diarrhoea.pptx
- 2. Diarrhea • A disturbance of the intestinal tract that alters motility and absorption and accelerates the excretion of intestinal contents. • Most infectious diarrheas in this country are caused by: – Giardia – most commonly seen in daycare centers – Rotovirus – seen in infants in young children
- 3. Diarrhea Definitions • AGE: three or more loose stools per day. • Persistent diarrhea : >14 days (chronic diarrhea). • Dysentery: bloody diarrhea • Watery diarrhea: three or more liquid stool per day 3
- 4. Diarrhea Etiology Viral: Rotavirus, calicivirus, corona and adenoviruses Bacterial: E.coli, shigella, campylobacter, salmonella Parasitic: Amoeba, Gardia, cryptosporidia, etc. Malabsorption: Celiac disease, lactase deficiency Allergic enteritis : Food allergies Food poisoning:Toxins of s,aureus, E.coli etc Antibiotic associated diarrhea (AAD) 4
- 5. Diarrhea Chronic diarrhea (persistent diarrhea) Due to repeated or persistent infection. Mucosal damage and loss of lactase Common causes of chronic diarrhea • HIV infection (Cryptosporidiosis, Isosporiasis) • Malnutrition (Repeated or persistent infection) • Celiac disease (Gluten sensitivity) • Giardiasis (blunting of villi) 10/23/2023 5
- 6. Child hood diarrhea • EPIDEMIOLOGY • Second cause of under five mortality • Death is due to severe dehydration • Complicated by malnutrition and poor hygiene • Increased incidence during infancy • Common in poor society 10/23/2023 6
- 7. Diarrhea Pathogenesis • Feco-oral transmission • Incubation period 2-5 days for most pathogens • Proliferation of pathogens in the intestine • Mucosal damage and microvillus atrophy • Fluid and electrolyte loss • Secondary malabsorption 10/23/2023 7
- 8. Diarrhea Mechanisms of diarrhea occurrence Secretory (toxins: cholera, E.coli, S.aureus) cholera toxin directly stimulates excessive secretion of electrolytes and fluid from the crypts of Lieberkühn in the distal ileum and colon. Inflammatory (bacteria, viruses, parasites) Everywhere the infection is present, the mucosa becomes extensively irritated, and its rate of secretion becomes greatly enhanced. 10/23/2023 8
- 9. Cont. … • In addition, motility of the intestinal wall usually increases many folds. • As a result, large quantities of fluid are made available for washing the infectious agent toward the anus, and at the same time strong propulsive movements propel this fluid forward.
- 10. Cont. … • In addition, motility of the intestinal wall usually increases many folds. • As a result, large quantities of fluid are made available for washing the infectious agent toward the anus, and at the same time strong propulsive movements propel this fluid forward.
- 11. Osmotic diarrhea • intake of non-absorbable, isotonic solute, there will be diarrhea with no dehydration. • intake of non-absorbable, hypertonic solute, results in more diarrhea with hypernatremic dehydration. 10/23/2023 11
- 12. Possible mechanisms • Absorptive capacity reduced by selective loss of mature absorptive enterocytes, cryptal secretion is increasedNon-structural viral protein (NSP4) functioning as an enterotoxin…. • Stimulation of secretory and motility reflexes of the enteric nervous system via chemokine mediators Villous ischemia secondary to derangement of intestinal microcirculation. 10/23/2023 12
- 13. Risk factors • Formula feeding, Malnutrition, Day care centers • Poor hygiene (lack of latrine and safe water) • Immunodeficiency (HIV, Malnutrition, malignancy) 10/23/2023 13
- 14. Diarrhea Clinical manifestations • Acute onset of fever, vomiting and watery diarrhea • There is also abdominal cramp and irritability • Watery diarrhea is mainly due to viral infection • Bloody or mucoid stool is due to bacterial or amoeba • Bulky, greasy and foul smelling stools are often due to malabsorption syndromes like Giardiasis • Patients also develop dehydration signs and symptoms 10/23/2023 14
- 15. Diarrhea Some dehydration ( two or more) • Irritable • Sunken eye balls • Skin pinch goes slowly • Thirsty (drink water eagerly) Severe dehydration ( one or more signs) • Lethargic or coma • Skin pinch goes very slowly • Drinks poorly or not at all • Very sunken eye balls No dehydration: if there are no enough signs to classify as “some” or “severe” dehydration. 10/23/2023 15
- 17. complications • The commonest complications that are expected in patients with acute watery diarrhea are: • Dehydration and hypovolemic shock • Electrolyte imbalance, most importantly • hypokalemia, • hyponatremia • Base deficit acidosis • Hypoglycemia • Malnutrition 10/23/2023 17
- 18. Diagnosis Stool Culture Stool for O&P Blood Gases
- 19. Diarrhea Diagnosis • Clinical presentation • Excessive mucus or blood in the stool is suggestive of bacterial or parasitic infection • Watery diarrhea signal viral enteritis in infants • Excess RBC and Leucocytes in stool suggests bacterial or parasitic mucosal invasion. • Stool culture for suspected bacteria • Viral PCR or ELISA for suspected viral etiology 10/23/2023 19
- 20. Diarrhea due to bacteria 10/23/2023 20 Salmonela- with flagela E. Coli causing villi atrophy and mucosal damage during GIT infection
- 22. Types of Diarrhea 10/23/2023 22 DYSENTRY: BLOODY DIARRHEA Greenish diarrhea: Viral AGE
- 24. Diarrhea Chronic Complications • Severe dehydration • Hypovolemic shock • Electrolyte imbalance • Bacterial sepsis • Metabolic acidosis • Hemolytic uremic syndrome (acute renal failure) • Intussusceptions (intestinal obstruction) 10/23/2023 24
- 25. Diarrhea Treatment of AGE with no dehydration Deficit…. Ongoing loss…maintenance • Replace ongoing loss (ORS 10ml/kg/loose stool) • Breast milk, rice water, gruel and formula feeds are alternative fluids at home • Avoid soft drinks, juices and beverages • Vitamin A oral supplementation • Zinc 10 mg PO daily for 10 days • Lactose free formula for chronic diarrhea 10/23/2023 25
- 26. Diarrhea Treatment of some dehydration • ORS 70ml/kg/4 hours to replace deficit orally • Assess for correction of hydration • Continue 10ml/kg ORS every diarrhea at home 10/23/2023 26
- 27. Cont. … Treatment of severe dehydration Secure IV line and start N/S or R/L • 30ml/kg/1hr then 70ml/kg/5hr for infants • 30ml/kg/30min then 70ml/kg/2.5 hrs for older child • Assess hydration every one hour • Continue home management
- 28. Cont. … • Treatment Plan A: If no dehydration, treat diarrhea at home. • Counsel the mother on the three rules of home treatment: • Give extra fluid, Continue feeding and Advise the mother when to return • Treatment plan B. Treat some dehydration with ORS in Clinic • Treatment plan C: treat severe dehydration quickly.
- 29. Oral Rehydration Avoid fluids that are high in sugar – soft drinks, jello, fruit drinks, tea
- 30. Diarrhea Prevention • Exclusive breast feeding for the first 6 months • Safe water supply • Safe waste disposal system • Hand hygiene during preparation of infant feeds • Rota virus vaccination for infants • Adequate nutrition for children • Routine supply of Vitamin A and anti- parsitoses 10/23/2023 30
- 32. The newborn and infant have a high percentage of body weight comprised of water, especially extracellular fluid, which is lost from the body easily. Note the small stomach size which limits ability to rehydrate quickly.
- 33. Dehydration Infant • Depressed fontanels • Sunken eye orbits • Fussy, Irritable • Thirsty • Fewer wet diapers Child • Decreased tear production • Skin non-elastic • Decreased urinary output • Thirsty • Restless
- 34. Treatment & Nursing Care • Treat cause • Fluid and electrolyte balance • Weigh daily • Monitor I&O • Assess for dehydration • Isolate • Skin care
- 35. Thank you