Acute infectious diarrhea is usually caused by faecal–oral transmission of bacteria or their toxins, viruses or parasites. It is typically short-lived and presents with acute diarrhea, sometimes with vomiting, as the predominant symptom. Clinical assessment involves evaluating the history of illness, examining the patient for dehydration, and investigating stool and blood samples. Management focuses on fluid replacement to treat dehydration as well as controlling symptoms, while antibiotics are usually not needed except for specific invasive bacterial infections.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
Discussion about Acute Gastroenteritis, causes, treatment and management of different types organism that cause AGE. Also had a brief discussion about it's difference from diarrhea. This discussion was taken from WHO 2012(which is currently the latest as of now) and Merck 2016. It also include on how to discuss it.
CHRONIC DYSPEPSIA
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
Escherichia coli species are components of the
Normal animal and human colonic flora;
Flora of a variety of environmental habitats, including long-term care facilities (LTCFs) and hospitals.
E.coli are the cause of most nosocomial infections.
Defined as inflammation of the mucous membrane of stomach and intestine usually causing nausea ,vomiting and diarrhea.
Gastro-intestinal infections represent a major public health and clinical problem worldwide. Many species of bacteria, viruses and protozoa cause gastro-intestinal infection.
Diarrhea is loose, watery stools. Having
diarrhea means passing loose stools three or more times a day. Acute diarrhea
is a common problem that usually lasts 1 or 2 days and goes away on its own.
Diarrhea lasting more than 2 days may be a
sign of a more serious problem. Chronic diarrhea—diarrhea that lasts at least 4
weeks—may be a symptom of a chronic disease. Chronic diarrhea symptoms may be
continual or they may come and go.
Diarrhea of any duration may cause
dehydration, which means the body lacks enough fluid and electrolytes—chemicals
in salts, including sodium, potassium, and chloride—to function properly. Loose
stools contain more fluid and electrolytes and weigh more than solid stools.
People of all ages can get diarrhea. In the
United States, adults average one bout of acute diarrhea each year, and young
children have an average of two episodes of acute diarrhea each year.
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
Discussion about Acute Gastroenteritis, causes, treatment and management of different types organism that cause AGE. Also had a brief discussion about it's difference from diarrhea. This discussion was taken from WHO 2012(which is currently the latest as of now) and Merck 2016. It also include on how to discuss it.
CHRONIC DYSPEPSIA
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
Escherichia coli species are components of the
Normal animal and human colonic flora;
Flora of a variety of environmental habitats, including long-term care facilities (LTCFs) and hospitals.
E.coli are the cause of most nosocomial infections.
Defined as inflammation of the mucous membrane of stomach and intestine usually causing nausea ,vomiting and diarrhea.
Gastro-intestinal infections represent a major public health and clinical problem worldwide. Many species of bacteria, viruses and protozoa cause gastro-intestinal infection.
"Diarrhoea-This is characterized by 3 or more watery schools per day or having more stools than is normal for that person. Almost everybody has diarrhoea at some point in their lives. Diarrhoea may be a cause of concern because it may cause the more life threatening dehydration. Mindheal homeopathy can help in the treatment of diarrhoea."/>
Diarrhea is an increased frequency and decreased consistency of fecal discharge as compared with an individual’s normal bowel pattern.
It is often a symptom of a systemic disease.
Acute diarrhea is commonly defined as shorter than 14 days’ duration.
Persistent diarrhea as longer than 14 days’ duration.
Chronic diarrhea as longer than 30 days’ duration.
Most cases of acute diarrhea are caused by infections with viruses, bacteria, or protozoa, and are generally self-limited.
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases,The World Health Organization has announced that COVID-19 is a pandemic.
Seminar Prepared by :-
Mohammed Musa (M.B.Ch.B)
Azadi Teaching Hospital - Kirkuk
ATHEROSCLEROSIS
Seminar Prepared by :-
Ali Abdulazeem
Shilan Adnan Abdulrahman
Alaa Shamil
Guldan Hameed
Internal Medicine
College of Medicine - University of Kirkuk
Hemostasis
Seminar Prepared by :-
Mohammed Saadi
Mohammed Musa
Hussein Jassam
Mahmoud Ahmed
Internal Medicine
College of Medicine - University of Kirkuk
Drug resistance against malaria
Seminar Prepared by:
Mohammed Musa
Mohammed Saadi
Ali Abdulazeem
Nora Shaker
Shilan Adnan
Parasitology
College of Medicine - University of Kirkuk
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
4. Diarrhoea
4
▰ Diarrhoea is defined as the passage of more than 200g of stool daily
and measurement of stool volume is helpful in confirming this.
▰ The most severe symptom in many patients is urgency of defecation,
and faecal incontinence is a common event in acute and chronic
diarrhoeal illnesses
5. Acute diarrhea
5
▰ This is extremely common and is usually caused by faecal–oral
transmission of bacteria or their toxins, viruses or parasites.
▰ Infective diarrhoea is usually short-lived and patients who present with
a history of diarrhoea lasting more than 10 days rarely have an
infective cause.
▰ A variety of drugs, including antibiotics, cytotoxic drugs, PPIs and
NSAIDs, may be responsible.
6. 6
▰ Acute diarrhoea, sometimes with vomiting, is the predominant
symptom in infective gastroenteritis.
▰ Acute diarrhoea may also be a symptom of other infectious and
non-infectious diseases.
▰ Stress, whether psychological or physical, can also produce loose
stools.
8. Secretory Diarrhea
8
▰ Large volumes of water are normally secreted into the small intestinal
lumen, but a large majority of this water is efficiently absorbed before
reaching the large intestine.
▰ Diarrhea occurs when secretion of water into the intestinal lumen
exceeds absorption.
9. Secretory Diarrhea
9
▰ Many millions of people have died of the secretory diarrhea.
associated with cholera. The responsible organism, Vibrio cholerae,
produces cholera toxin, which strongly activates adenylyl cyclase,
causing a prolonged increase in intracellular concentration of cyclic
AMP within crypt enterocytes.
▰ This change results in prolonged opening of the chloride channels that
are instrumental in secretion of water from the crypts, allowing
uncontrolled secretion of water. Additionally, cholera toxin affects
the enteric nervous system, resulting in an independent stimulus of
secretion.
10. Secretory Diarrhea
10
▰ Exposure to toxins from several other types of bacteria (e.g. E.
coli heat-labile toxin) induce the same series of steps and massive
secretory diarrhea that is often lethal unless the person is aggressively
treated to maintain hydration.
▰ In addition to bacterial toxins, a large number of other agents can
induce secretory diarrhea by turning on the intestinal secretory
machinery, including:
▰ some laxatives, hormones, drugs, certain metals, organic toxins, and
plant products (e.g. arsenic, insecticides, mushroom toxins, caffeine)
▰ In most cases, secretory diarrheas will not resolve
during a 2-3 day fast.
11. Inflammatory and Infectious Diarrhea
11
▰ The epithelium of the digestive tube is protected from insult by a
number of mechanisms constituting the gastrointestinal barrier, but
like many barriers, it can be breached.
▰ Disruption of the epithelium of the intestine due to microbial or viral
pathogens is a very common cause of diarrhea in all species.
▰ Destruction of the epithelium results not only in exudation of serum
and blood into the lumen but often is associated with widespread
destruction of absorptive epithelium.
▰ In such cases, absorption of water occurs very inefficiently and
diarrhea results.
12. Inflammatory and Infectious Diarrhea
12
▰ Examples of pathogens frequently associated with infectious diarrhea
include:
▻ Bacteria: Salmonella, E. coli, Campylobacter
▻ Viruses: rotaviruses, norovirus
▻ Protozoa: Giardia, Cryptosporium,
13. Inflammatory and Infectious Diarrhea
13
▰ The immune response to inflammatory conditions in the bowel
contributes substantively to development of diarrhea.
▰ Activation of white blood cells leads them to secrete inflammatory
mediators and cytokines which can stimulate secretion, in effect
imposing a secretory component on top of an inflammatory diarrhea.
▰ Reactive oxygen species from leukocytes can damage or kill intestinal
epithelial cells, which are replaced with immature cells that typically
are deficient in the brush border enyzmes and transporters necessary
for absorption of nutrients and water. In this way, components of an
osmotic (malabsorption) diarrhea are added to the problem.
14. Osmotic diarrhea
14
It is the diarrhea that occurs due to the ingestion of poorly absorbed
osmotically active substances that cause shifting of the water into the
intestinal lumen
▻ If you stop oral feeding the diarrhea will stop.
▰ Can be Occur in:
1.ingestion of high CHO diet.
2-Congenital Lactase deficiency (primary)
3.infection with rotavirus or Salmonella, Enter hemorrhagic E.coli
causes severe shedding of villi that contains Disaccharidases
enzyme (secondary lactase deficiency).
15. Dysmotility/Functional diarrhea
15
▰ Gut dysmotility may cause increased intestinal and colonic transit
time as well as decrease contact time with intestinal absorptive
mucosa.
▰ Functional syndromes such as irritable bowel syndrome (IBS) include
a pain component as well as a change in bowel habits.
17. Epidemiology
17
▰ Diarrhoeal disease is the second leading cause of death in
children under five years old. It is both preventable and treatable.
▰ The World Health Organisation (WHO) estimates that there are
more than 1.7 billion cases of acute diarrhoea annually globally.
▰ Each year diarrhoea kills around
760 000 children under five.
▰ In developed countries, diarrhoea remains
an important problem, with the elderly being
most vulnerable.
21. ▰ Gram –ve bacillus
▰ Normal commensal in human gut Virulent types-
▰ Enterotoxigenic - leading cause of watery diarrhea, most common
cause of travellers’ diarrhea
▰ Enteropathogenic- diarrhea with mucus
▰ Enteroinvasive- profuse diarrhea with fever
▰ Enterohemorrhagic - dysentery, can cause HUS Enteroaggregative-
watery diarrhea
21
Escherichia coli
22. ▰ Caused by bacteria Vibrio cholerae Primarily affects small-intestine
▰ People with O blood group more affected, carriers of cystic fibrosis are
protected??
▰ Toxin leads to cAMP activation causing secretion of water, Na, K, Cl &
HCO3
▰ Causes profuse diarrhea (rice water),
▰ with abdominal pain, ± vomiting
22
Cholera
29. Campylobacter
▰ Typically caused by Campylobacter jejuni
▻ or C. coli; it is largely a foodborne disease.
▰ Primarily uncooked poultry
▰ Diarrhea (bloody ~10%), abdominal pain
31. 31
• Fever with chills
• Abdominal cramps
• Diarrhea often with blood and mucus
• Headache, malaise
• Direct person-to-person spread
• Tx Trimethoprim-
▻ sulfamethoxazole, ciprofloxin, levofloxacin, ampicillin
• Increasing resistance to antibiotics noted
• Azithromycin, 500mg orally on day 1 and 250mg orally one time a day
for 4 days, may be an effective alternative treatment
for resistant strains
Shigellosis
32. 32
• Clostridium difficile
• 20% chance after completing broad spectrum antibiotic
• The A and B toxins produced by C. difficile can cause severe diarrhea,
pseudomembranous colitis, or toxic megacolon.
• High risk pts: nursing home residents and employees, hospitalized pts and
employees
• metronidazole (250mg orally four times a day or 500mg orally three times
a day for 10 days)
CLOSTRIDIUM DIFFICILE
36. Clinical assessment
36
▰ The history should address foods ingested, duration and frequency of
diarrhoea, presence of blood or steatorrhoea, abdominal pain and
tenesmus, and whether other people have been affected.
▰ Fever and bloody diarrhoea suggest an invasive, colitic, dysenteric
process.
▰ An incubation period of less than 18 hours suggests toxin-mediated
food poisoning, and longer than 5 days suggests diarrhoea caused by
protozoa or helminthes.
▰ Person-to-person spread suggests certain infections,
such asshigellosis or cholera.
39. Clinical assessment
39
▰ Examination includes assessment of the degree of dehydration.
▰ Assessment for early signs of hypotension, such as thirst, headache,
altered skin turgor, dry mucous membranes and postural hypotension,
is important, particularly in tropical regions where dehydration
progresses rapidly.
▰ Signs of more marked dehydration include supine hypotension and
tachycardia, decreased urinary output, delirium and sunken eyes.
▰ The blood pressure, pulse rate, urine output and ongoing stool losses
should be monitored closely.
41. Clinical assessment
41
▰ The severity of diarrhoea may be assessed by reference to the Bristol
stool form scale (Bristol stool chart), which allows an objective
assessment of stool consistency by providing a verbal and visual
reference scale.
▰ The Bristol stool form scale was developed in the 1990s to monitor
patients with irritable bowel syndrome, but its main use (at least in UK
hospitals) is to monitor hospital inpatients with loose stool to assist in
decisions on stool sampling and infection prevention precautions,
especially in relation to C. difficile.
42. Bristol stool chart
▰ The stool is given a ‘score’ of 1–7 by
▰ reference to the verbal and visual
description.
▰ This is recorded on a chart (usually known
as a ‘Bristol stool chart’) or in a patient
monitoring database.
42
44. Investigations
44
These include stool inspection for blood and microscopy for leucocytes,
and also an examination for ova, cysts and parasites if the history indicates
residence or travel to areas where these infections are prevalent.
▰ Stool culture should be performed and C. difficile toxin sought.
▰ FBC and serum electrolytes indicate the degree of inflammation and
dehydration.
▰ Where cholera is prevalent, examination of a wet film with dark-field
microscopy for darting motility may provide a diagnosis.
▰ In a malarious area, a blood film for malaria parasites
should be obtained.
46. Investigations
46
▰ Blood and urine cultures and a chest X-ray may identify alternative
sites of infection, particularly if the clinical features suggest a
syndrome other than gastroenteritis.
47. Investigations
47
▰ Structural examination by sigmoidoscopy, colonoscopy, or abdominal
computed tomography (CT) scanning (or other imaging approaches)
may be appropriate in patients with uncharacterized persistent
diarrhea to exclude IBD or as an initial approach in patients with
suspected noninfectious acute diarrhea such as ischemic colitis,
diverticulitis, or partial bowel obstruction.
49. Management
49
▰ All patients with acute, potentially infective diarrhoea should be
appropriately isolated to minimise person-to-person spread of
infection.
▰ If the history suggests a food-borne source, public health measures
must be implemented to identify the source and to establish whether
other linked cases exist.
50. Fluid replacement
50
▰ Replacement of fluid losses in diarrheal illness is crucial and may be life-
saving.
▰ Although normal daily fluid intake in an adult is only 1–2 L, there is
considerable additional fluid movement in and out of the gut in
secretions.
▰ Altered gut resorption with diarrhea can result in substantial fluid loss;
for example, 10–20 L of fluid may be lost in 24 hours in cholera.
▰ The fluid lost in diarrhea is isotonic, so both water and electrolytes need
to be replaced.
51. 51
Fluid homeostasis in the gastrointestinal
tract.
• Absorption of electrolytes from the
gut is an active process requiring
energy.
• Infected mucosa is capable of very
rapid fluid and electrolyte transport
if carbohydrate is available as an
energy source.
52. Fluid replacement
52
▰ Oral rehydration solutions (ORS) therefore contain sugars, as well as
water and electrolytes.
▰ ORS can be just as effective as intravenous replacement fluid, even in
the management of cholera.
▰ In mild to moderate gastroenteritis, adults should be encouraged to
drink fluids and, if possible, continue normal dietary food intake.
▰ If this is impossible – due to vomiting, for example – intravenous fluid
administration will be required.
53. ▰ In very sick patients or
those with cardiac or
renal disease,
monitoring of urine
output and central
venous pressure may
be necessary.
53
Fluid replacement
54. Fluid replacement
54
The volume of fluid replacement required should be estimated based on
the following considerations:
▰ Replacement of established deficit
▰ Replacement of ongoing losses
▰ Replacement of normal daily requirement
55. Fluid replacement
55
Replacement of established deficit
▰ After 48 hours of moderate diarrhoea (6–10 stools per 24 hrs), the
average adult will be 2–4 L depleted from diarrhoea alone. Associated
vomiting will compound this.
▰ Adults with this symptomatology should therefore be given rapid
replacement of 1–1.5 L, either orally (ORS) or by intravenous infusion
(normal saline), within the first 2–4 hours of presentation.
▰ Longer symptomatology or more persistent/severe diarrhoea rapidly
produces fluid losses comparable to diabetic ketoacidosis and is a
metabolic emergency requiring active intervention.
56. Fluid replacement
56
Replacement of ongoing losses
▰ The average adult’s diarrheal stool accounts for a loss of 200 mL of
isotonic fluid.
▰ Stool losses should be carefully charted and an estimate of ongoing
replacement fluid calculated.
▰ Commercially available rehydration sachets are conveniently produced
to provide 200 mL of ORS; one sachet per diarrhoea stool is an
appropriate estimate of supplementary replacement requirements.
57. Fluid replacement
57
Replacement of normal daily requirement
▰ The average adult has a daily requirement of 1–1.5 L of fluid in
addition to the previous calculations.
▰ This will be increased substantially in fever or a hot environment.
58. Antimicrobial agents
58
▰ In non-specific gastroenteritis, routine use of antimicrobials does not
improve outcome and may lead to antimicrobial resistance or side-
effects.
▰ They are usually used where there is systemic involvement, a host with
immunocompromise or significant comorbidity.
▰ Evidence suggests that, in Enterohaemorrhagic Escherichia coli (EHEC)
infections, the use of antibiotics may make the complication of
haemolytic uraemic syndrome (HUS) more likely due to increased toxin
release. Antibiotics should therefore not be used in
this condition.
59. Antimicrobial agents
59
▰ Conversely, antibiotics are indicated in Shigella dysenteriae infection
and in invasive salmonellosis – in particular, typhoid fever.
▰ Antibiotics may also be advantageous in cholera epidemics, reducing
infectivity and controlling the spread of infection.
60. Antidiarrhoeal, antimotility and
antisecretory agents
60
▰ These agents are not usually recommended in acute infective
diarrhoea.
▰ Loperamide, diphenoxylate and opiates are potentially dangerous
in dysentery in childhood, causing intussusception.
▰ Antisecretory agents, such as bismuth and chlorpromazine, may
make the stools appear more bulky but do not reduce stool fluid losses
and may cause significant sedation.
▰ Adsorbents, such as kaolin or charcoal, have little effect.
62. ▰ Good hygiene, hand washing,
safe food preparation, and
access to clean water are key
factors in preventing diarrheal
illness.
▰ Vaccine development remains
a high priority for disease
prevention.
▰ Effective and safe vaccines
exist for rotavirus, typhoid
fever, and cholera, and are
under investigation for
Campylobacter,
enterotoxigenic E. coli,
and Shigella infections.
62
Prevention
63. 63
Take Home Message
▰ Infectious diarrhoea is due to faeco–oral transmission of viruses,
bacteria, bacterial toxins or parasites.
▰ Most cases are self-limiting and a pathogen is rarely identified.
▰ Viruses and toxins causes large-volume watery diarrhoea.
▰ Invasive intestinal pathogens (cause bloody diarrhoea)
▰ Clostridium difficile infection (CDI) (cause hospital-acquired diarrhoea).
▰ Diarrhoea that persists for >10 days is unlikely to be infective.
▰ Consider protozoal infections in patients who are immunocompromised
or have recently travelled to the tropics.