DYSENTERY

By :
Anggrainy Intan Kusuma Putri 11310445
Selvi Wardati Rahima

11310436

Mega Vera Yuris Kurnia

11310209

Neneng Sari

11310253

LANGUAGE CENTRE OF MALAHAYATI UNIVERSITY

BANDAR LAMPUNG
2014

1. CASE
The mother of a 12-month-old male infant calls you at midnight stating that her
son has been cryin incessantly for the last 6 hour ago. His bouts of crying for
about 20 minutes. Then completely disappear for 15 minutes at a time. Since
early afternoon the child has not been eating much and he has started to vomit
the small amounts of juice and milk he had ingested. She decided to call you
because the vomitus is now green and the bouts of crying seem to be getting
worse. In the emergency room, you recall that the patient does not have any pas
medical history, was born at term without complications, and is up to date on
immunizations. On examination his temperature is 100 F, his respiration rate is
40 breaths per minute. His pulse is 15 bpm, his blood pressure is 109/60 mmHg,
and his weight is 22 lb. He cries inconsolably for 15 minutes, drawing his legs
up to his chest, then becomes quite. You notice he still produces tears and his
mucosae are moist. Heart and lung examintaions are normal, abdominal
examination reveals markedly dfecreased bowel sounds with generalized
tenderness to palpation. You feel a sausagelike mass in the right side of the
abdomen. His diaper holds some amount of bloody stool mixed with mucus.
The rest of the examination is normal

2.

KEYWORD
A 12-month-old male infant
Crying incessantly for the last 6 hours
Has not been eating much
Vomit the small amounts of juice and milk
Vomitus is now green
Crying seem to be getting worse
On examination:
T: 1000 F ( 37,20C)
Hr: 155 beats/min
BP: 109/60 mmHg
R: 40 breaths/min

3. PROBLEM
The vomitus of infant is green and the bouts of crying seem to be getting
worse
4. Differential Diagnostic
Difteri
Diarrhea
5. HYPOTHESIS
The vomitus of infant is green and the bouts of crying seem to be getting
worse because of Dysentery

6. Definition / Theories
Dysentery is a general term for a group of gastrointestinal disorders
characterized by inflammation of the intestines, particularly the colon.
Characteristic features include abdominal pain and cramps, straining at stool
(tenesmus), and frequent passage of watery diarrhea or stools containing blood
and mucus. The English word dysentery comes from two Greek words meaning
"ill" or "bad" and "intestine."
It should be noted that some doctors use the word "dysentery" to refer only
to the first two major types of dysentery discussed below, while others use the
term in a broader sense. For example, some doctors speak of schistosomiasis, a
disease caused by a parasitic worm, as bilharzial dysentery, while others refer to
acute diarrhea caused by viruses as viral dysentery.

7. Discussion
7.1Clinical Manifestation
Bacillary dysentery. The symptoms of shigellosis may range from the
classical bloody diarrhea and tenesmus characteristic of dysentery to
the passage of nonbloody diarrhea that resembles the loose stools
caused by other intestinal disorders. The high feverassociated with
shigellosis begins within one to three days after exposure to the
organism. The patient may also have pain in the rectum as well as
abdominal cramping. The acute symptoms last for three to seven days,
occasionally for as long as a month. Bacillary dysentery may lead to
two potentially fatal complications outside the digestive
tract: bacteremia (bacteria in the bloodstream), which is most likely to
occur in malnourished children; and hemolytic uremic syndrome, a
type of kidney failure that has a mortality rate above 50 percent.

Amebic dysentery. Amebic dysentery often has a slow and gradual

onset; most patients with amebiasis visit the doctor after several weeks
of diarrhea and bloody stools. Fever is unusual with amebiasis unless
the patient has developed a liver abscess as a complication of the
infection. The most serious complication of amebic dysentery,
however, is fulminant or necrotizing colitis, which is a severe

inflammation of the colon characterized by dehydration, severe

abdominal pain, and the risk of perforation (rupture) of the colon.
7.2Causes
Dysentery can have a number of causes. Bacterial infections are by
far the most common causes of dysentery. These infections include
shigella, Campylobacter, E.coli, and Salmonella species of
bacteria. The frequency of each pathogen varies considerably in
different regions of the world. For example, shigellosis is most
common in latin America while Campylobacter is the dominant
bacteria in Southeast Asia. Dysentery is rarely caused by chemical
irritants or by intestinal worms.
Intestinal amoebiasis is caused by a protozoan parasite, Entamoeba
histolytica. The amoeba can exist for long periods of time in the
large bowel ( colon ). In the vast majority of cases, amoebiasis
causes no symptoms only 10 % of infected individuals become
ill. It is uncommon expect in the worlds tropical zones, where it is
very prevalent. People can become infected after ingesting feces
that contain somebodys excreted parasites. People are at high risk
of acquiring the parasite through food and water if the water for
hosehold use isnt separated from waste water. The parasites can
also enter through the mouth when hands are washed in
contaminated water. If people neglect to wash properly before
preparing food, the food may become contaminated. Fruits and
vegetables can be contaminated if wahed in polluted water or
grown in soil fertilized by human waste.
7.3High Risk Occupations
Food handlers whose work involves touching unwrapped
foods to be consumed raw or without further cooking.
Healthcare, nursery or other staff who have direct contact, or
contact through serving food, high susceptible patients or
persons, in whom an intestinal infection would have
particularly serious consequences.
7.4Investigation

The physical examination in the primary care doctor's office will

not usually allow the doctor to determine the specific parasite or other
disease agent that is causing the bloody diarrhea and other symptoms of
dysentery, although the presence or absence of fever may help to narrow
the diagnostic possibilities. The patient's age and history are usually
better sources of information. The doctor may ask about such matters as
the household water supply and food preparation habits, recent contact
with or employment in a nursing home or day care center, recent visits to
tropical countries, and similar questions. The doctor will also need to
know when the patient first noticed the symptoms.
The doctor will also evaluate the patient for signs of dehydration
resulting from the loss of fluid through the intestines. Fatigue,
drowsiness, dryness of the mucous membranes lining the mouth, low
blood pressure, loss of normal skin tone, and rapid heartbeat (above 100
beats per minute) may indicate that the patient is dehydrated.

7.5Laboratory tests
The most common laboratory test to determine the cause of
dysentery is a stool sample. The patient should be asked to avoid using
over-the-counter antacids or antidiarrheal medications until the sample
has been collected, as these preparations can interfere with the test
results. The organisms that cause cryptosporidiosis, bacillary dysentery,
amebic dysentery, and giardiasis can be seen under the microscope, as
can the eggs produced by parasitic worms. In some cases repeated stool
samples, a sample of mucus from the intestinal lining obtained through a
proctoscope, or a tissue sample from the patient's colon may be necessary
to confirm the diagnosis. Antigen testing of a stool sample can be used to
diagnose a rotavirus infection as well as parasitic worm infestations.
The doctor will also usually order a blood test to evaluate the
electrolyte levels in the patient's blood in order to assess the need for
rehydration.

7.5.1 Imaging studies

Imaging studies (usually CT scans, x rays, or ultrasound) may be
performed in patients with amebic dysentery to determine whether the

lungs or liver have been affected. They may also be used to diagnose
schistosomiasis, as the eggs produced by the worms will show up on
ultrasound or MRI studies of the liver, intestinal wall, or bladder.
7.6MAKING THE DIAGNOSIS
If a doctor suspects dysentery, a stool sample usually will be
required for analysis. For bacterial infections such as shigella, the
diagnosis is made by culture of the stool. Unfortunately, such cultures are
not available in most developing countries and the diagnosis is made
clinically on the basis of symptoms. Amoebiasis is often diagnosed by
finding parasites under a microscope. An antibody blood test helps to
confirm the diagnosis of amoebic dysentery or liver abscess.

7.7TREATMENT OF DYSENTERY
Bacillary dysentery. Dysentery caused by Shigella is usually treated
with such antibiotics as trimethoprim-sulfamethoxazole1mg/kgBB
AC(Bactrim, Septra), nalidixic acid 2 mg/kgBBPC(NegGram), or
ciprofloxacin 1mg/kgBB PC(Cipro, Ciloxan). Because the various
species of Shigella are becoming resistant to these drugs, however, the
doctor may prescribe one of the newer drugs described below. Patients
with bacillary dysentery should not be given antidiarrheal medications,
including loperamide1,5 mg/kgBB DC (Imodium), paregoric, and
diphenolate (Lomotil), because they may make the illness worse.

Amebic dysentery. The most common drugs given for amebiasis are
diloxanidefuroate1.2 mg/ kgBB AC (Diloxide), iodoquinol1,5
mg/kgBB AC(Diquinol, Yodoxin), and metronidazole 1mg/kgBB
AC(Flagyl). Metronidazole should not be given to pregnant women but
paromomycin1,3 mg/kgBB PC (Humatin) may be used instead.
Patients with very severe symptoms may be given emetine
dihydrochloride or dehydroemetine, but these drugs should be stopped
once the patient's symptoms are controlled.
Dysentery caused by other protozoa. Balantidiasis, giardiasis, and
cryptosporidiosis are treated with the same drugs as amebic dysentery;

patients with giardiasis resistant to treatment may be given

albendazole1,2 mg/kgBB AC (Zentel) or furazolidone 1 mg/kgBB AC
(Furoxone).

Viral dysentery. The primary concern in treating viral dysentery,

particularly in small children, is to prevent dehydration. Antinausea
and antidiarrhea medications should not be given to small children.
Probiotics, including Lactobacillus casei and Saccharomyces boulardii,
have been shown to reduce the duration and severity of viral diarrhea
in small children by 30-70 percent.

Dysentery caused by parasitic worms. Whipworm infestations are

usually treated with anthelminthic medications, most commonly
mebendazole1 mg/kgBB AC (Vermox). Schistosomiasis may be treated
with praziquantel2 mg/kgBB PC (Biltricide), metrifonate 1
mg/kgBBPC(Trichlorfon), or oxamniquine1,5 mg/kgBB PC,
depending on the species causing the infestation.
Newer drugs that have been developed to treat dysentery include
tinidazole1.5 mg/kgBB PC (Tindamax, Fasigyn), an antiprotozoal drug
approved by the Food and Drug Administration (FDA) in 2004 to treat
giardiasis and amebiasis in adults and children over the age of three years. This
drug should not be given to women in the first three months of pregnancy. In
addition, adults taking tinidazole should not drink alcoholic beverages while
using it, or for three days after the end of treatment. The other new drug is
nitazoxanide (Alinia), another antiprotozoal medication that has the advantage
of lacking the bitter taste of metronidazole and tinidazole 2 mg/kgBB PC oral.
Fluid replacement is given if the patient has shown signs of dehydration.
The most common treatment is an oral rehydration fluid containing a precise
amount of salt and a smaller amount of sugar to replace electrolytes 40 bits
/minute parentral IV, as well as water lost through the intestines. Infalyte and
Pedialyte30 bits / minutes parentralIV,are oral rehydration fluids formulated for
the special replacement needs of infants and young children.

8. CONCLUSION
Dysentery is a general term for a group of gastrointestinal disorders
characterized by inflammation of the intestines, particularly the colon. If
a doctor suspects dysentery, a stool sample usually will be required for
analysis.

9. REFERENCE
Cummings, Stephen, MD, and Dana Ullman, MPH. Everybody's Guide to
Homeopathic Medicines, revised and expanded. New York: Jeremy P. Tarcher,
1991.
"Enterobacteriaceae Infections." Section 13, Chapter 161 in The Merck
Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert
Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
"Intestinal Protozoa." Section 13, Chapter 161 in The Merck Manual of
Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow,
MD. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Pelletier, Kenneth R., MD. The Best Alternative Medicine. New York: Simon
& Schuster, 2002.
Reid, Daniel P. Chinese Herbal Medicine. Boston: Shambhala, 1993.