Gastro-Intestinal tract Infection. Gastroenteritis Hepatitis NEC (Necrotizing Entero-colitis) Intra abdominal Infection
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2 Gastro-Intestinal tract Infection Gastroenteritis Hepatitis NEC (Necrotizing Entero-colitis) Intra abdominal Infection
3 อ จจาระร วง (Gastroenteritis) ถ ายอ จจาระเป นน า 1 คร ง หร อถ ายเหลวม น ามากกว าปกต 3 คร ง ในเวลา 12 ช วโมง หร อถ ายเหลวม ม กเล อดปน 1 คร ง 1 ก นยายน 2549 ระบบการจ ดการค ณภาพ 3
4 อ จจาระร วงและคล นไส อาเจ ยน รวมท งม ข อม ลสน บสน นในข อใดข อหน งด งน 1. ไข 2. อ จจาระเป นม กเล อดหร อตรวจพบเม ด เล อดขาวจ านวนมาก 3. การเพาะเช อจากอ จจาระหร อเล อด พบเช อก อโรค 4. ม การระบาดของเช อน นในขณะน น
5 เช อท เป นสาเหต Bacterial Inflammatory diarrhea Aeromonas Campylobacter jejuni Clostridium dificile E. coli: enteroinvasive, O157:H7 Plesiomonas shigelloides Salmonella Shigella Vibrio parahaemolyticus Yersinia enterocolitica Bacterial Non-inflammatory E. coli: enteropathogenic, enterotoxigenic Vibrio cholerae
6 Bacterial enterocolitis Sign of inflammation blood or pus in stool, fever E. Coli bacteria Contaminated food or water Usually affect small kids
7 Bacterial enterocolitis Sign of inflammation blood or pus in stool, fever Salmonella enteritidis bact In contaminated raw or undercooked chicken and eggs
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12 Bacterial enterocolitis Sign of inflammation blood or pus in stool, fever Shigella bacteria Campylobacter bacteria
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15 Bacterial enterocolitis Sign of inflammation blood or pus in stool, fever Clostridium difficile พบเป นเช อก อโรคท สาค ญมากในโรงพยาบาล ท ทาให เก ดอาการอ จจาระร วง
16 Clostridium difficile
17 Clostridium difficile Infection เป นเช อท ส าค ญท ส ดของการต ดเช อในรงพยาบาล พบเป นสาเหต ของการต ดเช อในโรงพยาบาลถ ง 15% โดย พบ 95% ของผ ป วยผ าต ด พบ 97 % ของผ ป วยอาย รกรรม พบอย ในส งแวดล อมได นาน ส มพ นธ ก บการใช ยาต านจ ลช พ
18 การแพร กระจายของเช อ เช ออย ในอ จจาระ แพร โดย * ม อของบ คลากร ท ส มผ สผ ป วยและส งของต างๆ * ของใช ท ใช ร วมก น (e.g., commodes, bathing tubs, and electronic rectal thermometers)
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21 เช อท เป นสาเหต Viral Rotavirus Enteric adenovirus Astroviruus Calcivirus Norwalk CMV HSV
22 Common Causes of Acute Diarrhoea Infection highly contagious Viral gastroenteritis ( stomach flu ) Usually cause explosive, watery diarrhoea Typically last only 48-72hrs Usually no blood and pus in stool Rotavirus
23 เช อท เป นสาเหต Parasites Giardia lamblida Entamoeba histolytica Strongyloides stercoralis Balantidium coli Cryptosporidium parvum Cyclospora cayetanensis Isospora belli
24 Parasites Cryptosporidium in contaminated water can survive chlorination Giardia lamblia in contaminated water Usually not associated with inflammation
25 Common Causes of Acute Diarrhoea Food Poisoning Brief illness cause by toxins produced by bacteria Cause abdominal pain, vomitting Cause SI secrete high amnt of water diarrhoea Some bacteria produce toxins in food before intake or in intestine after food is eaten Symptoms usually appear within sev. hours
26 Food Poisoning Staphylococcus aureus Produces toxins in food before it is eaten Usually food contaminated left unrefrigerated overnight
27 อาหาร Clostridium perfringens Multiplies in food Produces toxins in SI after contaminated food is eaten
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29 Bacteria Growth
30 Take care to clean all kitchen utensils and surfaces Good personal hygiene and sanitary food handling (proper wash hands before food preparation and after handling raw meat) Cook and reheat foods thoroughly: etc. meat, poultry and eggs. (keep cooked foods hot above 60 degree C) Separate raw foods from cooked foods. Do not leave food for over two hours at room temperature.
31 Proper storage (refrigeration) Refrigerate food at below 5 degree C. Carefully examine canned goods and do not use any that show danger signs Used water has been properly treated Dispense and serving thoroughly.
32 Control Contact precautions & hand hygiene Education Investigation & Control of outbreak Discharge Surveillance 1 ก นยายน 2549 ระบบการจ ดการค ณภาพ 32
33 Contact precautions & hand hygiene Education Mode of acquisition Methods to decrease transmission Exclusion from day care until diarrhea subsides Surveillance Vaccine: Salmonella typhi Discharge 1 ก นยายน 2549 ระบบการจ ดการค ณภาพ 33
34 Standard Poor
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36 The most common and devastating diseases in neonates Occurred in the first few weeks of life Prevalence rate 7-10% among infants with a birth weight between 500 and 1500 g. The estimated rate of death associated with necrotizing enterocolitis ranges between 20-50% N Engl J Med 2011; 364: January 20, 2011
37 Enteral feeding is associated with necrotizing enterocolitis An increased duration of intravenous nutrition in infants, potentially increasing the risk of infectious complications and the length of hospitalization. Cost (USA ) between $500 million and $1 billion per year Hospitalized 60 days Organism: Pseudomonas aeruginosa, Klebsiella species N Engl J Med 2011; 364: January 20, 2011
38 Signs and Symptoms of classic necrotizing enterocolitis Feeding intolerance Abdominal distention Bloody stools after 8 to 10 days of age Ileus/decreased bowel sounds The pathognomonic findings on abdominal radiography are pneumatosis intestinalis, portal venous gas, or both Abdominal discoloration Intestinal perforation Peritonitis Shock N Engl J Med 2011; 364: January 20, 2011
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