chronic diarrhea
SOEPLE – 3

AHMAD MHD AL-DHLAWIY
Contents…
SOEPEL
Definetion
Epideiology
Physiology
patohphysiology
Classification
Causes
Clinical features

Diagnosis
Trea...
SOEPEL
Subject:
A 3 years old child came with abdominal pain, and diarrhea since 3 weeks.
Analysis of pain:
1.

Site: diff...
SOEPEL
Object: General examination & Abdominal examination

Evaluation (DD): Celiac disease, Crohn’s disease.

Plan: CBC, ...
Epidemiology …
- According to ( WHO ) there are more than 700 million episodes of
diarrhea annuallyin children 5 years of ...
Physiology …
Physiology
Pathophysiology …
Osmotic diarrhea.
Secretory diarrhea.
Mutations in apical membrane transport proteins.
Reduction in anat...
Osmotic diarrhea
It’s caused by the presence of nonabsorbable solutes in the
gastrointestinal tract.
e.g. lactose intolera...
Secretory diarrhea …
Activation of intracellular mediators (cAMP, cGMP and intracellular
calcium)
This stimulates active c...
Mutations in apical membrane
transport proteins …
Congenital defects in:
1.

Sodium-hydrogen exchange.

2.

Chloride-bicar...
CON’T …
Reduction in anatomic surface area:
This is called short bowel syndrome and can occur after surgical
indications.
...
Causes …
1- Noninfectious Causes of Chronic Diarrhea :
A. Antibiotic Therapy
B. Extraintestinal Infections
C. Malnutrition...
CON’T …
2- Infectious Causes of Chronic Diarrhea:
e.g. salmonella, Giardia lamblia
common in immune deficiency
states, esp...
Clinical features …
Cramping
Abdominal pain
Nausea
Fever
Bloody stools
Dehydration
Incontinence
Investigation …
History
Physical examination
General examination:
CON’T …
CON’T …
Treatment …
References …
- Nelson textbook of pediatrics.
- CURRENT diagnosis and treatment pediatrics.
- Some figures from websites.
Chronic diarrhea
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Chronic diarrhea

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Chronic diarrhea

  1. 1. chronic diarrhea SOEPLE – 3 AHMAD MHD AL-DHLAWIY
  2. 2. Contents… SOEPEL Definetion Epideiology Physiology patohphysiology Classification Causes Clinical features Diagnosis Treatment
  3. 3. SOEPEL Subject: A 3 years old child came with abdominal pain, and diarrhea since 3 weeks. Analysis of pain: 1. Site: diffuse 2. Onset: gradually 3. Character: -- 4. Associated factors: -- 5. Time/duration: 2 week. 6. Exaggerated and relieving factors: -- 7. Severity: moderate
  4. 4. SOEPEL Object: General examination & Abdominal examination Evaluation (DD): Celiac disease, Crohn’s disease. Plan: CBC, stool examination, and Antibody test. Elaboration: Diet management. Learning goals: chronic diarrhea.
  5. 5. Epidemiology … - According to ( WHO ) there are more than 700 million episodes of diarrhea annuallyin children 5 years of age in developing countries. - more than two to four weeks occurs in up to 3 to 5 percent of the population worldwide. - more frequent in men.
  6. 6. Physiology …
  7. 7. Physiology
  8. 8. Pathophysiology … Osmotic diarrhea. Secretory diarrhea. Mutations in apical membrane transport proteins. Reduction in anatomic surface area. And alteration in intestinal motility.
  9. 9. Osmotic diarrhea It’s caused by the presence of nonabsorbable solutes in the gastrointestinal tract. e.g. lactose intolerance
  10. 10. Secretory diarrhea … Activation of intracellular mediators (cAMP, cGMP and intracellular calcium) This stimulates active chloride secretions from the crypt and prevent the neutral coupled sodium chloride absorption. Thus the intraluminal electrolyte content will be high and this leads to diarrhea. e.g. cholrea, E.coli.
  11. 11. Mutations in apical membrane transport proteins … Congenital defects in: 1. Sodium-hydrogen exchange. 2. Chloride-bicarbonate exchange. 3. And sodium-bile acid transport protein
  12. 12. CON’T … Reduction in anatomic surface area: This is called short bowel syndrome and can occur after surgical indications. And alteration in intestinal motility: This can result duo to malnutrition, scleroderma, and diabetes mellitus.
  13. 13. Causes … 1- Noninfectious Causes of Chronic Diarrhea : A. Antibiotic Therapy B. Extraintestinal Infections C. Malnutrition D. Diet and Medications E. Allergic Diarrhea F. Chronic Nonspecific Diarrhea G. Secretory Diarrhea H.Inflammatory bowel disease
  14. 14. CON’T … 2- Infectious Causes of Chronic Diarrhea: e.g. salmonella, Giardia lamblia common in immune deficiency states, especially IgA deficiency and T-cell abnormalities.
  15. 15. Clinical features … Cramping Abdominal pain Nausea Fever Bloody stools Dehydration Incontinence
  16. 16. Investigation … History Physical examination General examination:
  17. 17. CON’T …
  18. 18. CON’T …
  19. 19. Treatment …
  20. 20. References … - Nelson textbook of pediatrics. - CURRENT diagnosis and treatment pediatrics. - Some figures from websites.
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