First described by Jean Marie Charcot in 1877, acute (ascending) cholangitis occurs in an infected and usually obstructed biliary system, typically at the level of the common bile duct. This illness is characterized by fever, abdominal pain, and jaundice and is an important cause of the “acute abdomen.” If the biliary obstruction is not relieved, persistently elevated intraductal pressures can cause reflux of biliary contents and bacteremia, ultimately leading to sepsis.Bile is normally sterile because of the constant flow into the duodenum, flushing the biliary system, and the antibacterial properties of immunoglobulin A and bile salts in the bile itself. The sphincter of Oddi also helps to prevent intestinal contents from refluxing onto the common bile duct. Obstruction of the common bile duct causes a rise in pressure that leads to edema and necrosis of the walls of the biliary tree. Obstructions are primarily due to gallstones in the majority of cases, and these may arise from the gallbladder or spontaneously form in the common bile duct after cholecystectomy. Other reasons for biliary obstruction include malignancy, benign strictures, congenital abnormalities, cysts, parasites (Ascaris, Clonorchis, or Echinococcus species), pancreatitis, or extrinsic compression. In the presence of any of these causes of obstruction, bacteria may reach the biliary tree by either reflux from the duodenum or translocation from the portal circulation. *106/348/5*
Shigella species require an inoculum of only 10 to 100 organisms and thus is highly communicable. Outbreaks have been traced to food and water, but most infections are transmitted person-to-person. Shigella is, therefore, a major pathogen in day care centers and nursing homes. Variable in its morbidity, Shigella produces Shiga toxin, which causes fever, malaise, cramping, tenesemus, and voluminous diarrhea that is initially watery and often becomes bloody. Because most cases are self-limited and resistance is increasing, antimicrobial therapy may not be indicated, especially if the patient is improving at presentation. But, in cases of moderate to severe illness, patients at the extremes of age, and patients with comorbid illness, antibiotic therapy should not be withheld because may decrease symptoms and shorten fecal excretion. Trimethoprim-sulfamethoxazole, ampicilline, tetracyclines, and fluoroquinolones are acceptable agents, but resistance is becoming more common.*68/348/5*
In otherwise healthy people, influenza, or flu, is usually not serious. Symptoms, including aches and pains, nausea, diarrhea, fever, and cold-like ailments, generally pass very quickly. However, in combination with other disorders or among the elderly (people over the age of 65), those with respiratory or heart disease, or the very young (children under the age of 5), the flu can be very serious.
To date, three major varieties of flu virus have been discovered, with many different strains existing within each variety. The “A” form of the virus is generally the most virulent, followed by the “B” and “C” varieties. If you contract one form of influenza you may develop immunity to it, but you will not necessarily be immune to other forms of the disease. Little can be done to treat flu patients once the infection has become established. Some vaccines have proved effective against certain strains of flu virus, but they are totally ineffective against others. In spite of minor risks, it is recommended that people over the age of 65; pregnant women; people with heart disease or conditions such as asthma, emphysema, and bronchitis; and those with certain other illnesses be vaccinated. Because flu shots take anywhere from 2 to 3 weeks to become effective, you should get these shots in the fall, before the flu season begins.
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