus and blood or mucus alone. Watery consistency,
frequency is more than 3 times, spending time : 3-5 days (acute diarrhea), more than 7 days
(prolonged diarrhea), more than 14 days (chronic diarrhea).

4. Past medical history

Never had diarrhea before, to those on long-term antibiotics or corticosteroids (candida albicans
changes from saprophyte to parasite), food allergies, respiratory infections, UTI, OMA measles .

5. History of Nutrition
At toddler age children are given food as in adults, the portion given 3 times per day with additional
fruit and milk. Malnutrition in toddler age children are particularly vulnerable. Way better food
management, food hygiene and sanitation, hand-washing habits.

6. Family health history

There is one family that has diarrhea.

7. Environmental Health History

Food storage at room temperature, lacking hygiene, neighborhood .

8. Growth and development history

a. growth

 Weight gain since age 1 -3 years ranged between 1.5-2.5 kg (average of 2 kg), a body length
of 6-10 cm (mean 8 cm) per year.
 The increase in head circumference: 12cm 2 cm in the first year and second year and so on.
 Teething 8 pieces: additional milk teeth; first molars and canines, totaling 14-16 pieces
 Eruption of teeth: molars perama menusul canines.
b. development

 Psychosexual stages of development according to Sigmund Freud.