Effects
Effects
Effects
It’s a disorder due to discontinuation of gastrointestinal intestinal tract ( the stomach and and the
duodenum) as a result of gastric acid or pepsin which may extend to the lower esophagus, jejunum and
can extend into the muscularis propria .
224. What is the difference between gastric ulcer and duodenal ulcer?
GASTRIC ULCER
EFFECTS:
i) Produces grease that breaks down urea to ammonia acid which protects the mucosa
layer from gastric acid
ii) Produces toxins ( cagA and vacA) that causes inflammation
i) Epigastric pain
ii) Heart burn
iii) Nausea and vomiting
iv) Bloating
v) Dark stools
vi) Hematemesis
i) If bleeding
o Endoscopic injections, clamping and catheterization of the bleeding vessels
ii) Proton pump inhibitors reduces gastric acid secretion e.g omeprazole, pantoprazole,
esoprazole, rabeprazole
iii) Histamine receptor blockers reduces gastric acid secretion
iv) Antacid forms a protective layer e g bismuth sulphate
v) Triple regimen;
PPI + CLARITHROMYCIN + METRONIDAZOLE /AMOXICILLIN
vi) Quadriple regimen;
Triple regimen + Bismuth sulphate but no metronidazole
PPI + levofloxacin /amoxicillin + bismuth sulphate
vii) Dietary modifications; stop NSAIDS , smoking and alcohol
viii) Surgery;
Vagotomy
Partial gastrectomy
Indications for surgery
a) Unresponsive to medical treatment
b) Non compliance
c) High risk for developing complications
d) Refractory PUD ; ulcer >5mm in diameter, that doesn’t heal 8-12 weeks of
PPI treatment
Causes of Refractory PUD
i) Persistent H.pylori infection
ii) Continous use of NSAIDS
iii) Significant morbidity that impairs ulcer healing
i) Bleeding
ii) Perforation
iii) Gastric outlet obstruction
i) Gastritis
ii) Gastro esophageal reflux disease
iii) Gastric cancer
iv) Pancreatitis
Asexual cycle: → The life cycle of the malaria parasite in the host from merozoite
invasion of red blood cells to schizont rupture (merozoite →ring stage→
trophozoite → schizont → merozoites) with approximate duration of ;
1. 24 hrs - plasmodium knowlesi
2. 48 hrs - Plasmodium Falciparum ,Ovale , Vivax
3. 72 hrs – Plasmodium Malariae
Cerebral Malaria:
Severe Plasmodium falciparum , with coma (Glasgow coma scale < 11, Blantyre
coma scale < 3); malaria with coma persisting for > 30 min after a seizure.
Cure : Elimination of the malaria parasites that caused the treated illness
Drug resistance: The ability of a parasite strain to survive and/or to multiply
despite the administration and absorption of a drug given in doses equal to or
higher than those usually recommended, provided the exposure is adequate.
Resistance to antimalarial agents arises because of the selection of parasites with
genetic changes (mutations or gene amplifications) that confer reduced
susceptibility
Gametocytes: The sexual stages of malaria parasites that infect anopheline
mosquitoes when taken up during a blood meal
Hyperparasitaemia: A high density of parasites in the blood, which increases the
risk of deterioration to severe malaria (although the risk varies in different
endemic areas according to the level of transmission) and of antimalarial drug
resistance and subsequent treatment failure.
The term is used to refer to
1. a parasite density > 4% ( Patients with knowlesi P. falciparum ∼ 200
000/µL)
2. parasite densities > 10% and patients with parasite densities > 100
000/µL ( ∼ P. 2%) are considered to have severe malaria even if they do
not have evidence of vital organ dysfunction
Malaria pigment (hemozoin): A dark brown granular material product
formed by malaria parasites as a by- product of hemoglobin digestion
The pigment is evident in mature trophozoites and schizonts
and may also be phagocytosed by monocytes, macrophages and
polymorphonuclear neutrophils
Malaria is a potentially fatal infection caused by the parasite Plasmodium species and one of the
significant health problems of humans
238. On the basis of splenomegaly prevalence rate in children 2-9 years old , Define the 4 endemicity
areas based on the malariometric indices
1. Fever
2. Headache
3. Malaise
4. Weakness
5. Gastrointestinal distress( nausea , vomiting, diarrhea)
6. Neurological complaints ( dizziness, disorientation, confusion, coma)
7. Back pain
8. Chills
9. Cough
10. Features of severe malaria
242. What is the difference between uncomplicated malaria and complicated malaria
Uncomplicated malaria is defined as symptoms present ( fever) but no clinical or laboratory features to
indicate severity or vital dysfunction
While
Complicated typically occurs due to delayed treatment of uncomplicated malaria and is defined as
clinical or laboratory evidence of vital dysfunction
243. What is the difference between asymptomatic and symptomatic malaria infection
Asymptomatic malaria infection is defined as positive malaria smear or other diagnostic test without
symptoms of malaria
While
Symptomatic malaria infection is defined as positive malaria smear with symptoms of malaria ( fever )
1. Microscopic examination
a. Thick blood films – Parasite detection and and quantification
b. Thin blood films- specie identification
c. Results should be available within 2 hours
d. Negative blood smears- diagnosis of malaria unlikely
e. In non immune individuals :
they may be symptomatic with very low parasite densities which may initially be
undetectable
Blood tests should be repeated every 12- 24 hours for a total of 3 sets to rule
out malaria
i. Malaria Positive Slides: Malaria parasite seen (MPS) clearly stating the
parasite stage
1 ii. Negative malaria slides: No Malaria Parasite seen
• The patient who has been treated for malaria within two weeks should not be
subjected to mRDT; instead microscopy is recommended
Defined as one or more of the following, occurring in the absence of an identified alternative
cause, and in the presence of P. falciparum asexual parasitemia
1.Impaired consciousness :
A Glasgow Coma Score <11 in adults or a Blantyre Coma Score <3 in children
2.Prostration :
Generalized weakness so that the person is unable to sit, stand or walk without assistance
3. Severe hypoglycaemia : Blood or plasma glucose <2.2mmol/L (<40mg/dL).
A hemoglobin concentration < 5g/dL or a hematocrit of < 15% in children <12 years of age
< 7g/dl and <20% respectively in adults a parasite count >10,000/ μL
Plasma or serum creatinine >265 μ mol/L (3mg/dL) or blood urea > 20 mmol/L
6. Acidosis :
Severe acidosis manifests clinically as respiratory distress- rapid, deep and labored
breathing.
7. Multiple convulsions :
8. Jaundice:
Plasma or serum bilirubin > 50μmol/L (3mg/dL) together with a parasite count >100,000/ mL
9. Pulmonary oedema:
Radiologically confirmed, or oxygen saturation < 90% on room air or respiratory rate
>30/minute
often with chest in drawing and crepitations on auscultation
including recurrent or prolonged bleeding from nose, gums or venepuncture sites; hematemesis or
melaena.
11. Shock:
Compensated shock is defined as capillary refill ≥3 seconds or temperature gradient on leg (mid
to proximal limb), but no hypotension
Decompensated shock is defined as systolic blood pressure less than 70 mmHg in children or
<80 mm Hg in adults with evidence of impaired perfusion (cool peripheries or prolonged
capillary refill)
12. Hyperparasitaemia:
Red blood cell P. falciparum parasitemia >10% or malaria parasite density of ≥200,000
parasite/µl of blood.( This definition is variable depending on the level of malaria
transmission)
Severe vivax malaria is defined as above but with no parasite density thresholds
Severe knowlesi malaria is also defined as above with two differences:
• P. knowlesi hyperparasitaemia:
1. Children <5years
×3 days ×3days
25 -<35kg 3 Tabs twice daily NA NA
×3days
>35kg 4 Tabs twice daily 2 Tabs twice daily 1 Tab twice daily
1 – 5 years
6 -13 years
> 14years
iii) In children;
iv) In adults;
7. Febrile Seizures
8. In pregnancy
b. CONVULSIONS
2. Correct hypoglycemia
1. Give 20-30ml/kg of normal saline and re access the patient within 30 minutes to decide on the
next fluid requirement according to the degree of dehydration
2. After corrections of the fluid deficit it is important to reduce the maintenance fluid to 2/3rds of the
required volume when the patient is well hydrated.
d. SEVERE ANEMIA
2. The blood must be screened against blood borne pathogens such as HIV, Viral Hepatitis etc.
3. Use packed cells ( 10ml/kg in children ) or whole blood ( with preceding parenteral frusemide to avoid
cardiovascular overload)
4. Where blood is not available give pre referral treatment and refer urgently to a health facility with
blood transfusion services
e. HYPER PYREXIA
1. In children
Avoid overclothing
Tepid sponge ( wipe the body with a towel soaked in lukewarm water)
If temperature is >39.5°c give antipyretics such as paracetamol
f. PULMONARY EDEMA
3. If the patient doesn’t pass urine within the next 24 hours refer for peritoneal or hemodialysis
1. Transfuse with screened fresh whole blood (cryoprecipitate , fresh frozen plasma and whole blood
if available)
I. METABOLIC ACIDOSIS
1. Preventive chemotherapy is different from chemoprophylaxis for travelers and non immune
individuals
2. Chemoprophylaxis is the use of sub-therapeutic doses of anti malarial to prevent the
development of malaria .
3. Chemo preventive therapies includes
a. Intermittent preventive treatment of pregnant women (IPTp)
b. Intermittent preventive treatment of infants ( IPTi) also known as perennial malaria
chemoprevention( PMC)
c. Seasonal chemoprevention (SMC)
4. Objective; prevent malaria illness by maintaining therapeutic drug levels in the blood
throughout the period of greatest malaria risk
Piloted by WHO in 3 different African countries; Ghana ,Kenya and malawi, will be
deployed in Nigeria for approved use in 2023
• The Target areas for implementation are those in malaria transmission and the
majority >60% of clinical malaria cases occur during a short period of about 4 months
o Bauchi
o Borno
o Jigawa
o Kano
o Kastina
o Kebbi
o Sokoto
o Yobe
o Zamfara
1. A child with acute febrile illness or to severely ill children unable to take
oral medications
2. An HIV positive child receiving cotrimoxazole prophylaxis
3. A child who has received a dose of either Sulfadoxine/pyrimethamine or
Amodiaquine during the past months
4. A child is who is allergic to sulfadoxine/pyrimethamine or Amodiaquine
5. Children who are being administered PMC
2.Doses should be taken prior to arrival in Nigeria and continued during the stay and two weeks
following departure from Nigeria
- Mefloquine
o Given at a dose of 5mg/mg weekly
o Approximately 250mg of base in an
adult weekly
o Should be started 2-3 weeks prior to
arrival
o Weekly in the country
o Then 2-3weeks after departure
- Atovaquone-Proguanil
o It’s a fixed dose combination that is
administered daily
o Commencing 1-2 days prior to arrival
o Then continue through out the stay
o Thereafter 7days after departure
Its is given according to body weight as Weight Total daily Dosage Regimen
shown below (kg) dose
11 - 20 kg 62.5mg/25mg 1 Daily
paediatric
Tablet
21 - 30 kg 125mg/50mg 2 As a single
paediatrics daily dose
Tablets
31 - 40 kg 187.5mg/75mg 3 As a single
paediatrics daily dose
Tablets
>40kg 250mg/100mg 1 Adult As a single
strength daily dose
dose
4. For nonimmune visitors who develop acute malaria, institute the guidelines on
management of severe malaria for prompt treatment in centres equipped to treat severe
malaria.
i) Incorrect dosing
ii) problem of treatment compliance
iii) poor drug quality
iv) Interactions with other drugs
v) Compromised drug absorption
vi)