2.2 INFLAMMATORY DISEASES
2.2.1 TYPHOID ENTERITIS
An
acute, systemic infection caused
by Salmonella Typhii
and
manifests with:
*
Fever
*
Headache
*
Prostration
*
Maculopapular rash
*
Abdominal pain
*
Leucopenia
The
surgical complications of
this infection are
due to
hyperplasia and ulceration of Payer's patches of the
intestine
and mesenteric lymphadenopathy Fig.
18.2
Confirmation of diagnosis is obtained
by culturing S; typhii from
blood
or feces or by finding a high titre of agglutinin against
the O and H antigens in the serum.
Chloramphenicol is
given orally in doses of 60mg/Kg
of body
weight/day in four divided doses until
the temperature is normal,
then reduced to 30mg/kg/day for a
total of two weeks.
Ampicillin is also effective and
should be given intravenously or
intramuscularly in does of 1 gm every
6 hours for two weeks.
MANAGEMENT
Gross haemorrhage occurs in 10 to 20%
of patient even while they
are on adequate therapy.
-
Perforation of the ulcerated
Payer's patches occurs in about
2%
-
Like haemorrhage, this complication should also be
handled
conservatively
Chloramphenicol or ampicillin are given intravenously in large
doses.
-
Nasogastric suction is started
-
Blood, serum albumin and fluids and electrolytes are given as
indicated.
-
An operative approach should be
considered only in good-risk
patients who are seen within 6 hours of the perforation.
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