jejunum

This is the second part of the small intestine. It follows the above DUODENUM and ileum.

This is the longest part of the small intestine. It may be the seat of many diseases, such as disease CROHN.

Hepatitis markers

To assert hepatitis A, we can find the HAV IgM anti marker several weeks after the contagion.

For hepatitis B:

- From 4 to 12 weeks after the contagion:
HBs antigen or antigen australia will be present. Is the antigen on the surface of the virus;

- 6 to 15 weeks after the contagion:
HBeAg is found in serum. It is a surface antigen which corresponds to a complete virus;

- Another antigen, HBc antigen, exists within the capsid of the virus and does not found in serum. Appears in the recovery period as anti HBc antibody in serum.

Each antigen causes the appearance of a specific antibody to a greater or lesser time period away from contagion.

In summary:

- HBsAg appears at the beginning of infection and persists in the period of state and disappears convalescence;

- HBeAg appears later and disappears earlier than HBsAg;

- Anti HBs appears a few months after the contagion and may persist for several years;

- Anti HBc appears 6 weeks after contagion and may persist for years.

Ag (antigen) HBsAg + anti-HBs anti-HBc + = acute or chronic infection during

HBsAg, anti-HBc anti-HBs + + = history of hepatitis B: about protected

HBsAg, anti-HBs + anti-HBc = after immunization protected person, after natural contact: about vaccinating

HBsAg, anti-HBs and anti-HBc + = a recent infection before the appearance of anti-HBs after previous infection or disappearance of anti-HBs.

The presence of HBsAg carrier excludes blood donation.

healing of acute hepatitis B means:
- Normalization of transaminases,
- The appearance of HBc antibody
- The disappearance of HBsAg.

The transition to chronicity characterized by:
- The persistence of elevated transaminases,
- The presence of HBsAg and HBeAg.

For hepatitis C, HCV marker research confirms the diagnosis. Chronicity is accompanied by anti-HCV and elevated transaminases (sometimes normal though). The virus can be asserted by sophisticated laboratory techniques (PCR HCV).

Hepatitis A risk countries

Hepatitis A is the most common infections reaching the exotic travelers can be prevented by vaccination.

The luxury tourists are not free of the disease, of course with less risk than other tourists traveling in worse conditions.

Those most at risk are India, Mexico, South America, the Caribbean and Africa. Then come from North Africa, the Middle East and Southeast Asia.

It is therefore imperative to get vaccinated before going to these destinations, especially the subjects less than 40 years in our developed countries have a much better chance of not being immunized.

A new possibility of vaccination can be protected by a single injection (HAVRIX 1440), with booster 6-12 months later that provides protection over several years

Regurgitation infant

It is always difficult to tell the difference between a trivial regurgitation in infants and gastro-oesophageal reflux true. Gastro-oesophageal reflux is mentioned as severe vomiting causing digestive symptoms:

1 - esophagitis: agitation baby during feeding and during sleep, sometimes anorexia (lack of appetite), a DYSPHAGIA;

2 - thrive impact, the child no longer grows;

3 - respiratory symptoms and acute or chronic ENT;

4 - or asthma;

5 - serious ailments of the baby, which would be due to a slowing of the heart or apnea, associated with the presence of stomach acid into the lower esophagus.

Mundane regurgitation yield to 5-7 months, events of gastro-oesophageal reflux will last up to 2 or 3 years.

Additional tests are required only if atypical symptoms: severe discomfort, respiratory and ENT repetition, further examination is the reference PH METRY. Sometimes ultrasound or endoscopy stomach will be required.

TREATMENT

The simple regurgitation requires only simple dietary measures: thickening of the bottle and the bottle after postural advice.

Pathological regurgitation causing infectious pulmonary complications, a faltering weight, require, in addition to dietary measures, drug therapy.

It will give the milk to predominate in favor of soluble proteins in milk casein predominant.

Y add thickeners.

Note the excellent effect of milk ENFAMIL AR exists in milk for infants up to 4 months and the second milk after age 4 months.

In addition:

- It should not be given to drink between meals and before bedtime,

- Avoid fruit juices that are acidic liquids

- Avoid older children soft drinks, chocolate and mint (decrease SPHINCTER factors, see this term, lower esophagus)

- Avoid PASSIVE SMOKING.

Drug treatment is based cisapride, administered in 4 divided doses during the day according to medical advice.

We will be adding the administration of alginate or smectite in complicated cases.

Treatment in gastro-oesophageal reflux should be continued until the age of 18 months.

Finally, surgery should only be considered to gastro-oesophageal reflux that persists beyond 3 or 4 years.

Proctitis

These are inflammatory diseases of the rectum and anus, whose causes are multiple:

1 - some are cryptogenic, that is to say the cause is unknown or escape our means of investigation, such as the illness or CROHN

,

3 - some may be iatrogenic (caused by radiation, certain medications or abnormal practices).

The lesions are variable. They may involve edema, congestion, ulceration or cracks, pustules or various blooms (see WARTS, adenoids ULCERATIVE Hemorrhagic (see these terms)

2 - others can be infectious, parasitic, tumors).

SYMPTOMS

It generally flows mucus, muco-purulent or bloody stools that may accompany or occur outside them.

False needs are common and result in a non-fecal evacuation. These false needs are often compelling, they are accompanied by tenesmus (qv, painful tension with burning) and rectal pain.

BLEEDING ALL BE ORIGINAL LOW (NAFTA) OR HIGH (RECTAL) NEED A COMPREHENSIVE REVIEW AND COLORECTAL.

CAUSES

1 - The ULCERATIVE and Hemorrhagic disease CROHN (see these terms) anorectal causes are unknown but serious origin;

2 - with specific infectious:

- Anorectites venereal syphilis that can be (see SYPHILIS), gonorrhea (see gonorrhea), viral, or due to disease NICOLAS FAVRE (sickness)

- Anorectal tuberculosis has become rare;

3 - Parasitic proctitis: amebiasis, schistosomiasis;

4 - Iatrogenic proctitis:

- Prolonged antibiotic,

- Therapeutic local irritating or allergenic,

- Rectal melanosis due to misuse of anthraquinone laxatives (phenolphthalein, rhubarb, senna, buckthorn)

- Thermometer lesions

- Post-radiotherapy lesions.

TREATMENT

The treatment is the cause.

Virus persistence

Some virus after infection persist in the body and are not removed, as opposed to some that after infection are destroyed by antibodies that the body will be made (eg Rubella is caused by a virus that triggers the production of antibodies that destroy the virus).

Viral persistence is responsible for:

- Highs of episodes in the life of the subject,

- A viral infection that can occur in case of impairment of the immune system,

- Chronic infection,

- Viral infections may be associated with cancer,

- Especially because this virus is always survival of the virus in a population.

The virus somehow escapes the immune system and reaches its target tissue where it will remain more or less dormant (latent) during the lifetime of the subject without events too damaging to the survival of the organization achieves.

- The HERPES virus is a DNA virus causes this phenomenon of viral persistence.

During primary infection, the virus wins ganglia and integrates its GENOME CHROMOSOME in neuronal ganglion cells.

When various factors such as the flu, sunburn, fever, rules, psychological conflicts, the virus is reactivated and suddenly manifest, for example a BUTTON FEVER. The number of activations varies depending on the subject.

- The POX virus ZONA site has its persistence in the nerve ganglia also. Reactivation is usually after several years. If the immune system fails, reactivation can be extremely serious by the occurrence of an extremely severe shingles.

- The CYTOMEGALOVIRUS site has its persistence in the lymph nodes. It integrates its genome into B lymphocytes. Reactivation can be very severe in immunocompromised giving lung, liver sometimes very serious digestive diseases,.

- The Epstein Barr virus persistence has its site in the lymph nodes and integrates its genome into B lymphocytes. Reactivation can be very serious in some areas of the world where it causes LYMPHOMA BURKITT.

- The virus HEPATITIS B's site persistence in the liver and salivary glands. Fortunately, the virus is usually eliminated by the body through a good immune response. However, in some cases it integrates its genome into the genome of liver cells. Reactivation causes chronic hepatitis and cirrhosis and sometimes liver cancer.

Remember that viral persistence is reflected by the presence of HBsAg antigen (australia) in the blood and the absence of anti-HBs (anti-HBs Ab). The HBeAg is a marker of viral replication.

- HEPATITIS C virus: the virus RNA appears to persist through continuous replication in the body and not by integrating its genome into the cell genome. reactivation causes chronic hepatitis and cirrhosis sometimes even liver cancer.

- The AIDS virus have their site persistence in the lymph nodes, especially in the T-CELL 4 and Macrophages (see these terms). See AIDS VIRAL PERSISTENCE.

The phenomenon of viral persistence is important to know to find and administer the most effective treatment at the right time, and for making possible vaccines.

Viral infections are very complex and difficult to control.