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  • • Infection leads to acute enteritis (acute inflammation of the small intestine) and mesenteric lymphadenitis (inflammation of regional small intestinal lymph nodes)

    • Small intestinal infections often mimic surgical conditions of the abdomen such as acute appendicitis

    • May also cause complications (such as perforation or bleeding) that require surgical intervention

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Epidemiology

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  • HIV-associated enteropathy

    • -Associated with opportunistic GI infections

      -Intestinal perforation is a known complication

    Yersinia enteritis: Associated withacute gastroenteritis, terminal ileitis, mesenteric lymphadenitis, hepatic and splenic abscesses

    Campylobacter jejuni: Raw milk, untreated drinking water, and undercooked poultry are recognized vehicles of transmission

    TB

    • -Most infections due to swallowing the human tubercle bacillus

      -About 1% of patients with pulmonary TB have intestinal involvement

      -Recent immigration from endemic areas and infection with HIV are risk factors

      -Often affects the distal ileum

    Salmonella typhi: May cause ulcers in the distal ileum or cecum

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Symptoms and Signs

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  • • Fever

    • Diarrhea

    • Chronic or relapsing bloody diarrhea in severe cases

    • Nausea and vomiting

    • Abdominal pain

    • Abdominal tenderness

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Laboratory Findings

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  • • Elevated WBC count with eosinophilia

    • Culture of stool or tissue obtained by biopsy may allow isolation and identification of the pathogen

    • Organisms may be visualized by microscopic exam of stool or biopsy specimens

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Imaging Findings

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  • Plain film radiography or CT scan:

    • -Findings are nonspecific

      -Intestinal dilation, bowel wall thickening, and fat stranding in the mesentery may be observed

    Endoscopy: May reveal mucosal lesions, inflammation, and ulcerations and allow biopsy for potential isolation and identification of the infectious pathogen

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  • • Pathogens associated with HIV-Associated enteropathy include:

    • -Cryptosporidium

      -Cytomegalovirus

      -Entamoeba histolytica

      -Giardia lamblia

      -Mycobacterium avium-intracellulare

      -Salmonella typhimurium

      -Shigella

      -Campylobacter jejuni

      -HIV

    • Tuberculosis: The pathologic reaction is hypertrophic (causing stenosis and obstruction) or ulcerative (causing abdominal pain, diarrhea, free perforation, fistula formation, or hemorrhage)

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Rule Out

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  • • Noninfectious causes of GI inflammation (pancreatitis, appendicitis)

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  • • CBC

    • Stool for culture

    • Plain film or CT scan of the abdomen

    • Endoscopy for exam and biopsy

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When to Admit

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  • • Perforation

    • Obstruction

    • Severe bleeding

    • Dehydration

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Surgery

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  • • If operation is performed for a diagnosis of appendicitis and the entire distal small bowel is grossly inflamed, appendectomy is usually performed

    • Resection is indicated for complications

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Indications

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  • • Perforation

    • Obstruction

    • Bleeding

    • Uncertain diagnosis

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Medications

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  • • Many of these infections are self-limited and require no specific treatment

    • Antimicrobial treatment should be aimed at the suspected or confirmed pathogen

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Complications

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  • • Perforation

    • Hemorrhage

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Prognosis

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  • • Overall good prognosis if appropriate antimicrobial treatment is instituted ...

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