DYSENTERY

dysentery

Ques : 1    What is Dysentery?

Ans :         Dysentery is an acute inflammation of the large intestine characterised by diarrhoea with blood and mucous in stools associated with tenesmus.

Ques : 2    Describe shigellosis or Acute Dysentery?

Ans :         Bacillary dysentery is caused by infection of the wall of the large gut by species of bacteria of the genus Shigella. There are four groups (Shigella) are recognized, viz.

  1. Boydii, and
  2. Sonnei, Incubation period – usually 1 to 7 days.
  3. Dysenteria (most virulent),
  4. Flexneri,

Pathology : There is a generalized inflammation of the large bowel, which sometimes involves the lower part of the small intestine. The mucosa is a red and swollen with layer of mucous; there are patchy hemorrhagic areas. Ulcers  can be  formed and the adjacent lymph nodes are enlarged.

Ques : 3    What are the symptoms of acute dysentery?

Ans :         Clinical Features : Acute onset.

Symptoms :

  1. Fever with prostration.
  2. Headache and muscular aching.
  3. Thirst & dryness of tongue, (7) Oliguria.
  4. Loose stools (small quantity) with blood, pus and mucous for numberless times.
  5. Colicky pain.

On Examination :

  1. Tenderness over the whole colon more easily elicited over the sigmoid part in the left iliac fossa.
  2. Signs of dehydration, e.g. dry tongue, inelastic skin, sunken eyes, toxic appearance, pulse shows tachycardia, low blood pressure, raised temperature.

Investigations :

  1. Urine – scanty, may be albuminuria.
  2. Stool-pinkish red or bloody. Mucous, fecal matter scanty or nil, alkaline in reaction, Culture shows causative organism.
  3. Blood shows leucocytosis.

Complications :

  1. Temporary disacchridase deficiency.
  2. Rectal prolapsed.
  3. Peripheral circulatory failure.
  4. Toxic carditis.
  5. Renal failure, hemolytic uremic syndrome.
  6. Peripheral neuritis, Guillain-Barre syndrome.
  7. Pneumonia, pleurisy.
  8. Toxic non-suppurative arthritis.
  9. Conjunctivitis and iritis.
  10. Electrolyte imbalance.
  11. Cutaneous hemorrhages.
  12. Severe hemorrhage and anemia.

Prognosis : It depends on the virulence of the organism, susceptibility and constitutions of the individual early diagnosis and proper treatment.

Ques : 4    What is the treatment of dysentery?   

Ans :         The treatment of dysentery are:-

Treatment :

  1. Plenty of fluids orally ; if dehydration is marked, 5% glucose in normal saline should be given intravenously.
  2. For severe colicky pain, atropine, or atropine substitutes may be given.
  3. In case of severe anemia as a result of bleeding, blood transfusion may be given.
  4. Homoeopathic remedies.
  5. Bed rest to prevent embarrassment and spread of infection.
  6. Semifluid low sausage diet.

Ques : 5    Which Homoeopathic medicines work well in dysentery?

Ans :         (1) NITRIC ACID – Stools profuse bloody, Before stool, drawing, colicky pain, During stool, tenesmus and spasmodic contraction of anus. Long-lasting pains after stool, very exhausting Spreading ulcers in mouth with fetid breath.

(2) MERC. COR.- Stools pure blood. Or bloody mucous; green, bilious, followed by slime tinged with blood. During stools, painful pressing straining and tenesmus. Severe paints in the rectum, continuing after the discharge Cutting pain in abdomen, mostly around umbilicus.

(3) NUX VOM.- Stools thin, bloody mucous; before stool, constant urging; backache. During stool, bloody mucous; before stool, constant urging: with desire to vomit. After stool, relief. Symptoms worse In morning.

(4) MERC. SOL. – Stools bloody mucous, or green slimy, excoriating. Before stool violent and frequent urging, violent tenesmus. Wants to remain a long time at chamber. Pinching and cutting colic profuse night sweats, worse at night.

Ques : 6    Which Biochemic medicines work in dysentery?

Ans :         Biochemic remedies –

(1) KALI PHOS. – When the stool consists of blood only, and the patient becomes delirious, abdomen swollen, or when stools have a putrid odor. Putrid, very offensive stools, and great dryness of the tongue. Tenesmus after stools.

(2) KALI MUR. – Intense pain in the abdomen, cutting as from knives, calls to stool every few minutes, with tenesmus, extorting cries, purging with slimy, sanious stools.

(3) FERRUM PHOS. – If dystentery begins with violent fever, if pain is dependent on inflammation making no intervals and increased by pressure.

(4) MAG. PHOS. – Crampy pains eased by bending double, by warmth, friction or pressure. Tenesms and tormina, with constant desire to pass water and go to stool. Pain in rectum with every stool as from a prolonged spasm of muscles.

Ques : 7    What is the difference between Amebic dysentery and Bacillary dysentery?

Ans :        

S.No.

Points

Amebic dysentery

Bacillary dysentery

(1)   

Organism :

Entameba histolytica.

Sh. Dysenteriae, Sh. Flexneryi, Sh. Boydii, Sh. Sonnei,

(2)          

Onset :

Less acute.

Very acute

(3)          

Fever & Chill

Usually absent.

Usually present.

(4)          

No. of stools :

Less frequent. (10-30)

More frequent. (50-100)

(5)          

Toxaemia :

Absent.

Present.

(6)          

Tenesmus :

Less.

More.

(7)          

Pain in abdomen:

Over caecum & pelvic

Diffuse.

(8)          

Anemia :

Absent.

Present.

(9)          

Dehydration :

Absent.

Present.

(10)        

B.P.

Normal.

May be low.

(11)        

Blood picture

Normal.

Leucocytosis with increased polymorphs.

(12)        

Stool :

Faecal mass-present, RBC few, pus cells scanty, organism vegetative form-present.

Faecal mass-absent,RBC, pus cells & bacteria plenty.

(13)        

Prognosis :

Good.

May be bad due to complications.

(14)        

Complication :

Less common.

More common.

(15)        

Treatment :

Antiamoebic drugs.

Antibiotics & chemotherapeutic agents.

 

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