DIARRHOEA

DR HARSHAD DIGAMBAR BAKLE

INTRODUCTION DIARRHOEA (FROM THE GREEK DIA MEANS

“THROUGH”RHOEA “FLOW’’ MEANING “FLOWING THROUGH IS THE CONDITION OF HAVING THREE OR MORE LOOSE OR LIQUID BOWEL MOVEMENT PER DAY

DEFINATION OF DIARRHOEADIARREOEA IS DEFIND BY THE WORLD HEALTH

ORGANIZATION AS HAVING THREE OR MORE LOOSE OR LIQUID STOOLS PER DAY OR AS HAVING MORE STOOLS THEN IS NORMAL FOR THAT PERSON

CAUSES THE MOST COMMON CAUSES OF DIARRHOEA IS VIRUS

ROTOVIRUS OR ENTEROVIRUS THAT INFECT THE GUT ( THE INFECTION USALLY LAST FOR TWO DAY AND IS SOMETIMES CALLED INTESTIONAL FLU OR STOMACH FIU)

INFECTION BY BACTERIUM SUCH AS E,COLI,SALMONELLA,SHIGELLA OR CHOLERA

EATING FOOD THAT UPSET THE DIGESTIVE SYSTEM

ALLERGIES TO CERTAIN FOOD

DISEASE OF THE INTESTINE (CROHN’S DISEASE AND ULCERATIVE COLITIS

MALABSORPTION ( WHERE THE BODY IS UNABLE TO ADEQUATELY ABSORB CERTAIN NEUTRIENTS FROM THE DIET

A PARASITE SUCH AS THOSE THAT CAUSE GIARDIASIS AND AMOEBIOSIS

ALCOHOL ABUSE

SYMPTOMS LOOSE WATERY STOOL

ABDOMINAL CRAMPS

ABDOMINAL PAIN

VOMITTING

NAUSEA

TEMPERATURE

HEADACHE

LOOSE OF APPETITE

FATIGUE

BLOOD IN STOOL

PATHOPHYSIOLOGY• DIARRHOEA CAN BE CONSIDERD TO BE EITHER

OSMOTIC OR SECRETORY .

• OSMOTIC DIARRHOEA OCCURS WHEN EXCESSIVE OSMOTICALLY ACTIVE PARTICLE ARE PRESNT IN THE LUMEN , RESULTING IN MORE FLUID PASSIVELY MOVING INTO THE BOWEL LUMEN DOWN THE OSMOTIC GRADIENT.

• SECRETORY DIARRHOEA OCCURS WHEN THE BOWEL MUCOSA SECRETES EXCESSIVE AMOUNT OF FLUID IN TO THE GUT LUMEN, EITHER DUE TO ACTIVATION OF PATHWAY BY A TOXIN OR DUE TO INHERANT ABNORMALITIES IN THE ENTEROCYTES

TYPES OF DIARRHEOEAACUTE

CHRONIC

ACUTE DIARRHEOEAIT IS LESS THEN FOUR WEEKS IS USALLY DUE

TO INFECTION AND IS OFTEN SELF LIMITED

IT IS ASSOCIATED WITH FEVER PAIN IN ABDOMEN OR DEHYDRATION

THIS IS EXTREMALY COMMON AND USALLY DUE TO FEACAL-ORAL TRANSMISSION OF BACTERIAL TOXIN, VIRUSES PROTOZON ORGANISM

CHRONIC OR RELAPSING DIARRHOEAMORE THEN FOUR WEEK

THE MOST COMMON CAUSE IS IRRITABLE BOWEL SYNDROME( IT IS A FUNTIONAL BOWEL DISORDER IN WHICH ABDOMINAL PAIN IS ASSOCIATED WITH DEFICATION

INCREASE FREQUENCY OF DEFICATION AND LOOSE WATERY OR PELLETY STOOL

DIARRHEOEA RARELY OCCURS AT NIGHT AND IS MOST SEVERE BEFORE AND AFTER BREAKFAST AT OTHER TIMES THE PATIENT IS CONSTIPATED

ON THE BASIS OF ABSORPTIONSECRETORY

OSMOTIC

INFLAMMATORY

DYSENTERY

MOTILITY

SECRETORYTHE GUT IS SECREATING MORE FLUIDS THEN

USAL OR IT CANNOT ABSORB FLUID PROPERLY STRUCTURAL DAMAGE IS MINIMAL

THIS IS MOST COMMNLY CUSED BY A CHOLERA TOXIN (A PROTEN SECREATED BY THE BACTERIUM VIBRIO CHOLERA

OSMOTIC DIARRHEOEADUE TO POORLY ABSORABLE OSMOTICALLY

ACTIVE SUBSTANCES AS AFTER INGESTION OF OSMOTIC LAXATIVES IN LACTASE DEFICIECY

VITAMIN C ,UNDIGESTED LACTOSE OR UNDIGESTED FRUCTOSE CAN ALSO TRIGGER OSMOTIC DIARRHEOEA

THE LINING OF THE GUT BECOMES INFIAMED THIS IS USALLY CAUSED BY BACTERIAL INFECTION VIRAL INFECTION, PARASITIC INFECTION

TUBERCULOSIS COLON CANCER CAN ALSO CAUSE INFLAMATORY DIARRHOEA

INFLAMATORY DIARRHOEA

DYSENTERY THE PRESENCE OF BLOOD IN STOOLS IS USALLY

A SIGN OF DYSENTERY RATHER THEN DIARRHOEA

IT IS CUSED BY A RELEASE EXCESS WATER (BY ANTI DIURETIC HARMONE)

MOTILITY RELATED DIARRHOEAFOOD MOVES TOO QUICKLY THROUGH THE

INTESTINE (HYPERMOTILITY)

IF THE FOOD MOVES TOO QUICKLY THERE IS NOT ENOUGH TIME TO ABSORB SUFICIENT NUTRIENTS AND WATER

PATIENT WHO HAD A VAGOTOMY( REMOVAL OF VAGUS NERVE AS WELL AS THOSE WITH DIBETIC NEUROPATHY ARE SUCEPTIBLE TO THIS TYPE OF DIARRHOEA

DIFFERENCELARGE BOWEL SMALL BOWEL

PRESENSE OF BLOOD AND MUCUS

SMALL VOLUME STOOLS

ASSOCIATED HYPOGASTRIC CRAMPS

PRESENSE OF UNDIGESTED FOOD

LARGE VOLUME STOOLS

MILD ABDOMINAL CRAMPS

LAB INVESTIGATIONMICROSCOPIC EXAMINATION OF STOOL

COMPLETE BLOOD COUNT

COMPLICATION DEHYDRATION

HYPOKALAEMIA

HYPOVOLEMIC SHOCK

SODIUM LEVEL LOW (URINE)

HYPOMAGNESEMIA

HYPOPHOSPHATAEMIA

DIARRHOEA IN CHILDRENDIARRHOEA OFTEN OCCURS WITH FEVER

NAUSEA VOMITTING CRAMPS AND DEHYDRATION SOME OF THE MOST COMMON RESONS KIDS GET DIARRHOEA INCLUDE

INFECTON FROM VIRUSES LIKE ROTOVIRUS BACTERIA LIKE SALMONELLA AND PARASITES LIKE GIARDIA

THE MOST COMMON CAUSE CONSUMING TOO MUCH FRUITS OR FRUIT JUICE

FOOD SENSITIVITY

FOOD POISONING CAN ALSO CAUSE DIARRHOEA IN KIDS

TREATMENT IN ADULTORS (ORAL REHYDRATON SOLUTION)

ANTIDIARRHEOAL MEDICINE (LOPERAMIDE)

PAINKILER ( IBUPFOFEN , PARACETAMOL)

ANTIMOTILITY MEDICINES(LOFENOXAL)

HOSPITALIZATION

DIET (HIGH IN FIBER)

TREATMENT IN CHILDRENIT IS IMPORTANT TO PREVENT FLUID LOSS

ADDITONAL BREAST MILK

(ORS) ORAL REHYDRATION SOLUTION TO INFANT AND YOUNG CHILDRENS

ROTAVIRUS ( VACCINATION IS GIVEN UNDER SIX MONTH)

CLINICAL FEATURE AND DRUG RECOMMENDED IN INFECTIVE DIARRHOEA

SHIGELLA- CIPROFIOXACIN, NORFIOXACIN , COTRIMOXAZOLE, NITAZOXAMIDE

SALMONELLA- CEFTRIDAXONE

E, COLI-COTRIMAXAZOLE

VIBRIO-DOXYCYCLINE , FLUOROQUINOLONE

CAMPYLOBACTER- ERYTHROMYCIN

GIARDIA-METRONIDAZOLE

AMOEBIASIS-METRONIDAZOLE

VIRAL-NO ANTIMICROBIAL MEDICINE

MORTALITY RATE DIRRHOEA DISEASE IS THE SECOND LEADING

CAUSE OF DEATH IN CHILDREN UNDER FIVE YEAR OLD IS RESPONSIBLE FOR KILLING AROUND 76000 CHILDREN EVERY YEAR

MOST PEOPLE WHO DIE FROM DIARRHOEA ( SEVERE DEHYDRATION AND FLUID LOSS)