Editing Enteritis (section)

== Typhoid enteritis ==

* Acute systemic infection caused primarily by Salmonella typhi
* Epidemiology
** Suspect with recent travel to developing countries
* Pathophysiology
** Initiated by ingestion of typhoid bacillus
** Organisms penetrate small bowel mucosa, passing through lymphatics then entering systemic circulation
** Associated with hyperplasia of the reticuloendothelial system, including lymph nodes, liver and spleen
** Peyer patches in the small bowel become hyperplastic and may subsequently ulcerate, complicated by haemorrhage or perforation
* Investigation
** Blood culture - positive in 90% of patients during first week, and confirms diagnosis
** Bone marrow culture
** Stool culture
** Widal test (high titres of agglutinins against O and H antigens) is no longer necessary as it is non-specific
** PCR for S. typhi are inaccurate
* Management
** Antibiotics
*** Immediate broad-spectrum antibiotics if suspected
*** Fluoroquinolones or third-generation cephalosporins
* Complications
** Haemorrhage
*** Usually managed with transfusion as necessary
*** Laparotomy for uncontrollable life-threatening haemorrhage
** Perforation
*** Occurs through an ulcerated Peyer patch in 2% of cases
*** Typically single perforation in TI - can be closed primarily
*** Multiple perforations require resection with primary anastomosis or loop ileostomy

[[Category:Small bowel]]