Intestinal obstruction

Intestinal obstruction may come on either slowly or suddenly; a common cause is a strangulated hernia. The bowel will always try to push intestinal contents past any obstruction, and as it does so the bowel muscle will contract strongly, causing colicky pain. The strong contractions may be seen and also heard as loud gurgling noises.

In the early stages, the patient may often complain of an attack of wind and constipation.

Later on he can pass neither wind nor faeces downwards. The patient's abdomen may distend and harden, owing to the production of gas he cannot get rid of, and the bowel sounds become louder. The patient may vomit, at first the stomach contents and later faecal matter.

General treatment

As one of the causes of obstruction is a stran­gulated hernia, look carefully for this condition and do everything possible to alleviate it, if present. Whatever the cause, it is essential for the patient to be removed as quickly as possible to a place where surgical treatment can be carried out to relieve the obstruction. Delay can be fatal. Get RADIO MEDICAL ADVICE.

In the meantime, put the patient to bed. Give him nothing by mouth except water to wash out his mouth if he vomits. Fluids may need to be given intravenously to maintain fluid balance. Get RADIO MEDICAL ADVICE.

Specific treatment

The patient may be given morphine, 10 mg intramuscularly.

UNIT 8

1. Read and translate the text

Infectious diseases

Communicable diseases are those that can be transmitted from one person (or animal) to another. There may be direct or indirect transmission to a well person from an infected person or animal – at times through an intermediate animal host, a vector (a mosquito), or the inanimate environment. Illnesses result when an infectious agent invades and multiplies in the host.

The occurrence and spread of disease are determined by interplay of factors specific to the causative agent, the environment, and the individuals or groups in whom the disease occurs. A causative agent (if many were to fall ill at the same time) could endanger the operation and the safety of the ship. Thus, it is important to know how various diseases are spread, and what measures should be taken to ensure their prevention and control.

Infectious agents

Organisms that produce disease in man range in size from the submicroscopic viruses to the tapeworm, which may attain a length of several meters.

Various groups of infectious agents are listed below, together with some of the diseases they cause.

Bacteria	Sore throat, pneumonia, tuberculosis, syphilis, bacillary dysentery, cholera
Viruses	Common cold, influenza, yellow fever, poliomyelitis, rabies, measles, and viral pneumonia
Rickettsiae	Typhus fever
Protozoa	Malaria, amoebic dysentery
Metazoa	Filariasis, trichinosis, hookworm and tapeworm infections
Fungi	Ringworm and tinea pedis (athlete’s foot)

Infectious agents are usually specific in their disease-producing capabilities. Several different organisms can produce diseases that resemble each other clinically (in symptoms and course) and pathogenically (in the anatomical changes they cause).

Essential basic rules for the management of communicable diseases

• Isolate. If anyone suffers from a temperature without obvious cause it is best to isolate him until a diagnosis has been made.

• Strip the patientand make a thorough examination, looking for any signs of utensils, in order to try to establish the diagnosis.

• Put the patient to bed, and appoint someone to look after and nurse him and organize the control of his eating and drinking utensils and their sterilization after use.

• Give fluids in the first instance.

• If the patient’s temperature exceeds 39.5ºC make arrangements for tepid sponging.

• Arrange the use of bedpan and urine bottle if the patient shows any sign of prostration or if his temperature is high.

• If the patient is seriously ill and if there is any doubt as to diagnosis, seek RADIO MEDICAL ADVICE, failing which you should consider making for port.

• Treat symptoms as they arise.

• Do not attempt to get the patient up during convalescence if he is feeble, but keep him in bed until the next port is reached.

• When approaching port, send a radio message giving details of the case to enable the port health authorities to make arrangements for the isolation of the case and any contacts on arrival.

2. Answer the following questions

1. What is a communicable disease?

2. What factors determine the occurrence and spread of communicable diseases?

3. What groups of infectious agents do you know?

4. What are the essential basic rules for the management of communicable diseases?

3. Give summaries of the following texts