diarrhea final
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DIARRHEA
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DIARRHEA
Diarrhea is defined as the passage ofloose,
liquid or watery stools for more than 3 times
a day.
However, it is the recent change in
consistency and character of stools rather
than number of stool that is more important.
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CLINICAL TYPES OF DIARRHEA
ACUTE WATYERY DIARRHEA
ACUTE BLOODY DIARRHEA
PERSISTENT DIARRHEA
DIARRHEA WITH SEVERE
MALNUTRITION
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ACUTE WATERY DIARRHEA
Lasts several hours to days.
The main danger is dehydration, weight loss alsooccurs if feeding is not continued.
The pathogens that usually cause acute waterydiarrhea are:
V.chlorae
E.coli
Rota virus
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ACUTE BLOODY DIARRHEA
Also known as Dysentery
The main dangers are the damage of the
intestinal mucosa, sepsis, and malnutrition.
Other complications including dehydration
may also occur
It is marked by visible blood in the stools.
Most common cause of bloody diarrhea is
Shigella.
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PERSISTENT DIARRHEA
Diarrhea which lasts for 14 days or longer.
The main danger is Malnutrition and serious
non-intestinal, infection, dehydration may also
occur.
Persons with other illness such as AIDS, are
more likely to develop persistent diarrhea.
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DIARRHEA WITH SEVERE
MALNUTRION
The main dangers are:
1. Severe systemic infection
2. Dehydration3. Heart failure
4. Vitamin & mineral deficiency.
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Chronic diarrhoea Generally lasts > 3 weeks
Common causes: IBS,AIDS, bacterial outgrowthof small int., Colon cancer,Chrons disease
Acute diarrhoea lasts a few days or up to
a week
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PROBLEM STATEMENT
The current estimate in Under 5 children
suggest that there are about 1.4 billion
episodes of diarrhea per year with 123 million
clinic visits annually and 9 million
hospitalizations worldwide.
About 15% under 5 mortality is diarrheal
related.
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In India, acute diarrheal disease accounts for
about 13% of deaths in under 5 years age
group.
During the year 2009 about 11.2 Million cases
with 1762 deaths were reported in India.
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Leading Causes of Mortality and Burden of Disease
world, 2004
%
1. Ischaemic heart disease 12.2
2. Cerebrovascular disease 9.7
3. Lower respiratory infections 7.1
4. COPD 5.1
5. Diarrhoeal diseases3.7
6. HIV/AIDS 3.5
7. Tuberculosis 2.5
8. Trachea, bronchus, lung cancers 2.39. Road traffic accidents 2.2
10. Prematurity, low birth weight 2.0
%
1. Lower respiratory infections 6.2
2. Diarrhoeal diseases 4.83. Depression 4.3
4. Ischaemic heart disease 4.1
5. HIV/AIDS 3.8
6. Cerebrovascular disease 3.1
7. Prematurity, low birth weight 2.9
8. Birth asphyxia, birth trauma 2.7
9. Road traffic accidents 2.710. Neonatal infections and other 2.7
Mortality DALYs
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AGENT FACTORS
In the developing countries - INFECTIOUS in origin
VIRAL BACTERIAL
OTHERS
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INFECTIOUS CAUSES OF DIARRHEA
1. VIRUSES:
Rotaviruses
Astroviruses
Adenoviruses
Calciviruses
Norwalk group of viruses Enteroviruses
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2. BACTERIA:
Campylobacter jejuni
E.coli
Shigella
Salmonella
V. cholrae Bacillus cereus
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3. OTHERS:
E.histolytica
Giardia intestinalis
Trichuriasis
Cryptosporidium
Intestinal worms
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DIARRHEA-MALNUTRITION VISCIOUS
CYCLE
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Interactions between malnutrition and infection.
Katona P , Katona-Apte J Clin Infect Dis. 2008;46:1582-1588
2008 Infectious Diseases Society of America
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ASSESSMENT OF DEHYDRATION
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PARAMETERS NO DEHYDRATION SOME DEHYDRATION SEVERE
DEHYDRATION
OVERALL CONDITION WELL, ALERT RESTLESS, IRRITABLE LETHARGIC/UNCONS
CIOUS : FLOPPY
EYES NORMAL SUNKEN VERY SUNKEN & DRY
TEARS PRESENT ABSENT ABSENT
MOUTH & TONGUE MOIST DRY VERY DRY
THIRST DRINKS NORMALLY,
NOT THIRSTY
THIRSTY DRINKS
EAGERLY
DRINKS POORLY OR
NOT ABLE TO DRINK
FEEL: SKIN PINCH GOES BACK QUICKLY GOES BACK SLOWLY GOES BACK VERY
SLOWLY
DECIDE: PT. HAS NO SIGNS OF
DEHYDRATION
IF THE PATIENT HAS
TWO OR MORE
SIGNS INCLUDING AT
LEAST ONE
SIGN,THERE IS SOME
DEHYDRATION
IF THE PATIENT HAS
TWO OR MORE
SIGNS ,INCLUDING
ATLEAST ONE SIGN,
THERE IS SEVERE
DEHYDRATION
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Signs of Dehydration
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ORAL REHYDRATION THERAPY
Replacement of fluid & electrolytes losses is
the essential part of the treatment of
diarrhea.
This can be achieved by administration of
adequate & proper fluid either in the form of
ORS or IV therapy depending on the
circumstances.
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Diarrhea treatment should be started at home
at the time of onset of diarrhea by themothers using Oral Rehydration Salt(ORS).
It is recommended that all the diarrhea
episodes should be treated with ORS. If ORS is not available then home available
fluids (HAF) like salt sugar solution, lassi,
kanji, pop-rice water etc may be given.
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ORS SOLUTION RECOMMENDED
BY WHO
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REDUCED OSMOLARITY ORS
CONSTITUENTS:
Sodium- 75 mmol/Litre
Chloride- 65 mmol/Litre
Glucose anhydrous- 75 mmol/Litre
Potassium- 20 mmol/Litre
Citrate- 10 mmol/LitreTOTAL OSMOLARITY- 245 mmol/Litre
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Continued. Nacl- 2.6gm
KCL- 1.5gm
Trisodium citrate- 2.9gm
Glucose- 13.5gm Water -1 L
TOTAL WEIGHT: 20.5gm
TOTAL OSMOLARITY: 245 mmol/litre
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New Who ORS is very effective & safe.
It reduces the stool output, duration, and
frequency of diarrhea.
It also reduces the vomiting and the need of
unscheduled use of IV fluid.
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BASIS OF ORAL FLUID THERAPY IN
DIARRHEA
In most diarrheas the absorptive capacity of
gut is retained and nutrients such as Glucose,
Amino acids and dipeptides tends to be
absorbed in most cases.
As glucose is absorbed in the gut sodium is
carried along and also gets absorbed.
ORS helps in absorption of glucose and
sodium.
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One Na ion is transported along with each
molecule of the glucose is absorbed.
This mechanism remains active even in severecases of diarrhea.
In other words oral fluid therapy is based on
the observation that glucose given orallyenhances the intestinal absorption of salt and
water,and is capable of correcting the
electrolyte and water deficit
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ROLE OF ZINC
When zinc supplement is given during anepisode of acute diarrhea, it reduces theepisodes duration and severity.
In addition, zinc supplements given for 10 to
14 days lowers the incidence of diarrheas inthe following 2-3 months.
WHO & UNICEF therefore recommends daily
10 mg of zinc for infants under 6 months ofage and 20 mg for children older than 6months for 10-14 days.
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Interactions among events related to zinc deficiency, malnutrition and diarrheal disease.
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Interactions among events related to zinc deficiency, malnutrition and diarrheal disease.
Wapnir R A J. Nutr. 2000;130:1388S-1392S
http://www.couvrette-photography.on.ca/2/pages/images/whitekids.jpghttp://www.couvrette-photography.on.ca/2/pages/images/whitekids.jpghttp://www.couvrette-photography.on.ca/2/pages/images/whitekids.jpg