1. Diarrhea is defined as having three or more loose or liquid bowel movements per day. The most common causes are viral or bacterial infections of the gut. 2. Symptoms include loose watery stools, abdominal cramps, pain, vomiting, nausea, fever and fatigue. 3. Treatment involves oral rehydration, antidiarrheal medications, and diet modifications. For children, continued breastfeeding and oral rehydration solutions are important.

1. DIARRHOEA
DR HARSHAD DIGAMBAR BAKLE

2. INTRODUCTION
 DIARRHOEA (FROM THE GREEK DIA MEANS
“THROUGH”RHOEA “FLOW’’ MEANING
“FLOWING THROUGH IS THE CONDITION OF
HAVING THREE OR MORE LOOSE OR LIQUID
BOWEL MOVEMENT PER DAY

3. DEFINATION OF DIARRHOEA
DIARREOEA IS DEFIND BY THE WORLD HEALTH
ORGANIZATION AS HAVING THREE OR MORE
LOOSE OR LIQUID STOOLS PER DAY OR AS
HAVING MORE STOOLS THEN IS NORMAL FOR
THAT PERSON

4. CAUSES
 THE MOST COMMON CAUSES OF DIARRHOEA IS VIRUS
ROTOVIRUS OR ENTEROVIRUS THAT INFECT THE GUT ( THE
INFECTION USALLY LAST FOR TWO DAY AND IS SOMETIMES
CALLED INTESTIONAL FLU OR STOMACH FIU)
 INFECTION BY BACTERIUM SUCH AS
E,COLI,SALMONELLA,SHIGELLA OR CHOLERA
 EATING FOOD THAT UPSET THE DIGESTIVE SYSTEM
 ALLERGIES TO CERTAIN FOOD
 DISEASE OF THE INTESTINE (CROHN’S DISEASE AND
ULCERATIVE COLITIS
 MALABSORPTION ( WHERE THE BODY IS UNABLE TO
ADEQUATELY ABSORB CERTAIN NEUTRIENTS FROM THE DIET
 A PARASITE SUCH AS THOSE THAT CAUSE GIARDIASIS AND
AMOEBIOSIS
 ALCOHOL ABUSE

5. SYMPTOMS
 LOOSE WATERY STOOL
 ABDOMINAL CRAMPS
 ABDOMINAL PAIN
 VOMITTING
 NAUSEA
 TEMPERATURE
 HEADACHE
 LOOSE OF APPETITE
 FATIGUE
 BLOOD IN STOOL

6. PATHOPHYSIOLOGY
• DIARRHOEA CAN BE CONSIDERD TO BE EITHER
OSMOTIC OR SECRETORY .
• OSMOTIC DIARRHOEA OCCURS WHEN EXCESSIVE
OSMOTICALLY ACTIVE PARTICLE ARE PRESNT IN
THE LUMEN , RESULTING IN MORE FLUID PASSIVELY
MOVING INTO THE BOWEL LUMEN DOWN THE
OSMOTIC GRADIENT.
• SECRETORY DIARRHOEA OCCURS WHEN THE
BOWEL MUCOSA SECRETES EXCESSIVE AMOUNT OF
FLUID IN TO THE GUT LUMEN, EITHER DUE TO
ACTIVATION OF PATHWAY BY A TOXIN OR DUE TO
INHERANT ABNORMALITIES IN THE ENTEROCYTES

7. TYPES OF DIARRHEOEA
ACUTE
CHRONIC

8. ACUTE DIARRHEOEA
IT IS LESS THEN FOUR WEEKS IS USALLY DUE
TO INFECTION AND IS OFTEN SELF LIMITED
IT IS ASSOCIATED WITH FEVER PAIN IN
ABDOMEN OR DEHYDRATION
THIS IS EXTREMALY COMMON AND USALLY
DUE TO FEACAL-ORAL TRANSMISSION OF
BACTERIAL TOXIN, VIRUSES PROTOZON
ORGANISM

9. CHRONIC OR RELAPSING DIARRHOEA
 MORE THEN FOUR WEEK
 THE MOST COMMON CAUSE IS IRRITABLE BOWEL SYNDROME(
IT IS A FUNTIONAL BOWEL DISORDER IN WHICH ABDOMINAL
PAIN IS ASSOCIATED WITH DEFICATION
 INCREASE FREQUENCY OF DEFICATION AND LOOSE WATERY
OR PELLETY STOOL
 DIARRHEOEA RARELY OCCURS AT NIGHT AND IS MOST SEVERE
BEFORE AND AFTER BREAKFAST AT OTHER TIMES THE PATIENT
IS CONSTIPATED

10. ON THE BASIS OF ABSORPTION
SECRETORY
OSMOTIC
INFLAMMATORY
DYSENTERY
MOTILITY

11. SECRETORY
THE GUT IS SECREATING MORE FLUIDS THEN
USAL OR IT CANNOT ABSORB FLUID PROPERLY
STRUCTURAL DAMAGE IS MINIMAL
THIS IS MOST COMMNLY CUSED BY A CHOLERA
TOXIN (A PROTEN SECREATED BY THE
BACTERIUM VIBRIO CHOLERA

12. OSMOTIC DIARRHEOEA
DUE TO POORLY ABSORABLE OSMOTICALLY
ACTIVE SUBSTANCES AS AFTER INGESTION OF
OSMOTIC LAXATIVES IN LACTASE DEFICIECY
VITAMIN C ,UNDIGESTED LACTOSE OR
UNDIGESTED FRUCTOSE CAN ALSO TRIGGER
OSMOTIC DIARRHEOEA

13. THE LINING OF THE GUT BECOMES INFIAMED
THIS IS USALLY CAUSED BY BACTERIAL
INFECTION VIRAL INFECTION, PARASITIC
INFECTION
TUBERCULOSIS COLON CANCER CAN ALSO
CAUSE INFLAMATORY DIARRHOEA
INFLAMATORY DIARRHOEA

14. DYSENTERY
 THE PRESENCE OF BLOOD IN STOOLS IS USALLY
A SIGN OF DYSENTERY RATHER THEN
DIARRHOEA
 IT IS CUSED BY A RELEASE EXCESS WATER (BY
ANTI DIURETIC HARMONE)

15. MOTILITY RELATED DIARRHOEA
FOOD MOVES TOO QUICKLY THROUGH THE
INTESTINE (HYPERMOTILITY)
IF THE FOOD MOVES TOO QUICKLY THERE IS
NOT ENOUGH TIME TO ABSORB SUFICIENT
NUTRIENTS AND WATER
 PATIENT WHO HAD A VAGOTOMY( REMOVAL OF
VAGUS NERVE AS WELL AS THOSE WITH DIBETIC
NEUROPATHY ARE SUCEPTIBLE TO THIS TYPE OF
DIARRHOEA

16. DIFFERENCE
LARGE BOWEL SMALL BOWEL
PRESENSE OF BLOOD AND
MUCUS
SMALL VOLUME STOOLS
ASSOCIATED
HYPOGASTRIC CRAMPS
PRESENSE OF
UNDIGESTED FOOD
LARGE VOLUME STOOLS
MILD ABDOMINAL
CRAMPS

17. LAB INVESTIGATION
MICROSCOPIC EXAMINATION OF STOOL
COMPLETE BLOOD COUNT

18. COMPLICATION
DEHYDRATION
 HYPOKALAEMIA
HYPOVOLEMIC SHOCK
SODIUM LEVEL LOW (URINE)
HYPOMAGNESEMIA
HYPOPHOSPHATAEMIA

19. DIARRHOEA IN CHILDREN
DIARRHOEA OFTEN OCCURS WITH FEVER
NAUSEA VOMITTING CRAMPS AND DEHYDRATION
SOME OF THE MOST COMMON RESONS KIDS
GET DIARRHOEA INCLUDE
INFECTON FROM VIRUSES LIKE ROTOVIRUS
BACTERIA LIKE SALMONELLA AND PARASITES
LIKE GIARDIA
THE MOST COMMON CAUSE CONSUMING TOO
MUCH FRUITS OR FRUIT JUICE
FOOD SENSITIVITY
FOOD POISONING CAN ALSO CAUSE DIARRHOEA IN
KIDS

20. TREATMENT IN ADULT
ORS (ORAL REHYDRATON SOLUTION)
ANTIDIARRHEOAL MEDICINE (LOPERAMIDE)
PAINKILER ( IBUPFOFEN , PARACETAMOL)
ANTIMOTILITY MEDICINES(LOFENOXAL)
HOSPITALIZATION
DIET (HIGH IN FIBER)

21. TREATMENT IN CHILDREN
IT IS IMPORTANT TO PREVENT FLUID LOSS
ADDITONAL BREAST MILK
(ORS) ORAL REHYDRATION SOLUTION TO
INFANT AND YOUNG CHILDRENS
ROTAVIRUS ( VACCINATION IS GIVEN UNDER
SIX MONTH)

22. CLINICAL FEATURE AND DRUG RECOMMENDED
IN INFECTIVE DIARRHOEA
 SHIGELLA- CIPROFIOXACIN, NORFIOXACIN ,
COTRIMOXAZOLE, NITAZOXAMIDE
SALMONELLA- CEFTRIDAXONE
 E, COLI-COTRIMAXAZOLE
VIBRIO-DOXYCYCLINE , FLUOROQUINOLONE
CAMPYLOBACTER- ERYTHROMYCIN
GIARDIA-METRONIDAZOLE
AMOEBIASIS-METRONIDAZOLE
VIRAL-NO ANTIMICROBIAL MEDICINE

23. MORTALITY RATE
 DIRRHOEA DISEASE IS THE SECOND LEADING
CAUSE OF DEATH IN CHILDREN UNDER FIVE
YEAR OLD IS RESPONSIBLE FOR KILLING
AROUND 76000 CHILDREN EVERY YEAR
 MOST PEOPLE WHO DIE FROM DIARRHOEA (
SEVERE DEHYDRATION AND FLUID LOSS)