1. PBL 14 SUPERVISOR : DR SAHAR ZAKARIA
DYSENTERY
PBL 14
SUPERVISOR : DR SAHAR ZAKARIA

2. DEFINITION
Dysentery is a form of severe diarrhea with mucus and blood in the stools with or without tenesmus.
As the result of intestinal inflammation mainly in the colon

3. CAUSATIVE AGENTS A- INFECTIOUS CAUSES :
Bacterial (shigella, salmonella, campylobacter, E-coli, colistredium difficile )
Parasitic (Entamoeba histolytica, Balantedium. coli, Schistosom. mansoni, Plasmodium. falciparum, Leishmania. donovani)
Viral (rotavirus, norovirus, adenovirus and CMV ) uncommon cause of dysentery

4. B. NON INFECTIOUS CAUSES
Ulcerative colitis
- A chronic inflammatory and ulcerative disease arising in the colonic mucosa
Ischemic colitis
- Transient reduction in blood flow to the colon
Colorectal tumor
- Malignancy in the colon

5. CLINICAL MANIFESTATION

6. Most common dysentery
Bacillary dysentery
Amoebic dysentery
Causative agents
Shigella flexneri, Shigella dyenteriae, Shigella boydi, Shigella sonnei
Parasite entamoeba histolytica
Frequency of Diarrhea
More (up to 20 or 30 watery bowel movements in 1 day)
 Less
Sign & Symptom
High fever
Dehydration
Bloody + pus stool
Loss of appetite
Flatulence
Painful bowel movement
Abdominal pain
Nausea & vomiting
Mild fever
Watery diarrhea, which can contain blood, mucus or pus
Intermittent  constipation and diarrhea
Painful passing of stools
Fatigue
Nausea and vomiting
Most common Country
Western Europe & USA
Developing countries

7. Stool culture
Presence of fecal leukocytes on smear stained with methylene blue
Presence of E histolytica trophozoites or cysts in faeces with direct saline smear
Sigmoidoscopy
Diffusely erythematous with numerous small ulcer
Shallow skip lesion and flask shaped or ‘collar – stud’
N/E
Little- a lot of blood & mucus
Bulky- little blood- little mucus
M/E
Numerous pus cells
Gram negative bacilli
Macrophages numerous
RBC scattered
Absent Charcot Leydon Crystal
Scanty pus cells
E. Histolytica
Macrophage very few
RBC is rouleaux
Present Charcot Leydon Crystal

8. Bacillary dysentery Amoebic dysentery Complication Dehydration
Exudative arthritis
Bacteremia
Ulcer colonic lesion
Reiter’s syndrome
Amoeboma
Liver abscess
Perforation of an amoebic ulcer
Strictures of the colon
Treatment
Rehydration
By oral or IV (commonly in children)
By oral only
Antimicrobial
Ciprofloxacin
Metronidazole
Anti diarrheal
Non preferable (can cause aggravating of disease)
Preferable

9. OTHERS INFECTIOUS CAUSES
SALMONELLA
Common bacterial disease that affects the intestinal tract. Salmonella live in animal and human intestines & shed through feces. Humans become infected most frequently through contaminated water or food. 
ROTAVIRUS
Most common cause of severe diarrhea among infants and young children
The virus is transmitted by the fecal-oral route. It infects and damages the cells that line the small intestine and causes gastroenteritis.

10. DIAGNOSIS
1. Direct stool inspection to check the presence of blood in the stool 2. Stool culture to find organism that cause gastroenteritis 3. Immunoassay to detect and identify certain bacterial toxin, viral and protozoal antigen in blood 4. Sigmoidoscopy with biopsies to screen for colorectal cancer, rectal bleeding & bowel habits. 5. Colonoscopy and abdominal CT for determine the cause of colorectal problems & to screen for colorectal cancer.

11. GENERAL TREATMENT Drinking fluids
Drinking plenty of fluid to replace the those that have been lost and to avoid dehydration.
Oral rehydration solution (ORS)
Usually come in sachets that are available without prescription.
Help to replace salt, glucose and other minerals that the body losses through dehydration
Advise about eating
Eat small, light meals and avoid heavy, spicy or heavy food

12. PREVENTION & CONTROL
Environmental sanitation as anti-fly measures, proper sewage disposal and safe water supply.
Faeces must not be used as fertilizer.
Health education for: washing of green vegetables, fruits before eating.
Make sure drink only purified water
Wash the hands with antibacterial soap after using bathroom, before preparing and eating food

13. THANK YOU

14. PBL-mates Ebrahim Amanina Safwan Syahirah Faisal Najihah Irfan Yasmeen
Fatin
Eika
Munirah