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1. MINISTRY OF HEALTH AND SANITATION
SCHOOL OF CLINICAL SCIENCES
MAKAMBO – MAKENI
GROUP PRESENTATION
MODULE: PEDIATRICS
TOPIC: BLOODY DIARRHOEA
LECTURER(S): DR AMADU JALLOH/ DR ABUBAKARR KANU
GROUP MEMBERS
SULAIMAN JALLOH
SIDIKIE KALLAY
FODAY HASSAN KALOKOH
ABDULRAHMAN B. KAMARA

2.  General Introduction of Diarrhoea
 General Classification/Types of Diarrhoea
 Background of Bloody Diarrhoea
 Types of bloody stool
 Causes/pathogens involved
 Signs and Symptoms of Bloody Diarrhoea
 General Assessment
 Risk Factors
 Investigations
 Complications
 Treatment
 Prevention
OUTLINE

3. Diarrhoea is defined as passage of unusually loose or watery
stools usually at least three times in a 24 hour period. (WHO)
However it is the consistency of the stools rather than the
number that is moreimportant.
Passage of even one large watery stool in young children is
diarrhoea.
Frequent passage of normal stool is not diarrhoea.
Definition:

4. 6-12 months of age are affected severely & account for high
mortality.
Dehydration occurs when water & salts are not replaced
adequately - may lead to shock & death.
 Diarrhoea also produces under nutrition andgrowth failure.
Diarrhoeal disease constitute one of theimportant
“nutritional leak” in young children.
 Even a brief episode of diarrhoea leads to the loss of 1-2 % of
body weight in children.
CONT,

5. HOW MANY TYPES OF DIARRHOEA ARE THERE?
 ACUTE WATERY DIARRHOEA.
 DYSENTRY (BLOOD IN STOOLS).
 PERSISTENT DIARRHOEA.
Types of Diarrhoea

6. Any diarrheal episode in which there is loose or watery
stools containing red visible blood
Usually a sign of invasive enteric infection with pathogens
that invade the bowel mucosa
Indicates inflammation and tissue damage
Background of Bloody Diarrhoea

7. Bloody Stool
Usually results from GI bleeding
TYPES OF BLOODY STOOL
Melena: describes stools that appear black and tar-like , usually suggest
upper GI Bleeding
HOWEVER, certain medications e.g. iron or food(large amount of dark green
leafy vegetables) may present as black stool but do not contain blood
Hematochezia: passing of bright red stool per rectum, which usually suggest
lower GIB from the colon or anus that can be mucoid or watery stool with
blood
Occult GIB: may not be visible to patient or physician, usually present as iron
deficiency anemia or identify by testing for stool occult blood

8. Dysentery
 Syndrome of bloody diarrhoea with fever, abdominal
cramps, tenesmus or painful defecation
 It implies inflammatory colitis or invasion and
destruction of colonic mucosa by bacteria, cytotoxic
product or parasites

9. viruses
Rotavirus
Adenovirus
bacteria
Shigella sp.
Campylobacter spp
Salmonella spp.
Vibrio cholerae
others
parasites
Cryptosporidium
Giardia lamblia
E. histolytica
Causes/Pathogens

10. Signs and Symptoms of Bloody Diarrhoea
 Abdominal Cramps
 Headache
 Tenesmus
 Fever
 Malaise

11. GENERAL ASSESSMENT OF A CHILD WITH DIARRHEA
Degree of dehydration signs Mild Severe
a. Look for
General condition
Eyes
Tears on cry
Mouth and tongue
Thirst
Restless, irritable
Sunken
Absent
Dry
Thirsty (drinks eagerly)
Lethargic, floppy, unconscious,
Deeply sunken and dry
Absent
Very dry
Very thirsty but (drinks poorly or unable
to drink)
b. Feel for
Skin pinch Goes back slowly, takes 1 to 2 seconds Goes back very slowly, takes more than
2 seconds
c. Decide There is some dehydration. There is severe dehydration.
d. Treatment Plan B
With WHO recommended ORS solution to
correct some dehydration.
Plan C
With IV infusion urgently to correct
severe dehydration and to prevent death
Fluid deficit is 5-10% of body weight > 10% of body weight

12. Risk Factors of Diarrhoea
Bottle fed babies have more chances todevelop
diarrhoea because of uncleanbottles
Flies can also bring germs to uncovered food
Drinking contaminated water
Unclean food, milk, unclean hands & uncleanutensils

13. If the history is unclear, it is reasonable to check:
 CBC
 endoscopy/colonoscopy
 stool microscopy
 stool culture
 HB
Investigations

14.  Anaemia
 Dehydration
 Hemolytic uremic syndrome or other types of kidney failure
 Severe blood loss
 Shock
Complications

15. Four (4) Principal Steps in the Management of Children with Bloody Diarrhea
1. F - Fluids
• Prevent dehydration with oral or IV rehydration fluids
2. F - Feeding
• Continue provision of nutritious food: breastfeeding; small frequent meals
3. F - Follow-up
• Re-evaluate clinical status after 48 hrs
4. A - Antimicrobial therapy
• Antimicrobial treatment should be based on suspected or identified specific bacterial
pathogen
WHO.The Management of Bloody Diarrhoea inYoung Children.WHO/CDD/94.49
Treatment/Management

16. Prevention of Diarrhoea:
DIARRHOEACAN BE PREVENTED BY:
 Promoting exclusive breastfeeding
 Bottle feeding should beavoided
 Using sanitary latrines
 Eat clean Food
 Drink cleanwater
 Immunization e.g. Measles, Rotavirus
 Vit. A - Prophylacticdoses
 Nutrition
 Washing hands before eating & afterdefecation.

18. ORS is bestdrink.
A child with diarrhoea needs more foodand frequent
breast feeding.
A child who is recovering from diarrhoea needsan extra meal
every day for at least 2 weeks.
Medicine other than ORS should not beused except on
medical advice.
MESSAGES:

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