This document discusses the approach to chronic diarrhea in children. It defines chronic diarrhea and outlines its pathophysiology and types. A wide range of potential causes are described. The clinical approach involves a detailed history, laboratory evaluation including celiac serology, and consideration of functional diarrhea in young children. Management focuses on hydration, nutrition, and treating any underlying disease. Probiotics may help in some cases while antidiarrheal medications can improve symptoms but have side effects.
An inflammatory condition of the pancreas
Acute pancreatitis is a reversible process,
whereas Chronic pancreatitis (CP) is irreversible
Acinar Cell Injury
An inflammatory condition of the pancreas
Acute pancreatitis is a reversible process,
whereas Chronic pancreatitis (CP) is irreversible
Acinar Cell Injury
GEMC - Gastrointestinal Bleeding in the Pediatric PatientOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Bleeding Per Rectum In Children By Prof. Sushmita N. Bhatnagar MBBS, M.S., M.Ch,M.PHIL(Hospital Management)
HEAD, PEDIATRIC SURGERY
B.J WADIA CHILDREN’S HOSPITAL, MUMBAI
CONSULTANT PEDIATRIC SURGEON
BOMBAY HOSPITAL
JOINT SECRETARY
ASSOCIATION OF MEDICAL CONSULTANTS
For info log on to www.healthlibrary.com.
GEMC - Gastrointestinal Bleeding in the Pediatric PatientOpen.Michigan
This is a lecture from the Ghana Emergency Medicine Collaborative (GEMC). To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.
Bleeding Per Rectum In Children By Prof. Sushmita N. Bhatnagar MBBS, M.S., M.Ch,M.PHIL(Hospital Management)
HEAD, PEDIATRIC SURGERY
B.J WADIA CHILDREN’S HOSPITAL, MUMBAI
CONSULTANT PEDIATRIC SURGEON
BOMBAY HOSPITAL
JOINT SECRETARY
ASSOCIATION OF MEDICAL CONSULTANTS
For info log on to www.healthlibrary.com.
Mal absorption syndrome is a group of disorders marked by
Indigestion
Excessive nutrients loss in stools
Abnormal absorption of dietary constituents
It is a state arising from abnormality in absorption of food nutrients across the gastrointestinal tract.
Impairment can be of single or multiple nutrients depending on the abnormality. This may lead to malnutrition and a variety of anemia.
Malabsorption constitutes the pathological interference with the normal physiological sequence of body.
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.
Diarrhea is a very common daily based issue with lots of contributing factors. The need is to determine the underlying causes, otherwise the consequences may get worsen.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
3. DEFINITION
As stool volume of more than 10 grams/kg/day in
infants and toddlers, or more than 200 grams/day in
older children for more than 14 days
• Increased frequency
• Increased fluidity
• Increased volume
• Or any combination of above
Persistent diarrhea : defined as an episode that
begins acutely but lasts for 14 days or longer.
Most diarrheal disorders resolve within the first
week of the illness. 3% of acute diarrhoeas become
chronic, With a high mortality and morbidity.
4. PATHOPHYSIOLOGY
Normal stool frequency ranges from three times a
week to three times a day
Incomplete absorption of water from the intestinal
lumen either because of a reduced rate of net water
absorption (related to impaired electrolyte
absorption or excessive electrolyte secretion) or
because of osmotic retention of water in the
lumen
6. SECRETORY DIARRHEA:
results from a disturbance in the balance
between absorption and secretion
• Examples:
Various bacterial enterotoxins (Cholera, Escherichia
coli, Shigella and Salmonella)
Tumors-secretions: neuroblastoma, Vaso-active
Intestinal Peptides (VIPomas)..
Ion transport defects (congenital chloride diarrhea
(CCD) and congenital sodium diarrhea(CSD)
7. OSMOTIC DIARRHEA:
is caused by ingestion of non-absorbable solutes or
by disease states that interfere with normal solute
absorption.
typical example is lactose intolerance
The colonic bacteria ferment the non-absorbed sugar
to short chain organic acid , generate an osmotic
load resulting in diarrhea
acidic pH (short chain organic acid): burning diaper
area
Reducing substance (unabsorbed sugar in stool)
8. Parameter Osmotic Diarrhea Secretory Diarrhea
Stool volume Small (generally <200 ml/24 hours) Large (>200 ml/24 hours)
Responding to
fasting
Diarrhea reduced significantly Diarrhea continues
Stool osmotic
gap
> 50 ( typically >100 mOsm/l) < 50 mOsm/l
Stool Na < 70 mmol/l > 70 mmol/l
Stool pH < 5.5 > 6
Stool reducing
substance Positive (> 0.5 %) Negative
9. INFLAMMATORY DIARRHEA:
Characterized by the presence of blood, mucus
and leukocytes in the stool
Infective process,
Allergic colitis (CMPA, allergic enteropathy)
Inflammatory bowel disease (IBD).
10. DIARRHEA DUE TO MOTILITY DISTURBANCES:
It can be either:
hypermotility as in hyperthyroidism .
Hypomotility as in pseudo-obstruction tends to
produce loose or normal looking stools. Stasis
predisposes to bacterial overgrowth, leading to
diarrhea and malabsorption.
11. CAUSES OF DIARRHEA
Chronicdiarrhea
Without FTT
Toddler’s diarrhea
Lactose
malabsorption
Infectious colitis
(Giardiasis, C diff)
IBS
Cow milk allergy
Medication :
antibiotics , laxative
Over feeding
With FTT
14. HISTORY
Timing of onset:
Neonatal onset of watery diarrhea strongly
suggests one of the congenital diarrheas :
microvillus atrophy or congenital chloride diarrhea.
Gradual onset of a mild chronic diarrhea in an
otherwise healthy toddler suggests functional
diarrhea.
The onset of symptoms in celiac disease varies
greatly, but cannot precede the introduction of
gluten-containing foods
15. HISTORY
Stool characteristics:
Stools that become looser as the day progresses
are typical of functional diarrhea.
Diarrheal stools that are passed at night are more
concerning for an underlying organic disorder.
16. HISTORY
Stool characteristics:
Stools that contain visible or occult blood or
mucus suggest an inflammatory diarrhea, which
may be caused by a dietary protein intolerance
(common in infants), inflammatory bowel disease,
or (rarely) chronic infection with an enteric
pathogen.
Infant having chronic diarrhea, with a history of
delayed passage of meconium and if constipation
preceded diarrhea,-Hirschsprung's disease
17. HISTORY
history of failure to thrive or weight loss suggests
the possibility of malabsorption disease (celiac
disease, cystic fibrosis, or other cause of pancreatic
exocrine insufficiency), hyperthyroidism, or
anorexia nervosa in the school-age child or
adolescent.
Weight loss is also a common feature of
inflammatory bowel disease .
A history of recurrent infections suggests
underlying immunodeficiency or cystic fibrosis.
history of previous abdominal surgery may
indicate anatomical or structural causes.
18. HISTORY
Diet history:
record a detailed history of feeding, prior to the
onset of the disease and during the disease. It
may provide vital clues to the aetiology, e.g., cow's
milk protein intolerance, lactose intolerance, gluten
enteropathy. Soy protien intolerance,
Overfeeding, concentrated formula feeds>
osmotic diarrhoea.
19. HISTORY
Family history:
A family history of disease affecting the bowel may
provide clues to heritable diseases
Abdominal examination:
Severe abdominal pain or abdominal distension may
be caused by intestinal obstruction or enterocolitis.
20. LABORATORY EVALUATION
Celiac serology
(anti-tTG), which is highly sensitive, specific, and more
cost-effective than other antibody tests.
Occult blood and leukocyte markers:
ulcerative colitis and Crohn's colitis . Sometimes celiac
disease and rotavirus diarrhea also test positive for occult
fecal blood.
Stool fat:
A variety of tests can be used to detect fat malabsorption
(steatorrhea). The gold standard for diagnosis of
steatorrhea is quantitative estimation of stool fat, usually
performed over 72 hours. qualitative tests also are used
21. LABORATORY EVALUATION
Stool pH, electrolytes, and reducing substances:
stool pH < 5.5 (on cow's milk) or < 5 (on breast milk)
is suggestive of carbohydrate malabsorption and
proximal small bowel damage.
Stool pH gives a clue to the amount of organic acids
in stool while the increased amounts of reducing
substances indicate the presence of unabsorbed
sugars.
22. LABORATORY EVALUATION
CBC:
Haemoglobin
bacterial infections like septicaemia, urinary tract infection
etc.
ESR – CRP
fecal alpha-1 antitrypsin testing:
to measure Protein-losing gastroenteropathy (reduced
serum concentrations of albumin and gamma globulins,
peripheral edema)
23. LABORATORY EVALUATION
sweat chloride testing: CF
zinc blood level
fecal elastase-1 and/or chymotrypsin:
the stool content of these enzymes is reduced in patients
with pancreatic insufficiency.
Upper endoscopy and colonoscopy with biopsies
and small-bowel barium x-rays are helpful to rule
out structural or occult inflammatory disease.
24.
25. FUNCTIONAL DIARRHEA
Consider functional diarrhea:
Onset of diarrhea between 6 and 36 months of age
Painless passage of three or more large, unformed
stools daily
Stools usually passed only during waking hours
No failure to thrive (if caloric intake is adequate)
26. MANAGEMENT
Good hydration and treat underlying disease
The most important complication of chronic
diarrhea is the malnutrition, and growth failure.
adequate control of the diarrhea and rapid
improvement of the nutritional status is important
Prolonged periods of clear liquid or diluted formula
feeding must be avoided in order to prevent
worsening of nutritional status.
27. MANAGEMENT
Sufficient calories should be provided to allow for
catch-up weight gain. When oral intake is
inadequate or malabsorption prevent adequate
intake, continuous enteral feedings or parenteral
nutrition may be necessary.
Micronutrient and vitamin supplementation are part
of nutritional rehabilitation
28. MANAGEMENT
Indications for TPN
Persistent diarrhea with intolerance to oral diets
after 10 days.
Severe forms of IBD and resistant colitis.
Severe necrotizing enteritis.
Some of the Problems of' TPN
Needs trained personnel and round the clock
monitoring and team work.
Very high cost
Sepsis
Cholestasis which may lead to cirrhosis.
29. MEDICATIONS
Antidiarrheal drugs:
Loperamide and diphenoxylate/atropine may
improve symptoms in children with severe and
protracted diarrhea
side effects, including sedation and risk for toxic
megacolon
Somatostatin or Octreotide :
has been used in diarrhea caused by neoplastic
diseases and in intestinal infections. It also has
been shown to be effective in reducing fecal output
in HIV infected children with severe
cryptosporidiosis
30. MANAGEMENT
Probiotics:
Randomized studies and meta-analyses have
demonstrated modest efficacy of specific probiotics
in the prevention of C. difficile associated diarrhea
and treatment of acute diarrhea in children
There is limited evidence, that probiotics are
effective in treating chronic pediatric diarrhea
31. SUMMARY
A wide variety of problems can cause chronic
diarrhea in infants and children
detailed history may provide clues to the
diagnosis
suggest serologic testing for celiac disease for
all children with chronic diarrhea
Functional diarrhea accounts for a high proportion
of chronic diarrheas in young children
Regardless of the cause of the diarrhea, evaluation
for and treatment of malnutrition is an important
step in recovery.