INTRODUCTION

Amoebiasis is due to invasion of the intestinal wall by the protozoan parasite Entemoeba
histolytica. Amoebic colitis results from ulcerating mucosal lesions caused by the release of
parasite-derived hyaluronidases and proteases. It refers to infection of man by Entamoeba
hystolytica initially involving the colon but which may spread to other soft tissues organs by
contiguity or by hematogenous or lymphatic dissemination most commonly to the liver and
lungs. (William A. Petri, Jr.)
It is a worldwide parasitic disease. It creates many medical and surgical problems. About
15 to 20 per cent of Indians are affected by the parasite. It can be acute and chronic and can have
intestinal and extra-intestinal manifestations. The causative organism is a protozoa which
remains in the large intestine and can be transmitted to other organs like liver, lungs, brain,
spleen and skin etc. It is transmitted through contaminated food, water and infected human
feces. (Rashidul Haque, Scientist and Head of Parasitology Laboratory)
Amoebiasis can occur at any age. There is no gender or racial difference in the
occurrence of the disease. It is a household infection and the human being is responsible for
spreading the disease. Most of the infected people remain asymptomatic (without symptoms) and
are called as healthy carriers. If one person in a family gets infected with the parasite, other
family members are at the great risk of infection. The human carrier can discharge up to 1.5x107
cysts per day. (Vinod K Dhawan, MD, FACP, FRCPC,)
Pathogenic amoeba which produce condition of a great clinical variations; Acute
Amoebic Dysentery stools contain blood and mucus which may give rise to amoebic hepatitis or
liver abscess, Chronic Amoebic Dysentery with recurrent attack of diarrhea or relatively mild
dysentery, Amoebic Colitis characterized by periods of constipation and diarrhea and episodes of
abdominal discomfort frequently stimulating appendicitis (Mehmet Tanyuksel and William A.
Petri, Jr.)
P. P. a nine year old child residing in Purok 4 Barangay Poktoy Surigao Del Norte was
admitted at Surigao Medical Center last November 6, 2018 at exactly 6:06 am with chief
complain of loss bowel movement and fever of 39.1°c with chills for further management.
Patient P. P was diagnosed Intestinal Ameobiasis with Moderate Dehydration.

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 The second year students chose the case of Patient P. P to gain more knowledge and
experience in the field of nursing to establish holistic approach to the S.O and to the patient
promoting for optimal health of the patient’s condition. Enhance critical thinking and skills that
can be useful in the future as to provide appropriate nursing care to our clients. Also this output
will be useful for future purposes related to the case Intestinal Amoebiasis with Moderate
Dehydration.

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 Review Related Literature

According to Dr. Nagata, 2009, amoebiasis is an infection of small intestine, which is

caused by an protozoan called Entamoeba histolytica. It is simply called as Amoebic dysentery.
This is usually contracted by ingesting water or food contamination by amoebic cysts. Amoebic
abscesses may form in the liver, lungs, brain, and elsewhere in the body. There are several
different species of amoeba, but the most dangerous, such as Entamoeba histolytica, live
predominantly in tropical areas. People living in rural areas or persons traveling in such areas
are the highest risk of developing this disease, which occurs when something infected with the
parasites is eaten or swallowed.
Intestinal and Extraintestinal are the two types amoebiasis. Extraintestinal amoebiasis is
occur when the parasites invades other organs such as liver, lungs, or skin. The incubation period
varies from a few days to several months of years(commonly 2-4 weeks). Intestinal Amoebiasis
is a frequent symptomatic and varies from fulminant dysentery with fever, chills, and bloody or
mucoid diarrhea to mild abdominal discomfort with diarrhea containing blood or mucus
alternating with periods of constipation or remission.
The main cause of amoebiasis is – single cell parasite called entamoeba histolytica. The
parasite burrows into the wall of the intestine to cause small abscesses and ulcer. From there they
enter the veins of the intestine and are carried to the liver. Even though there is constant spread
of infection, some people are resistant to amoebiasis. Transmission occurs via Faecal–oral route,
either directly by person-to-person contact or indirectly by eating or drinking faecally
contaminated food or water.
Sexual transmission by oral-rectal contact is also recognized especially among male
homosexuals.
Vectors such as flies, cockroaches and rodents can also transmit the infection.

Signs and Symptoms:

Only about 10% to 20% of people who are infected with E. histolytica become sick from
the infection. The symptoms often are quite mild and can include loose stools, stomach pain, and
stomach cramping. Amoebic dysentery is a severe form of amoebiasis associated with stomach
pain, bloody stools, and fever. Rarely, E. histolyticainvades the liver and forms an abscess. Even

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less commonly, it spreads to other parts of the body, such as the lungs or brain. The symptoms
are in two forms. First, burrowing the intestines and making ulcers, which bleed and cause
anemia or other disease due to added infection. Second, absorbing the food from the host or
letting out toxic substances in the intestines
The important symptoms of amoebiasis are passing of more number of stools is one of
the main symptom in amoebiasis; the presence of mucus is common in stool and can sometimes
also be accompanied with blood; usually symptoms starts with diarrhea and pain in right
hypochondrium.
It could be associated with a low-grade fever too. Sometimes allergic reactions can occur
throughout the body, due to release of toxic substances or dead parasites inside the intestine.
Loss of Weight and stamina is encountered with person suffering from amoebiasis. Others are
foul smelling stool, loss of appetite, stomach cramp and nausea

Risk Factors:
The risk factors are exposure to contaminated water, poor hygiene, lack of proper
sanitation facilities. Traveling to tropical areas with unsanitary conditions, increases the
likelihood of exposure to this disease. Young or elderly people, who have poor immune function;
such individuals are more likely to develop this disease, because their immune systems are
weaker. Consequently, individuals who lack proper nutrition may have weaker immune systems,
and are more likely to develop Infection due to Entamoeba histolytica, when they consume
contaminated food/water.

Complications:

Fulminant or necrotizing colitis - Acute fulminant necrotizing amebic colitis (FNAC) is a rare
complication of intestinal amebiasis that is associated with high mortality and requires prompt
diagnosis and surgical intervention. (Suhani, Ali S, Thomas S, Aggarwal L., Ann Trop Med
Public Health 2013;6:661-3)

Toxic megacolon- Toxic megacolon is the clinical term for an acute toxic colitis with dilatation
of the colon. The dilatation can be either total or segmental. A more contemporary term for toxic

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megacolon is simply toxic colitis, because patients may develop toxicity without megacolon.
(Clin Colon Rectal Surg. 2010 Dec. 23(4):274-84.)

Bowel perforation- Bowel perforations occur when a hole is made in this lining, often as a
result of colon surgery or serious bowel disease. A hole in the colon then allows the contents of
the colon to leak into the usually sterile contents of your abdominal cavity. (Digestive Diseases
and Sciences. 2017. 62(6):1607-1614)

Gastrointestinal bleeding- Gastrointestinal bleeding refers to any bleeding that occurs in the
gastrointestinal tract, which runs from your mouth to your anus. More specifically, the
gastrointestinal tract is divided into the upper gastrointestinal tract and the lower gastrointestinal
tract. The upper gastrointestinal tract is the section between the mouth and the outflow tract of
the stomach. The lower gastrointestinal tract is the section from the outflow tract of the stomach
to the anus, including the small and large bowel. ( Gastrointestinal Bleeding. Scott Moses, MD.
6/1/2008)
Peritonitis- Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of
the abdomen and covers and supports most of your abdominal organs. Peritonitis is usually
caused by infection from bacteria or fungi.
Left untreated, peritonitis can rapidly spread into the blood(sepsis) and to other organs, resulting
in multiple organ failure and death. (Minesh Khatri, MD, 2017)

Prognosis

In uncomplicated disease, the mortality rate is less than 1% but is much higher in complicated
severe disease - eg, fulminant amoebic colitis, chest involvement or cerebral amoebiasis. More
severe illness occurs in children (especially neonates), the immunosuppressed, malnourished,
pregnancy and postpartum. Recurrence is common if amoebae are not completely eradicated.

The bowel heals rapidly and completely; hepatic abscesses usually disappear within 8 months to
2 years. (Dr. Roger Henderson, 2016)

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Prevention
According to Park’s Textbook of Preventive and Social Medicine, 22nd Edition, Amoebiasis,
219-220, amoebiasis can be prevented and controlled both by non-specific and specific
measures.
Non-specific measures are concerned with:
1.Improved water supply– The cysts are not killed by chlorine in amount used for water
disinfection. Water filtration and boiling are more effective than chemical treatment of
water against amoebiasis.
2.Sanitation–Safe disposal of human excreta coupled with the sanitary practice of
washing hands after defecation and always before handling and consuming food.
3.Food safety– Uncooked fruits and vegetables should be washed thoroughly with safe
water, peel fruits, and boil vegetables prior to eating.Measures should also include the
protection of food and drink from flies and cockroaches and the control of these insects.
Carriers, who pass cysts and are involved in handling food, whether at home, at street
stalls, or in catering establishments, should be actively detected and treated since they are
major transmitters of amoebiasis.
4.Health education of the public as well as health personnel at all levels about sanitation
and food hygiene-Elementary hygienic practices should be propagated and constantly
reinforced in schools, health care units, and the home through periodic campaigns using
the mass media.
5.General social and economic development-The implementation of individual and
community preventive measures (e.g., washing of hands, proper excreta disposal) should
be an essential part of these activities.
Specific measures that should be undertaken when possible are-
1.community surveys to monitor the local epidemiological situation with regard to
amoebiasis;
2.improvement of case management, i.e., rapid diagnosis and adequate treatment of
patients with invasive amoebiasis at all levels of the health services, including the
community and health centre levels;
3.surveillance and control of situations that may encourage the further spread of
amoebiasis, e.g., refugee camps, contaminated public water sources.

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Test and Diagnosis:
Hematology is the science or study of blood, blood-forming organs and blood diseases.
In the medical field, hematology includes the treatment of blood disorders and malignancies,
including types of hemophilia, leukemia, lymphoma and sickle-cell anemia. Hematology is a
branch of internal medicine that deals with the physiology, pathology, etiology, diagnosis,
treatment, prognosis and prevention of blood-related disorders. (Ramanan, 2013)
Stool Exam - A stool analysis is a series of tests done on a stool (feces) sample to help diagnose
certain conditions affecting the digestive tract. These conditions can include infection (such as
from parasites,viruses, or bacteria), poor nutrient absorption, or cancer.
For a stool analysis, a stool sample is collected in a clean container and then sent to the
laboratory. Laboratory analysis includes microscopic examination, chemical tests, and
microbiologic tests. The stool will be checked for color, consistency, amount, shape, odor, and
the presence of mucus. The stool may be examined for hidden (occult) blood, fat, meat fibers,
bile, white blood cells, and sugars called reducing substances. The pH of the stool also may be
measured. A stool culture is done to find out if bacteria may be causing an infection (Wolters
Kluwer Health/Lippincott Williams & Wilkins, 2009.)

Microscopy- Microscopic examination of fresh stool smears for trophozoites that contain
ingested red blood cells (RBCs) is commonly done (see the image below). The presence of
intracytoplasmic RBCs in trophozoites is diagnostic of E histolyticainfection, though some
studies have demonstrated the same phenomenon with E dispar.

Culture- Cultures can be performed either with fecal or rectal biopsy specimens or with liver
abscess aspirates. Culture has a success rate of 50-70%, but it is technically difficult. Overall,
culture is less sensitive than microscopy.
Xenic cultivation, first introduced in 1925, is defined as the growth of the parasite in the
presence of an undefined flora. This technique is still in use today, using modified Locke-egg
media. Axenic cultivation, first achieved in 1961, involves growing the parasite in the absence of
any other metabolizing cells. Only a few strains of E dispar have been reported to be viable in
axenic cultures.

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Medication/Treatment:
Several antibiotics are available to treat amebiasis. Treatment must be prescribed by a
physician. You will be treated with only one antibiotic if your E. histolytica infection has not
made you sick. You probably will be treated with two antibiotics (first one and then the other) if
your infection has made you sick. (Centers for Disease Control and Prevention).
Gastrointestinal amoebiasis is treated with ranitidine is for treatment and prevention of
heartburn, acid indigestion, and sour stomach and prophylaxis of GI hemorrhage from stress
ulceration. Ceftriazone is for indicated in patients with neurologic complications, carditis and
arthritis. It is also effective in Gram negative infections; Meningitis, Gonorrhea. It is also for
Bone and joint infections, Lower respiratory tract infections, middle ear infection, PID,
Septicemia and Urinary Tract infections. Metronidazole is for acute infection with susceptible
anaerobic bacteria and acute intestinal amoebiasis. Bacillus Clausii is for acute diarrhea with
duration of ≤14 days due to infection, drugs or poisons and chronic or persistent diarrhea with
duration of >14 days. ( Wolters Kluwer, 2016)
Prevalence

Worldwide, approximately 50 million cases of invasive E histolytica disease occur each

year, resulting in as many as 100,000 deaths. This represents the tip of the iceberg because only
10%-20% of infected individuals become symptomatic. The incidence of amoebiasis is higher in
developing countries. Earlier estimates of E histolytica infection, based on examination of stool
for ova and parasites, are inaccurate, because this test cannot differentiate E histolytica from E
dispar and E moshkovskii. In developing countries, the prevalence of E histolytica, as
determined by enzyme-linked immunosorbent assay (ELISA) or polymerase chain reaction
(PCR) assay of stool from asymptomatic persons, ranges from 1% to 21%. (Vinod K Dhawan,
MD,2017)

Epidemiology
Worldwide, approximately 50 million cases of invasive E histolytica disease occur each
year, resulting in as many as 100,000 deaths. This represents the tip of the iceberg because only
10%-20% of infected individuals become symptomatic. The incidence of amebiasis is higher in
developing countries.

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 Earlier estimates of E histolytica infection, based on examination of stool for ova and
parasites, are inaccurate, because this test cannot differentiate E histolytica from E dispar and E
moshkovskii. In developing countries, the prevalence of E histolytica, as determined by enzyme-
linked immunosorbent assay (ELISA) or polymerase chain reaction (PCR) assay of stool from
asymptomatic persons, ranges from 1% to 21%. On the basis of current techniques, it is
estimated that 500 million people with Entamoeba infection are colonized by E dispar.
The prevalence of Entamoeba infection is as high as 50% in areas of Central and South
America, Africa, and Asia. E histolytica seroprevalence studies in Mexico revealed that more
than 8% of the population were positive. In endemic areas, as many as 25% of patients may be
carrying antibodies to E histolytica as a result of prior infections, which may be largely
asymptomatic. The prevalence of asymptomatic E histolytica infections seem to be region-
dependent; in Brazil, for example, it may be as high as 11%.
In Egypt, 38% of individuals presenting with acute diarrhea to an outpatient clinic were
found to have amebic colitis. A study in Bangladesh indicated that preschool children
experienced 0.09 episodes of E histolytica -associated diarrhea and 0.03 episodes of amebic
dysentery each year. In Hue City, Vietnam, the annual incidence of amebic liver abscess was
reported to be 21 cases per 100,000 inhabitants.
An epidemiologic study in Mexico City reported that 9% of the population was infected
with E histolytica in the 5-year to 10-year period preceding the study. Various factors, such as
poor education, poverty, overcrowding, contaminated water supply, and unsanitary conditions,
contributed to fecal-oral transmission.
Several studies have evaluated the association of amebiasis with AIDS. The impact of
the AIDS pandemic on the prevalence of invasive amebiasis remains controversial. Some reports
suggest that invasive amebiif leasis is not increased among patients with HIV infection; however,
others suggest that amebic liver abscess is an emerging parasite infection in individuals with HIV
infection in disease-endemic areas, as well as in non–disease-endemic areas.
Of 31 patients with amebic liver abscess at Seoul National University Hospital from 1990
to 2005, 10 (32%) were HIV-positive. In a case-control study of persons seeking voluntary
counseling and testing for HIV infection, homosexual activity, fecal-oral contamination, lower
educational achievement, and older age were associated with increased risk of amebiasis.

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 CLIENT HEALTH HISTORY
A. Client Profile

P. P. is a 9 year old boy, catholic, Filipino child, born on November 28, 2008. Currently
living with his family at Purok 4 Barangay Poktoy Surigao del Norte, a grade three
elementary pupil at the Clavero Memorial Elementary School. Major reason for seeking
health care is due to a fever of 39.1°c with presents chills and a loss of bowel movement
on the morning of November 6, 2018.

Treatments/Medications:
Prescribed: none
OTC: Cherifer as his vitamins taken everyday
Past Illness/Hospitalization
Diarrhea at 8 months old hospitalized at Surigao Medical Center
Allergies
No known food allergies and drug allergies except on to wild grasses

B. DEVELOPMENTAL HISTORY
Developmental milestone the pt. is Industry vs. Inferiority. Describes that he enjoys his
life being as a child and he wanted to be a policeman in the future. Describes relationship
with his parents and siblings as close and sharing, active in school activities and living
with his parents.

C. HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN

Client’s rating of health
Scale: 10 is best; 1 is worst
Five years ago: 10
Now: 8
Five years from now: 10
Health does interfere with self-care or other desired activities of daily living.
Unaware of the signs and symptoms and the causes of the disease.

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D. NUTRITONAL METABOLIC PATTERN
SO stated that the patient’s usual meals are canned goods and he doesn’t like to eat any
kind of vegetables. Before that he was admitted, he would take his breakfast 7 in the
morning with a cup of milk, have lunch during noon, will have a dinner mostly 8 in the
evening and drinks up to five glasses of water per day. As of his current situation, patient
losses his appetite and will only have a banana as his meal. Patient can consume almost
two liters of water per day.

E. ELIMINATION PATTERN
Bowel habits: 2 times a day brown, soft and form stool.
Bladder habits: Voids 5-6 times per day, clear yellow urine. Doesn’t have current
problems like dysuria, hematuria, incontinence but sometimes experience nocturia mostly
when excessive activities during the day.

F. ACTIVITY EXERCISE PATTERN

Arises at 6 am in the morning. Eat breakfast and getting ready for school. In early
afternoon goes to his home to eat lunch together with his family. Goes home at 4 pm.
Plays basketball and computer games with his friends after school. Doesn’t have chest
pain, fatigue, wheezing, stiffness, cramps, or joint pain or swelling with an activity.
During evening he would have dinner with his family at 6:30 pm.
Hygiene: showers and washes hair everyday
Occupational activities: none

G. SEXUALITY-REPRODUCTION PATTERN
A child becoming more aware of his body, possibly developing secondary sex
characteristics. He is independently starts wanting privacy when going to toilet or
shower. Curious about sexuality and play with the same age.

H. SLEEP-REST PATTERN

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 Goes to bed at 8 pm. Doesn’t have any difficulty falling asleep or sleeping. Feels well
rested when he rises at 6 in the morning. Never uses sleep medications.

I. SENSORY-PERCEPTUAL PATTERN
Vision: Doesn’t have any difficulty in his vision
Hearing: Doesn’t have any difficulty in hearing
Smell: Doesn’t have difficulty with smell, pain, postnasal drip, sneezing and nosebleed
Touch: no difficulty in touching
Taste: no difficulty tasting foods

J. COGNITIVE PATTERN
Speech clear without slur or stutter and follows verbal cues. He can recall past weekly
events. Learn best by studying at school then reviewing it to their house. Makes major
decision jointly with his parents.

K. ROLE-RELATIONSHIP PATTERN
Client is the second child and only son in his family. Has a good relationship with his
siblings and parents. No conflict in any person in their community.

L. SELF-PERCEPTION-SELF-CONCEPT PATTERN
Describe his self as a friendly and happy person and likes outdoor activities such as
playing basketball with his friends at their Barangay gymnasium. He stated that his
condition is now getting well and recovered.

M. COPING-STRESS TOLERANCE
The major stressors in his life are the house hold chores and the bullies at school. He
copes up with his stress through playing basketball and computer games.

N. VALUE-BELIEF PATTERN
A Roman Catholic child and attended mass every Sunday with his family. He believes
that Jesus Christ is our savior and prayer is the only communication through God.

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 PHYSICAL EXAMINATION

General Physical Survey

Properly groomed, alert and cooperative. Sitting comfortably on bed conscious, oriented,
with sunken eyeballs, febrile, appears fatigue, thin and has dry skin. Hooked with an IVF of D5
0.3 NaCl 500cc @ 20gtt/min at left cephalic vein and infiltration noted. Abrasion wounds
located at both anterior tibia with pus.. Ht: 4’5 ft, Wt: 48 lbs, Apical pulse: 85, Resp: 16, Temp:
38 C.

Mental Status Examination

Alert and awake with eyes open and looking at the examiner; client responds
appropriately. Oriented to time and place and also oriented to people around. Able to recall when
and who visits a while ago for immediate memory. Can recall his name. Attentive and able to
memorize, think, read, reason and pay attention. Takes incoming information and move it into
the bank of knowledge.

Skin

Skin is brown, warm and dry to touch. Poor skin turgor noted. Abrasion wound located at
both anterior tibia with pus upon inspection. No edema. No scalp lesions or flaking.

Head and Face

No scalp lesions or flaking. Head symmetrically rounded upon palpation. Function of CN

V, pt. identifies light touch and sharp touch to forehead, cheek and chin. Bilateral corneal reflex
intact. Masseter muscles contract equally and bilaterally. Function of CN VII pt. smiles, frowns,
shows teeth, blow cheeks, and raises eyebrows as instructed.

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Eyes

Eyeballs are sunken. Eyebrows sparse with equal distribution. No scaliness noted. Lids
brown, without edema, or lesions noted. Sclera without increased vascularity or lesions noted.
Palpebral and bulbar conjunctiva pale without lesions noted. Irises uniformly black. Pupils are
equally round and react to light and accommodation (PERRLA).

Ears and Nose

Auricle without deformity, lumps or lesions. Auricles and mastoid processes non-tender.
Auricle aligned with outer canthus of eye about 10 degree from vertical. Pinna recoils after it is
folded.
Whisper test: Client identifies words clearly. Nose is symmetrical and straight upon palpation.
Nares patent. No tenderness, masses, and displacement of bone cartilages. No redness, swelling,
and abnormal discharge on the nasal mucosa.

Mouth and Throat

Lips are pale and dry to touch, cracked lips. Intact teeth and no teeth anomalies upon
inspection. Tonsils appear to be normal. No swelling on uvula.

Neck

Neck symmetrical without masses and scars. Lymph nodes are non-palpable. Trachea is
in center placement in midline of neck.

Arms, Hands, and Fingers

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 Arms are equal in size and symmetry bilaterally; brown; warm and dry to touch without
edema, bruising, or lesions noted. No lesions and bruising on hands. Three flexion creases
present in palm. Fingernails are finely cut, clean and clear. No clubbing.
Posterior and Lateral Chest

Posterior lateral diameter is 1:2 ratio. Respiration rate is 16 cpm. Symmetrical expansion
on posterior thorax.

Anterior Chest

Chest symmetry is equal. Anterior lateral diameter is 1:2 ratio. Shape and position of
sternum is level with ribs. Position of trachea is in midline. No pain or tenderness in the anterior
thorax. Symmetrical expansion on anterior thorax.
Breasts (Male)
Skin is the same color as the abdomen/back. No swelling, ulcerations, or nodules noted.
Flat disk of undeveloped breast tissue under nipple noted.

Heart
Apical pulse rate is 85 bpm. No gallops or murmurs, or rubs.

Abdomen
Vomits and visceral pain noted in the umbilical region with the pain scale rate of 7 out of
10. Abdomen is uniform in color upon inspection. No rashes or lesions. No evidence of
enlargement of liver and spleen upon inspection and palpation. Navel is protruding. Hyperactive
sounds were heard due to GI disturbance.

Legs, Feet and Toes

Legs has abrasion wound located at both anterior tibia with pus. Skin intact, brown,
warm and dry to touch without edema. Lymph nodes are non-palpable. No edema palpated.
Toenails are finely cut, clean and clear. No clubbing.

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Genitalia (Male)

No bulging or masses in inguinal area. No discharge. No pubic hair. Not yet circumcise
Muscoloskeletal and Neurologic examination

Muscle strength 4/5. No edema noted at both lower extremities. Active resistive range of
motion against some resistance noted. No deviations, inflammations, or bony deformities. Moves
upper and lower extremities freely against gravity and against resistance. Pt. is alert and awake
with eyes open and looking at the examiner; client responds appropriately. Oriented to time and
place and also oriented to people around. Able to recall when and who visits a while ago for
immediate memory. Can recall his name. Attentive and able to memorize, think, read, reason and
pay attention. Takes incoming information and move it into the bank of knowledge.
Cereberal and motor function: Alternates finger to nose with eyes closed; occasionally tends to
hit opposite side of nose. Rapidly opposes fingers to thumb bilaterally without difficulty.
Alternates pronation and supination of hands rapidly without difficulty. Heel to shin intact
bilaterally. Walks steady. No involuntary movements noted.
Sensory status: Superficial light- and deep-touch sensation intact on arms, legs, neck, chest, and
back. Position sense of toes and fingers intact bilaterally.

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Cranial Nerve Assessment
Cranial Nerve Name Result

I Olfactory Can smell and can identify what

it is

II Optic No difficulty of reading either

near or far.

III Occulomotor Pupils are round and react to

light and accommodation.

IV Trochlear Both eyes are well coordinated

and moves in unison without
tenderness felt when left and
right eyes moves. Patient lids
close symmetrically.

V Trigeminal No difficulty in moving his

mouth

VI Abducens Can move left and right eyeballs

in a moderate manner.

VII Facial Raises his left and right

eyebrows whenever you say
something to him. Can close his
both eyes.

VIII Acoustic Can clearly hear normal voice

tone.

IX Glossopharyngeal Positive gag reflex

X Vagus Positive swallowing reflex

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XI Spinal Accessory Patient can move his neck

XII Hypoglossal Can protrude tongue

REVIEW OF SYSTEMS

General Survey
The usual weight of the client is 26kg upon hospitalization, after 3 days of hospitalization
the patient’s weight decreased from 26kg to 24kg. A sunken eyeball, febrile, appears fatigue, thin
and dry skin noted upon assessment.

Integumentary System
Skin is brown, warm and dry to touch. Poor skin turgor noted. Abrasion wound located at the
both anterior tibia with pus. No edema. Healthy black hair and evenly distributed on the scalp.
No scalp lesions or flaking. No hair noted on axilla, or on chest, back or face. Fingernails are
finely cut, clean and clear. No clubbing.

Head, Eyes, Ears, Nose, and Throat (EENT)

Head: Head symmetrically rounded. Identifies light and deep touch to various parts of the face.
Identifies light touch and sharp touch to forehead, cheek and chin. Bilateral corneal reflex intact.
Masseter muscles contract equally and bilaterally. Smiles, frowns, shows teeth, blow cheeks, and
raises eyebrows as instructed.

Eyes: Eyeballs are sunken. Eyebrows sparse with equal distribution. No scaliness noted. Lids
brown, without edema, or lesions noted. Sclera without increased vascularity or lesions noted.
Palpebral and bulbar conjunctiva pale without lesions noted. Irises uniformly black. Pupils are
round and react to light and accommodation.

Ears: Auricle without deformity, lumps or lesions. Auricles and mastoid processes non-tender.
Auricle aligned with outer canthus of eye about 10 degree from vertical. Pinna recoils after it is
folded.
Whisper test: Client identifies words clearly.
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Nose: Nose is symmetrical and straight upon palpation. Nares patent. No tenderness, masses, and
displacement of bone cartilages. No redness, swelling, and abnormal discharge on the nasal
mucosa.

Throat: Tonsils appear to be normal. No swelling on uvula.

Gastrointestinal System
Visceral pain in the umbilical region with the pain scale rate of 7 out of 10. Abdomen is uniform
in color upon inspection. No rashes or lesions. No evidence of enlargement of liver and spleen
upon inspection and palpation. Navel is protruding. Hyperactive bowel sounds with the count of
10 were heard due to GI disturbance. Vomits, diarrhea for 2 days, and stools had soft mucoid
with blood streaks.

Muscoloskeletal System
Muscle strength 3/5. No edema noted at both lower extremities. Active resistive range of motion
against some resistance noted. No deviations, inflammations, or bony deformities. Moves upper
and lower extremities freely against gravity and against resistance. The child cannot be able to
perform ADLS.

Neurologic System
Alert and awake with eyes open and looking at the examiner; client responds appropriately.
Oriented to time and place and also oriented to people around. Able to recall when and who visits
a while ago for immediate memory. Can recall his name. Attentive and able to memorize, think,
read, reason and pay attention. Takes incoming information and move it into the bank of
knowledge. Alternates finger to nose with eyes closed; occasionally tends to hit opposite side of
nose. Rapidly opposes fingers to thumb bilaterally without difficulty. Alternates pronation and
supination of hands rapidly without difficulty. Heel to shin intact bilaterally. Walks steady. No
involuntary movements noted. Superficial light and deep-touch sensation intact on arms, legs,
neck, chest, and back. Position sense of toes and fingers intact bilaterally.

19
 Urinary Systems
Patient has no history of any urinary tract infection. No pain in urination. No discharge.

Reproductive System (Male)

No bulging or masses in inguinal area. No discharge. No pubic hair. Not yet circumcised.

Hematologic
Patient had leukocytosis (High WBC) and thrombocytosis (High platelet count), and decreased
iodized calcium upon admission (November 6, 2018). Positive anemia and blood streak in stool.
No bruising.
WHITE 11.1 4.5-10 10^9/L Increased Infection
BLOOD
CELLS
PLATELET 545 150-450 10^9/L Increased Thrombocyto
COUNT sis

TEST RESULT NORMAL VALUES SIGNIFICANT RATIONALE

SODIUM 134.4 135-146 mmol/L Decreased Hyponatremia
POTASSIUM 3.30 3.50-5.30 mmol/L Decreased Hypokalaemia
IODIZED CALCIUM 0.97 1.37-1.35 Decreased Hypocalcemia
CHLORIDE 104.8 97-107 mmol/L Normal

Endocrine
Diaphoresis was present. No polyuria. Child has loss of appetite

Psychiatric
No signs of depression, memory change, or suicide attempts.

20
 LABORATORY RESULTS

HEMATOLOGY
COMPLETE BLOOD COUNT
November 6, 2018

TEST RESULT NORMAL UNIT SIGNIFICANT RATIONALE

VALUES
RED BLOOD 5.19 4-6 10^12/L Normal
CELL
HEMOGLOBIN 13.6 12-17 g/dL Normal
HEMATOCRIT 42.4 37-54 % Normal
MCV 81.6 87 ± 5 fl Normal

21
MCH 26.2 29 ± 2 pg Decrease Anemia
PLATELET 545 150-450 10^9/L Increased Thrombocytosis
COUNT
RDW 13.9 11.6-14.6 % Normal
WHITE BLOOD 11.1 4.5-10 10^9/L Increased Infection
CELLS

TEST RESULT NORMAL UNIT

VALUES
LYMPHOCYTE 7.4 20-40 % Decreased Lymphocytopenia
SEGMENTERS 85.4 50-70 % Increased Neutrophilia
MID CELL 7.2 1.0-7.0 % Increased Infection

ANALYSIS:
The result of the exam with the platelet count 545 caused by several conditions, including
anemia, inflammation and infection in the GI tract. Elevated white blood cell counts of 11.1 are
infections and inflammation. Lymphocyte count decreased to 7.4 that may indicate
lymphocytopenia. Segmenters and mid cells increased that respond to a bacterial infection.

22
 HEMATOLOGY

COMPLETE BLOOD COUNT

November 7, 2018

TEST RESULT NORMAL UNIT SIGNIFICANT RATIONALE

VALUES
RED BLOOD 4.69 4-6 10^12/L Normal
CELL
HEMOGLOBIN 12.7 12-17 g/dL Normal
HEMATOCRIT 38.4 37-54 % Normal
MCV 81.9 87 ± 5 fl Normal
MCH 27.1 29 ± 2 Pg3 Normal
PLATELET 303 150-450 10^9/L Normal
COUNT
RDW 13.8 11.6-14.6 % Normal
WHITE BLOOD 6.8 4.5-10 10^9/L Normal
CELLS

TEST RESULT NORMAL UNIT

VALUES
LYMPHOCYTE 11.9 20-40 % Decreased Lymphocytopenia
SEGMENTERS 80.9 50-70 % Increased Neutrophilia
MID CELL 7.2 1.0-7.0 % Increased Infection

ANALYSIS:
Lymphocyte count increased from previous day 7.4 to 11.9 but still below normal that
may indicate lymphocytopenia. Segmenters and mid cells increased that respond to a bacterial
infection.

23
 BLOOD CHEMISTRY

NOVEMBER 7, 2018

TEST RESULT NORMAL VALUES SIGNIFICANT RATIONALE

SODIUM 134.4 135-146 mmol/L Decreased Hyponatremia
POTASSIUM 3.30 3.50-5.30 mmol/L Decreased Hypokalaemia
IODIZED CALCIUM 0.97 1.37-1.35 Decreased Hypocalcemia
CHLORIDE 104.8 97-107 mmol/L Normal

Analysis
The result shows decreased sodium counts of 134.4, for the amount of fluid contains is less or
the sodium in the body may be diluted because often the body retains more fluid than sodium,
which means the sodium is diluted. The patient is having diarrhea that causes its potassium level
decreased to 3.30 lost in the digestive tract. Iodized calcium decreased to 0.97 because of
abnormal level in the blood protein malabsorption of calcium, vitamin d, phosphorous and
magnesium deficiency.

24
 URINALYSIS
NOVEMBER 6, 2018

TEST RESULT NORMAL SIGNIFICANT RATIONALE

VALUES
SPECIFIC GRAVITY 1.015 1.025 Decrease
COLOR Amber Normal
TRANSPARENCY Slightly Hazy Normal
GLUCOSE Negative Normal
PROTEIN Negative Normal
pH 6.0 6.0 Normal
WBC 9-10/hpf 9-11/hpf Normal
RBC 0-/hp2 0-2/hpf Normal

Analysis
Urinalysis shown normal urine color amber and slightly hazy a decrease urine specific
gravity it is less precise than urine osmolality and reflects both the quantity and the nature of
particles. Therefore, protein, Glucose, and intravenous contrast agent specific gravity than
osmolality. Urine is a good medium for growth of bacteria that’s why urine ideally performed on

25
 fresh specimen preferably the first voiding. If left standing at room temperature urine become
alkaline because of contamination of urea-splitting bacteria.

STOOL EXAM
November 6, 2018

RESULT SIGNIFICANT RATIONALE

COLOR BROWNISH Normal
CONSISTENCY SOFT MUCOID WITH An indicator of blood entering the
BLOODSTREAK lower portion of the GI tract or
passing rapidly through it.
ENTAMOEBAHISTOLY 2-3 Positive with amoebiasis
TICA CYST
RBC 6-7 /hpf Normal
WBC >50 /hpf Infection
BACTERIA FEW Has presence of bacteria

Analysis:
Stool exam show a brownish in color which it contains a pigment called bilirubin, which
forms when red blood cells break down. Soft mucoid with blood streak indicates of blood

26
entering the lower portion of the GI tract or passing rapidly through it. WBC decreased because
of infection and has a few bacteria in the stool of the patient.

TYPHOID TEST
November 7, 2018

RESULT SIGNIFICANT RATIONALE

TYPHOID 1 IGm rapid Negative Normal
TYPHOID 1 IGm rapid Negative Normal

27
 Anatomy and Physiology

Mouth The mucosal layer of the mouth is composed of stratified squamous epithelial cells. These
cells slough off during normal food chewing and are easily replaced. The mouth functions to
break down food into smaller parts.

The main structures of the mouth include:

Tongue ‐ a muscle that is covered by taste buds. It also assists with the process of chewing, and
helps to maneuver food to a position where it can be swallowed easily.
Salivary glands ‐ these glands produce saliva, which moistens food to assist with swallowing.
The salivary glands also begin the process of chemical digestion through the secretion of the
enzyme, salivary amylase, which begins the process of breaking down carbohydrates. Lingual

28
lipase in saliva is responsible to begin digestion of fats. Ptyalin and salivary amylase begin the
digestion of starch and maltose. Additionally, the saliva is composed of mucous to facilitate
swallowing and Immunoglobulin A (IgA) which consists of antibodies that fight bacteria and
viruses.

Teeth ‐ teeth mechanically break food down into smaller particles for easier swallowing and
ingestion Pharynx ‐ allows the passage of both food and air (Scanlon, 2011).
Esophagus The esophagus is the “food tube” that allows the passage of the food bolus from the
mouth to the stomach. It plays no part in the digestive process.
The esophagus only produces mucus, which acts to:
• Facilitates the passage of food
• Lubricate and protect the esophagus

At the lower end of the esophagus is the gastroesophageal or cardiac sphincter. This sphincter
prevents reflux of gastric contents into the esophagus. Increased gastrin secretion and certain
drugs that increase parasympathetic activity influence the patency of this sphincter. Cigarettes
and alcohol decrease the sphincter’s tone and increase the potential for reflux here as
well. Blood supply to the esophagus comes via the left gastric artery (Scanlon, 2011).
Stomach

The uppermost regions of the stomach are the cardiac region and the fundus, which lead into the
body of the stomach. The antrum is the lower segment of the stomach, leading into the most
distal part of the stomach, known as the pylorus. At the base of the pylorus is the pyloric
sphincter, which allows the passage of chyme into the small intestine.

The stomach functions to store, churn, and puree food into a substance known as chyme:
• Digestion of fats and starches begin in the mouth with the action of salivary enzymes, and
continues in the stomach.
• Protein digestion begins in the stomach.
• There is some digestion of water, alcohol, and glucose in the stomach. Additionally, gastric
acid is produced in the stomach which destroys most bacteria that is ingested with food.

29
Gastric juices are secreted by the cells of the stomach, contributing to chemical digestion. The
food ends up in semi‐ liquid form that is called chyme.

The stomach functions to store, churn, and puree food into chyme:

Digestion of fats and starches begin in the mouth with the action of salivary enzymes, and
continues in the stomach. Protein digestion begins in the stomach. There is some digestion of
water, alcohol, and glucose in the stomach. Additionally, hydrochloric (or gastric) acid is
produced in the stomach, which destroys most bacteria that is ingested with food. Food usually
remains in the stomach for three to four hours for the process of breakdown (Krumhardt &
Alcamo, 2010).

Gastric Cells
There are several types of cells in the stomach that serve both protective and digestive
functions:
• Goblet cells: Are typically mucus secreting cells. Their role in the stomach is protective in
nature.
• Parietal cells: Secrete hydrochloric acid which lowers the pH of the stomach to destroy
bacteria, viruses, and other organisms. The hydrochloric acid also changes pepsinogen into
pepsin and intrinsic factor. These two substances aid in vitamin B12 absorption.
• Chief cells: Secrete pepsinogen, which helps to change ingested proteins into amino acids.
• G cells: Located in the antrum of the stomach, which is lined by mucosa that does not
produce acid. The G cells secrete the hormone, gastrin. Gastrin secretion is stimulated by
stomach distention, presence of protein in the stomach, vagal stimulation, elevated blood
levels of calcium and epinephrine, and decreased acidity. Gastrin helps the gastric mucosa
grow and repair itself. It stimulates the secretion of hydrochloric acid by the parietal cells and
pepsin by the chief cells. Many drugs that prevent the formation of gastric ulcers work in this

30
 area of the stomach. Gastrin also increases the flow of bile and decreases gastric emptying
(Krumhardt & Alcamo, 2010).

Gastric Blood Supply & Innervation

Blood supply to the stomach is via the celiac plexus.

The celiac plexus is composed of:
• The right and left gastric artery
• Gastroduodenal artery
• Splenic artery Innervation to stomach includes:
• Intrinsic innervation: This occurs via the mesenteric (Auerbach’s) plexus and the sub‐
mucosal (Meissner’s) plexus. Intrinsic innervation influences muscle tone, contractions, speed,
excitation, and secretions of the stomach.
• Extrinsic innervation: This occurs via the parasympathetic and sympathetic nerves.
Parasympathetic innervation occurs via the vagus nerve, which causes:
 Increased gastrointestinal functions and activity by increasing acetylcholine.
 Increased glandular section and decreases sphincter tone.
Conversely, sympathetic tracts run alongside the blood supply to the stomach and secrete
norepinephrine when stimulated. Sympathetic stimulation inhibits gastrointestinal activity
(Krumhardt & Alcamo, 2010).

31
Small Intestine
The small intestine extends from the pylorus to the ileocecal valve. The small intestine is
composed of the duodenum, jejunum, and ileum. The ligament of Treitz divides the duodenum
from the jejunum. Upper gastrointestinal bleeding occurs above this ligament and lower
gastrointestinal bleeding occurs below this ligament.

The primary function of the small intestine is the absorption of vitamins and nutrients, including
electrolytes, iron, carbohydrates, proteins, and fats. Most digestion of nutrients happens here.
The small intestine also absorbs approximately 8,000 milliliters (mL) of water per day (Barron,
2010). Three thousand milliliters of digestive enzymes are secreted in the small intestine daily.

These enzymes include:

Lipase – splits fats into monoglycerides, glycerol, and fatty acids
Amylase – converts starch to maltose
Maltase – converts maltose to glucose
Lactase – converts lactose into galactose and glucose
Sucrase – converts sucrose into fructose and glucose
Dextrinase – converts specific dextrins into glucose

Intestinal Hormones

The mucosa in the intestines also contains hormones. These include (Barron, 2010):

Enterogastrone: Found in the duodenal mucosa. Inhibits gastric acid secretion and gastric
motility. Gastric inhibitory polypeptide (GIP): Found in the duodenal and jejunal mucosa.
Inhibits gastric acid secretion, pepsin secretion, and gastric motility.

Secretin: Found in the duodenal mucosa. Stimulates pepsinogen secretion, secretions of

pancreatic digestive enzymes, and secretion of bile from the liver. Also decreases gastric acid

32
secretion. Cholecystokinin (CCK): Found in the jejunal mucosa. Stimulates contraction of the
gallbladder and secretion of pancreatic enzymes, and inhibits gastric motility.

Vasoactive intestinal peptide (VIP): Found in intestinal mucosa. Similar effects as secretin,
stimulates production of intestinal secretions that decrease chyme acidity, and inhibits gastric
secretion. Somatostatin: Found in the intestines. Inhibits secretion of gastric acid, saliva, pepsin,
intrinsic factor, and pancreatic enzymes. Inhibits gastric motility, gallbladder contraction,
intestinal motility, and blood flow to the liver and intestine. Also inhibits secretion of insulin and
growth hormone.

Serotonin: Found in the intestines. Inhibits gastric acid secretion.

Intestinal Blood Supply & Innervation

Blood supply to the small intestine is derived from:

 The celiac artery
 The superior mesenteric artery Innervation of the small intestine is the same as for the stomach
(Krumhardt & Alcamo, 2010).

Large Intestine

The large intestine extends from the terminal ileum at the ileocecal valve to the rectum. At the
terminal ileum, the large intestine becomes the ascending colon, the transverse colon, and then
the descending colon. Following the descending colon is the sigmoid colon and the rectum
(Scanlon, 2011). The main function of the large intestine is water absorption. Typically, the large
intestine absorbs about one and one‐ half liters of water per day. It can, however, absorb up to six
liters. The large intestine also absorbs potassium, sodium, and chloride. It produces mucous
which lubricates the intestinal wall and holds the produced feces together for elimination. The
superior and inferior mesenteric arteries and the hypogastric arteries supply the blood supply to
the large intestine. Innervation of the intestine is the same as for the stomach (Scanlon, 2011)

Gallbladder

33
The gallbladder is a pear‐shaped, sac‐like organ attached to the liver that serves as a storage
facility for bile. It can hold and concentrate approximately 50 mL of bile. The cystic duct
connects the gallbladder to the common bile duct, which terminates at the Sphincter of Oddi in
the duodenum of the small intestine. When a large or fatty meal is consumed, nerve and chemical
signals (release of the enzyme CCK) cause the gallbladder to contract. This contraction releases
bile into the digestive system. The gallbladder receives blood from the cystic and hepatic artery
and is innervated by the splanchnic nerve and the right branch of the vagus nerve (Scanlon,
2011).
Bile & Bile Pigments
Bile has three major components:
• Water
• Bile salts
• Bile pigments Bile salts absorb and emulsify fats and fat‐soluble vitamins (A, D, E, &
K). Bile pigments are composed primarily of bilirubin, cholesterol, and
phospholipids. Bilirubin is the by‐product of hemolysis (Scanlon, 2011).

There are Two Types of Bilirubin

Indirect‐Bilirubin ‐ Unconjugated or indirect‐bilirubin: This is bilirubin that is in a lipid‐soluble

form, and circulates in loose association with the plasma proteins. When red blood cells, or
erythrocytes, are broken down, the heme is converted to unconjugated bilirubin by the cells in
the pancreas. It can then bind to albumin to go to the liver.

Direct‐Bilirubin ‐ Conjugated or direct bilirubin: This is bilirubin that has been taken up by the
liver cells and conjugated to form the water‐soluble bilirubin diglucuronide. Most conjugated
bilirubin ends up in bile. Total bilirubin is the indirect plus the direct bilirubin. When total
bilirubin is elevated and the cause is unknown, direct and indirect bilirubin should be measured
(Krumhardt & Alcamo, 2010)

Liver

34
The liver is a very large organ located in the upper right abdomen. There are right, left, and
caudate lobes of the liver. Each of these lobes is further sub‐divided into eight segments. These
segments can be resected during surgery if diseased or traumatized. The functional unit of the
liver is the lobule or the acinus. Blood supply to the liver arises from both the portal vein and
hepatic artery. Nearly one‐quarter of our cardiac output is delivered through the liver per minute,
most of which travels through the portal vein. The blood is filtered through the Kupffer cells of
the liver, which destroy debris and unwanted organisms (Scanlon, 2011).

Functions of the Liver

Although there are literally hundreds of functions of the liver, the main functions can be
categorized into five groups:
1. Conjugation of bilirubin
• Bilirubin is typically formed from the destruction of red blood cells. Conjugation or
conversion to the water‐soluble form of bilirubin occurs in the liver. The kidneys can
excrete this form of bilirubin.
• Patients with liver dysfunction are often jaundiced due to the accumulation of bilirubin
in the body.
2. Synthesis and deactivation of clotting factors
• Produces all Vitamin K dependant clotting factors including II, VI, VII, IX, and
X.
• Removes activated clotting factors and produces heparin which prevents too much
clot formation in the body.
• Patients with nutritional problems have abnormal clotting mechanisms and may
develop thrombocytopenia.
3. Detoxification of hormones, ammonia, and drugs
• Converts many fat‐soluble drugs and substances into a water‐soluble form that can be
excreted from the body in the urine.
• Patients with liver dysfunction may manifest inability to excrete certain drugs,
ammonia, and hormones.
4. Phagocytosis

35
 • Seventy percent of the body’s total macrophages are in the liver in the form of
Kupffer Cells.
• Patients with liver dysfunction have a poor immune response. 5. Carbohydrate,
protein, and fat metabolism
• Maintains normal serum glucose levels by carbohydrate synthesis, metabolism, and
transport.
• The liver allows the body to use essential nutrients effectively, even if the nutrients
are artificially supplied through partial parental nutrition (PPN) or total parental nutrition
(TPN). So, giving a patient with liver failure TPN or PPN may not correct their
nutritional deficits.
• Patients with liver dysfunction have extreme nutritional deficits. (Scanlon, 2011)

Pancreas
The pancreas is both an endocrine and exocrine gland. The endocrine functions include
the production of:
• Insulin
• Glucagon
• Somatostatin (see also the RN.com course on Endocrine Anatomy and Physiology)

The exocrine function of the pancreas is mainly digestive in nature, and involves the
secretion of pancreatic enzymes and bicarbonate.
The major digestive enzymes secreted by the pancreas are:
• Trypsin
• Lipase
• Amylase
These enzymes help digest carbohydrates, proteins, and fats. They are normally secreted
into the duodenum in their inactive form. Once in the duodenum they are converted to
their active form and begin the digestive process. Bicarbonate is necessary to neutralize
these and other enzymes located in the duodenum. Bicarbonate is secreted by the
exocrine pancreas to prevent duodenal ulceration and irritation (Scanlon, 2011).

36
Blood Supply & Innervation of the Pancreas Blood supply to the pancreas occurs via the
hepatic and cystic artery. The pancreas is innervated by the splanchnic nerve and right
branch of the vagus nerve. Vagal (parasympathetic) stimulation results in the secretion
of pancreatic enzymes. These secretions travel through the main pancreatic exocrine duct,
the Duct of Wirsung. This duct terminates next to the common bile duct at the Sphincter
of Oddi (Scanlon, 2011).

Biliary Ducts
While not organs themselves, the ducts of the biliary tract are very important in the
proper functioning of the gastrointestinal system and body as a whole. In the liver, bile
is collected in the bile calculi, which eventually become the left and right hepatic ducts,
which exit the liver as the common hepatic duct. The cystic duct allows stored bile to be
released from the gallbladder. The cystic duct and the common hepatic duct meet to form
the common bile duct, which eventually terminates in the duodenum, next to the Duct of
Wirsung (from the pancreas) at the Sphincter of Oddi (Krumhardt & Alcamo,
2010). Obstruction or damage to any of these ducts may result in the improper drainage
of bile and pancreatic enzymes. Complications can include hepatitis, liver failure,
pancreatitis, cholangitis, cholecystitis, and others (Scanlon, 2011)

37
 PATHOPHYSIOLOGY

Predisposing factors: Precipitating factors:

 Age: 9 years old  Ingestion of contaminated

 Weak immune system food and drinks
 Lives in rural area (Poktoy,  Unsanitary food handling
SDN  Poor environmental
sanitation
 Socioeconomic status

Ingestion of cyst of the

infecting microorganism

Invades the epithelium cells of

 Diarrhea
the colon and start of
 Abdominal Pain
inflammation
 Hyperthermia

Cyst Development in the

 Metronidazole Sigmoid colon and intestinal Decrease integrity of the
 Hydration (IVF D5 o.3 damage intestinal wall
NaCl 500ml
 Paracetamol
 Ranitidine
 Erceflora  Decreased
Stimulation of the
sympathetic/parasympathetic absorption
 Vomiting responses
 Diarrhea
 Dehydration

Increased platelet(545),  Anemia

 Hydration (IVF D5 o.3 WBC(11.1), segmenters, mid  Infection
NaCl 500ml cells and decreased  Thrombocytosis
 Erceflora lymphocyte  Lymphocytopenia
 Neutrophilia
38
  Ceftriaxone
 Zinc Sulfate
 Metronidazole

If left untreated

If infection is severe

Peritonitis

Sepsis

Multiple Organ Failure

Death

LEGEND:
= Disease Process
= Client Manifestation
= Clinical Manifestation
= Treatment/management
= If Left Untreated
= Death

39
 PATHOPHYSIOLOGY:

The predisposing factor of patient P.P are the age, weak immune system and the location
of their residency at Brgy. Poktoy Surigao Del Norte. The precipitating factors are the ingestion
of contaminated food and drinks, unsanitary food handling, poor environment sanitation and
socioeconomic status.
When cyst is swallowed, it passes through the stomach unharmed and shows no activity
while in an acidic environment. When it reaches the alkaline medium of the intestine, the
metacyst begins to move within the cyst wall, which rapidly weakens, tears and start of
inflammation with client manifestation of diarrhea, abdominal pain and hyperthermia. Treatment
for hydration is IVFD o.3 NaCL 500ml, paracetamol, ranitidine and erceflora.
When cyst has opportunity of the organism to colonize and developed in the lower GI
tract it will have clinical manifestation of decreasing integrity of the intestinal wall.
When the invasion of pathogen is detected the sympathetic and parasympathetic
responses and stimulate client manifestation of vomiting, diarrhea and dehydration with
treatment of IVFD5 o.3 NaCI 500ml and erceflora. The clinical manifestation is the decreased of
absorption.
As the progress of invasion grows the platelet, WBC, segmenters, mid cells increased
while lymphocyte decreased with client manifestation of anemia, infection, thrombocytosis,
lymphocytopenia and neutrophilia with management of taking ceftriaxone, zinc sulfate and
metronidiazole.
If left untreated, peritonitis can rapidly spread into the blood(sepsis) and to other organs,
resulting in multiple organ failure and death.

40
 Drug Study No. 1

Generic name:
Paracetamol

Brand name:
BIOGESIC

Dosage:
500 mg/tab 1 tab

Route:
Oral

Frequency:
q 4°

Classification
Analgesic ( Non-opioid)
Antipyretic

Mechanism of action
Paracetamol may cause analgesia by inhibiting CNS prostaglandin synthesis. The mechanism of
morphine is believed to involve decreased permeability of the cell membrane to sodium, which
results in diminished transmission of pain impulses therefore analgesia.

Indications
To relieve mild to moderate pain due to things such as headache, muscle and joint pain, backache
and period pains. It is also used to bring down a high temperature. For this reason, paracetamol
can be given to children after vaccinations to prevent post-immunization pyrexia (high
temperature). Paracetamol is often included in cough, cold and flu remedies

41
Contraindications
Hypersensitivity to acetaminophen or phenacetin; use with alcohol

Adverse effect
Hematologic:
Hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia.
Hepatic:
Liver damage, jaundice
Metabolic:
Hypoglycemia
Skin:
Rash, urticuria

Nursing Responsibility

Assess patient’s fever or pain: type of pain, location, intensity, duration, temperature, and
diaphoresis.
Assess allergic reactions: rash, urticaria; if these occur, drug may have to be discontinued.
Teach patient to recognize signs of chronic overdose: bleeding, bruising, malaise, fever,
sore throat.
Tell patient to notify prescriber for pain/ fever lasting for more than 3 days.

42
 Drug Study No. 2

Generic:
Ranitidine

Brand:
ZANTAC

Classification:
Anti-ulcer

Dosage:
50mg/tab 1 tab

Route:
Oral

Frequency:
OD

Mechanism of Action:
Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells,
resulting in inhibition of gastric acid secretion has some antibacterial action against H. pylori

Indications
Treatment and prevention of heartburn, acid indigestion, and sour stomach
Prophylaxis of GI hemorrhage from stress ulceration

Contraindications
Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be
avoided in patients with known intolerance

43
Nursing Intervention
 Instruct patient not to take new medication w/o consulting physician
 Instruct patient to take as directed and do not increase dose
 Allow 1 hour between any other antacid and ranitidine
 Avoid excessive alcohol
 Assess patient for epigastric or abdominal pain and frank or occult blood in the stool,
emesis, or gastric aspirate
 Nurse should know that it may cause false-positive results for urine protein; test with
sulfosalicylic acid
 Inform patient that it may cause drowsiness or dizziness
 Inform patient that increased fluid and fiber intake may minimize constipation
 Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness;
rash; confusion; or hallucinations to health care professional promptly
 Inform patient that medication may temporarily cause stools and tongue to appear gray
black
 Instruct patients to monitor for and report occurrence of drug-induced adverse reaction

44
 Drug Study No. 3

Genenric name:
Ceftriazone

Brand Name:
FORGRAM

Dosage:
450mg/vial

Route:
IVTT

Frequency:
q 12 hours

Classification
3rd generation cephalosporin

Mechanism of Action
Works by inhibiting the mucopeptide synthesis in the bacterial cell wall. The beta-lactam moiety
of Ceftriaxone binds to carboxypeptidases, endopeptidases, and transpeptidases in the bacterial
cytoplasmicmembrane. These enzymes are involved in cell-wall synthesis and cell division. By
binding to these enzymes, Ceftriaxone results in the formation of of defective cell walls and cell
death.

Indication
Indicated in patients with neurologic complications, carditis and arthritis. It is also effective in
Gram negative infections; Meningitis, Gonorrhea. It is also for Bone and joint infections, Lower
respiratory tract infections, middle ear infection, PID, Septicemia and Urinary Tract infections.

45
Contraindications
Hypersensitive to cephalosporins, penicillins and related antibiotics.

Side Effect
• Pain
• Induration
• Phlebitis
• Rash
• Diarrhea
• Thrombocytosis
• Leucopenia
• Respiratory super infections

Nursing Consideration

 Assess patient’s previous sensitivity reaction to penicillin or other cephalosphorins.

 Assess patient for signs and symptoms of infection before and during the treatment
 Obtain C&S before beginning drug therapy to identify if correct treatment has been
initiated.
 Report signs such as petechiae, ecchymotic areas, epistaxis or other forms of unexplained
bleeding.
 Monitor hematologic, electrolytes, renal and hepatic function.
 Assess for possible upper infection: itching fever,

46
 Drug Study No. 4

Generic Name
Metronidazole

Brand Name
FLAGYL

Actual Dose
125mg/5mL,
2.5mL/bottle

Route:
Oral

Frequency:
q 8 hours

Classification
 Antibiotic
 Antibacterial
 Amebicide
 Antiprotozoal

Mechanism of action
Inhibits growth of amoebae by binding to DNA, resulting in loss of helical structure, strand
breakage, inhibition of nucleic acid synthesis and cell death.

47
Therapeutic Effects:
Hinders growth of selected organisms, including most anaerobic bacteria and protozoa
Drug Half Life

Indication
 Acute infection with susceptible anaerobic bacteria
 Acute intestinal amoebiasis

Contraindication
 Active organic disease of the CNS
 Drug Allergy
 Blood dyscrasia
 hypersensitivity
 hypersensitivity to parabens
 first trimester of pregnancy

Precautions
>history of blood dyscrasias; seizures or neurologic problems
>severe hepatic impairment
>pregnancy, lactation and children

Drug interactions
>cimetidine
>phenobarbital
>warfarin
>disulfiram
>fluorouracil

Side effects
 Headache,
 Nausea,

48
  dry mouth,
 vomiting,
 diarrhea

Adverse Reactions
CNS: seizures, dizziness, headache
EENT: Tearing(topical only)
GI: abdominal pain, anorexia, nausea and vomiting, diarrhea, dry mouth, glossitis
Derm: rashes, urticarial, mild dryness, skin irritation
Hemat: leukopenia
Local: Phlebitis at Iv site
Neuro: peripheral neuropathy
Misc: superinfection

Nursing Responsibilities
 Observe the 10 Rs before giving the drug.
 Instruct to take drug with food or milk to decrease GI upset
 Inform that drug may turn urine brown, don’t be alarmed

Before
 >assess pts. Infection
 >watch carefully for edema because it may cause sodium retention
 >assess skin for severity areas of local adverse reactions
 >record number and character of stools
 >assess pt’s and family’s knowledge of drug therapy

During
 >give drug with meals to minimize GI distress
 >to treat trichomoniasis, give drug for 7days instead of 2-g single dose
 >use only after T.vaginalis has been confirmed by wet smear
 >tablets may be crushed for pt’s. with difficult swallowing

49
  >do not use aluminium needles or hubs, color will turn orange/rust

After
 >tell pt. that metallic taste and dark or red brown urine may occur
 >instruct pt. to take oral form with meals to minimize reactions
 >instruct to complete full course of therapy
 >tell pt. not to use alcohol or drugs that contain alcohol.
 >may cause dizziness/ light headedness

50
 Drug Study No. 5

Generic Name:
Bacillus Clausii

Brand Name:
ERCEFLORA

Dosage
1 respule of 2 billion/5ml suspension

Route:
Oral

Frequency:
q 12 hours

Classification:
Antidiarrheals

.
Mechanism of Action
 Contributes to the recovery of the intestinal microbial flora altered during the course of
microbial disorders of diverse origin.
 Produces various vitamins, particularly group B vitamins thus contributing to correction
of vitamin disorders caused by antibiotics & chemotherapeutic agents.
 Promotes normalization of intestinal flora.

Indication:
 Acute diarrhea with duration of ≤14 days due to infection, drugs or poisons.

51
  Chronic or persistent diarrhea with duration of >14 days.

Contraindication
Not for use in immune compromised patients (cancer patients on chemotherapy, patients taking
immune suppressant meds)

Side/Adverse Effect
No known side/adverse effects

Nursing Consideration
 Shake drug well before administration.
 Monitor patient for any unusual effects from drug.
 Administer drug within 30 minutes after opening container.
 Dilute drug with sweetened milk, orange juice or tea.
 Administer drug orally.

BEFORE
 Shake drug well before administration.
 Allows equal distribution of the drug in the fluid it is in.

DURING:
 Monitor patient for any unusual effects from drug.
 Monitoring allows detection of possible side effects of the drug since there
has been no known side effect of the drug.

AFTER:
 Administer drug within 30 minutes after opening container.
 To avoid contamination of the drug. Dilute drug with sweetened milk, orange
juice or tea.
 To allow easy administration of the drug. Administer drug orally.
 Proper administration allows better effects of the drug and prevent possible
complications

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 Drug Study No. 6

Generic name:
Zinc Sulfate

Brand name:
ZINCATE

Classification:
Mineral and electrolyte replacements/supplements

Dosage
10ml/bottle suspension

Route
Oral

Frequency
OD

Mechanism of Action
Serves as a cofactor for many enzymatic reactions. Required for normal growth and tissue repair,
wound healing and sense of taste and smell.

Indication
Dietary supplementation; supplement to IV solutions given for TPN; treatment or prevention of
zinc deficiencies. Ophthalmic solution used as mild astringent for relief of eye
irritation.Treatment of acrodermatitis enteropathica and delayed wound healing associated with
zinc deficiency; treatment of acne, rheumatoid arthritis, Wilson's disease.

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Contraindication
Direct injection of undiluted solution into peripheral vein.

Adverse effects
 Abdominal pain, dyspepsia, nausea, vomiting, diarrhea, gastric irritation, gastritis.

 Prolonged use may cause copper deficiency (e.g. sideroblastic anemia, neutropenia)

Nursing responsibility
• Tell patient to contact health care provider if nausea, severe vomiting, dehydration, or
restlessness occurs.
• Identify food sources of zinc (e.g., seafood, organ meats, wheat germ).
• Inform patient that sense of taste and smell, skin hydration, and wound healing should
improve.

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 NURSING CAREPLAN #1

Assessment
Subjective: “ Sige ako kalibang nan basa na tae” as verbalized by the
patient.

Objective:

 Body malaise
 Sunken eyeballs
 Poor skin turgor noted
 Fatigue
 Loose bowel movement stool had soft mucoid with blood streak
 10 times defecate
 Decrease urine specific gravity(1.015)

Nursing Diagnoses: Mild fluid volume secondary to Intestinal Amoebiasis

Planning: After 1 day of nursing interventions, the patient will maintain adequate fluid volume
as evidenced by good skin turgor and balance intake and output.
Nursing intervention Rationale

INDEPENDENT Provides baseline for assessing and evaluating

Assess vital signs. interventions.

Note physical signs of dehydration. Predictors of fluid balance that should be in

client’s usual range in a healthy state.

Encouraged fluid intake and monitoring of daily To detect early signs of dehydration.
fluid intake and output.

Estimate or measure traumatic or procedural fluid These factors are used to determine degree of
losses and note possible routes of insensible fluid volume depletion and method of fluid

55
losses. Determine customary and current weight. replacement.

Note change in usual mentation, behavior and These signs indicate sufficient dehydration to
functional abilities ( e.g.;confusion, falling, loss of cause poor cerebral perfusion or can reflect the
ability to carry out usual activities, lethargy ,and effects of electrolyte imbalance. In a hypovolemic
dizziness. shock state, mentation changes rapidly and client
may present in coma.

DEPENDENT
IVF Therapy D5 0.3 NaCl To hydrate and replace the fluid loss
Administer medications (Erceflora, To limit gastric/intestinal losses; to treat
Metronidazole, Ceftriaxone) bacteria.

Evaluation: Goal was met. Client was able to maintain adequate fluid volume as evidence by
good skin turgor and balance intake and output.

56
 NURSING CAREPLAN #2

Assessment
Subjective: “ Sakit karajao ako tijan” as verbalized by the patient with the pain scale of
from 0-10, pain can be rated as 7. Search sa characteristic sa pain location
Objective:
Diaphoresis
Facial expression of pain ( e.g., grimace, eyes lack luster)

Nursing Diagnosis :Acute pain related to inflammation secondary to Amoebiasis

Planning: After 2 hours of nursing intervention the patient will report pain is relieve or
controlled with the pain scale 5 out 10.
Nursing Intervention Rationale

DEPENDENT

Administer medications as prescribed To eliminate the pain

(Paracetamol, Ranitidine)

Evaluation: Goal met. The patient reported pain is relieved and controlled with the pain scale of
from 0-10 is 5.

57
 NURSING CAREPLAN #3

Assessment:

Subjective: “Nag niwang siya maayo maam kaysa adtong niagi nga adlaw” as
verbalized by the SO

Objective: Weight loss from 26kgs to 24kgs in 3 days

Vomiting
Weakness
Decreased appetite
Poor muscle tone
Normal BMI for 9 y/o: 20-27
Patient BMI: 14.27 (underweight)
Loss bowel movement 10 times a day
Nursing Diagnosis: Imbalanced nutrition: Less than body requirements related
to frequent vomiting.

Planning: After 1 day of nursing intervention the patient will be able to :

 Verbalize food preference which is not contraindicated to underlying the disease
to promote good appetite
 Improve appetite from poor to fair
 Reduces the occurrence of vomiting

Nursing Intervention Rationale

( Independent )

Use flavoring agents to determine enhance Suggest severity of effect in fluid and
food satisfaction and stimulate appetite. electrolyte balance and nutritional status.
Encourage clients to choose foods, have family To promote comfort and enhance intake.
members to bring food that seen appealing(

58
which are not contraindicated)
Promote pleasant relaxing environment
including socialization when possible to
enhance food intake.
Prevent/minimize unpleasant odors.
Auscultated bowel sounds.
Collavborative
Refer to dietician from modification of diet (
General liquids )
To reduce gastric acidity and improve nutrient
intake.
To reduce the occurrence of vomiting
Hyperactive bowel sounds due to GI
disturbance.
To gradually stimulate appetite for fast
recovery.

Evaluation: Goal partially met at the end of 2 hours of nursing intervention the patient will be
able to verbalize food preference which are not contraindicated to underlying disease to promote
good appetite and reduced the occurrence of vomiting but failed to improve appetite from poor to
fair.

59
 NURSING CAREPLAN #4

Assessment
Subjective: “Arang ka init sa lawas ug tag takigan ako anak’ as verbalized
by the SO
Objective:
 Warm and flushed skin
 Chattering teeth noted
 Chills noted
Vital Signs
 Elevated temperature (38 degree Celsius)
 Vomits 3 times a day

Nursing diagnosis: Hyperthermia related to dehydration

Planning: After 2 hours of rendering of nursing intervention, patient will be able to maintain
body temperature within normal range and be free of convulsion activity.
Nursing intervention Rationale

INDEPENDENT
Adjust and monitor environmental factors like
room temperature and bed linens as indicated.
Room temperature may be accustomed to near
normal body temperature and blankets and linens
may be adjusted as indicated to regulate
temperature of the patient

Eliminate excess clothing and covers Exposing skin to room air decreases warmth and
increases evaporative cooling.

Monitor use of hypothermia blanket. To minimize shivering.

Raise the side rails at all times This is to ensure patient’s safety even without the

60
 presence of seizure activity.

Educate patient and family members about the
signs and symptoms of hypothermia and help in
identifying factors related to occurrence of fever;
discuss importance of increased fluid intake to
avoid dehydration.
Providing health teachings to the patient and
family aids in coping with disease condition and
could help prevent further complications of
hypothermia.

Provide additional cooling mechanisms This measures help promote cooling and lower
commensurate with significance of fever and core temperature.
related manifestations:
• Noninvasive: cooling mattress cold packs
applied to major blood vessels

DEPENDENT

IVF Therapy (D5 0.3 NaCl) Hydrate and replace fluid loss

Give antipyretic medications as prescribed

Antipyretic medications lower body temperature
(Paracetamol)
by blocking the synthesis of prostaglandins that
act in the hypothalamus.

Evaluation:
Goal is met, the patient was able to maintain body temperature of within the normal range 36.5
degree Celsius and free from convulsion activity.

61
 NURSING CAREPLAN #5

Assessment

Subjective: “luja ija lawas og pid-as” verbalized by SO

Objective: Inability to restore energy even after sleep

Lack of energy
Tired
Lethargic or restless
Increased physical complaints
Hypokalemia (135-146 mmol/L)
Hyponatremia (134.4 mmol/L)
Hypocalcemia (1.37-1.35)

Nursing diagnosis : : Electrolyte imbalance related to insufficient fluid volume secondary to

amoebiasis
Planning : After 2 days of nursing intervention patient will be free of complication resulting
from electrolyte imbalance

Nursing intervention Rationale

INDEPENDENT Tachycardia, bradycardia, and other dysrhythmias

Monitor heart rate and rhythm by palpation and are associated with potassium, calcium, and
auscultation. magnesium imbalances.

Auscultate breath sounds, assess rate and depth of Certain electrolyte imbalances such as
respirations and ease of respiratory effort, observe hypokalemia, can cause or exacerbate respiratory
color of nailbeds and mucous membranes, and insufficiency.
note pulse oximetry or blood gas measurement, as
indicated.

Review the clients food intake These condition point to electrolyte imbalances

62
Assess fluid intake and output Many factors such as ability to drink, affect an
individual’s fluid balance, disrupting electrolyte
transport, function and excretion.

Note the presence of medical conditions that may Hyponatremia ay be associated such as metabolic
impact sodium level acidosis and intestinal conditions.

DEPENDENT Administer fluids and electrolytes to prevent

Administer isotonic IV fluids peaks and valleys in fluid level.

Evaluation: Goal met,the patient is free of complication resulting from electrolyte imbalance

63
 DISCHARGE PLAN
MEDICATIONS:
 Inform the S.O about the possible side effects of the medications.
 Inform the S.O about the importance of compliance to prescribed medications and
consequences.

Hydrite Powder 1 sachet in 1 glass of water every 4 hours for 2days

Metronidzaole 250mg/tab one tab three times a day for 10 days
Erceflora 1 respule two times a day for three days
Cefixime suspension 10 ml 2 times a day for 7 days

ENVIRONMENT
 Wash hands with soap after going to the toilet and before eating or preparing food.
 Avoid contact with soil
 Avoid sharing towels with infected persons

TREATMENT
Treat intestinal amoebiasis with metronidazole 250mg/tab one tab three times a day for 10 days it
kills trophozoites of Entamoeba histolytica in intestines and tissue.

HEALTH TEACHINGS
Activities
 Bed rest upon arrival at home from the hospital.
 Light exercise every morning.
 Eventually the patient can return to its normal activities of daily living.

Hygiene
 Cut and keep your nails clean
 Proper handwashing is necessary
 Take care of drinking water - either option for mineral water or water boiled for 20
minutes.

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OPD- FOLLOW-UP:
 Return again after a week for follow up check-up at OPD November 14, 2018.

DIETARY MANAGEMENT:
 Diet as tolerated but encouraged to have clear liquids such as water, juice and tea to
rehydrate.
 Oral rehydration or electrolyte solutions may help.
 Drinking small amounts at frequent intervals is better accepted in cases of nausea.
 Light soups, toast, rice and eggs are good foods; eat foods high in fiber and
carbohydrates.

SPIRITUAL
 Continue religious practices.
 Always pray for fast recovery.

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 APPENDICES

IVF CHART

Date # of Solution Volume Additive Rate of Time

Bottle Drop
11/6/18 1 1L D5LR 5-10 gtts 6:30 pm
2 1L D5LR 10 gtts
3 500 cc D5LR 10 gtts 6:30 pm
4 500 cc D5LR 10 gtts 12:35 am
11/7/18 1 500 cc D5LR 20 gtts 5:40 am
2 500 cc D5LR 20 gtts 9:30 am
3 1L D5 0.3 NaCl 20 gtts 9:25 am
11/8/18 1 500 cc D5 0.3 NaCl 10 gtts 9 am
11/9/18 1 500 cc D5 0.3 NaCl 10 gtts 5:30 am

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 Vital Signs

Date Time BP PR RR Temp

11/6/18 8 am - 134 32 38.1
12 nn - 109 28 38.9
4 pm - 136 32 37.6
8 pm - 128 26 38.1
12 am - 126 26 38.4
4 am - 136 32 37
11/7/18 8 am - 110 22 37
12 nn - 98 25 37.7
4 pm - 85 21 37.6
8 pm - 86 23 36
12 am - 93 20 36.4
4 am - 98 22 36.1
11/8/18 8 am - 76 24 36
12 nn - 97 21 36.6
4 pm - 94 20 36.8
8 pm - 88 32 37
12 am - 94 27 36.2
4 am - 83 23 36
11/9/18 8 am - 79 25 36.2

67
 I AND O SHEET

Date Credit Consumed Oral Total Urine Vomitus Bm Total

fluid Taken Output Output
taken
11/7/18 R-210 600 - 600 500 - 3x 500+3
7 pm- 7 600 bm
am

CFAC

COLOR FREQUENCY AMOUNT CHARACTERISTICS

11/6/18 BROWNISH 10 MEDIUM SOFT WATERY WITH
(7AM) BLOOD STREAK
11/6/18 BROWNISH 10 FEW SOFT WATERY
(7PM)
11/7/18 YELLOW 10 MODERATE WATERY
(7AM)
11/7/18 YELLOW 3X MODERATE SOFT
(7PM)

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 GENOGRAM

LEGENDS:

Mother, diabetes and UTI

Father, alive and well

Grandfather, alive and well

Siblings, alive and well

Grandmother, alive and well Patient, ameobiasis

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 DEFINITION OF TERMS

AMOEBIASIS
- Is an infection of small intestine, which is caused by an protozoan called Entamoeba
histolytica. It is simply called as Amoebic dysentery. This is usually contracted by ingesting
water or food contamination by amoebic cysts.(Dr. Nagata, 2009)

Fulminant or necrotizing colitis

- Acute fulminant necrotizing amebic colitis (FNAC) is a rare complication of intestinal
amebiasis that is associated with high mortality and requires prompt diagnosis and surgical
intervention. (Suhani, Ali S, Thomas S, Aggarwal L., Ann Trop Med Public Health 2013;6:661-
3)

Toxic megacolon
- Toxic megacolon is the clinical term for an acute toxic colitis with dilatation of the colon. The
dilatation can be either total or segmental. A more contemporary term for toxic megacolon is
simply toxic colitis, because patients may develop toxicity without megacolon. (Clin Colon
Rectal Surg. 2010 Dec. 23(4):274-84.)

Bowel perforation
- Bowel perforations occur when a hole is made in this lining, often as a result of colon surgery
or serious bowel disease. A hole in the colon then allows the contents of the colon to leak into the
usually sterile contents of your abdominal cavity. (Digestive Diseases and Sciences. 2017.
62(6):1607-1614)

Peritonitis
- Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the
abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused
by infection from bacteria or fungi.

70