True regarding the ulcers seen in typhoid is
|A||The complication are most common in the 1st week|
|B||They are commonly penetrating and cause severe local granuloma formation|
|C||The ulcers are longitudinally oriented|
|D||The disease is more common in the elderly|
a. Typhoid fever remains a significant problem in developing countries, most commonly in areas with contaminated water supplies and inadequate waste disposal.
b. Children and young adults are most often affected.
c. Typhoid enteritis is an acute systemic infection of several weeks' duration caused primarily by Salmonella typhosa.
d. The pathologic events of typhoid fever are initiated in the intestinal tract after oral ingestion of the typhoid bacillus.
e. These organisms penetrate the small bowel mucosa, making their way rapidly to the lymphatics and then systemically.
f. Hyperplasia of the reticuloendothelial system, including lymph nodes, liver, and spleen, is characteristic of typhoid fever.
g. Peyer patches in the small bowel become hyperplastic and may subsequently ulcerate with complications of hemorrhage or perforation.
h. The diagnosis of typhoid fever is confirmed by isolating the organism from blood (positive in 90% of the patients during the first week of the illness), bone marrow, and stool cultures.
i. In addition, the finding of high titers of agglutinins against the O and H antigens is strongly suggestive of typhoid fever. Assays for the diagnosis of S. typhosa using PCR have been developed but are still experimental.
j. Treatment of typhoid fever and uncomplicated typhoid enteritis is accomplished by antibiotic administration.
l. Complications requiring potential surgical intervention include hemorrhage and perforation.
m. When hemorrhage occurs, transfusion is indicated and usually suffices.
n. Typically, it is a single perforation in the terminal ileum, and simple closure of the perforation is the treatment of choice.
o. With multiple perforations, which occur in about one fourth of the patients, resection with primary anastomosis or exteriorization of the intestinal loops may be required.