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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)
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