Diarrhoea Classifications

8/10/2019 Diarrhoea Classifications

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Classifications of diarrheal disease

1939

Manson-Bahr, Philip:The Dysenteric Disorders: The Diagnosis and Treatment of Dysentery, Sprue,

Colitis and other diarrhoeas in General Practice

London 1939

1: classification of the causes of diarrhoea ( people were concerned about the

causes):

1 Pri!ar" diarrhoea

-

dietetic- constipation

- chan#es of cli!ate

- food poisonin#

$ %lterations of intestinal secretions or absorption

- acute and chronic d"spepsia, pancreato#enous diarrhoea and cholec"stitis

- idiopathic steatorhoea ( coeliac disease)

- &prue and 'ill diarrhoea

- erous diarrhoea

3 &econdar" diarrhoea: infectious

-t"phoid

- bacillar" *"senter"

- colear

- +aerner and %ertr"ce infections

- %!oebiasis, #iardiasis, fla#elate diarrhoea, coccidiosis, !alarial d"senter",

leish!anial d"senter"

- Bilhariasis and other wor! infections

. &pecial t"pe of diarrhoea:

- ulceratie colitis

-!uco-!e!branous colitis

- pol"posis

- pol"pus

- sterecoral ulceration

- forei#n bod" in rectu!

&pecial diisions: / C'/L*0

- si!ple diarrhoea fro! chills or diet errors

- acute #astro-enteritis, su!!er diarrhoea

-a!oebic *"senter"

- Coeliac disease


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19:

'ippocrates distin#uished between d"senter" and other for!s of diarrhoea

2ther authors !entioned it as blood" flu45 with crude clinical descriptions

6thc %* epide!ics were noted in urope

epide!ics of d"senter" were noted in 63. 637 in 8rance, ; northern urope1thc clearl" distin#uished blood"-stained d"senter" stools

$;

first half of 19thcentur" d"senter" was thou#ht of bein# 5but one e4pression of

!alaria5

rese!blance to !alaria: tendenc" to brea out at lon# interals in pande!ic

for!

$1

durin# wars it was classified alon# with t"phoid and t"phus a!on#st the

fore!ost pestilence of war (1-19th)

$$

19thcentur" /ndia brou#ht forth a lot of research and stud" o d"senter", and

a!oebiasis

$

earl" $;thcentur" once patho#ens were discoered classification was:

bacillar" d"senter"

a!oebic

clinical diarrhoea

colitis

*"senter" was seen different fro! colitis and diarrhoea thou#h all of the! had

as s"!pto!s diarrhoea

$7

classification of d"senter", was necessar" for the professional as the diseases of

a wide and distinct aetiolo#" rese!ble each other in !an" wa"s


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8ield Michael:Diarrheal Diseases,%!sterda! 1991

Part of #astroenterolo#"

P i4: !aturation of the field leads to fra#!entation of the nowled#e-base and

its diffusion throu#h an eer-e4pandin# literature


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Basic classification is: 1-.

%cute infectious and persistent ( oer 1. da"s) and chronic diarrhoea

%cute *:

- rotairus and other irus infections

-

enteric bacterial infections- antibiotic induced diarrhoea throu#h e# Clostridiu! difficile ( to4in

producin# bacteriu!), reco#nised since late 19;s

- al#ae

- traellers *: sal!onella , shi#ella, parasites, iruses ( oerlap with other

classificationsD)

- food-borne *, ( !entioned especiall" as it is a !aEor proble! in

industrialised as well as deelopin# counties because of the food chains):

oerlap with the !icrobes: sal!onella, staph"lococcus aureus,

ca!ph"lobacter, "ersenia

- protooan diarrhoea : #iardia

- parasites: cr"ptosporidiu!

-

P0&/&


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$.3

/nfectious *:

due to

- enteroto4ins

-

bacteria- iruses

$13 classification in research on !ortalit":

acute * 36G of death rates in /ndia, Ban#ladesh, Brail and &ene#al

d"senter" ($;G)

nond"senteric persistent * .6G

$.$

%/*& and diarrhoea

ew classification in 197. called %/*&


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aluation of * as a patient co!plaint has 1 classifications of acute and

chronic * dependin# on the t"pe of patient ( table 31 p.)

Classification between s"ste!aticall" or non-s"ste!aticall" ill patient with the

sa!e s"!pto! because the clinical histor" is the !ost i!portant deter!inant in

differentiation of the clinical proble!5 (p3)

6

classifications accordin# to stool ealuation ( colour, #ross or occult blood,

bacterial culture, consistenc" etc) (table 1. p6)

e# classification of blood" * can still hae seeral causes: anal fissures,

hae!orrhoids, which are not releant to the !ain proble! *

1;

classification of chronic *:

1 * due to abnor!al bowel !otilit": irritable bowel s"ndro!e is !ost freHuent

cause of chronic :

$ Malabsorptie *: decreased absorption of fluid, celiac sprue, lactose

!alabsorption

3 &ecretor" *: cholera or hor!onal *, seeral litres dail"

. /nfla!!ator" *


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8/14

&panish flu4, Poona poohs, Bo!ba" runs, 'on# Jon# *o#,

3

beca!e pro!inent after 19;

differs fro! countries and continentsseeral or#anis!s !" be responsible for a sin#le attac


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Classif of persistant * allows addressin# different ris factors: a#e, nutrition,

i!!unolo#", preious infections, conco!itant bacteria etc

2n the other hand, adance!ent of science, especiall" in !icroscopic inasietechniHues hae lead to detailed nowled#e on absorption of different arts of the

intestines which led to further classification of * as !alabsorption related or

unrelated or s!all intestinal and colon related diarrhoea

lectronic !icroscopic technolo#" and the entire science strea! of irolo#" and

parasitolo#" hae brou#ht detailed adanced nowled#e on the actual causes for

*, thus brin#in# about another classification which is i!portant for !edical

treat!ent not so !uch for the patient who !ostl" doesnt now about these

classifications

Patient related classification of * is i!portant durin# tain# the case histor",

when the patient will describe the s"!pto! of * and use si!ple classifications

such as freHuenc", consistenc", colour, s!ell, etc


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@'2: 0eadin#s on diarrhoea, &tudent Manual

+enea 199$

P .


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Baillieres Clinical +astroenterolo#", /nfectious diarrhoea

/nternational Practice and 0esearch

+race" M Bouchier /%diarrhoea ( eds)

?ol =$ 1993

Bailliere


12/14

$3:

other bacterial *

5 ach "ear new or#ansi!s are found to be patho#ens, and old ones are found to

hae new trics that cause diseaseN

*ouble classification is useful:

@ater", blood" and chronic and the underlinin# !olecualr patho#ens ( bacteria,

irus, parasites)

Proble! of dru# restistance ( shi#ella)


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111 d"senter" accounts for $;G of * related eaths, 6; ;;; death per "ear

11$

'ealth &ocial &cience 0esearch on the &tud" of *iarrheal *isease: % focus on

*"sneter"

&i!pl" classif of secretor"-water" * and inasie-infla!!ator" for!s ofd"senter"


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Diarrhoea Classifications