approach to the patient of Acute Diarrhoea
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This document discusses the approach to a patient presenting with acute diarrhea, which is defined as 3-4 loose stools per day lasting less than 2 weeks. The most common causes are infections (90%), with inflammatory causes including Shigella, Salmonella, and Clostridium difficile. The history should inquire about travel, food, and medication exposures. The exam evaluates for dehydration by checking vital signs and skin turgor. Rehydration is the primary treatment, using oral rehydration solution for mild to moderate cases and IV fluids for severe dehydration. Antibiotics may be used for inflammatory cases while anti-diarrheals are only suitable for mild non-inflammatory diarrhea. Prevention involves
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approach to the patient of Acute Diarrhoea
- 1. Approach to the patient of acute diarrhea
- 3. DEFINATION Passage of 3—4 stools of consistency softer than normal per day,lasting less than 2 weaks.
- 6. INFECTIOUS DIARRHEA INFLAMMATORY Shigella Salmonella Campylobacter Clostridium difficle Entamoeba histolytica Cytomegalovirus
- 7. NON-INFLAMMATORY Rota Virus Norwalk E.Coli V.Cholera Staphaureus Bacillus Cereus
- 8. Giardia
- 9. Shigella
- 10. salmonella
- 11. Vibrio Cholera
- 12. HISTORY Ask about the onset,duration and frequency of loose stools Any recent travelling Exposure to unpurified water Any unusual food intake Any history of drug intake Similar illness in family
- 13. EXAMINATION General appearance Mental status VITALS Blood pressure Pulse Rate Temprature Resp.Rate
- 14. LOOK FOR DEHYDRATION Confused Dry mouth Inelastic Skin Lethargy Sunken Eyes Decrease Urination
- 15. Symptom s Mental status Thirst Minimal Moderate Severe Alert Restless Lethargic Pulse Normal drinking Eager to drink Normal Decrease Eyes Normal Tongue Skin Fold Moist Instant recoil Extremitie Warm Unable to drink Weak ,Thready Slightly Deeply sunken sunken Dry Parched Less than More than 2 sec. 2 sec Cool Cold,cyan
- 16. CLUE TO THE ORGANISM WATER V.Cholera,Giardia,Norwalk POULTRY Salmonella,Shigella EGGS Salmonella
- 18. MANAGEMENT Maintain IV line or pass CVP line Monitor vitals Monitor urine output Rehydrate the patient
- 19. Degree of Rehydration Replacement dehydration Mild Moderate Severe Nutrition Not Applicable 120—240ml Ors Normal soft for each loose diet with stool adequate calories ORS 50— SAME SAME 100ml body wt over 4 hours R.Lactate or SAME. By NG if SAME N/S,@ unable to drink 20ml/kg bolus until perfusion improves,then 100ml/kg ORS over 4 hrs.
- 20. In Emergency rehydrate by giving Normal saline or Ringer Lactate @ 50….200ml/kg/24hrs Fluids should be given according to hydration status Look for basal crepts…or cvp pressure .r
- 21. Anti diarrheal Can be used in mild – moderate diarrhea Should not be used in inflammatory diarrhea Loperamide 4mg initially,then 2mg after each loose stool
- 22. ANTIBIOTICS In most of the cases not required Empirical therapy given in inflammatory cases Ciprofloxacin 500mg BD Metronidazole 500 mg Tds if Giardia suspected
- 23. ADVISE FOR HOME Plenty of fluids Specially ORS…1 sachet in 1 litre boiled water(100..200ml after each stool ) OR Add 1tsp salt,8 tsp sugar.1tsp baking powder in 1 litre boiled water. Take 1 or 2 banana alongwith it.
- 27. DIET Soft diet BANANA RICE APPLE MASH TOAST Avoid fats,milk,caffiene,alcohal
- 28. PREVENTION Always wash hands after trip to the toilet Make sure ,dairy products you use are pasteurized Avoid unnecessary antibiotics use Eat freshly cooked meal Use boiled water
- 29. MCQ’S
- 30. Salmonella and shigella cause.. 1.Inflammatory diarrhea 2.Non.Inflammatory diarrhea 3.Both 4.Non of the above
- 31. Anti.diarrheals may be given in.. 1.Salmonella 2.Shigella 3.Staphaureus 4.Non of the above
- 32. Antimicrobials are indicated in… 1.Inflamatory diarrhea 2.Non Inflammatory diarrhea 3.Both
- 33. Water contains… 1.V.Cholera 2.Giardia 3.Norwalk 4.All 5.None
- 34. Diarrhea by C.difficle is due to. 1.Unpurified water 2.Use of antibiotics 3.Poultry 4.Shell fish
- 35. Identify the Organism. 1.Salmonella 2.Shigella 3.E.coli 4.Non of the above
- 36. In Dehydration Heart rate .. 1.Increases 2.Remains normal 3.May be decreased 4.Both 1&3 true.
- 37. THANKS