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XI. PATHOPHYSIOLOGY

Medical Diagnosis

T/C Dengue Hemorrhagic Fever/ Pleural Effusion, T/C Liver Pathology

Definition

Dengue Hemorrhagic Fever - is a severe, potentially deadly infection spread by certain species of mosquitoes (Aedes aegypti).

Pleural Effusion - is excess fluid that accumulates in the pleural cavity, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair
breathing by limiting the expansion of the lungs during inhalation.

Liver Pathology – a condition characterized by any liver diseases or condition

Schematic Diagram
Precipitating
Environmental conditions (open spaces with water
Predisposing pots, and plants)
Geographical area – tropical islands in the Immunocompromise
Pacific (Philippines) and Asia Mosquito carrying dengue virus
Soldier
Sweaty skin

Aedes aegypti (dengue virus carrier): 8-12 days of viral

replication on mosquitos’ salivary glands

Bite from mosquito (Portal of Entry in the Skin) Redness & itchiness in the area

Allowing dengue virus to be inoculated towards the circulation/blood

(Incubation Period: 3-14 days)
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Diagnostic:
Virus disseminated rapidly into the blood and Hematology :
stimulates WBCs including B lymphocytes that Increased WBC:
produces and secretes immunoglobulins (antibodies), 12,900/cumm
and monocytes/macrophges, neutrophils (5,000- 10,000/cumm)
Diagnostic: Increased Lymphocytes: 49%
Hematology : (20-40%)
Decreased
Monocytes: 4%(8- Antibodies attach to the viral antigens, and
14%) then monocytes/macrophages will perform
Decreased phagocytosis through Fc receptor (FcR)
Neutrophils: within the cells and dengue virus replicates
49%(50-70%) Entry to the Entry to the bone
in the cells of monocytes/macrophages
spleen, and liver marrow

Recognition of dengue viral antigen on

infected monocyte by cytotoxic T cells

Release of cytokines which consist of vasoactive

agents such as interleukins, tumor necrosis
factor, urokinase and platelet activating factors
which stimulates WBCs and pyrogen release

Signs/ symptoms:
Febrile: 38.6C
Diaphoresis, warm skin, Dengue Fever
flushed; headache of 3/10 pain
scale; whitish spots; body
weakness

Diagnostic:
Ultrasound:
minimal hepatospleno
megaly
Blood Chemistry:
SGOT: 558.0 U/L(Up to Hepatosplenomegaly
46)
SGPT:433.3 U/L(Up to
Signs/ symptoms:
>Abdominal pain with
5/10 pain scale as
verbalized.
Signs/ symptoms:
Profuse non-productive
cough with white sputum
with blood spots noted;
shallow & rapid respirations
of 35cpm; crackles/rales
Diagnostic:
Ultrasound:
Conclusion:
Minimal bilateral pleural
effusion.
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Cellular direct destruction and infection of
red bone marrow precursor cells as well as
immunological shortened platelet survival Diagnostic:
causing platelet lyses Hematology :
Decreased Platelet:
68,000/cumm
(150,000-400,000)
Thrombocytopenia
Signs/ symptoms:
Red sclera in both
Dengue Hemorrhagic Fever eyes
Petechiae
Increase number and size of the pores
Signs/ symptoms:
in the capillaries which leads to a
+1 Bipedal edema;
leakage of fluid from the blood to the
weak bounding
interstitial fluid (capillary leakage) of pulse of 79bpm
the different organs and skin
Signs/ symptoms:
Abdominal distention with
Pleural effusion Ascites abdominal girth of 93cm
(36.6 inches); hypoactive
bowel sounds of 2/min
Diagnostic:
Ultrasound:
Conclusion:
Recovery Complications: Moderate ascites
Intense bleeding
Pulmonary Edema
Shock
Very low blood pressure
Liver cirrhosis
Death
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Legend:

- Pathophsiology

- Medications - Signs and symptoms

- Diagnostic exams - Complications

- Interventions - Early signs