Watery Diarrhoea

1,607 views

Published on

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,607
On SlideShare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
88
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Watery Diarrhoea

  1. 1. Watery diarrhoea By Dr. Osman Sadig
  2. 2. <ul><li>Definitions </li></ul><ul><li>- Diarrhoea is passage of 3 motions per day OR passage of loose or watery stools irrespective of the frequency. </li></ul><ul><li>- Acute diarrhoea : less than 2Ws duration </li></ul><ul><li>- Chronic diarrhoea : more than 2WS durations </li></ul>
  3. 3. <ul><li>Causes: </li></ul><ul><li>- V. cholerae </li></ul><ul><li>- Algid malaria </li></ul><ul><li>- ETEC </li></ul><ul><li>- Food poisoning </li></ul><ul><li>- viral. </li></ul>
  4. 4. <ul><li>Justification </li></ul><ul><li>1- To increase za awareness about cholera and its diagn & management </li></ul><ul><li>2- High mortality if not properly managed. </li></ul><ul><li>3- Epidemics & pandemics can occur </li></ul><ul><li>4- Management can save lives if properly planned </li></ul><ul><li>5- Preventive measures are effective </li></ul><ul><li>6- Economic drawbacks . </li></ul><ul><li>7- Notifiable and quarantinable under international health regulation. </li></ul>
  5. 5. <ul><li>- Cholera is an acute GIT infection caused by Vibrio cholerae: </li></ul><ul><li>- Curved, motile & flagellated G-ve bacilli </li></ul><ul><li>- Rapidly killed by heat at 100C, but can </li></ul><ul><li>survive for 6/12 in ice, 8/52 in salted water </li></ul><ul><li>and 2/52in fresh water </li></ul><ul><li>- Possess somatic Ags & accordingly subdivid </li></ul><ul><li>into O1 & O139 serotypes </li></ul><ul><li>- Classic ( Inaba, Ogawa & Hikojima) and </li></ul><ul><li>Eltor V. cholerae biotypes. </li></ul><ul><li>- Passed in za stools & vomitus of patients, </li></ul><ul><li>clinical or sub-clinical </li></ul>
  6. 7. <ul><li>Epidemiology </li></ul><ul><li>- The home land of cholera is za fertile, humid and highly populated valleys of za Ganges in Far East. </li></ul><ul><li>- Pandemics have spread za dis across za world </li></ul><ul><li>following trade routes claiming thousands of lives. </li></ul><ul><li>- Transmission is faecal-oral through contaminated water , foodstuffs & achlorhydria </li></ul><ul><li>facilitates infection. </li></ul><ul><li>- Source of infections are patients & sub-clinical </li></ul><ul><li>carriers who are import in maintainingg infection. </li></ul>
  7. 9. <ul><li>Pathogenesis </li></ul><ul><li>- V. cholerae are non-invasive but proliferate in </li></ul><ul><li>in small bowel lumen </li></ul><ul><li>- Powerful exotoxin & 5-HT released by za organism cause out pouring of isotonic alkaline small intestinal secretions through cyclic AMP and neural secretory reflex respectively. Absorption is also impaired . The out-come is depletion of fluids, salt, K & acidosis causing peripheral circulatory failure & ARF & death If not corrected. </li></ul>
  8. 11. <ul><li>Clinical features </li></ul><ul><li>- IP is hours to 5 days </li></ul><ul><li>- Asym & mild cases out number za classic cases </li></ul><ul><li>- The dis is more severe in children </li></ul><ul><li>- 3 phases are recognized in za classical case </li></ul><ul><li>1- Evacuation phase : acute painless, effortless </li></ul><ul><li>severe diarrhoea followed by vomiting. First </li></ul><ul><li>faecal gut contents are evacuated followed by typical rice water motions. </li></ul><ul><li>2- Collapse phase : If appropriate management </li></ul><ul><li>is not offered enormous loss of fluids and </li></ul><ul><li>electrolytes causes acute circulatory failure </li></ul>
  9. 12. <ul><li>and shock followed by ARF & death if fluids and electrolytes are not replaced. Signs of dehydration are detected. Cholera sicca and death can occur sp in children. </li></ul><ul><li>3- Recovery phase : recovery is usually complete </li></ul><ul><li>if za pt survives za collapse phase. </li></ul>
  10. 13. ASSESSMENT OF DEHYDRATION DEGREE Not present for 6hrs Few & dark Normal Urine Unable to Drink Eager Normal Thirst FREQUENT SOMETIMES MILD VOMITING MORE THAN 10 4-10 LESS THAN 4 Sessions/DAY DIRRHEA SEVERE DEHYDRATIOn moderate DEHYDRATIOn mild DEHYDRATIOn ASK
  11. 14. Assessment of dehydration degree V. Rapid and deep Rapid Normal Respiratory V-Day Dry Wet Mouth & Tongue V. Sunken Sunken Normal Eyes V-Day Dry Normal Tears Convulsing Drowsy comatose Irritable Active & alert General condition Severe Dehydration Moderate dehydration Mild dehydration NOTICE
  12. 19. <ul><li>Diagnosis </li></ul><ul><li>- Clinical , during epidemics </li></ul><ul><li>- Stool or rectal swab microscopy and culture and sensitivity. </li></ul>
  13. 21. <ul><li>Management </li></ul><ul><li>1- Assess degree of dehydration </li></ul><ul><li>2- Replace fluid & electrolyte loss </li></ul><ul><li>3- Antibiotics </li></ul><ul><li>4- Nutritional rehabilitation </li></ul><ul><li>Generally: </li></ul><ul><li>- ORS for mild & moderate dehydration </li></ul><ul><li>- IV Ringer lactate if za pt is vomiting and in severe dehydration (Darrows, Hartmann's, isotonic saline wz NaHCO3 & K supplements). </li></ul><ul><li>-Shift to ORS as soon as dehydration is corrected in severe dehydration. </li></ul>
  14. 22. Treatment of severe dehydration <ul><li>Establish L.V line </li></ul><ul><li>Give Ringers lactate or normal saline . </li></ul><ul><li>Give 100 ml/kg according to the following table . </li></ul>5 70 1 30 1< 2 ½ 70 ½ 30 1> Time in hrs Amount ml/ kg Age/ years
  15. 23. <ul><li>If the patient is able to drink , give O.R.S while giving intravenous fluid : O.R.S 5ML/KG / hour </li></ul><ul><li>Watch and follow the pt- closely . </li></ul><ul><li>Re – assess the patient condition after 3 hours (6 hours for children less than one year) . </li></ul><ul><li>If still severe dehydration is present : </li></ul><ul><li>Re hydrate the patient intravenously </li></ul><ul><li>If dehydration is not present Replace output. </li></ul>
  16. 25. Treatment of mild and moderate dehydration. <ul><li>Give the patient O.R.S according to the following table : </li></ul>2200-4000 120-2200 800-1200 600-800 400-600 200-400 O.R.S ML More than 30 16-30 11-15 8-10 5-7 Less than 5kg WT/ kg 15 yrs and more 5-14 yrs 2-4 yrs 12-23 mo 4 – 11 mo Less than 4 mo Age
  17. 27. Treatment of mild & moderate dehydration: <ul><li>Follow up the patient – to make sure that the patient is taking fluid sufficiently. </li></ul><ul><li>Re- examine (evaluate) after 4 hrs . </li></ul><ul><li>Detect severe dehydration and treat accordingly </li></ul><ul><li>if there is no severe dehydration – re hydrate according to degree of dehydration give fluid & food </li></ul><ul><li>If no signs of dehydration replace fluid output. </li></ul><ul><li>Continue to re-evaluate every 4hrs (at least) </li></ul><ul><li>Give suitable antibiotic . </li></ul>
  18. 28. The patient should return to the health unit if there is : <ul><li>Increase frequency of diarrhea . </li></ul><ul><li>Unable to drink or eat </li></ul><ul><li>Severe thirst . </li></ul><ul><li>Frequent vomiting . </li></ul><ul><li>Fever </li></ul><ul><li>Blood in stool . </li></ul>
  19. 29. Treatment if no dehydration <ul><li>Patient should be : </li></ul><ul><li>1-Given O.R.S at home for two day 2-Taught how to use it . </li></ul><ul><li>3-Taught the dose . </li></ul>
  20. 30. O.R.S AT HOME Two Any if able More than 10year One 100-200 2-9year One 50-100 per motion Less than two No of cases day Amount /ml AGE /YRS
  21. 31. <ul><li>- Antibiotics as soon as vomiting stops. </li></ul><ul><li>- Discharge (-ve culture ??) and follow up. </li></ul><ul><li>- Epidemics need preparation & funding . </li></ul>
  22. 32. Antibiotics Started after vomiting stops, usually after fluid replacement . 100mg 6 hrs for 3 days 1 mg/kg 6= for 3 days Ferozilipdin 1600mg TM + 800 mg SD for 5 days 5 mg /kg trimethoprin+ 25mg/kg suphadoxine Septrin : twice daily for 3 days 300mg single dose - Doxycycline 250-500mg 6 hr for 3 days. - tetracycline Adult Children Drug
  23. 34. Antibiotics <ul><li>Tetracycline is contraindicated in : </li></ul><ul><li>-Children </li></ul><ul><li>-Pregnancy </li></ul><ul><li>Septrin is preferred for children </li></ul><ul><li>Ferozilipdine is preferred in pregnancy . </li></ul><ul><li>Prevention of co-pt </li></ul><ul><li>- Doxycycime (300mg) single dose for adult </li></ul><ul><li>- Erythromycin (syrup or tablets ) </li></ul><ul><li>30-50 mg/kg for children for 5 days </li></ul><ul><li>500mg6 hrs for 5 days in pregnancy . </li></ul>
  24. 36. <ul><li>Complications </li></ul><ul><li>- Hyponatraemia, hypokalaemia, hypoglycemia, </li></ul><ul><li>acidosis & seizures sp in children </li></ul><ul><li>- Fluid overload in children, elderly, anaemics and cardiac patients. </li></ul><ul><li>- Abortion in pregnant ladies </li></ul><ul><li>- cholecystitis & pneumonia </li></ul><ul><li>- Renal failure </li></ul><ul><li>- Mortality is 5% in adults & may reach 15% in </li></ul><ul><li>children. </li></ul>
  25. 37. <ul><li>Prevention </li></ul><ul><li>1- Improved sanitation & control of house flies </li></ul><ul><li>2- Personal hygiene </li></ul><ul><li>3- Safety disposal of excreta </li></ul><ul><li>4- Clean water supply ( piped or boiled) </li></ul><ul><li>5- Control of water source of infection </li></ul><ul><li>6- Disinfection </li></ul><ul><li>7- Chemoprophylaxis (mass tetracycline TR) </li></ul><ul><li>8- Quarantine </li></ul><ul><li>9- Control of population movement </li></ul><ul><li>10- Health education </li></ul><ul><li>11- Vaccination ? ( limited protection) </li></ul>

×