Documentos de Académico
Documentos de Profesional
Documentos de Cultura
1939
Manson-Bahr, Philip:
The Dysenteric Disorders: The Diagnosis and Treatment of Dysentery, Sprue,
Colitis and other diarrhoeas in General Practice
London 1939
1: classification of the causes of diarrhoea ( people were concerned about the
causes):
1. Primary diarrhoea
- dietetic
- constipation
- changes of climate
- food poisoning
2. Alterations of intestinal secretions or absorption
- acute and chronic dyspepsia, pancreatogenous diarrhoea and cholecystitis
- idiopathic steatorhoea ( coeliac disease)
- Sprue and Hill diarrhoea
- Nervous diarrhoea
3. Secondary diarrhoea: infectious
- typhoid
- bacillary Dysentery
- colear
- Gaerner and Aertrycke infections
- Amoebiasis, giardiasis, flagelate diarrhoea, coccidiosis, malarial dysentery,
leishmanial dysentery
- Bilharziasis and other worm infections
4. .... Special type of diarrhoea:
- ulcerative colitis
- muco-membranous colitis
- polyposis
- polypus
- sterecoral ulceration
- foreign body in rectum
Special divisions: IN CHILDREN
- simple diarrhoea from chills or diet errors
- acute gastro-enteritis, summer diarrhoea
- amoebic Dysentery
- Coeliac disease
19:
Hippocrates distinguished between dysentery and other forms of diarrhoea
Other authors mentioned it as bloody flux with crude clinical descriptions
5th c AD epidemics were noted in Europe
epidemics of dysentery were noted in 534 538 in France, 760 northern Europe
17th c clearly distinguished bloody-stained dysentery stools
20
first half of 19th century dysentery was thought of being but one expression of
malaria
resemblance to malaria: tendency to break out at long intervals in pandemic
form
21
during wars it was classified along with typhoid and typhus amongst the
foremost pestilence of war. (17-19th)
22
19th century India brought forth a lot of research and study o dysentery, and
amoebiasis
27
early 20th century once pathogens were discovered classification was:
bacillary dysentery
amoebic
clinical
diarrhoea
colitis
Dysentery was seen different from colitis and diarrhoea though all of them had
as symptoms diarrhoea.
28
classification of dysentery, was necessary for the professional as the diseases of
a wide and distinct aetiology resemble each other in many ways. Thus the
experts showed that classification according to micro-organisms would be
applied ( which cannot be seen by patients/public)
took medicine a step further ahead into distance from public and individual
illness experience.
Bacillary or epidemic dysentery
Protozoalor endemic dysentery: e.g. amoebiasis, giardiasis, malaria dysentery
Metazoal or helminthic dysentery: ulceration by helminths
Def: dysentery Greek a bowel complaint explains main outstanding
symptoms, passage of abnormal blood stained mucus with tenesmus and pain
243
Infectious D:
due to
- enterotoxins
- bacteria
- viruses
213 classification in research on mortality:
acute D 35% of death rates in India, Bangladesh, Brazil and Senegal
dysentery (20%)
nondysenteric persistent D 45%
242
AIDS and diarrhoea
New classification in 1984 called AIDS ENTEROPATHY or culturenegative D no pathogens could be identified in this type of D
279
Growth retardation due to chronic diarrhoea
In most situations retarded growth is due to other factors, the D being one
symptom:
classification according to pathophysiologic mechanisms of D:
- pancreas insufficiency
- intestinal malabsorption: celiac disease
- inflammatory bowel disease: crohns disease
1993
The Evaluation and Treatment of the Patient with Diarrhea
Miskowitz P.F. Rochwarger A. M.
Andover Medical Publishers: Boston, London, Oxford,
3
diarrhea Greek flowing through
Patients will refer with this term to frequency, consistency or volume of stool.
Their descriptions may be vague. Physician has to classify the clinical history.
4
D may be rigorously defined as the presence of 250 ml of water in the stool per
24 hrs ( normal 100 150 gm per 24 hrs, out of which 60 80% is water)
1990
A new short Textbook of Preventive Medicine for the Tropics
Lucas A O, Gilles H M
Edward Arnold: London, Melbourne, Auckland
My thoughts
Classification in acute and persistent/chronic D is a matter of statistics and
health management. As the problem is pandemic and occurs in many different
countries it is important to have an international classification scheme to
monitor the disease globally. Thus WHO has defined D accordingly.
1993
365
Travellers D always separate clas.
Def: 3 or more unformed stool per day and one of the follwing symtomps:
abdominal pain, cramps, nausea, vomiting, dysentery..., occuring within two
weeks of arrival in a foerign country. 30-50% of travellers are affectediarrhoea
Useful calss because of special traget group
243
E.coli D
1940s first suggestion that e-coli caused D
advances in molecular biology lead to further class.
Now: 5 major categories of E- Coli: ETEC EIEC EPEC EHEC EaggEC (Levine,
1987), each of them have several sub groups ( p.245)
EPEC was detected in the 1980s as the main cause of D epeidemics in the UK in
1940s and 1950s.
You need a microbiology lab to classifiy these, not useful for the feield or
undeveloped countries.
But this class. Has been indetified by gene coding worldwide.
263:
other bacterial D
Each year new organsims are found to be pathogens, and old ones are found to
have new tricks that cause disease.
Double classification is useful:
Watery, bloody and chronic and the underlining molecualr pathogens ( bacteria,
virus, parasites)
Problem of drug restistance ( shigella)
There has been a change of focus from ameobas to bacterial pathogens!
264
treatment of chronic D is unclear becuase of malnurishment involved as a factor
classifi of organisms accoring to the part of the intestinal tract which is attacked
by the toxins
class of INVASIVE organisms: salmonella, shigella, campylobacter, yersenia
These invasive organism invade the gut eptelium in the distal ileum and colon.
1996
Nicher Mark and Nichter Mimi, Anthrolpology and International Health
Asian Case Studies
Gordon and Breach Publishers
Chapter 5 p. 135Social Science Lessons from Diarrhea research and Their Application to ARI
(acute respiratoy infections)
p.157 No.. 14
Use local illness categories when evaluating the impact of health
interventions.
Study in Bangladesh on usage of ORS among D patients have shown that use
rates vary significantly by illness category. A meaningful assesemnt of the
project could only be done by analysing local illness categories and e.g.
indigenous concepts of blood in diarrhoea The analysis of local illness
categories in relation to ORS made a difference to programme planning and
evaluation (Bangladesh Study by Chowdhury, Vaugan and Abed 1988).
Chapter 4 p. 111-134
111 dysentery accounts for 20% of D related eaths, 750 000 death per year
112
Health Social Science Research on the Study of Diarrheal Disease: A focus on
Dysnetery.
Simply classif of secretory-watery D and invasive-inflammatory forms of
dysentery. This class is useful in the field because these two broad categories of
enteric infection require disinct lind of monitoring and care. (p.112)
Ehnographic data of South Asia and Phillipines suggest that health workers do
not often distinguish between the two. They have been trained to judge the
severity of D bin relation to signs of dehydration (see WHO Form) and give
ORT. ORT needs to continue but bloody D needs promt antbiotic treatmentAnthropoloical studies are requireed becuase this process depends on
- cutura conyepualisation of blood and blood loss
- local categories of blood stools
- language of illness
- sensitivity and specificity of local inllnes terms for bloody D which
corespond to clinical cases of dyentery
- popular use of biomedical terms of D
- hometreatment
- perceived signs of illness severity ( bloody sorcery involved)
- parnet health care decision making
- prescription pracices f local docotrs for bloody D
- pharmaceutical involvement
115
connotative and dennotative illness classifications
Good 1977 semantic ilness networks: connotative illnes categories
are important to look at because it shows that illness categoeries are embedded
in culture and cannot be seen just dennotative
1998
Harrisons Principles of Internal Medicine 14th ed
New York: McGraw-Hill