BURNS 1

BURNS

1.  Intact human skin must be looked upon as a highly efficient

FUNCTIONING organ of the human body.

The complete unbroken skin envelop is ascribed four main

functions:

1.1   It is capable of maintaining the internal environment

      through limiting the loss of water and electrolytes from

      the body surface.

1.2   Provides very efficient barriers to invasion by bacteria on

      its surface and in the surrounding atmosphere.

1.3   It provides an efficient apparatus for maintenance of body

      temperature, both through direct radiation of heat through

      the vast vascular bed in the skin, and through evaporation of

      sweat from the surface of the skin.       

1.4   Through its vast surface sensory nerve network, provides  

      an apparatus for detecting injurious agents and withdrawing

      the part from their vicinity.

2.  A  burn is a combination of dis-integrative,and copulative

necrosis of skin, and deeper structures, brought about by  any  of

the causes listed below:

THERMAL

   a)  Dry heat (open fire)

   b)  Moist heat (steam + hot liquids)

   CHEMICALS (ACIDS + ALKALIES)

   ELECTRIC BURNS (TOUCHING LIVE ELECTRIC WIRES)

   FLASH BURNS (HIGH TEMPERATURE SHORT DURATION)

   LIGHTNING.

   ULTRA VIOLET RAYS.

   RADIATION BURNS

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TROPICAL DISEASE 21

6.3.3 INVESTIGATIO

TB GIT

- There is a mild anaemia in about 80% of patients. 

- Hypoalbuninaemia may be present. 

- The ESR is elevated in over 90%of patients. 

- There is a relative neutropaenia with a relative lymphocytosis in

about one-third of patients. 

- Tuberculin test is positive in over 90% of patients.

6.3.4 SURGICAL TREATMENT

With  modern antituberculous drugs complete cure and  improvement

of  symptoms  occurs  in about 90%  of  patients  with  abdominal

tuberculosis.  

Surgery   is  reserved  for  the   treatment   of

complications namely:

   *  Bowel OBSTRUCTION.

   *  Peforation of an ulcer with PERITONITIS or combined with

      FISTULA formation of adjoining loops.

   *  Massive HAEMORRHAGE. The presence of an ileo-caecal mass of

      uncertain origin is an additional indication

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TROPICAL DISEASE 20

T.B.
DIGESTIVE TRACT





6.3.2 CLINICAL FEATURES

The most frequent symptoms is abdominal pain.

- There may be accompanying weight loss, abdominal distension and

vomiting.

-  Another  group  of  patients may  present  with  weight  loss,

anorexia, diarrhoea and fever. 

-  The pain intensity depends upon the site, duration and  extent

of the lesion and the presence of complications.

-  It is most frequently present in the umbical region which  may

become generalised or localised to the right iliac fossa.

-  The pain is often colicky in nature with nausea  and  vomiting

and visible peristalsis with lesions like  stricture,hypertrophic

lesions or adhesions producing intestinal obstruction.

- Abdominal tenderness is frequently seen and can be elicited  in

two-thirds  of the patients, indicating extension of the  disease

to the peritoneum and lymph nodes.

-  A palpable mass, and visible peristalsis can be seen  in  over

one-third of the patients.

- The mass can be due to hypertrophic ileoceacal tuberculosis  or

enlargement  of  lymph nodes and matting of loops  of  the  small

bowel.

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TROPICAL DISEASE 19

6.3 GASTROINTESTINAL TUBERCULOSIS

Gastrointestinal tuberculosis constitute nearly 1 percent of  all hospital   admission  

and  11  percent   of   small   intestinal obstruction.

These figures are low if compared with the clinical experience of

Surgeons.

The   explanation   is  that  establishing   the   diagnosis   of

tuberculosis  by  histopathology or demonstration of  bacilli  is

difficult.

6.3.1 PATHOLOGY

The abdominal cavity may be affected with tuberculosis through;   

   *  Primary  infection  due to direct ingestion  of  tubercular

      bacillus

   *  Spread from tuberculosis from other parts of the body

   *  Spread from female genital tract

There are three types of lesions seen:

   *  Ulcerative

   *  Fibrotic

   *  Hyperplastic

On  histology  a  typical granuloma  is  seen  however  caseation

necrosis is not always present.

Identification of tubercle bacilli is rare.

A  granuloma may show central caseation surronded  by  epitheloid

and  Langhans giant cells there are also areas  with  lymphocytes

and plasma cells.

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TROPICAL DISEASE 18

TRANSMISSION 2

- The risk of transmission is increased when susceptible contacts

share the air for prolonged periods of time with a person who has

untreated pulmonary TB and who is coughing freely.

-  In individuals who become infected, infectious  particles  are

inhaled through the nose and mouth, are carried down the  airways

of  the  lungs,  and eventually reach the  small  air  sacs  (the

alveoli).

It is in the alveoli that infection usually begins and where  the

tubercle bacilli are initially able to multiply.

-  During the first few weeks after infection,  tubercle  bacilli

spread  unchallanged from the initial location in the  lungs,to  the

lymph  nodes, in the center of the chest, and then to other  parts

of the body by way of the bloodstream.

-  Tubercle  bacilli  can  reach  all  areas  of  the  body,  but

frequently   travel  to  certain  areas  that  are   particularly

susceptible to developing disease, such as the upper portions  of

the lungs,the kidneys, the brain, and bone.

-  Within 2 to 10 weeks, the body's immunologic response to  the

tubercle  bacilli  is  usually  sufficient  to  prevent   further

bacterial multiplication and spread. 

-  At this point an infected person will usually have a  positive

tuberculin skin test.

- For those who develop active TB, the lungs are the most  common

site of disease (in approximately 85 percent of all cases). 

- But disease may occur at any site in the body.

- Extrapulmonary disease may occur in the;

lymph nodes,

brain(causing TB meningitis),

kidney,

bones, or any other site.

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TROPICAL DESEASE 16

6. TUBERCULOSIS


- Tuberculosis is a bacterial infection with many manifestations
and wide distribution in the world.
- The lungs are most commonly affected, but lesions may also
occur in the kidney, bones, lymph nodes, or disseminated
throughout the body.

- The causative organism is Mycobacterium tuberculosis, a rod 2
to 4 um in length and 0.3 um in thickness, it " is acid fast".

- Tubercle bacilli are aerobes thus the organs affected are
vascular and relatively high in oxygen tension; two species of
tubercle bacilli cause the disorder M.tuberculosis and M.bovis.

6.1 TRANSMISSION

This communicable disease caused by Mycobacterium tuberculosis,
often called tubercle bacilli.
- Is spread person to person.
- Airborne infectious particles are produced when a person with
infectious TB of the lung or larynx forcefully exhales such as
when coughing, sneezing, speaking,or singing.

- These particles are dispersed in the local environment, remain
airborne, and can be inhaled by someone sharing the same air
space.

- TB is more easily transmitted in closed air spaces where
ventilation is poor.

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TROPICAL DISEASE 15

4.2 VISCERAL LEISHMANIASIS (KALA-AZAR)

The causitive organism is L Donovani also transmitted by a

sandfly.

The prasite is transported by lymphatic to lymph nodes

and viscera.

Some control of the disease has occured through DDT

and antimalaria programmes.

It still persists in Assam, Bihar,West Bengal, Nepal and Sikkim.

4.2.1 Clinical

In the early stage the patient suffers from intermittant fever

and anaemia.

In later stages there is hepatosplenomegaly.

Bone marrow smears slow L. Donovani.

The patients respond to pentavalant antimony therapy.

TREATMENT

The disorder can be treated with stibogluconate.

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