Acute diarrhoea

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Acute diarrhoea

  1. 1. DIARRHOEA Defined as passage of abnormally liquid or unformed stools at an increased frequency Stool weight more than 200 g/ day Classification •Acute - < 2 weeks •Persistent- 2 to 4 weeks •Chronic- > 4 weeks
  2. 2.  Two common conditions associated with passage of stools < 200g/day 1.Pseudo diarrhoea 2.Fecal incontinence
  3. 3. Acute DiarrhoeaCauses 90 % - INFECTIOUS AGENTS 10 % - Medications , Toxic ingestions, Ischeamia
  4. 4. Infectious Agents Fecal-oral transmission Bacterias,Viruses,Parasites
  5. 5. Pathogenesis of BacterialDiarrhoea without mucosal injury mediated by: Enterotoxins Adhesins with mucosal injury mediated by: Adhesins Invasins Cytotoxins
  6. 6. PATHOGENESIS VIRUS DIARRHOEA VIRUS DIARRHOEA Effect on villus structure and function Enzyme damage Significant effect on digestion and absorption Rotavirus Norwalk virus Enteric Adenovirus Astrovirus
  7. 7. HIGH RISK GROUPS1.Travellers – ETEC, EAEC ,Campylobacter, Shigella2 . Consumers of certain foods - picnic,banquet,restaurant3.Immunodeficiancy persons4. Institutionalised persons
  8. 8. The agents include1 . Toxin producers Preformed toxin – B.Cereus , Staph aureus, C.perfringens Enterotoxin – V.cholera,ETEC2. Enteroadherant EAEC,Giardia,Cryptosporidium
  9. 9. 3 . Cytoxin Producers C. difficile 4 . Invasive Rota virus,Salmonella,Campylobacter V. parahmolyticus,Shigella
  10. 10. Clinical features Preformed & Entero toxin Profuse watery diarrhoea + vomitting•Enteroadherant High fever + Abdominal cramps•Invasive – Bloody diarrhoea
  11. 11. Other Causes A/E of certain drugs – Antibiotics,NSAIDs, Antiarrythmics, Bronchodialaters,Antacids Occlusive or Non occlusive colitis Above 50 years Lower abdominal pain preceeding watery, then bloody diarrhoea
  12. 12. Approach to Patient Most acute diarrhoeas – Mild & self limited Indications for evaluation Profuse diarrhoea with dehydration Grossly bloody stools Duration >48 hrs without improvement Recent antibiotic use
  13. 13. Severe abdominal pain in patient >50 yearsElderlyImmunocompromised patients
  14. 14. Algorithm for Management
  15. 15. History and Physical Exam Main goals  Estimate the level of dehydration  Identify likely causes on the basis of history and clinical findings
  16. 16. History Onset, frequency, quantity, and character of diarrhea Associated symptoms: nausea, vomiting, fever, abdominal pain, tenesmus, malaise Recent oral intake Signs and symptoms of dehydration
  17. 17. Physical Exam Vitals, vitals, vitals! Abdominal exam Presence of occult blood Signs of dehydration
  18. 18. Investigations Corner stone of diagnosis – Microbiologic analysis of stools Investigations – Cultures for bacterial & viral pathogens - Inspection for ova & parasites - Immunoassays
  19. 19. Treatement Fluid & electrolyte replacemet Oral sugar & electrolyte solution I.V rehydration Moderately severe, non febrile & non bloody diarrhoea – Loperamide Antibiotics
  20. 20.  Empirical therapy Febrile – Ciprofloxacin 500 mg bid for 3-5 days Suspected giardiasis – Metronidasole 250 mg qid for 7 days Antibiotic prophylaxis Cotrimoxazole,Ciprofloxacin
  21. 21. In Summary Extremely common Most is viral in origin and self-limited A good H&P is crucial Warning signs include high fever, severe abd. pain, dehydration, and bloody stool Fluid replacement is most important Antibiotics are usually not necessary
  22. 22. Good nutrition and hygiene can prevent most diarrhea
  23. 23. THANK YOU

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