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Discussion

I *think* I've figured it out..

q: why are drugs used to treat connective tissue diseases not used to treat immunosuppressive diseases?

a: connective tissue diseases are treated with immunosuppressive drugs and nsaids. you wouldn't give immunosuppressants to an already-immunocompromised patient (such as hiv) or they will have an even greater risk of opportunistic infection, and the manifestations of infection would be masked.

does that look right? also, why not nsaids? might it have something to do with the bleeding in the stomach?

i appreciate any help i might get...

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  • Expert

Is this the way this question was actually worded? I'm having a hard time making sense of the question.

  • Author

Yes, that is exactly the way it was worded. Thanks for asking.

(The answer is mine.)

Another thought I had about the NSAIDs, if they were to cause bleeding in the stomach, would not the damaged (non-intact) tissue be more likely to succumb to opportunistic infection?

  • Expert
Another thought I had about the NSAIDs, if they were to cause bleeding in the stomach, would not the damaged (non-intact) tissue be more likely to succumb to opportunistic infection?

Yes, but the only one I can think of that thrives in the stomach is pylobactor.

  • Author

What about all the bacterias that cause severe diarrhea in HIV? Or are they infecting areas further down the GI tract?

  • Expert
What about all the bacterias that cause severe diarrhea in HIV? Or are they infecting areas further down the GI tract?

I believe it is not the bacterias causing the diarrhea, but the toxins produced by them. I answered a thread on diarrhea once. I'll have to search and see if I can find it.

"Also, why not NSAIDs?"

Here's what I'm thinking:

NSAIDs suppress inflammation and inflammation is part of the immune response.

About diarrhea-

Severe yeast infection (Candida) can cause severe, irretractable diarrhea in AIDS pts. It can grow to such a huge extent that the entire intestinal mucosa is covered in it, and it prevent water from being reabsorbed by the large intestine, resulting in intractable diarrhea.

Antibiotics help to induce diarrhea in AIDS pts by killing off the normal flora of the GI tract- which, in turn, promotes Candida proliferation. It's a viscious cycle.

  • Author

Thanks to both of you! i am sure amongst the three of us, we must have hit upon what my instructor is looking for. :)

  • Expert
About diarrhea-

Severe yeast infection (Candida) can cause severe, irretractable diarrhea in AIDS pts. It can grow to such a huge extent that the entire intestinal mucosa is covered in it, and it prevent water from being reabsorbed by the large intestine, resulting in intractable diarrhea.

Antibiotics help to induce diarrhea in AIDS pts by killing off the normal flora of the GI tract- which, in turn, promotes Candida proliferation. It's a viscious cycle.

Read the pathophysiology. The bug only starts the problem. It's what goes on chemically that causes diarrhea. The bug is just one trigger that sets it off. Diarrhea is actually an osmotic water loss process through the large intestine. This is why is has it's own nursing diagnosis.

  • Author

Yes, I understand. Increased motility or osmotic diarrhea. It doesn't quite fit my theory about the bleeding in the stomach allowing a port of entry for the bacteria though, since it is happening further down in the GI tract. I am thinking it has more to do with the loss of clotting factors and perhaps the further suppression of the inflammatory system.

Thanks for helping me think this through.

Read the pathophysiology. The bug only starts the problem. It's what goes on chemically that causes diarrhea. The bug is just one trigger that sets it off. Diarrhea is actually an osmotic water loss process through the large intestine. This is why is has it's own nursing diagnosis.

The diarrhea is initiated by osmotic processes. If this were the only problem, the diarrhea could be successfully treated.

It is the physical barrier of the candida proliferation blocking the semipermiable membrane of the intestinal mucosa, preventing the reabsorption of water via the large intestine- that causes diarrhea to become intractable in AIDS pts.

Intractable diarrhea should be treate with Nytstatin- treatement with only anti-diarrheals and/or anticolinergics is not effective.

My information is from a handout I received from a hospice physician's inservice.

  • Expert
The diarrhea is initiated by osmotic processes. If this were the only problem, the diarrhea could be successfully treated.

It is the physical barrier of the candida proliferation blocking the semipermiable membrane of the intestinal mucosa, preventing the reabsorption of water via the large intestine- that causes diarrhea to become intractable in AIDS pts.

Intractable diarrhea should be treate with Nytstatin- treatement with only anti-diarrheals and/or anticolinergics is not effective.

My information is from a handout I received from a hospice physician's inservice.

Correct. Diarrhea is the resulting problem (thus, the diagnosis). The bug is one of the underlying causes that trigger it.

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