Download MBBS Surgery Presentations 60 Tropical Surgery Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 60 Tropical Surgery PPT-Powerpoint Presentations and lecture notes


Tropical Surgery:

TB, Amoebiasis, Filariasis,

Typhoid, Ascariasis

Dept Of Surgery

Tuberculosis






M. tuberculosis as causative agent for

tuberculosis

Robert Koch

1886

TB ? A Multi-system Infection
? Extra-pulmonary form of TB account for 10-15

per cent of all cases and up to 50 per cent of

patients with AIDS.

? TB of the gastrointestinal tract is the sixth most

frequent form of extra-pulmonary site, after

lymphatic, genitourinary, bone and joint,

miliary and meningeal tuberculosis.

Pathogenesis

The postulated mechanisms by which the

tubercule bacilli reach the gastrointestinal tract

are:

(i) hematogenous spread from the primary lung focus in

childhood, with later reactivation;

(ii) Ingestion of bacilli in sputum from active pulmonary focus;

(iii) direct spread from adjacent organs;

(iv) through lymph channels from infected nodes.






Pathogenesis

? The most common site of involvement-

ileocaecal region

? Frequency of bowel involvement declines as

one proceeds both proximally and distally

from the ileocaecal region.

Pathology

Most active inflammation in submucosa.

Bacil in depth of mucosal glands

Inflammatory reaction

Phagocytes carry bacil i to Peyers Patches

Formation of tubercle

Tubercles undergo necrosis

Portis (1953)








Pathology

Submucosal tubercles enlarge

Endarteritis & edema

Sloughing

Ulcer formation

Accumulation of col agenous tissue

Thickening & Stenosis

(Howel & Knapton, 1964)

Pathology

Inflammatory process in submucosa penetrates to serosa

Tubercles on serosal surface

Bacil i reach lymphatics

Bacil i via lymphatics

Lymphatic obstruction

Regional lymph nodes

of mesentery and bowel

? Hyperplasia

Thick fixed mass

? Caseation necrosis

? Calcification

(Boyed, 1943)










FORMS OF GI TB

Ulceroconstrictive

Hypertrophic

60% of patients

10% of patients

Highly virulent

Chronic

Mostly smal Intestinal

Mostly Ileocoecal

Mixed 30% of patients

(Howel & Knapton, 1964)

Clinical Features

? acute, chronic or acute on chronic.

? Constitutional symptoms of fever (40-70%), pain (80-

95%), diarrhoea (11-20%), constipation, alternating

constipation and diarrhoea, weight loss (40-90%),

anorexia and malaise.

? Pain-either colicky due to luminal compromise, or

dull and continuous when the mesenteric lymph

nodes are involved.
Diagnosis

Paustian in 1964 stated that one or more of the following four criteria

must be fulfil ed to diagnose abdominal tuberculosis:

(i) Histological evidence of tubercles with caseation necrosis;

(ii) a good typical gross description of operative findings with biopsy of

mesenteric nodes showing histologic evidence of tuberculosis;

(ii ) animal inoculation or culture of suspected tissue resulting in growth

of M. tuberculosis

(iv) histological demonstration of acid fast bacil i in a lesion

Non specific findings include raised ESR, anemia, hypoalbuminemia

? Plain X ray
? Small Bowel Barium Meal
? Barium Enema
? Ultrasonography
? CT Scan
? Colonoscopy
? Laparascopy
? Immunological Tests (value undefined)
? Ascitic Fluid Examination
Management

? Antitubercular therapy

? The recommended surgical procedures today

are conservative:

? Stricturoplasty
? Resection Anastomosis

Amoebiasis


Introduction

? Causative agent: Entamoeba histolytica

? Entamoeba histolytica is the second leading cause of

mortality due to parasitic disease in humans. (The

first being malaria). Amebiasis is the cause of an

estimated 50,000-100,000 deaths each year.

Entamoeba histolytica : life cycle
Clinical manifestations

? Dysentery- principal manifestation

? Appendicitis or amebic ceacal mass

? Amoebic granuloma

? Fibrous stricture

? Intestinal obstruction

? Paracolic abscess, ischiorectal abscess and fistula
Diagnosis

? Sigmoidoscopic examination

? Immunodiagnosis

? Microscopy

? Antigen Detection

? Molecular diagnosis

Amoebicides

Tissue amoebicides

? Metronidazole 500?750 mg three times a day for 5?10 days

? Tinidazole 2g once a day for 3 days is an alternative to metronidazole

Luminal Amoebicides

? Paromomycin 500 mg three times a day for 10 days

? Iodoquinol 650 mg three times a day for 20 days

Surgical Intervention
Filariasis

? MC cause of lymphedema

? Wucheria bancrofti (nematode) in 90% of cases

? Features

Acute

? Fever

? Headache

? Malaise

? Inguinal & axil ary lymphadenitis

? Lymphangitis, Cel ulitis

? Funiculo-epididymo-orchitis

-Chronic

Lymphedema of legs

Hydrocele

Abdominal lymphatic varices


Treatment

? Elevation or periodic compression
? Firm support bandage or compression garment (MLLB)
? Complex decongestive therapy (CDT)
? Massage (MLD)
? Drugs
? Foot and skin hygiene
? Surgery is rarely performed to remove hypertrophied lymph

channels or obstructed lymph channels

Symptomatic and supportive Treatment for other symptoms and signs
Typhoid

Introduction

? Acute enteric infectious disease

? Caused by salmonella typhi (S.Typhi)

? Prolonged fever, relative bradycardia, apathetic facial

expressions,roseola,splenomegaly,hepatomegaly,
leukopenia.

? Intestinal perforation, intestinal hemorrhage
? Antigens: located in the cell capsule

H (flagellar antigen).

O (Somatic or cell wall antigen).

Vi (polysaccharide virulence)

"widal test"

Transmission

? Fecal-oral route

? Close contact with patients or carriers

? Contaminated water and food

? Flies and cockroaches






S.Typhi.

liverspleengall

BM ,ect

2nd bacteremia

early stage&acme stage

(1-3W

stomach

(

Bac. In gall

mononu

clear

phagocy

tes )

Bac. In

Lower

feces

ileum

peyer's patches &

S.Typhi eliminated

mesenteric lymph nodes

convalvescence stage

(4-5w)

LN Proliferate,swel

1st bacteremia

necrosis

defervescence stage

thoracic

(Incubation stage)

Enterorrhagia,i

3-4w

duct

10-14d

ntestinal

perforation

Pathology

? Essential lesion:
Proliferation of RES (reticuloendothelial system )
specific changes in lymphoid tissues & mesenteric lymph

nodes.

"Typhoid nodules"

? Most characteristic lesion:
ulceration of mucous in the region of the peyer's patches

of the small intestine
Complications

? Intestinal hemorrhage
? Intestinal perforation
? Toxic hepatitis
? Acute cholecystitis
? Nephritis
? Hemolytic uremic syndrome.
? Toxic myocarditis
? Bronchitis, bronchopneumonia
? Toxic encephalopathy
? Meningitis

Diagnosis

? white blood cell count is normal or decreased
? Blood culture
? Urine and stool cultures
? Serological tests(Widal test)




Treatment

? Isolation and rest
? Good nursing care and supportive treatment
? Intravenous injection to maintain water and acid-base and

electrolyte balance

? Antibiotics:

? Quinolones
? Chloramphenicol
? Cephalosporines

? Treatment of complications

Ascariasis
Introduction

? a common cream colored roundworm that is

parasitic in the intestines of humans

? Most common helminthic human infection

? Largest nematode to infect the human intestine

? Definitive host : Humans or pigs

Modes of transmission

? Occurs mainly via ingestion of water or food

? Occasionally inhalation of contaminated dust

? Children playing in contaminated soil may acquire the parasite

from their hands

Prior infection does not confer protective immunity
Life Cycle
Symptoms

Symptoms associated with larvae migration

? hemorrhagic/ eosinophilic pneumonia, cough (Loeffler's Syndrome)

? Breathing difficulties and fever

? asthmatic attacks, pulmonary infiltration and urticaria

Symptoms associated with adult parasite in the intestine

? Usual y asymptomatic

? Abdominal discomfort, nausea in mild cases

? Malnutrition in host especial y children in severe cases

? Sometimes fatality may occur when mass of worm blocks the intestine

Diagnosis

? Stool microscopy

? Eosinophilia

? Imaging

? Ultrasound

? Endoscopic Retrograde Cholangiopancreatography
Treatment

? Mebendazole
? Albendazole
? Pyrantel pamoate
? Ivermectin
? Piperazine citrate
? Levamisole

This post was last modified on 08 April 2022