INTRODUCTION: AMOEBIASIS

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.
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.
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.
Pathogenic amoeba which produce condition of a great clinical variation:

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

SIGNS & SYMPTOMS

•Abdominal cramps.
•Nausea.
•Painful passage of stools.
•Loss of Weight.
•Severe stomach pain.
•Loss of Appetite.
•Profuse diarrhea
Diagnosis of Amoebiasis / Amoebic Dysentery

Stool examination - Microscopic examination for identifying demonstrable E.H

cysts or trophozoites in stool samples is the most confirmative method for
diagnosis. Trophozoites survive only for a few hours, so the diagnosis mostly
goes with the presence of cysts. But fresh warm faeces always show
trophozoites. The cysts are identified by their spherical nature with chromatin
bars and nucleus. They are noticed as brownish eggs when stained with iodine.

Biopsy also can point out E.H cysts or trophozoites.

Culture of the stool also can guide us for diagnosis.
Blood tests may suggest infection which may be indicated as leucocytosis
(increased level of white blood cells), also it can indicate whether any damage to
the liver has occurred or not.
Ultrasound scan - it should be performed when a liver abscess is suspected.

ANATOMY & PHYSIOLOGY

I. Structure. The GI System consists of the oral structures, esophagus, stomach, small
intestine, large intestine and associated structures.

A. Oral Structures include the lips, teeth, gingivae and oral mucosa, tongue, hard
palate, soft palate, pharynx and salivary glands.
B. The esophagus is a muscular tube extending from the pharynx to the stomach.

1. Esophageal openings include:

a. The upper esophageal sphincter at the cricopharyngeal muscle.

b. The lower esophageal sphincter (LES), or cardiac sphincter, which

normally remains closed and opens only to pass food into the stomach.

C. The Stomach is a muscular pouch situated in the upper abdomen under the liver
and diaphragm. Te stomach consists of three anatomic areas: the fundus, body
(i.e., corpus), and antrum (i.e., pylorus)

D. Sphincters. The LES allows food to enter the stomach and prevents reflux into
the esophagus. The pyloric sphincter regulates flow of stomach contents (chyme)
into the duodenum.

E. The small intestine, a coiled tube, extends from the pyloric sphincter to the
ileocecal valve at the large intestine. Sections of the small intestine include the
duodenum, jejunum and ileum

F. The large intestine is a shorter, wider tube beginning at the ileocecal valve and
ending at the anus. The large intestine consists of three sections:

1. The cecum is a blind pouch that extends from the ileocecal valve to the
vermiform appendix.

2. The colon, which is the main portion of the large intestine, is divided into four
anatomic sections: ascending, transverse, descending and sigmoid.

3. The rectum extends from the sigmoid colon to the anus.

G. The ileocecal valve prevents the return of feces from the cecum into the small
intestine and lies at the upper border of the cecum.

H. The appendix, which collects lymphoid tissues, arises from the cecum.

I. The GI tract is composed of five layers.

1. An inner mucosal layer lubricates and protects the inner surface of the
alimentary canal.
 2. A submucosal layer is responsible for secreting digestive enzymes.

3. A layer of circular smooth muscle fibers is responsible for movement of the GI

tract.

4. A layer of longitudinal smooth muscle fibers also facilitates movement of the

GI tract.

5. The peritoneum, an outer serosal layer, covers the entire abdomen and is
composed of the parietal and visceral layers.

II. Function. The GI system performs two major body functions: digestion and
elimination.

A. Digestion of food and fluid, with absorption of nutrients into the bloodstream,
occurs in the upper GI tract, stomach and small intestines.

1. Digestion begins in the mouth with chewing and the action of ptyalin, an
enzyme contained in saliva that breaks down starch.

2. Swallowed food passes through the esophagus to the stomach, where

digestion continues by several processes.

a. Secretion of gastric juice, containing hydrochloric acid and the enzymes

pepsin and lipase ( and renin in infants)

b. Mixing and churning through peristaltic action

3. From the pylorus, the mixed stomach contents (i.e. chyme) pass into the
duodenum through the pyloric valve.

4. In the small intestine, food digestion is completed, and most nutrient

absorption occurs. Digestion results from the action of numerous pancreatic
and intestinal enzymes (e.g., trypsin, lipase, amylase, lactase, maltase,
sucrase( and bile.

B. Elimination of waste products through defacation occurs in the large intestines

and rectum. In the large intestine, the cecum and ascending colon absorb water and
electrolytes from the now completely digested material. The rectum stores feces for
elimination.
Treatment :

 Drugs
• Metronidazole
• Replace Fluid and electrolytes

Prevention
 Observe isolation & enteric precaution
 Provide health education
 Boil water for drinking or use purified water
 Avoid washing food from open drum or pail
 Cover leftover food
 Wash hands after defecation or before eating
 Avoid ground vegetables ( lettuce, carrots, etc)
 Proper waste disposal

Nursing Management:

 Observe isolation and enteric precaution

 Provide health education and instruct patient to
• Boil water for drinking or use purified water
• Avoid washing food from open drum or pail
• Cover leftover food
• Wash hands after defacation and before eating
• Avoid ground vegetables (lettuce, carrots, and the like)
 .Proper collection of stool specimen
• Never give paraffin or any oil preparation for at least 48 hours prior to
collectionof specimen.
• Instruct patient to avoid mixing urine with stools.
• If whole stool cannot be sent to laboratory, select as much portion as
possible containing blood and mucus.
• Send specimen immediately to the laboratory; stool that is not fresh is
nearly useless for examination.Label specimen properly.
 Skin care
• Cleanliness, freedom from wrinkles on the sheet will be helpful with all the
usual precautionary measures against pressure sores.
 Mouth care
 Provide optimum comfort.
• Patient should be kept warm. Dysenteric patient should never be allowed
to feel,even for a moment.
 Diet
• During the acute stage, fluids should be forced.
• In the beginning of an attack, cereal and strained meat broths without fat
should be given.
• Chicken and fish maybe added when convalescence is established.
• Bland diet without cellulose or bulk-producing food should be maintained
for a long time.
 Arellano University

Legarda Campus

Case presentation in:

AMOEBIASIS

Submitted by:

Joble, Sheena

Hortelano, Francesca Marie

Jusay, Ma. Katrina

Lagar, Maria Jeraldine

Majaque, Mariah Jobelle

BSNIII- 2, Group 6

Submitted to:

Prof. Joy Tariman RN, MAN

AUGUST 19 2010