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Semiology of i nfectios diseases. Prof. Dr. Yaşar Küçükardalı Yeditepe University Faculty of Medicine Department of Internal Medicine. Semiology ; science of the findings and symtoms of the deseases. Subjective and Objective information. Infection. - PowerPoint PPT Presentation
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SEMİOLOGY OF İNFECTİOS DİSEASES
Prof. Dr. Yaşar Küçükardalı Yeditepe UniversityFaculty of Medicine
Department of Internal Medicine
Semiology ; science of the findings and symtoms of the deseases
Subjective and Objective information
subjective objective
What the patient says (chief complaint etc.)
Physician‘s physical examination
Laboratory findings
Radiological findings
INFECTİON
Infection: The invasion and multiplication of microorganisms such as bacteria, viruses,fungus and parasites that are not normally present within the body and the reaction of host tissues to these organisms and the toxins they produce .
An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent.
An infection may remain localized, or it may spread through the blood or lymphatic vessels to become systemic .
Microorganisms that live naturally in the body are not considered infections. For example, bacteria that normally live within the mouth and intestine are not infections.
transmissible diseases communicable diseases
HOW BACTERIA AND VIRUSES ENTER THE BODYPathogenic bacteria must gain access into the body. The range of access routes for bacteria includes: Cuts Contaminated food or water Close contact with an infected person Contact with the faeces of an infected person Breathing in the exhaled droplets when an
infected person coughs or sneezes Indirectly, by touching contaminated
surfaces – such as taps, toilet handles, toys and nappies.
VIRUSES ARE SPREAD FROM ONE PERSON TO ANOTHER BY:
Coughs Sneezes Vomits Bites from infected animals or insects Transfusion of the contaminated blood
products Exposure to infected bodily fluids through
activities such as sexual intercourse or sharing hypodermic needles.
Forgetting to wash your hands after handling pets and animals is another way for germs to be taken in by mouth.
Primary pathogens cause disease as a result of their presence or activity within the normal, healthy host, and their intrinsic virulence
Opportunistic pathogens can cause an infectious disease in a host with depressed resistance.
such as pathogenic bacteria or fungi in the gastrointestinal or the upper respiratory tract,
An opportunistic disease requires impairment of host defenses, which may occur as a :
result of genetic defects (such as Chronic granulomatous disease),
exposure to antimicrobial drugs or immunosuppressive chemicals (as might occur following poisoning or cancer chemotherapy),
exposure to ionizing radiation,
FEVER > 37.5 C oral, > 38.2
rectal
Endogen pirogens : IL-1, TNF, INF
Eksogen pirogens: Gr+, - , bacterial endo or egzo toxins,
Daily physiologic alteration may occur 1 C
20-30 % elderly patients may not have fever during th infection episode
HYPERPYREXIA Hyperpyrexia is a fever with an extreme elevation of
body temperature greater than or equal to 41.5 °C (106.7 °F). Such a high temperature is considered a medical emergency
The most common cause is an
intracranial hemorrhage
sepsis,
Kawasaki syndrome,
neuroleptic malignant syndrome,
drug effects,
serotonin syndrome,
thyroid storm.
Heatstroke
malignant hyperthermia
Infections commonly associated with hyperpyrexia include: rubeola and enteroviral infections
in hyperpyrexia the body's temperature regulation mechanism sets the body temperature above the normal temperature, then generates heat to achieve this temperature, while in hyperthermia the body temperature rises above its set point due to an outside source.
CAUSES OF FEVER İnfectious diseases Solid and hematologic malignancies Vasculitis and collageneous diseases Outoimmun Granulamatous Endocrin and metabolic Primary neurologic Other: FMF, allergic rx, alcoholic hepatitis,
hemolysis, histiositosis -X, drug fever, Kikuchi diseases, pancreatitis, Sweet syndrome, pulmonary emboli, hyperimmungloubulin D syndrome
Continuous fever: Temperature does not fluctuate more than 1 °C in 24 hours, e.g. lobar pneumonia, urinary tract infection, brucellosis, or typhus. Typhoid fever may show a specific fever pattern, with a slow stepwise increase and a high plateau.
Intermittent fever: The temperature elevation is present only for a certain period, later cycling back to normal, e.g. malaria, kala-azar, pyaemia, or septicemia
Remittent fever: Temperature remains above normal throughout the day and fluctuates more than 1 °C in 24 hours, e.g., infective endocarditis.
Pel-Ebstein fever: A specific kind of fever associated with Hodgkin's lymphoma, being high for one week and low for the next week and so on
MOST COMMON SYMPTOMS RELATED TO SİDE OF THE İNFECTİON Systemic Head and Neck Pulmonary
FeverFatigueAnorexiaWeaknessExtensive pain
HeadacheSore throatDifficulty on swollow
DyspneaCoahingChest pain
Cardiovasculary Hepatobiliary Gastrointestinal
PalpitationChest pain DyspneaSencopCloudicatio intermit.
Right upper guadrant pain , Right/left upper quadrant dullnessNausiaVomitingİcterusPuriritis
Abdominal painNausiaVomitingDiarea , mucoid, ..Abdominal bloatingPerirectal puriritisPain during the defecation
MOST COMMON SYMPTOMS RELATED TO SİDE OF THE İNFECTİON
Urogenital Musculosceletal Santral and peripheric nervous system
Burning during the urinationPollacuriaFlunk painDificulty on urinationReferred painUreteral discharge
Muscle / joint painDiminish ROM
Loss of memoryMental disordersNausia, vomitingParestesia
Skin
PururitisBurning
MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON
İnspection Oscultation
Percussion
Palpation
Head and Neck
Discharge of ear, Post nasal dischargeHyperemic conjonctivaIcteric sclereHyperemic apperence of pharenxExuda on tonsil
LymphadenomegalyTenderness of sinusNeck stiffnessTenderness of thyroid
MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON
İnspection Oscultation Percussion
Palpation
Chest TacipneaBradipneaVesiculary lesions
RalesRoncusDiminish lung sound
Matite Axillary lymphadenomegaly
MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON
İnspection Oscultation Percussion Palpation
Cardio-vasculary
Slinter hemoragiaJaneway lesionHyperemic vasculary line
Altered murmurDiminished heart sounds
Matite Weak radial pulse
MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON
İnspection Oscultation Percussion Palpation
Hepatobiliary
İcterusAbdominal distansionVomitingDark urineWhite stool
HapatomegalySplenomegaly
Murphy signReboundTenderness
MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON
İnspection Oscultation Percussion Palpation
Gastrointestinal Abd distantionCullenTurnerBloody stool
Hyperactive bowel soundsSilent abdomen
Sonorite
Matite
TendernessReboundMc Burney
MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON
İnspection Oscultation
Percussion Palpation
Urogenital system
Urethral dischargeGlob vesicaleGenital herpetic lesionsPiuria
Costa vertebral angle tenderness Suprapubic dullness
Testiculary tendernessInguinal LAMPelvic tendernessProstat tenderness
MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON
İnspection Oscultation
Percussion Palpation
Muscle and sceletal system
Milky synovial fluid apperenceBrown urineFoot ulcerChronic discharge
Hot jointDiminish ROMBallotmanBone tendernessPain point of on axial system
MOST PHYSİCAL FİNDİNGS RELATED TO SİDE OF THE İNFECTİON
İnspection Oscultation
Percussion Palpation
Central and peripheral nervous system
Loss of memoryNeurologic deficitVomitingDificulty on swollowAbnormal talking
Neck stiffnessLoos of sensationParestesiaPlegiaAbnormal reflexes
CHARACTERİSTİCS OF VİRAL İNFECTİONS In general, viral infections are systemic.
This means they involve many different parts of the body or more than one body system at the same time; i.e. a runny nose, sinus congestion, cough, body aches etc.
They can be local at times as in viral conjunctivitis or "pink eye" and herpes. Only a few viral infections are painful, like herpes.
The pain of viral infections is often described as itchy or burning.
Reye syndromeReye syndrome is sudden (acute) brain damage and liver function problems of unknown cause.The syndrome has occurred in children who have been given aspirin when they have chicken pox or the flu. Reye syndrome has become very uncommon since aspirin is no longer recommended for routine use in children.
DİAGNOSİS OF VİRAL DİSEASES Clinical presentation is used to detect viral disease
by looking for history of severe muscle and joint pains
before fever also detect skin rash lymph gland swelling
Laboratory investigations is not necessary to detect viral infections, because no increase in the white blood cells, the laboratory investigation is done to find other bacterial infections, if it is suspected.
Viruses commonly have self-limited life, so treatment is usually reduce the symptoms only and antipyretic and analgesicdrugs
CHARACTERİSTİCS OF BACTERİAL İNFECTİON The classic symptoms of a bacterial infection
are:localized redness, heat, swelling and pain.
One of the hallmarks of a bacterial infection is local pain, that occurs at the site of the infection.
Bacterial throat pain is often characterized by more pain on one side of the throat.
An ear infection is more likely to be diagnosed as bacterial if the pain occurs in only one ear.
Bacterial infections produces pus and milky-colored liquid
FEVER WİTHOUT LOCALİSE SYMPTOMS
Tuberculosis Endocarditis Micotic anevrisma Septic thrombophlebitis Spondilitis Osteomyelitis Pneumonia Intraabdominal abces Pyelonephritis Viral: CMV , mononucleosis, HIV, early
hepatitis
MAJOR SYMPTOMS MAY COEXİST WİTH FEVER Eruption Joint and bone pain Lymphadenopathy Face and neck swelling Headache and neck stiffness Neurological disturbances Cold ang flu like symptoms Coughing and chest pain icterus Splenomegali Diarea Abdominal pain Disuria Sepsis Heart diseases
FEVER AND PATECHİA / PURPURA
Bacteria, ricethsia, virus DİC Gram negative sepsis Endocarditis Meningococcemia Tiphus, Rocky Mountain
Fever, Rubella, rubeola,
mononucleosis, hepatitis, hemoragic fever
A petechia is a small (1 - 2 mm) red or purple spot on the skin, caused by a minor hemorrhage (broken capillary blood vessels).
NON INFECTİOUS CAUSES OF PATECHİA / PURPURA
Henoch schlein purpura SLE, ANCA related vasculitisPANChurg Strause Wegener Granulomatosis
MACULOPAPULARY EXANTEM
Rubella, rubeola, coxacie, ecovirus, mononucleosis, parvovirus
Streptococ,(erizipel,scarlet fever), staphylococ, ( TSS) , sec. Siphylis
Drug rx, serum sickness, lupus, Steven Johnson S, dermatomysotis,
Sweet Syndrome, Etiology ? leucocytosis, skin lesions, neutrophilic infiltration, myalgia, headache, fever, (infection, malignity, IBS vb )
An exanthem is a widespread rash usually occurring in children. Exanthems can be caused by toxins or drugs, microorganisms, or can result from autoimmune disease.
VESİCULARY AND PUSTULARY LESİONS
Varisella, zoster, herpes symplex, coxachie A16, hand, foot, mouth diseases,
Spahpylococ sepsis Disseminated gonococ
infection ( distal)
Drug eruption, allergic dermatitis, Sweet S, Steven Johnson S,
Vesicles are small, fluid-filled sacs that can appear on skin
NODULARY SKİN LESİONS
Treponema pallidum; Nocardia; and atypical mycobacteria, particularly Mycobacterium marinum and Mycobacterium chelonae, as well as Mycobacterium tuberculosis itself.
Fungal infections, including blastomycosis, coccidioidomycosis, sporotrichosis, and aspergillosis,
All these infectious disorders are due to Staphylococcus aureus or opportunistic bacteria such as Nocardia, Legionella or Aspergilli.
ULCERUOS SKİN LESİONS
Ulcerated skin lesions may result from Staphylococcus infections
The necrotic ulcer of anthrax is often surrounded by edema
Rarely, a painless destructive ulcer with undermining edges may result from infection with Mycobacterium ulcerans (Buruli ulcer).
cutaneous leishmaniasis. The lesion is a chronic, usually painless ulcer,
skin dephteria,tularemi, ectima gangrenosum ( pseudomonas aeroginosa) , ricetsia
Peripheral vasculary disease, Behçet diseases, vasculitis, cholesterol embolism, lymphoma, erithema multiforme major,
Stomatitis is an inflammation inside the mouth, such as a small sore or ulcer. Multiple blisters in the mouth can be a sign of herpetic stomatitis.
FEVER AND BONE/ JOİNT PAİN İnflammatory joint diseases together
with % 15-20 infectious pathogen Bacterial artritis: gonococ / rubeola,
hepatitis, mumps, polyarticulary , others monoarticulary
Cardinal findings of inflammation No fever / mycobacterium, fungal
infection Most common: Knee, hip, scholder,
elbow
Gram stain positive % 30-50 , staph,
Viral: rubeola, hepatitis B, Reactive artritis: Chlamidia, Shigella,
Camphylobacter, Salmonella, Yersinia, Gonococ
FEVER AND DİSSEMİNETED LAM
FEVER AND LOCALİSED LAM
Servical LAM: upper respiratory tract infections Virus, Group A streptococ, Ebstain Barr Virus, Diphteria, Toxoplasmosis, tbc lymphadenitis
Oxipital LAM: Rubella, rubeola, non -spesific infections of scalp
Axillary, İnguinal LAM: Group A streptococ
Inguinal LAM with pain: herpes symplex, lymphogranuloma venerum ( chlamidia) Soft chankır ( Haemophilus ducrei), granuloma inguinale
FEVER AND FACE / NECK SWOLLEN
Mumps, pürülan parotitis
Parotis , salivary gland lenfamatosis, Sjogren S, Warthin TM
Neck: Lemierre S Actinomicosis: Lemierre's syndrome (or Lemierre's disease, also known as postanginal shock including sepsis and human necrobacillosis) refers to thrombophlebitis of the internal jugular vein. It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteremia or septic emboli.
FEVER, HEADACHE AND NECK STİFNESS
İnfectious origine Drug Rx Allergic Rx, Leucemia SNS metastasis Subaracnoid hemoragia SVA ( emboli , trombosis)
MENİNGİTİS
Bacterial meningitis and viral encephalitis are two life-threatening causes of infection and inflammation within the central nervous system (CNS).
Evaluation in the acute care setting is focused on identifying patients who require urgent diagnostic testing and/or empiric treatment.
Meningitis affects patients of all ages, but those who are very young, elderly, or immunosuppressed are at increased risk.
MENENGİSM Neck stiffness Headache Fever Nousia Vomiting Photophobia Diplopia Hyperestesia Generalise convulsion
MENENJİTİS LİKE CONDİTİONS Purulan proceses near the meninxBrain abceses, mastoiditis, otitis, osteomyelitis, sinusitis, ………may caouse meningial irritation
İNFLUENZA There are two main types of influenza
(flu) virus: Types A and B. The influenza A and B viruses that routinely spread in people (human influenza viruses) are responsible for seasonal flu epidemics each year.
Fever* or feeling feverish/chills Cough Sore throat Runny or stuffy nose Muscle or body aches Headaches Fatigue (tiredness) Some people may have vomiting and
diarrhea, though this is more common in children than adults.
Acute respiratory diseases ( upper end lower tract)
Sec bacterial infections may occur ( staph., pneumococ, H influenza)
FEVER AND FLU LİKE İNFECTİONS
Bacterial tonsillitis and pharangitis Streptococal: odinophagia, LAM,
leucocytosis, scarlet; high fever with fast klinical course skin lesions may appear 2-5 day later
Dihpteria Plaunt vincent angina
Non Bacterial pharangitis: Mycoplasma, Ebstain Bar virus,
adenovirus, coxachie virus, CMV, herpes virus,
COLD: İNFLUENZA LİKE İNFECTİONS
Virus 90%, ( rhinovirus, coxachie virus, Mycoplasma, Chlamidia
Rhinitis, tosillopharengitis, larengotraceitis, trakeobronchitis, bronchopneumonia
In the absence of outbreak, influenza may be diffucult to differentiate from acut respiratory illness caused by other viruses or mycoplasma
Severe streptecocal pharangitis or early bacterial pneumonia may mimic acute influenza
SİNUSİTİS Sinus infections are caused by
infections from a pathogenic microorganism (virus, bacterium, or fungus), which grows within a sinus and causes intermittent blockage of the sinus ostium.
Sinus infection symptoms may include sinus headache, facial tenderness, pressure or pain in the sinuses, fever, cloudy discolored drainage, and feeling of nasal stuffiness, sore throat, and cough, and on rare occasions, associated with facial swelling.
OTİTİS
Otitis is a general term for inflammation or infection of the ear,
It is subdivided into the following: Otitis externa, or "swimmer's ear" involves the
outer ear and ear canal. Otitis media or middle ear infection involves the
middle ear. In otitis media, the ear is infected or clogged with fluid behind the ear drum, in the normally air-filled middle-ear space.
Otitis interna or labyrinthitis involves the inner ear. The inner ear includes sensory organs for balance and hearing. When the inner ear is inflamed, vertigo is a common symptom.
The eustachian tube is shorter in children than adults which allows easy entry of bacteria and viruses into the middle ear, resulting in acute otitis media. Bacteria such as Streptococcus pneumoniae (strep) and Haemophilus influenzae (H. flu) account for about 85% of cases of acute otitis media and viruses the remaining 15%.
pus within the middle ear causes pain , there is usually transient hearing loss during the infection, Severe ear infections may cause the eardrum to rupture. The pus then drains from the middle ear into the ear canal.
BRONCİTİS
Bronchitis is an inflammation of the bronchial tubes,
People who have bronchitis often cough up thickened mucus, which can be discolored.
Often developing from a cold or other respiratory infection, acute bronchitis is very common.
Acute bronchitis is usually caused by viruses, typically the same viruses that cause colds and flu (influenza). The most common cause of chronic bronchitis is smoking cigarettes. Air pollution and dust or toxic gases in the environment or workplace also can contribute to the condition.
Viruses cause about 90% of acute bronchitis cases, whereas bacteria account for about 10%
Mycoplasma pneumoniae, Chlamydophila pneumoniae,Bordetella pertussis, Streptococcus pneumoniae, Haemophilus influenzae
FEVER, COAHİNG, THORAX PAİN : PNEUMONİA
Pneumonia is a common lung infection caused by bacteria, a virus or fungi
Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites.
In bacterial pneumonia, your temperature may rise as high as 38 degrees . This pneumonia causes profuse sweating, and rapidly increased breathing and pulse rate. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be confused or delirious.
Bacteria are the most common cause of community-acquired pneumonia (CAP), with Streptococcus pneumoniae isolated in nearly 50% of cases. Haemophilus influenzae in 20%, Chlamydophila pneumoniae in 13%, and Mycoplasma pneumoniae in 3% of cases;[20] Staphylococcus aureus; Moraxella catarrhalis; Legionella pneumophila and Gram-negative bacilli
The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within 12 to 36 hours, there is increasing breathlessness; the cough becomes worse and produces a small amount of mucus. There is a high fever and there may be blueness of the lips.
In adults, viruses account for approximately a third[6] and in children for about 15% of pneumonia cases.[22] Commonly implicated agents include rhinoviruses, coronaviruses, influenza virus, respiratory syncytial virus (RSV), adenovirus, and
parainfluenza.
BREATHING SOUNDS:disease chest
inspection
palpation (thoracic vibration)
percussion
character of breathing
sounds
patological sounds
pneumonia
normal/dyspnea
increased normal/matitiy
decreased/bronchiolar/
bronchovesicular
inspiratory rales
atelectasis
depression
of onehemithor
ax
decreased matity decreased or absent
inspiratory rales
pneumothorax
increase of one
hemithorax
decreased hypersonority
decreased or absent
-
emphysema
increased thoracic
index
normal/decreased normal/hyperson
or
decreased -
COPD normal/dyspneic
normal normal normal/increased
wheezing/rhoncus
pulmonary fibrosis
tachypnea/
dyspnea
normal normal normal velcro rales
asthma dyspnea normal normal normal/decreased/silent
wheezing/rhoncus
cardiac failure
dyspnea normal/increased normal normal inspriatory rales/rhoncus
pleural effusion
increase of one
hemithorax
decreased matitiy decreased -/Frotman
FEVER AND İCTERUSPrehepatic
Clostridium perfiringens, M pneumonia may cause hemolysis ( low hgb, reticulosis, high LDH)
Sicle cell anemia, G6PD deficiency, PNH,
Hepatic
Acute viral hepatitis, mononucleosis, CMV,
Sepsis: pneumococ, klebsiella, Salmonella, Bacterides fragilis E Coli, Streptococ,
Milier tuberculosis
Intrahepatic abceses
Posthepatic
Chlangitis and choledecolitiasis
FEVER AND SPLENOMEGALY
Lymphoproliferative disorders İnfections Hemolitic anemia
Non infectious Felty Syndrome Still Diseases Lupus Diseases
The causes of massive splenomegaly (spleen >1000 g) are fewer, and include:visceral leishmaniasis (kala-azar)chronic myelogenous leukemiamyelofibrosismalariaprimary lymphoma of spleen
FEVER AND DİAREA
Diarrhea may be accompanied by fever (temperature greater than 100.4ºF or 38ºC), abdominal pain, or cramping
Viral diarrhea are typically associated with mild-to-moderate symptoms with frequent, watery bowel movements, abdominal cramps, and a low-grade fever.
The following are the common causes of diarrhea caused by viral infections:
rotavirus is a common cause of diarrhea in infants;
norovirus (for example, Norwalk virus, caliciviruses) is the most common cause of epidemics of diarrhea among adults and schoolage children (for example, cruise ship infection, schools, nursing homes, day care facilities, and restaurants); and adenovirus infections are common in all age groups.
Bacterial infections cause the more serious cases of diarrhea. Typically, infection with bacteria occurs from contaminated food or drinks (food poisoning). Bacterial infections also cause severe symptoms, often with vomiting, fever, and severe abdominal cramps or abdominal pain. Bowel movements occur frequently and may be watery.
The following are examples of diarrhea caused by bacterial infections:
In more serious cases, the stool may contain mucus, pus, or blood. Most of these infections are associated with local outbreaks of disease. Family members or others eating the same food may have similar illnesses.
Campylobacter, salmonellae, and shigella organisms are the most common causes of bacterial diarrhea.
Less common causes are Escherichia coli Yersinia, and listeria.
Use of antibiotics can lead to an overgrowth of Clostridium difficile (C diff) bacteria in the intestines.
Parasites cause infection of the digestive system by the use of contaminated water. Common parasitic causes of diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
Intestinal disorders or diseases including inflammatory bowel disease, irritable bowel syndrome (IBS), diverticulitis, microscopic colitis, and celiac disease can cause diarrhea.
Reaction to certain medications can cause diarrhea. Common medications include antibiotics, blood pressure medications, cancer drugs, gout medications,weight loss drugs, and antacids (especially those containing magnesium).
Intolerance to foods such as artificial sweeteners and lactose (the sugar found in milk) can cause diarrhea.
ORGANIC VERSUS FUNCTIONAL PAINHISTORY ORGANIC FUNCTIONAL
Pain character Acute, persistent pain Less likely to changeincreasing in intensity
Pain localization Sharply localized Various locations
Pain in relation to sleep Awakens at night No affect
Pain in relation to Further away At umbilicus umbilicus
Associated symptoms Fever, anorexia, Headache, dizziness,vomiting, wt loss, multiple system
com-anemia, elevated ESR plaints
Psychological stress None reported Present
Definition LocationWork-upAcute pain
syndromesChronic pain
syndromes
Definition LocationWork-upAcute pain
syndromesChronic pain
syndromes
FEVER AND ABDOMİNAL PAİN
Intraabdominal infectionsTime to antimicrobial therapy importantHistory and clinical findings are gold standart for diagnosis Primary peritonitis: 1% ,chrosis with ascites,
nephrotic syndrome, monomicrobial, E.Coli, pneumococ, group A streptococ,
Secondary peritonitis : necrotizing lesion of GI tract, traumatic perforation, perforation during the invasive procedure, aerobic ( E coli, enterobacter, enterococus, streptococ, pseudomonas) and anaerobic ( Bacteroides fragilis, Clostridium ) polymicrobial
INTRAABDOMİNAL ABCESES
Progression of diffuse peritoitis Spontan and travmatik perforation of GI
tract Leakega of surgical anastomos line
Tendency of intraabdominal abcessesCrohn: intraperitoneal, retroperitoneal, bacterial endocarditis Gallbladder diseases: liver abcessesPancreatitis: pancreatic abcesses
Rigor:
UROGENİTAL İNFECTİONS
FEVER, DİSURİA AND POLLAKURİA Üretritis: burning,discharge, leucocyturia,
gonococus, chlamidia, tricomonas, mycoplasma, uroplasma , no fever,
Uncomplicated urinary system infection in womens: disuria, pollacuria, lower abdominal pain E coli, Staph saprophiticus, short term antibiotic
Asemptopmatic bacteriuria: pregnancy, diabetes, transplantation, should be treated
Uncomplicated pyelonephritis: fever, chill, lomber pain, costa vertebral tenderness
Blood and urine culture +, 100000 mo / ml E Coli
Complicated pyelonephritis: plus, present complicated urologic diseases
MalformationRenal stoneProstat hyperplasiaDesensus uteri Diabetes
FEVER AND SEPSİS
Sepsis is a potentially life-threatening complication of an infection.
If sepsis progresses to septic shock, blood pressure drops dramatically, which may lead to death.
To be diagnosed with sepsis, you must exhibit at least two of the following symptoms:
Body temperature above 101 F (38.3 C) or below 96.8 F (36 C)Heart rate higher than 90 beats a minuteRespiratory rate higher than 20 breaths a minuteLeucocyt count >12000 or < 4000/ ulProbable or confirmed infection
While any type of infection — bacterial, viral or fungal — can lead to sepsis, the most likely varieties include: Pneumonia Abdominal infection Kidney infection Bloodstream infection (bacteremia)
INFECTIVE ENDOCARDITIS
– inflammatory process on-going inside endocardium – due to infection after endothelium damage– most often involving aortic and mitral valves
3-10/100 000/year Maximum at the age of 70-80 More common in women Staphylococcus aureus is the most common
pathogen Streptococcal IE is still the most common
in developing countries
Fever – over 90% of patients New intra-cardiac murmur - about 85% of patients Roth spots, petechiae, glomerulonephritis – up to 30% of
patients• When we suspect? • Sepsis of unknown origin• Fever coexsisting with:
– Intracardiac implantable material– IE history– Congenital heart disease or valve disease – IE risk factors– Congestive heart failure symptoms– New heart block– Positive blood cultures– Focal neurological signs without known aetiology– Periferal abscesess (kidney, spleen, brain, vertebral column)
DUKE CRITERIA
Major criteria
1. Blood culture positive for typical IE-causing microorganism
2. Evidence of endocardial involvement
Minor criteria
1. Predisposition – heart condition or i.v. drug abuse
2. Fever – temp. >38 °C3. Vascular phenomena –
arterial emboli etc.4. Immunologic phenomena
– glomerulonephritis, Osler’s nodes, Roth’s spots
5. Microbiological evidence – positive blood cultures but do not meet major criteria
Diagnosis• 2 major criteria• 1 major and 3 minor• 5 minor criteria
PALPATION OF THE LIVER:
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