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1. ACUTE GASTROENTERITIS, LACTOSE
INTOLERANCE AND CHRONIC DIARRHOEA
s. Gracelet melita
2nd year m.sc(n)

2. DEFINITIONS
ACUTE GASTOENTERITIS:
Diarrhoel disease of rapid onset with or without accompanying symptoms
signs such as nausea vomiting fever or abdominal pain
DIARRHOEA:
It is the frequent passage of unformed liquid stools( 3 or more loose stools
watery stool per day

3. LACTOSE INTOLERANCE
It is the inability to digest and metabolize lactose a sugar found in milk caused by
lactase deficiency

4. DIARRHOEA
Greek word meaning “flowing through” The loss of fluids can cause dehydration,
which if not managed promptly may result in
death of the child
Diarrhoea is both treatable and preventable

5. INCIDENCE
World wide every
year- 2 billion cases
1 billion lack access
to clean water
2.5 billion lack access
to basic sanitation
It is the 2nd leading
cause of death

6. CLASSIFICATIONS
BASED ON DURATION: acute diarrhea( <14days) chronic diarrhea( > 14 days)

7. BASED ON CLINICAL
PRESENTATIONS
ACUTE WATERY DIARRHEA ACUTE BLOODY DIARRHOEA

8. BASED ON
PHYSIOLOG
Y
Secretory diarrhea
Osmotic diarrhea
Exudative diarrhea
Motility diarrhea
Inflammatorydiarrhea

9. ETIOLOGY
Infection
Drugs
Dietary cause
Surgical condition
miscellaneous

10. PRE
DISPOSING
FACTORS
Age
Season
Socio
economic
status
Dietary
factors
teething

11. PHYSIOLOGIAL
DISTURBANCES OF
DIARRHEA

12. CLINICAL
FEATURES AND
ASSESSMENT
Mild diarrhea
Moderate diarrhea
Severe diarrhea

13. TREATMENT
PLAN A
ORS EVERY
STOOL
< 24
MONTHS
2- 10
YEARS
>10
YEARS
50- 100ML
100-200ML
AS MUCH AS
THE CHILD
CAN
TOLERATE

14. PLAN B
AGE APPROX IN
KG
ORS
<4mths <5kg 200-400
4-12mths 5-8 400-600
1-2yrs 8-11 600-800
2-4yrs 11-16 800-
1200
5-14yrs 16-30 1200-
2200
>15yrs >30 >2200

15. PLAN C
AGE 1ST GIVE THEN GIVE
<12mths 30ml/kg in 1
hr
70ml/kg in 5hrs
12mths-
5yrs
30ml/kg in
30min
70ml/kg in 2 1/2
hrs

16. MANAGEMENT
Replacement of the fluids
Administration of prescribed drugs
Maintenance of nutritional status
Prevention of diarrhea
Educating parents

17. LACTOSE INTOLERANCE
•It is a disaccharide of beta D galactose and beta D
glucose in beta(1,4) linkage
•Human milk contains 220mmol/l of lactose
•It is digested by enzyme lactase to form glucose and
galactose in the brush border of the intestine

18. LACTOSE CONTAINING FOOD
STUFFS
•Fresh, skimmed, non- fat and condensed milk
•Cream
•Yoghurt
•Cheese
•Processed foods
•Stuffings
•Salad dressings etc

19. LACTOSE INTOLERANCE
•Also called as lactase deficiency or hypo-lactasia
•It is the inability to digest and metabolize lactase, a
sugar found in milk
•Lactase intolerance is not an allergy but it is not an
immune response but caused by lactase deficiency
•Occurs in any age group or populations.

20. PATHOPHYSIOLOGY

21. SYMPTOMS
•Abdominal bloating, cramps
•Flatulence
•Diarrhea
•Nausea
•Borborygmi( rumbling stomach)
•Vomiting( particularly in adolescents)

22. TYPES
(i) PRIMARY LACTASE DEFICIENCY:
It is a genetically determined absence
or decrease in the enzyme is noted
Jejunal morphology is normal
(ii) SECONDARY LACTASE DEFICIENCY:
Transient lactase deficiency is due to
the small intestinal mucosal disease, abnormalities
of brush border cells and transport processes
it is often associated with celiac sprue

23. (iii) CONGENITAL LACTASE DEFICIENCY
very rare, autosomal recessive genetic
disorder that prevents lactase expression from the
first feed
infants may fail to thrive unless given
lactose free formula feed

24. DIAGNOSIS
•Dietary history( flatulence, abdominal pain,
diarrhea)
•Family history
•Surgical history ( PARTIAL gastrectomy or other
procedures)
•tests ( stool acidity, hydrogen breathe test)

25. MISDIAGNOSIS
•Crohn’s disease
•Food poisoning
•Gastroenteritis
•Celiac disease
•IBD

26. MANAGEMENT
•Avoiding lactose containing products
•Alternative products such as;
•Plant based milk and derivatives( lactose free)
eg: soy milk, rice milk, almond milk,
hazelnut milk , oat milk, hemp milk, peanut milk,
horchata

27. ACUTE GASTROENTERITIS
•It is an inflammation of the lining of the
stomach and small and large intestines,
mostly caused by viral or bacterial infections,
but also protozoa

28. INCIDENCE
•More than 10 million cases per year( India)
•Acute viral gastroenteritis is the leading cause of
infant mortality throughout the world
•Commonly seen among all age group

29. ETIOLOGY
• VIRAL:
70- 85% in developed countries
Rotavirus: represent of all pediatric
AGE hospitalizations
• PRESENTATIONS:
mild or moderate fever
vomiting followed by watery diarrhea( upto 10-
20 bowel movements per day)
diarrhea persisting for 5- 7 days

30. BACTERIAL
•Campylobacter, salmonella, shigella, e- coli, yersina,
clostridium difficle
PRESENTATION:
- high fevers
- shaking chills
- bloody bowel movements( dysentery)
- abdominal cramping and fecal leukocytes

31. PARASITIC
• Giardia and cryptosporidium
• < 10% of cases
PRESENTATION:
- watery stools
- low grade fever

32. OTHER CAUSES AND HIGH RISK
GROUPS
• Contaminated waters and food
• Poor hygiene
• Nutritional deficiency
• Poor sanitation
• Increase frequency in infancy
• Immune deficient individuals
• Malnutrition
• Travel to endemic areas
• Lack of breast feeding

33. CLINICAL MANIFESTATIONS
• Nausea and vomiting
• Diarrhea
• Loss of appetite
• Fever
• Headache
• Abdominal pain
• Bloody stools
• Fainting and weakness
• Heartburn
• Dehydration
• lethargic

34. PATHOPHYSIOLOGY

36. LAB INVESTIGATIONS
•History
•Stool analysis
•CBC
•Electrolytes

37. TREATMENT
•Assessment of fluid and electrolyte imbalance
•Rehydration
•Maintenance of fluid therapy
•Reintroduction of adequate diet

38. NURSING DIAGNOSIS
Fluid volume deficit related to excessive
gastrointestinal loss in stool and vomiting
Altered nutrition less than body requirement
Impaired skin integrity related to irritation caused
by frequent loose stools

40. JOURNALS
1. Lactose intolerance and risk of lung, breast and
ovarian cancers : aetiological clues from a
population based study in Sweden
2. Acute Gastroenteritis hospitalizations among US
children following implementation of the
Rotavirus vaccine