Condition in which appendix become inflamed.

HOW TO IDENTIFY CLINICALLY

• Pain- Migratory pain (initial around umbilicus later in the right iliac foss)
• Vomiting
• Fever

CHARACTERESTIC FEATURES/ DIAGNOSTIC FEATURS

• Abdominal pain
• Swollen belly
• Constipation
• Diarrhea
• Inability to pass gas
• Loss of appetite
• Low grade fever
• Nausea and vomiting
• Tenderness & reborn tenderness in right iliac fossa.

LAB DIAGNOSIS

Gold test- contrastenhance computed tomography(CECT)

Initial test- abdominal X-ray, abdominal ultrasound,  MRI,  CT-scan, urine test,  blood test

WARNING SIGNS

• Peritonitis
• Abdominal guarding
• Painful abdomen
• Distended tenderness
• Reboud
• Absent bowl sound

INITIAL MANAGEMENT

• Nill by mouth
• Insertion of Rule’s tube if vomiting
• I.V. Fluids
• I.V. antibiotics- ofloxacin + metrogyl

DEFINITIVE MANAGEMENT

• If no appendicular mass-

SURGERY

• Laparoscopic appendectomy/ open appendectomy.

• If appendicular mass-

• Conservative management (NMB, IV Fluids,IV antibiotics)
• Following interval appendectomy after 6 months.

•    It is viral infection of nose & throat.

•    The term common cold refer as mild upper respiratory viral illness.

•    Usually lasts approximately for 7 days.

•    Cold caused by many viruses which is having similar symptoms. (Eg. Rhinovirus, coronavirus, adenovirus, echovirus, enterovirus)

TRANSMISSION

•    Direct contact- primary spread from person to person person to person through hands. If sick person shake someone’s hand and that percentage is eye, nose or mouth, the viras can           transmitted & later infect.

•    Indirect- virus can survive on surface  for few hours can transmitted touching the surface and then touching his nose, mouth or eyes.

•    Inhaled viral particles- droplet containing viral particle can be transmitted while coughing, sneezing, breathing to close standing person.

CLINICAL FEATURES

•    Rhinitis (runny nose)

•    Sore throat

•    Sneezing

•    Cough

•    Headache

•    Fever seen in children, uncommon in adults.

•    Feeling tired.

INCUBATION PERIOD (24-72 hrs)

Symptoms usually 3- 10 days, last upto 2 weeks in some peoples

DIAGNOSIS

  The diagnosis is based on symptoms and observed signs:-

•    Swelling and congestion of nasal passages

•    Redness of the throat

•    Enlarged lymph nodes in the neck

•    Normal lung exam

Chest x-rays not needed unless chest exam is abnormal

LAB TEST

generally not needed

•    Detection of antigen (rapid test)

•    Viral isolation

•    Serology

COMPLICATIONS

•    exacerbation of  Asthma, COPD.

•    Acute bacteria bronchitis

•    Pneumonia

•    Strep throat (sore & scratchy throat)

•    Acute ear infections

TREATMENT Symptomatic

•    Antihistamine – for runny nose, sneezing, cough.

• diphenhydramine (benadryl) –  300mg/QID
• levocitrizine- 10mg/day – OD
• Chlor pheneramine – 24mg/ day – TID

•    Antitussive– for dry cough.

• Codeine- 10mg/5ml – TID ODextra methorphan – 30mg/5ml – TID

•    Expectorant– for productive cough.

•  Guaifenesis- 2.4g/day – TID
•  Acetyl cystein- 5- 10ml of 10-20% of solution 6-8 hr if needed.
•  Bromhexin- 400mg/5ml – TID

•    Docongestants– for block nose. OEphedrine-5-25mg iv

•  Phenyl ephedrine- 200mcg
•  Oxymethazoline 0.05% 2-3 sprey

•    Analgesic– for headache, sore throat, muscle ache, fever, chillness, sinus, ear ache.

•  Acetaminophen- 650mg
•  Ibuprofen- 200mg

•    Glucocorticoids- generally not needed 

•  Dexamethasone-  4mg
•  Methyl prednisolone- 4mg

•    Vit. C table

•    Zinc tablet (for loss of smell)

•    Antiviral therapy

•    Antibiotics therapy

PREVENTIONS

•    General hygiene should be maintained like washing hands.

•    Use alcohol containing sanitizer regularly

•    Avoid being close to infected person

•    Cover your mouth & nose while sneezing/coughing.

Red flags

• Difficult in swallowing & cough

Pearls

• Preventing aspects
• Social distance
• Maintain hand hygiene
• Arousal spread using mask

REFERENCE

•    Cooley, B. & McNeely, M. (1996). ETR Associates. Santa Cruz, CA.www.etr.org.

•   www.nature.com/news/commoncold 

•    World Health Organization(WHO)- viral diseases in India

• Amoebiasis is a parasitic,protozoan disease that effects the gut mucosa and liver, resulting in dysentery,colitis and liver abscess.
• The causative agent is Entamoeba histolytica, sapotent pathogen that is spread via ingestion of contaminated food and water.
• Globally,amoebiasis is highly prevalent and is the second leading cause of death To parasitic disease.

ETIOLOGY:-

• Contaminated food and water.
• Oral rectal contact specially among male homosexual.
• Vectors.

EPIDEMIOLOGY:-

• A worldwide distribution.
• Major health problem in the whole china, South Eastand WestAsia and latin America, specially Mexico.
• Worldwide 50 million people carry E.histolytica in their intestinal tract.
• 10%of infected people suffer from Invasive amoebiasis.
• Probable that invasive amoebiasis, accounted For about 10 lakhs deaths in the world.
• INDIA: Amoebiasis affects about 15%of the Indian Population.

SIGN & SYMPTOMS:

• Pain in the abdomen.
• Blood in stool, diarrhoea, orflatulence.
• fatigue, fever,or loss of appetite.
• Weightloss.

MODE OF TRANSMISSION:-

1. Faecal oral route-Intake of contaminated food and water, vegetables & fruit
2. Sexual transmission–oral rectal contact, specially among male homosexuals.
3. Vectors- flies, cockroaches and rodents are capable of carrying cysts and contaminated food and water.

INCUBATION PERIOD:-

• 2-4 weeks or longer than that.

Host factor contribution:–

1. Stress
2. Malnutrition
3. Alcoholism
4. Corticosteroidtherapy
5. Immunodeficiency

RISK FACTORS:-

1. Travellers to developing countries.
2. People who live in institutions that have poor sanitary conditions.
3. HIV-positive patients.
4. Homosexuals.

PATHOPHYSIOLOGY:-

   Ingestion of cysts through   contaminated food and water.

 |

 Excystation in small intestin

 |

      Division of cysts into 4 & then 8 trophozoits.

 |

                                                   Trophozoits moves to colonize the colo

 |

       Encystation

 |

                             Excretion of cysts

 |

Ingestion of cysts by the patients.

LAB INVESTIGATION:-

• Bloodtest
• Stooltest– ELISA test
• Indirect haemagglutination test regarded as the test (IHA) is most sensitive serological test.

TREATMENT:-

1.Metronidazole- 500-750mg – oral – TID – For8-10days.

2.Tinidazole- 600mg – oral – BD– for 5days.

MOA-Kills trophozoites in intestine & tissue.

3.Iodoquinol– 650mg – oral -TID – for 10days.

4.Diloxanidefuroate–500mg – oral – TID – for 10days.

MOA–Luminal Eradicate cysts.

PREVENTION:-

Primary prevention:-

• Safe excreta disposal
• Safe water supply
• Hygiene
• Health education

Secondary prevention

• Early diagnosis
• Treatment

Red flags :-

• Dysentery
• Large intestine effect

Pearls :-

• Avoid outside unhygienic food.

REFERENCES:-

•Parasitology,K.D.Chatterjee.

•Harrison’s principals of internal medicines

•Medscape

•www.Webmd.Com