Hydatid Cyst

It is a rare disease caused by Echinococcus.It is 0.5 cm long .It is found in a dogs bowel.Its eggs are passed the dog’s faeces, and contaminate grass. Ingestion of such grass infects rabbits,sheep.Ingestion of contaminated food infects human beings.Larvae develop from the eggs in the intestine. These pass through the mucous membrane into various organs and cause cyst formaton,specially in the liver.

 

Clinical features

1.Usually the disease is asymptomatic.

2.Sometimes the cyst becomes very large and causes abdominal distention.

3.There may be difficulty in breathing due to pressure on the diaphragm,and obstructive jaundice due to pressure on bile duct.

Treatment

The cyst are removed surgically.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Digestive System: Diseases of the Peritoneum

Peritonitis

It is a condition characterized by an inflammation of the peritoneum.It can be of any of the following types:-

1.Tuberculous.

2.Bacterial Peritonitis.

3.Chemical Peritonitis.

 

Tuberculous Peritonitis

Aetiology

1.Age:It is found often in children.Disease is not unknown in adults.

2.Sex:Male=Female.

3.The disease reaches the peritoneum by any of the following routes:-

           .Ingestion of infected cow’s or buffalo’s milk.

           .Spread from tuberculosis of the lungs through the blood.

           .Sometimes from adjacent organs ,e.g.genital tract,urinary tract.

 

Clinical features

1.The onset may be sudden or slow and insidious.

2.The progress is insidious.

3.Pain in abdomen.

4.Loss of appetite.

5.Loss of weight.

6.Low grade fever.

7.Diarrhoea alternating with constipation.

8.Abdominal distention  due to ascites.

 

Investigations

                                          Investigations in peritoneal Tuberculosis.

Test	Findings
Haemogram	.Low haemoglobin. .Lymphocytosis. .High ESR.
Chest x-ray	.Tuberculous infiltrates. .Peural effusion may be seen.
Abdominal X-ray	.Clacification may be seen. .Enlargement of soft tissue shadow of the abdomen may be seen due to ascites.
Mantoux test	.Positive.
Ascitc	.Amber coloured fluid rich in proteins and cells. .M.tuberculosis may be isolated from the fluid.

 

Treatment

1.Antituberculous chemotherapy is given (See chapter 18).

2.Ascitic fluid may have to be removed by  tapping.

Ascites

Definition

It is a condition characterized by accumulation of serous fluid in the in the peritoneal cavity.

Aetiology

1.Congestive cardiac failure:There is oedema all over  the body and ascites.

2.Diseases of the peritoneum

          .Tuberculosis.

          .Malignancy.

3.Portal hypertension due to any cause.

4.Diseases of the liver

            .Cirrhosis.

            .Cancer.

5.Diseases of the kidney:Loss of function of the kidneys results in accumulation of fluid in the body.

             .Nephritis.

             .Nephrotic syndrome.

Clinical features

1.Abdominal distention.

2.There may be oedema all over the body.

3.Difficulty in breathing due to pressure on the diaphragm.

4.Difficulty in Walking.

5.Fluid thrill: Tapping briskly on one side of the abdomen can be felt on the otherside of the abdomen can be felt on the other side due to transmission of the waves through the peritoneal fluid.

6.There is an inverted horse shoe-shaped area of dullness on percussion over the abdomen.

7.Shifting dullness: The medial limit of dullness in the flanks in supine position is found to shift medially when the patient is put in opposite lateral position.

8.Clinical features of the cause of the ascites are present.

 

Investigations

1.Haemogram.

2.Urinalysis.

3.Renal chemistry:Blood urea nitrogen,serum creatinine,serum electrolytes.

4.Liver function tests:SGPT,SGOT,serum bilirubin,serum proteins.

5.Abdominal ultrasonography.

6.Investigations for peritoneal tuberculosis:see before.

7.Investigations for cardiac disease:see chapter 5.

8.Investigations for anaemia:see chapter 7.

 

Special nursing care

1.Back rest is given to relieve difficulty in breathing.

2.Air cushion is given to prevent bedsores due to prolonged sitting position.

3.High protein diet is given because repeated ascetic tapping results in loss of proteins in the body,and also that hypoproteinemia can be the cause of ascites.

4.Care to be taken at the time of ascetic tapping is discussed later.

5.The disease which has caused the ascites is treated appropriately.its complications are watched for and treated.

6.If the patient does not get a clear motion every day ,heis given a laxative.

7.Urine output over 24 hours is measured.

8.The amount of salt in diet is restricted.

 

Daily  nursing care

1.The bed is made every day.

2.Body is sponged every day.

3.The back and pressure points are cared for to prevent bed sores.

4.Oral hygiene is maintained.

5.Proper diet is given.

6.Hair is kept clean.

7.Medical treatment is given  as advised by the doctor.

8.Adequate sleep at night is ensured.

9.The nails are cut once a week.

 

Abdominal Paracentesis

Definition

It is a procedure in which fluid in the peritoneal cavity is removed by insertion of a paracentesis needle into it.

Indications

1.Diagnosis of the cause of ascites(see before).

2.To relive pressure of effects,due to accumulation of a large quantity of fluid in the peritoneal cavity.

3.Intraperitoneal injection of drugs needs to be preceded by removal of excess of fluid there ,so as to prevent dilution of the drugs.It is meant for local action of the drug,e.g.antimalignancy drugs or radioactive phosphorous for the treatment of cancer of the ovary spread to the peritoneal cavity.

 

Preoperative Care

1.Equipment and drugs required for treatment of shock are kept ready,in case the patient goes into shock are kept readyin case the patient goes into shock  during the procedure.

2.Injection atropine 0.5 mg is given IM half an hour before the procedure to prevent vasovagal reaction during the procedure.

3.The procedure is explained to the patient and his written consent is obtained.

4.He is asked to empty the bladder just before the procedure to prevent accidental puncturing of the bladder.

Equipment

1.Screen.

2.Equipment to treat shock.

3.Material to wash hands.

4.Back rest.

5.Pillows.

6.Blanket.

7.Clean tray.

8.Savlon bottle.

9.Benzoin bottle.

10.Xylocaine 1% inection.

11.Kidney tray,bucket,point measure.

12.Mackintosh.

13.Drawsheet.

14.Sterile towels.

15.Sterile 5 ml syringes :Two.

16.Sterile injection needles: No.24,No.18.

17.Trocar and cannula:sterile.

18.Tubing and clip.

19.Cheatle forceps.

20.Cotton swabs,gauze:Sterile.

 

Procedure

1.A screen is put up to isolate the patient .

2.The patientis put in sitting position with the help or back rest and pillows behind his back.

3.A blanket is put on his shoulders.

4.His abdomen isexposed by removing the top of his dress and moving his pajamas down.

5.Mackintosh and draw sheet are placed on his thighs.

6.After the doctor scrubs and wears sterile gown and gloves all necessary help is given to him.

           .Swabs and savlon are given with cheatle,s forceps.

           .Sterile towel is given after the skin has been prepared.

           .xylocaine is given for infiltration under the skin for local anaesthesia.

           .Trocar and cnnula are given to drain the peritoneal fluid.

           .Tubing and clip are given for slow drainage of the fluid.

7.The patient’s pulse,respiration ,and skin colour  are observed during the procedure .He is asked if he has any discomfort,like giddiness.

8.A seal of tincture of benzoin is applied locally after the paracentesis needle or cannula is removed.

 

Complications

1.Infection.

2.Puncture of the bladder.

3.Puncture of the bowel.

4.Vasovagal reaction.

5.Bleeding.

6.Leaking of the fluid through the puncture after the procedure due to high pressure due to high pressure of the fluid in the peritoneal cavity.

7.Hypoproteinemia due to repeated removal of fluid rich in protein from the peritoneal cavity.