APPENDICITIS The site of your pain may vary, depending on your age

Appendicitis is an inflammation of the appendix, a finger- and the position of your appendix. When you're pregnant, the
shaped pouch that projects from your colon on the lower right pain may seem to come from your upper abdomen because your
side of your abdomen. The appendix doesn't seem to have a appendix is higher during pregnancy.
specific purpose.
Causes
Appendicitis causes pain in your lower right abdomen.
A blockage in the lining of the appendix that results in
However, in most people, pain begins around the navel and then
infection is the likely cause of appendicitis. The bacteria multiply
moves. As inflammation worsens, appendicitis pain typically
rapidly, causing the appendix to become inflamed, swollen and
increases and eventually becomes severe.
filled with pus. If not treated promptly, the appendix can rupture.
Although anyone can develop appendicitis, most often it Complications
occurs in people between the ages of 10 and 30. Standard Complications:
treatment is surgical removal of the appendix.  A ruptured appendix. A rupture spreads infection
Symptoms throughout your abdomen (peritonitis). Possibly life-
Signs and symptoms of appendicitis may include: threatening, this condition requires immediate surgery
 Sudden pain that begins on the right side of the lower to remove the appendix and clean your abdominal
abdomen cavity.
 Sudden pain that begins around your navel and often
 A pocket of pus that forms in the abdomen. If your
shifts to your lower right abdomen
appendix bursts, you may develop a pocket of infection
 Pain that worsens if you cough, walk or make other
(abscess). In most cases, a surgeon drains the abscess
jarring movements
by placing a tube through your abdominal wall into the
 Nausea and vomiting
abscess. The tube is left in place for two weeks, and
 Loss of appetite
 Low-grade fever that may worsen as the illness
you're given antibiotics to clear the infection.

progresses Once the infection is clear, you'll have surgery to

 Constipation or diarrhea remove the appendix. In some cases, the abscess is
 Abdominal bloating drained, and the appendix is removed immediately.
Diagnosis Treatment
Tests and procedures used to diagnose appendicitis include: -Appendicitis treatment usually involves surgery to remove the
 Physical exam to assess your pain. Your doctor may inflamed appendix. Before surgery you may be given a dose of
apply gentle pressure on the painful area. When the antibiotics to prevent infection.
pressure is suddenly released, appendicitis pain will often Surgery to remove the appendix (appendectomy)

feel worse, signaling that the adjacent peritoneum is -Appendectomy can be performed as open surgery using one

inflamed. abdominal incision about 2 to 4 inches (5 to 10 centimeters) long

Your doctor also may look for abdominal rigidity and a (laparotomy). Or the surgery can be done through a few small

tendency for you to stiffen your abdominal muscles in abdominal incisions (laparoscopic surgery).

response to pressure over the inflamed appendix -During a laparoscopic appendectomy, the surgeon inserts

(guarding). special surgical tools and a video camera into your abdomen to

Your doctor may use a lubricated, gloved finger to remove your appendix.

examine your lower rectum (digital rectal exam). Women -In general, laparoscopic surgery allows you to recover faster

of childbearing age may be given a pelvic exam to check and heal with less pain and scarring. It may be better for people

for possible gynecological problems that could be causing who are elderly or obese. But laparoscopic surgery isn't

the pain. appropriate for everyone. If your appendix has ruptured and
 Blood test. This allows your doctor to check for a high infection has spread beyond the appendix or you have an
white blood cell count, which may indicate an infection. abscess, you may need an open appendectomy, which allows
 Urine test. Your doctor may want you to have a urinalysis your surgeon to clean the abdominal cavity.
to make sure that a urinary tract infection or a kidney -Expect to spend one or two days in the hospital after your
stone isn't causing your pain. appendectomy.
 Imaging tests. Your doctor may also recommend an Draining an abscess before appendix surgery
abdominal X-ray, an abdominal ultrasound or a -If your appendix has burst and an abscess has formed around it,
computerized tomography (CT) scan to help confirm the abscess may be drained by placing a tube through your skin
appendicitis or find other causes for your pain. into the abscess. Appendectomy can be performed several weeks
later after controlling the infection.
UTI Causes

A urinary tract infection (UTI) is an infection in any part  Infection of the bladder (cystitis). This type of UTI is

of your urinary system — your kidneys, ureters, bladder and usually caused by Escherichia coli (E. coli), a type of

urethra. Most infections involve the lower urinary tract — the bacteria commonly found in the gastrointestinal (GI) tract.

bladder and the urethra. However, sometimes other bacteria are responsible.

Women are at greater risk of developing a UTI than are men. Sexual intercourse may lead to cystitis, but you don't have

Infection limited to your bladder can be painful and annoying. to be sexually active to develop it. All women are at risk of

However, serious consequences can occur if a UTI spreads to cystitis because of their anatomy — specifically, the short

your kidneys. distance from the urethra to the anus and the urethral

Doctors typically treat urinary tract infections with antibiotics. opening to the bladder.
 Infection of the urethra (urethritis). This type of UTI can
Symptoms occur when GI bacteria spread from the anus to the
Urinary tract infections don't always cause signs and symptoms, urethra. Also, because the female urethra is close to the
but when they do they may include: vagina, sexually transmitted infections, such as herpes,
 A strong, persistent urge to urinate gonorrhea, chlamydia and mycoplasma, can cause
 A burning sensation when urinating urethritis.
 Passing frequent, small amounts of urine
 Urine that appears cloudy
 Urine that appears red, bright pink or cola-colored — a
sign of blood in the urine
 Strong-smelling urine
 Pelvic pain, in women — especially in the center of the
pelvis and around the area of the pubic bone
Complications: ultrasound, a computerized tomography (CT) scan or
 Recurrent infections, especially in women who experience magnetic resonance imaging (MRI). Your doctor may also
two or more UTIs in a six-month period or four or more use a contrast dye to highlight structures in your urinary
within a year. tract.
 Permanent kidney damage from an acute or chronic kidney  Using a scope to see inside your bladder. If you have
infection (pyelonephritis) due to an untreated UTI. recurrent UTIs, your doctor may perform a cystoscopy,
 Increased risk in pregnant women of delivering low birth using a long, thin tube with a lens (cystoscope) to see
weight or premature infants. inside your urethra and bladder. The cystoscope is inserted
 Urethral narrowing (stricture) in men from recurrent in your urethra and passed through to your bladder.
urethritis, previously seen with gonococcal urethritis.
Treatment
 Sepsis, a potentially life-threatening complication of an
Antibiotics usually are the first line treatment for urinary tract
infection, especially if the infection works its way up your
infections. Which drugs are prescribed and for how long depend
urinary tract to your kidneys.
on your health condition and the type of bacteria found in your
Diagnosis urine.
 Analyzing a urine sample. Your doctor may ask for a Simple infection
urine sample for lab analysis to look for white blood cells, Drugs commonly recommended for simple UTIs include:
red blood cells or bacteria. To avoid potential  Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
contamination of the sample, you may be instructed to first  Fosfomycin (Monurol)
wipe your genital area with an antiseptic pad and to collect  Nitrofurantoin (Macrodantin, Macrobid)
the urine midstream.  Cephalexin (Keflex)
 Growing urinary tract bacteria in a lab. Lab analysis of  Ceftriaxone
the urine is sometimes followed by a urine culture. This
test tells your doctor what bacteria are causing your
infection and which medications will be most effective.
 Creating images of your urinary tract. If you are having
frequent infections that your doctor thinks may be caused
by an abnormality in your urinary tract, you may have an
KIDNEY STONES Pain caused by a kidney stone may change — for instance,
Kidney stones (renal lithiasis, nephrolithiasis) are hard shifting to a different location or increasing in intensity — as the
deposits made of minerals and salts that form inside your stone moves through your urinary tract.
kidneys. Seek immediate medical attention if you experience:
Kidney stones have many causes and can affect any part  Pain so severe that you can't sit still or find a comfortable
of your urinary tract — from your kidneys to your bladder. position
Often, stones form when the urine becomes concentrated,  Pain accompanied by nausea and vomiting
allowing minerals to crystallize and stick together.  Pain accompanied by fever and chills
 Blood in your urine
Symptoms  Difficulty passing urine
A kidney stone may not cause symptoms until it moves around
Causes
within your kidney or passes into your ureter — the tube
Kidney stones often have no definite, single cause, although
connecting the kidney and bladder. At that point, you may
several factors may increase your risk.
experience these signs and symptoms:
Kidney stones form when your urine contains more crystal-
 Severe pain in the side and back, below the ribs
forming substances — such as calcium, oxalate and uric acid —
 Pain that radiates to the lower abdomen and groin
 Pain that comes in waves and fluctuates in intensity than the fluid in your urine can dilute. At the same time, your
 Pain on urination urine may lack substances that prevent crystals from sticking
 Pink, red or brown urine together, creating an ideal environment for kidney stones to
 Cloudy or foul-smelling urine form.
 Nausea and vomiting Types of kidney stones
 Persistent need to urinate  Calcium stones. Most kidney stones are calcium stones,
 Urinating more often than usual usually in the form of calcium oxalate. Oxalate is a naturally
 Fever and chills if an infection is present occurring substance found in food and is also made daily
 Urinating small amounts by your liver. Some fruits and vegetables, as well as nuts
and chocolate, have high oxalate content.
 Dietary factors, high doses of vitamin D, intestinal bypass  Imaging. Imaging tests may show kidney stones in your
surgery and several metabolic disorders can increase the urinary tract. Options range from simple abdominal X-rays,
concentration of calcium or oxalate in urine. which can miss small kidney stones, to high-speed or dual
 Struvite stones. Struvite stones form in response to an energy computerized tomography (CT) that may reveal
infection, such as a urinary tract infection. These stones can even tiny stones.
grow quickly and become quite large, sometimes with few Other imaging options include an ultrasound, a
symptoms or little warning. noninvasive test, and intravenous urography, which
 Uric acid stones. Uric acid stones can form in people who
involves injecting dye into an arm vein and taking X-rays
don't drink enough fluids or who lose too much fluid, those
(intravenous pyelogram) or obtaining CT images (CT
who eat a high-protein diet, and those who have gout.
urogram) as the dye travels through your kidneys and
Certain genetic factors also may increase your risk of uric
bladder.
acid stones.
 Analysis of passed stones. You may be asked to urinate
 Cystine stones. These stones form in people with a
through a strainer to catch stones that you pass. Lab
hereditary disorder that causes the kidneys to excrete too
analysis will reveal the makeup of your kidney stones. Your
much of certain amino acids (cystinuria).
doctor uses this information to determine what's causing
Diagnosis your kidney stones and to form a plan to prevent more
 Blood testing. Blood tests may reveal too much calcium or kidney stones.
uric acid in your blood. Blood test results help monitor the
Treatment
health of your kidneys and may lead your doctor to check Small stones with minimal symptoms
for other medical conditions. Most small kidney stones won't require invasive treatment. You
 Urine testing. The 24-hour urine collection test may show may be able to pass a small stone by:
that you're excreting too many stone-forming minerals or  Drinking water. Drinking as much as 2 to 3 quarts (1.9 to
too few stone-preventing substances. For this test, your 2.8 liters) a day may help flush out your urinary system.
doctor may request that you perform two urine collections Unless your doctor tells you otherwise, drink enough fluid
over two consecutive days. — mostly water — to produce clear or nearly clear urine.
  Pain relievers. Passing a small stone can cause some  Surgery to remove very large stones in the kidney. A
discomfort. To relieve mild pain, your doctor may procedure called percutaneous nephrolithotomy (nef-row-
recommend pain relievers such as ibuprofen (Advil, Motrin lih-THOT-uh-me) involves surgically removing a kidney
IB, others), acetaminophen (Tylenol, others) or naproxen stone using small telescopes and instruments inserted
sodium (Aleve).
through a small incision in your back.
 Medical therapy. Your doctor may give you a medication
 Using a scope to remove stones. To remove a smaller
to help pass your kidney stone. This type of medication,
stone in your ureter or kidney, your doctor may pass a thin
known as an alpha blocker, relaxes the muscles in your
lighted tube (ureteroscope) equipped with a camera
ureter, helping you pass the kidney stone more quickly and
through your urethra and bladder to your ureter.
with less pain.
Large stones and those that cause symptoms Once the stone is located, special tools can snare the stone
Kidney stones that can't be treated with conservative measures or break it into pieces that will pass in your urine. Your
— either because they're too large to pass on their own or doctor may then place a small tube (stent) in the ureter to
because they cause bleeding, kidney damage or ongoing urinary relieve swelling and promote healing. You may need
tract infections — may require more-extensive treatment. general or local anesthesia during this procedure.
Procedures may include:  Parathyroid gland surgery. Some calcium phosphate
 Using sound waves to break up stones. For certain stones are caused by overactive parathyroid glands, which
kidney stones — depending on size and location — your are located on the four corners of your thyroid gland, just
doctor may recommend a procedure called extracorporeal below your Adam's apple. When these glands produce too
shock wave lithotripsy (ESWL). much parathyroid hormone (hyperparathyroidism), your
ESWL uses sound waves to create strong vibrations (shock calcium levels can become too high and kidney stones may
waves) that break the stones into tiny pieces that can be form as a result.
passed in your urine. The procedure lasts about 45 to 60
minutes and can cause moderate pain, so you may be under
sedation or light anesthesia to make you comfortable.
TYPHOID FEVER  Dry cough
Typhoid fever is caused by Salmonella typhi bacteria.  Loss of appetite and weight loss
Typhoid fever is rare in industrialized countries. However, it  Abdominal pain
remains a serious health threat in the developing world,  Diarrhea or constipation
 Rash
especially for children.
 Extremely swollen abdomen
Typhoid fever spreads through contaminated food and
Later illness:
water or through close contact with someone who's infected.
If you don't receive treatment, you may:
Signs and symptoms usually include a high fever, headache,  Become delirious
abdominal pain, and either constipation or diarrhea.  Lie motionless and exhausted with your eyes half-closed in
Most people with typhoid fever feel better within a few what's known as the typhoid state
days of starting antibiotic treatment, although a small number of In addition, life-threatening complications often develop at this
them may die of complications. Vaccines against typhoid fever time.
are available, but they're only partially effective. Vaccines usually In some people, signs and symptoms may return up to two
are reserved for those who may be exposed to the disease or are weeks after the fever has subsided.
traveling to areas where typhoid fever is common.
Causes
Symptoms Typhoid fever is caused by virulent bacteria called Salmonella
Signs and symptoms are likely to develop gradually — typhi. Although they're related, Salmonella typhi and the bacteria
often appearing one to three weeks after exposure to the disease. responsible for salmonellosis, another serious intestinal
Early illness:
infection, aren't the same.
Once signs and symptoms do appear, you're likely to experience: Fecal-oral transmission route
 Fever that starts low and increases daily, possibly reaching The bacteria that cause typhoid fever spread through
as high as 104.9 F (40.5 C) contaminated food or water and occasionally through direct
 Headache
contact with someone who is infected. In developing nations,
 Weakness and fatigue
where typhoid fever is established (endemic), most cases result
 Muscle aches
from contaminated drinking water and poor sanitation. The
 Sweating
majority of people in industrialized countries pick up typhoid If you live in a country where typhoid fever is rare, you're at
bacteria while traveling and spread it to others through the fecal- increased risk if you:
oral route.  Work in or travel to areas where typhoid fever is
This means that Salmonella typhi is passed in the feces and established (endemic)
sometimes in the urine of infected people. You can contract the  Work as a clinical microbiologist handling Salmonella typhi
infection if you eat food handled by someone with typhoid fever bacteria
 Have close contact with someone who is infected or has
who hasn't washed carefully after using the toilet. You can also
recently been infected with typhoid fever
become infected by drinking water contaminated with the
 Drink water contaminated by sewage that contains
bacteria.
Salmonella typhi

Typhoid carriers
Complications
Even after treatment with antibiotics, a small number of people  Intestinal bleeding or holes
who recover from typhoid fever continue to harbor the bacteria The most serious complications of typhoid fever — intestinal
in their intestinal tracts or gallbladders, often for years. These bleeding or holes (perforations) in the intestine — may develop
people, called chronic carriers, shed the bacteria in their feces in the third week of illness. A perforated intestine occurs when
and are capable of infecting others, although they no longer have your small intestine or large bowel develops a hole, causing
signs or symptoms of the disease themselves. intestinal contents to leak into your abdominal cavity and
Risk factors
triggering signs and symptoms such as severe abdominal pain,
Typhoid fever remains a serious worldwide threat — especially
nausea, vomiting and bloodstream infection (sepsis). This life-
in the developing world — affecting an estimated 26 million or
threatening complication requires immediate medical care.
more people each year. The disease is established (endemic) in  Other, less common complications
India, Southeast Asia, Africa, South America and many other Other possible complications include:
areas.  Inflammation of the heart muscle (myocarditis)
Worldwide, children are at greatest risk of getting the disease,  Inflammation of the lining of the heart and valves
although they generally have milder symptoms than adults do. (endocarditis)
 Pneumonia
  Inflammation of the pancreas (pancreatitis)  Wash your hands. Frequent hand-washing in hot, soapy
 Kidney or bladder infections water is the best way to control infection. Wash before
 Infection and inflammation of the membranes and fluid eating or preparing food and after using the toilet. Carry an
surrounding your brain and spinal cord (meningitis) alcohol-based hand sanitizer for times when water isn't
 Psychiatric problems, such as delirium, hallucinations and available.
paranoid psychosis  Avoid drinking untreated water. Contaminated drinking
water is a particular problem in areas where typhoid fever
Prevention
is endemic. For that reason, drink only bottled water or
In many developing nations, the public health goals that
canned or bottled carbonated beverages, wine and beer.
can help prevent and control typhoid fever — safe drinking
Carbonated bottled water is safer than uncarbonated
water, improved sanitation and adequate medical care — may be
bottled water is.
difficult to achieve. For that reason, some experts believe that
Ask for drinks without ice. Use bottled water to brush your
vaccinating high-risk populations is the best way to control
teeth, and try not to swallow water in the shower.
typhoid fever.  Avoid raw fruits and vegetables. Because raw produce
A vaccine is recommended if you live in or you're may have been washed in unsafe water, avoid fruits and
traveling to areas where the risk of getting typhoid fever is high. vegetables that you can't peel, especially lettuce. To be
Vaccines
absolutely safe, you may want to avoid raw foods entirely.
Two vaccines are available.  Choose hot foods. Avoid food that's stored or served at
 One is injected in a single dose at least one week before room temperature. Steaming hot foods are best. And
travel. although there's no guarantee that meals served at the
 One is given orally in four capsules, with one capsule to be finest restaurants are safe, it's best to avoid food from
taken every other day. street vendors — it's more likely to be contaminated.
Neither vaccine is 100 percent effective, and both require
repeat immunizations, as vaccine effectiveness diminishes over
time.
Prevent infecting others microscope for the presence of typhoid bacteria. A bone marrow
If you're recovering from typhoid fever, these measures can help culture often is the most sensitive test for Salmonella typhi.
keep others safe: Although performing a culture test is the mainstay for
 Take your antibiotics. Follow your doctor's instructions
diagnosis, in some instances other testing may be used to
for taking your antibiotics, and be sure to finish the entire
confirm a suspected typhoid fever infection, such as a test to
prescription.
detect antibodies to typhoid bacteria in your blood or a test that
 Wash your hands often. This is the single most important
checks for typhoid DNA in your blood.
thing you can do to keep from spreading the infection to
Treatment
others. Use hot, soapy water and scrub thoroughly for at
Antibiotic therapy is the only effective treatment for typhoid
least 30 seconds, especially before eating and after using
fever.
the toilet.
 Avoid handling food. Avoid preparing food for others Commonly prescribed antibiotics
until your doctor says you're no longer contagious. If you Commonly prescribed antibiotics include:
work in the food service industry or a health care facility,  Ciprofloxacin (Cipro). In the United States, doctors often
you won't be allowed to return to work until tests show prescribe this for nonpregnant adults. Another similar drug
that you're no longer shedding typhoid bacteria. called ofloxacin also may be used. Unfortunately, many
Salmonella typhi bacteria are no longer susceptible to
Diagnosis
 Medical and travel history antibiotics of this type, particularly strains acquired in
Your doctor is likely to suspect typhoid fever based on Southeast Asia.
 Azithromycin (Zithromax). This may be used if a person
your symptoms and your medical and travel history. But the
is unable to take ciprofloxacin or the bacteria is resistant to
diagnosis is usually confirmed by identifying Salmonella typhi in
ciprofloxacin.
a culture of your blood or other body fluid or tissue.
 Body fluid or tissue culture  Ceftriaxone. This injectable antibiotic is an alternative in
more-complicated or serious infections and for people who
For the culture, a small sample of your blood, stool, urine
may not be candidates for ciprofloxacin, such as children.
or bone marrow is placed on a special medium that encourages
These drugs can cause side effects, and long-term use can lead to
the growth of bacteria. The culture is checked under a
the development of antibiotic-resistant strains of bacteria.
Problems with antibiotic resistance
In the past, the drug of choice was chloramphenicol. Doctors no
longer commonly use it, however, because of side effects, a high
rate of health deterioration after a period of improvement
(relapse) and widespread bacterial resistance.
In fact, the existence of antibiotic-resistant bacteria is a growing
problem in the treatment of typhoid fever, especially in the
developing world. In recent years, Salmonella typhi has also
proved resistant to trimethoprim-sulfamethoxazole, ampicillin
and ciprofloxacin.

Other treatments
Other treatments include:
 Drinking fluids. This helps prevent the dehydration that
results from a prolonged fever and diarrhea. If you're
severely dehydrated, you may need to receive fluids
through a vein (intravenously).
 Surgery. If your intestines become perforated, you'll need
surgery to repair the hole.
TYPHOID FEVER: TREATMENT -In a small number of cases, the symptoms or infection may
recur. This is known as a relapse.
-Typhoid fever can usually be treated successfully with a course
of antibiotic medication. Staying off work or school
-Most cases can be treated at home, but you may need to be -Most people being treated for typhoid fever can return to work
admitted to hospital if the condition is severe. or school as soon as they start to feel better.
-The exceptions to this are people who work with food and
Treatment at home
vulnerable people, such as children under 5, the elderly and
-If typhoid fever is diagnosed in its early stages, a course of those in poor health.
antibiotic tablets may be prescribed for you. Most people need to
-In these cases, you or your child should only return to work or
take these for 7 to 14 days.
nursery after tests on 3 poo samples taken at 48-hour intervals
-Some strains of the Salmonella typhi bacteria that cause typhoid have shown that the bacteria are no longer present.
fever have developed a resistance to one or more types
of antibiotics. Hospital treatment
-This is increasingly becoming a problem with typhoid infections
originating in southeast Asia. -Hospital admission is usually recommended if you have
-Any blood, poo (stool) or pee (urine) samples taken during your severe symptoms of typhoid fever, such as persistent vomiting,
diagnosis will usually be tested in a laboratory to determine severe diarrhea or a swollen stomach.
which strain you're infected with, so you can be treated with an
appropriate antibiotic. -As a precaution, young children who develop typhoid fever may
-Your symptoms should begin to improve within 2 to 3 days of be admitted to hospital.
taking antibiotics. But it's very important you finish the course to
ensure the bacteria are completely removed from your body. -In hospital, you'll have antibiotic injections and you may also be
-Make sure you rest, drink plenty of fluids and eat regular meals. given fluids and nutrients directly into a vein through an
You may find it easier to eat smaller meals more frequently, intravenous drip.
rather than 3 larger meals a day.
-You should also maintain good standards of personal hygiene, -Surgery may be needed if you develop life-
such as regularly washing your hands with soap and warm threatening complications of typhoid fever, such as internal
water, to reduce the risk of spreading the infection to others. bleeding or a section of your digestive system splitting.

-Contact your GP as soon as possible if your symptoms get worse

-But this is very rare in people being treated with antibiotics.
or you develop new symptoms while being treated at home.
-Most people respond well to hospital treatment and improve -It's also very important that you wash your hands thoroughly
within 3 to 5 days, but it may be several weeks until you're well after going to the toilet.
enough to leave hospital.

Relapses

-Some people who are treated for typhoid fever experience a

relapse, which is when symptoms return.

-In these cases, the symptoms usually return around a week after
antibiotic treatment has finished.

-The second time around, symptoms are usually milder and last
for a shorter time than the original illness, but further treatment
with antibiotics is usually recommended.

-See your GP as soon as possible if your symptoms return after

treatment.

Long-term carriers

-After your symptoms have passed, you should have another

stool test to check whether there are still Salmonella typhi
bacteria in your poo.

-If there are, you may have become a carrier of the typhoid
infection. You may need to have a further 28-day course of
antibiotics to "flush out" the bacteria.

-Until test results show that you're free of bacteria, avoid

handling or preparing food.
 TYPHOID FEVER: COMPLICATIONS Perforation

The 2 most common complications in untreated typhoid fever Perforation is potentially a very serious complication. This is
are: because bacteria that live in your digestive system can move into
 internal bleeding in the digestive system your stomach and infect the lining of your abdomen (the
 splitting (perforation) of a section of the digestive system or peritoneum). This is known as peritonitis.
bowel, which spreads the infection to nearby tissue
Peritonitis is a medical emergency as the tissue of the
peritoneum is usually sterile (germ-free).
Internal bleeding
-Most internal bleeding that occurs in typhoid fever isn't life Unlike other parts of the body, such as the skin, the peritoneum
threatening, but it can make you feel very unwell. doesn't have an inbuilt defense mechanism for fighting infection.
Symptoms include:
 feeling tired all the time
In peritonitis, the infection can rapidly spread into the
 breathlessness blood (sepsis) before spreading to other organs.
 pale skin
This carries the risk of multiple organ failure. If it isn't
 an irregular heartbeat
treated properly, it may result in death.
 vomiting blood
 poo (stools) that are very dark or tar-like The most common symptom of peritonitis is sudden abdominal
pain that gets progressively worse.
A blood transfusion may be required to replace lost blood, and
surgery can be used to repair the site of the bleeding. If you have peritonitis, you'll be admitted to hospital, where
you'll be treated with antibiotic injections.

Surgery will then be used to seal the hole in your intestinal wall.