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Typhoid
 

Typhoid

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This presentation is made by Dr Ashok Jaisingani for study purpose, if any one like this than please give comments.

This presentation is made by Dr Ashok Jaisingani for study purpose, if any one like this than please give comments.

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    Typhoid Typhoid Presentation Transcript

    • TyphoidDr. Ashok Jaisingani
    • Introduction► Typhoid fever is caused by gram –ve organism salmonella typhi also called as typhoid bacillus.► Most common in developing countries in tropics► Poor hygiene and inadequate sanitary condition attributed to entry of organism into GIT.► Surgical importance of disease is because of perforation of typhoid ulcer.
    • Pathology► Organisms enter into GIT through ingestion of contaminated foods and water.► In GIT organism colonize the peyer’s patches of terminal ileum causing the hyperplasia of lymphoid follicles followed by necrosis and ulceration► Microscopic picture show erythrophagocytosis with histiocytes proliferation► Ulcer may lead to perforation or bleeding if pt left untreated or inadequately treated.► Bowl may perforate several sites including large bowl also.
    • Clinical Features & Diagnosis► The patient present in or has recently visited an endemic areas has persistent high temperature for 2 – 3 weeks.► The pt may be toxic with abdominal distension from paralytic ileus.► Pt may have melena due to hemorrhage from typhoid ulcer, can lead to hypovolemia► Positive blood & stool culture confirm the nature of infection and exclude malaria.► Widal test also used to detect the presence of agglutinins to O & H antigens of salmonella typhi► After second week signs of peritonitis usually denote perforation confirmed by presence of free gas seen on x- ray.
    • Other Test To detect specific & sensitive marker of typhoid fever► Practical and cheep kits are available for rapid detection need no special expertise or equipment are 1- Multi-Test Dip-S-Ticks to detect IgG 2- Tubex to detect IgM 3- TyphiDot to detect IgG & IgM► These tests are particularly valuable when blood culture are negative (due to self medication or pre-hospital treatment with antibiotics).► These test mostly used when facilities for other test not available.
    • Treatment► Resuscitate with IV fluid and antibiotics in ICU to stabilize patient condition.► Cephalosporin, metronidazole & gentamicin are used in combination.► Despite of potential side effects such as aplastic anemia of chloramphenical is still used in developing countries.► Laprotomy then carried out.
    • Surgery► Commonest site of perforation is terminal ileum► Most appropriate surgical option depend upon general condition of the patients, the site of perforation, number of perforation & degree of peritoneal soiling.► Closure of perforation after freshening the edges, wedges resection of ulcer area and closure,► Resection of bowl area with or without anastomosis► Closure of perforation and side-to-side anastomosis► Iliostomy or colostomy where the perforated bowl is exteriorised after refashioning the edges► After closing of ilial perforating area, surgeon should also look for other sites of perforation or necrotic patches► Peritoneal lavage is essential, peritoneum should be closed and wound should be open for delayed primary or secondary intention.