This document provides an overview of diarrhea, including its definition, causes, clinical features, diagnosis, evaluation of dehydration, treatment and prevention. It discusses acute, prolonged and persistent diarrhea. Key points include:
- Diarrhea is defined as excessive loss of fluid and electrolytes in stool. It can be caused by infections, malabsorption, medications and other conditions.
- Clinical features may indicate specific causes, such as bloody stools suggesting bacteria. Dehydration is evaluated through physical exam findings.
- Treatment involves oral rehydration with fluids and zinc supplementation. Severe dehydration requires intravenous fluids. Continued feeding is important.
- Prevention focuses on good hygiene, vaccines
This document discusses diarrhea, its causes, pathogenesis, clinical features, diagnosis, evaluation of dehydration, and treatment. Diarrhea is a common cause of death in developing countries and infant mortality worldwide. It is defined as passing watery stools at least 3 times in 24 hours. Common causes are viral (rotavirus, adenovirus), bacterial (Shigella, Salmonella, E. coli), and parasitic infections. Clinical features may include bloody stools or abdominal pain. Diagnosis involves assessing stool frequency and dehydration level. Treatment focuses on oral rehydration with zinc-fortified ORS or IV fluids for severe cases. Prevention emphasizes good hygiene, vaccines, and addressing factors like global warming that
A presentation created and delivered by me in the pediatric department of Ibrahim Malik Teaching Hospital (Khartoum, Sudan) on the 10th of May 2017. It is composed of the following parts:
- Definition
- Epidemiology
- Causes
- Assessment
- Management
The total number of slides is 19 slide. One of the slides contain a video from the IMCI program by World Health Organization (WHO) for assessment of children with dehydration. The youtube link of the video added in this online version instead of the complete video that was shown in the original presentation.
1. The boy has been experiencing recurrent episodes of intense nausea and vomiting for over 3 years, with stereotypical cyclical pattern consistent with cyclic vomiting syndrome.
2. Diagnostic workup found no underlying cause and the boy is otherwise healthy between episodes. Management includes lifestyle modifications and abortive/prophylactic medications like ondansetron and amitriptyline which have reduced severity and frequency of episodes.
3. Cyclic vomiting syndrome is an important consideration for children presenting with stereotypical episodes of vomiting, and further workup is only needed if alarm symptoms are present that suggest an alternative underlying cause.
The document provides an overview of diarrhea including definitions, causes, clinical features, diagnosis, evaluation of dehydration, treatment including oral rehydration solutions, and prevention. It discusses approaches to acute, prolonged, persistent, and chronic diarrhea. Evaluation involves assessing dehydration, laboratory tests, and considering various infectious, inflammatory, and structural etiologies.
This document discusses diarrheal disease, which is a major cause of death among children in developing countries. It defines diarrhea as three or more loose stools per day and outlines its various types including secretory, osmotic, and motility diarrhea. The main causes are intestinal infections from bacteria, viruses, and parasites. Diagnosis involves taking a thorough history and examining stool samples. Management focuses on oral rehydration therapy for mild to moderate cases and IV fluids for severe dehydration. Nursing care includes careful assessment and monitoring for dehydration, electrolyte imbalances, and other complications.
This document describes 7 scenarios of newborns presenting with vomiting and other symptoms. It then provides a differential diagnosis for vomiting in newborns, including overfeeding, gastroesophageal reflux, congenital pyloric stenosis, neonatal sepsis, infections like meningitis and encephalitis, inborn errors of metabolism, surgical causes like esophageal atresia, and endocrine disorders like congenital adrenal hyperplasia.
This document discusses acute diarrheal diseases, including their causes, risk factors, modes of transmission, clinical presentations, and methods of treatment and prevention. It notes that diarrhea is a major killer of children under 5 worldwide and in India. Oral rehydration therapy using reduced osmolarity oral rehydration solution is the primary treatment. Prevention strategies include improved maternal and child health practices, vaccination, vitamin A supplementation, and health education.
Approach to neonatal jaundice - Simplified
references : Cloherty And Stark's Manual Of Neonatal Care
AIIMS Protocol In Neonatology
Care Of The Newborn – Meherban Singh
This document discusses diarrhea, its causes, pathogenesis, clinical features, diagnosis, evaluation of dehydration, and treatment. Diarrhea is a common cause of death in developing countries and infant mortality worldwide. It is defined as passing watery stools at least 3 times in 24 hours. Common causes are viral (rotavirus, adenovirus), bacterial (Shigella, Salmonella, E. coli), and parasitic infections. Clinical features may include bloody stools or abdominal pain. Diagnosis involves assessing stool frequency and dehydration level. Treatment focuses on oral rehydration with zinc-fortified ORS or IV fluids for severe cases. Prevention emphasizes good hygiene, vaccines, and addressing factors like global warming that
A presentation created and delivered by me in the pediatric department of Ibrahim Malik Teaching Hospital (Khartoum, Sudan) on the 10th of May 2017. It is composed of the following parts:
- Definition
- Epidemiology
- Causes
- Assessment
- Management
The total number of slides is 19 slide. One of the slides contain a video from the IMCI program by World Health Organization (WHO) for assessment of children with dehydration. The youtube link of the video added in this online version instead of the complete video that was shown in the original presentation.
1. The boy has been experiencing recurrent episodes of intense nausea and vomiting for over 3 years, with stereotypical cyclical pattern consistent with cyclic vomiting syndrome.
2. Diagnostic workup found no underlying cause and the boy is otherwise healthy between episodes. Management includes lifestyle modifications and abortive/prophylactic medications like ondansetron and amitriptyline which have reduced severity and frequency of episodes.
3. Cyclic vomiting syndrome is an important consideration for children presenting with stereotypical episodes of vomiting, and further workup is only needed if alarm symptoms are present that suggest an alternative underlying cause.
The document provides an overview of diarrhea including definitions, causes, clinical features, diagnosis, evaluation of dehydration, treatment including oral rehydration solutions, and prevention. It discusses approaches to acute, prolonged, persistent, and chronic diarrhea. Evaluation involves assessing dehydration, laboratory tests, and considering various infectious, inflammatory, and structural etiologies.
This document discusses diarrheal disease, which is a major cause of death among children in developing countries. It defines diarrhea as three or more loose stools per day and outlines its various types including secretory, osmotic, and motility diarrhea. The main causes are intestinal infections from bacteria, viruses, and parasites. Diagnosis involves taking a thorough history and examining stool samples. Management focuses on oral rehydration therapy for mild to moderate cases and IV fluids for severe dehydration. Nursing care includes careful assessment and monitoring for dehydration, electrolyte imbalances, and other complications.
This document describes 7 scenarios of newborns presenting with vomiting and other symptoms. It then provides a differential diagnosis for vomiting in newborns, including overfeeding, gastroesophageal reflux, congenital pyloric stenosis, neonatal sepsis, infections like meningitis and encephalitis, inborn errors of metabolism, surgical causes like esophageal atresia, and endocrine disorders like congenital adrenal hyperplasia.
This document discusses acute diarrheal diseases, including their causes, risk factors, modes of transmission, clinical presentations, and methods of treatment and prevention. It notes that diarrhea is a major killer of children under 5 worldwide and in India. Oral rehydration therapy using reduced osmolarity oral rehydration solution is the primary treatment. Prevention strategies include improved maternal and child health practices, vaccination, vitamin A supplementation, and health education.
Approach to neonatal jaundice - Simplified
references : Cloherty And Stark's Manual Of Neonatal Care
AIIMS Protocol In Neonatology
Care Of The Newborn – Meherban Singh
This document discusses chronic diarrhea, defining it as diarrhea lasting more than 2 weeks. It outlines different types of diarrhea based on duration, including acute (<2 weeks), prolonged (7-14 days), and persistent (>14 weeks). The causes of chronic diarrhea are discussed for different age groups, including post-gastrointestinal infections, cow's milk protein intolerance, and celiac disease in infants. Pathophysiological causes of chronic diarrhea include secretory, osmotic, steatorrheal, inflammatory, and dysmotility mechanisms. The importance of a thorough history and physical exam is emphasized to guide diagnostic testing and treatment approaches, which may be curative, suppressive, or empirical depending on the underlying cause.
This document provides an overview of the approach to chronic diarrhea. It defines chronic diarrhea as diarrhea lasting over 2-3 weeks and discusses etiology, risk factors, symptoms, examination findings, diagnostic workup and management. The diagnostic workup involves screening tests, intestinal function tests, biopsy and special investigations. Management includes supportive measures, identifying and treating the underlying cause, elimination diets and nutritional rehabilitation. Prevention focuses on improved nutrition, hygiene, breastfeeding and access to clean water.
Drowning occurs when a person experiences respiratory impairment from submersion or immersion in liquid. There are several types of drowning including wet, dry, secondary, and immersion syndrome. The pathophysiology involves hypoxemia, hypothermia, and fluid and electrolyte disturbances depending on if the drowning occurred in freshwater versus saltwater. Management at the scene focuses on airway, breathing, circulation and rapid removal from the water. Prognosis depends on the extent of cerebral hypoxia and injury, time to resuscitation, and need for continued resuscitation efforts.
This document summarizes information on several types of pediatric poisonings including paracetamol, iron, ethanol, methanol, and ethylene glycol. It describes the pathophysiology, signs and symptoms, toxicity levels, and treatment approaches for each type of poisoning. The key points are that paracetamol is metabolized by the liver and can cause liver damage/failure in overdose. Iron toxicity causes gastrointestinal and liver damage. Ethanol intoxication affects the central nervous system, liver, and metabolism. Methanol and ethylene glycol are metabolized to toxic compounds that can cause blindness, acidosis, and kidney damage. Activated charcoal and decontamination are not effective for methanol, while hemodial
Management and complications of acute diarrhea in childrenRITURAJANMBBS
This document provides information on the management and complications of acute diarrhea. It discusses assessing patients with acute diarrhea by determining the type, examining for dehydration and complications, and assessing nutrition. It also covers taking a relevant history, examining the patient, assessing hydration status, laboratory investigations to identify the etiological organism, stool examination, and management including oral rehydration therapy. The management is based on rehydration, correcting electrolyte imbalance, ensuring adequate feeding and supplementation with zinc.
Trophic feeding, by dr Amal Ahmed Khalil ,Port Said University, mohamed osama hussein
Trophic feeding is the practice of feeding small volume of enteral feeds in order to stimulate the development of the immature gastrointestinal tract of the preterm infant. This practice has also been termed as minimal enteral nutrition (MEN).
This document summarizes meningitis in children, including the definition, causes, signs and symptoms, diagnosis, treatment, and prevention. Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. It most commonly affects infants and children under 5 years old. Bacteria such as pneumococcus, meningococcus, and H. influenzae are common causes. Signs include fever, headache, neck stiffness, and altered mental status. Diagnosis involves lumbar puncture and culture of spinal fluid. Treatment involves antibiotics and supportive care. Vaccines can help prevent certain bacterial types. Complications may include neurological deficits if not treated promptly.
This document summarizes dehydration in children. It defines dehydration as a loss of fluid from the extracellular space at a rate exceeding intake. Children are more susceptible to dehydration due to their higher body water content and metabolic rates. Common causes of dehydration in children include viral and bacterial infections causing vomiting and diarrhea. Signs of dehydration include sunken eyes, decreased urination, and irritability. Treatment depends on the severity of dehydration and includes oral rehydration for mild to moderate cases and intravenous fluids for severe cases. Care must be taken with hyponatremic and hypernatremic dehydration to slowly correct electrolyte imbalances.
This power-point includes content on brief introduction and classification & management of pneumonia based on Integrated Management of Neonatal & Childhood Illness (IMNCI).
This document discusses seizures in children, including febrile seizures. It defines seizures and different types, like generalized seizures and focal seizures. It covers the epidemiology, causes, clinical presentation and diagnosis of seizures. Complications, both acute and chronic, are outlined. Investigations and management approaches are also summarized. The document focuses in particular on febrile seizures, their definition, causes, types, evaluation and treatment in children presenting with fever and seizures.
This document provides an overview of pediatric poisoning for emergency medical providers. It reviews the initial assessment and management of pediatric ingestions, focusing on activated charcoal, whole bowel irrigation, and enhancing excretion to prevent absorption. Common ingestions like acetaminophen, alcohols, and antihistamines are discussed. The document also addresses caustic ingestions and emphasizes supportive care and avoiding interventions that could worsen injury.
Here are the steps to calculate fluid and electrolyte deficits and replacement for this infant:
1. Percent dehydration = (Pre-illness weight - Current weight) / Pre-illness weight x 100 = (7kg - 6.3kg) / 7kg x 100 = 10%
2. Fluid deficit = Percent dehydration x Pre-illness weight = 10% x 7kg = 0.7L
3. Na+ deficit = Fluid deficit x Proportion from ECF x Na+ concentration in ECF
= 0.7L x 0.6 x 145 mEq/L = 72.6 mEq
4. K+ deficit = Fluid deficit x Pro
1. Diarrhea is a common disease in childhood that can be caused by infections, non-infectious factors, or a combination of both. Infectious causes include viruses like rotavirus and bacteria like E. coli, while non-infectious causes include improper diet, weather factors, and feeding issues.
2. The pathogenesis of infectious diarrhea involves mechanisms like enterotoxins produced by bacteria that increase intestinal fluid secretion, or viruses and bacteria that directly invade and damage the intestinal mucosa. This leads to reduced nutrient absorption and an osmotic diarrhea.
3. Clinical manifestations of diarrhea range from mild cases involving changes in stool frequency and consistency, to more severe cases accompanied by dehydration
Pediatrics notes about "Pediatric Drowning". These notes were published in 2018.
You can download them from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
A Child with Vomiting (problem based approach)Sariu Ali
This document discusses the causes, evaluation, and management of vomiting in children. It begins by distinguishing vomiting from regurgitation and describes the physiology and control of vomiting. It then discusses obtaining a thorough history, including details on the vomiting episodes, associated symptoms, past medical history, and physical examination findings. The document outlines potential investigations that may be guided by the history and examination, including blood tests, imaging studies, and other tests. It concludes by stating that management involves rehydration, correcting electrolyte imbalances, encouraging oral intake, and treating any underlying causes.
This document provides information on assessing and treating dehydration in children. It defines dehydration as an excess loss of water and body fluids, and lists various causes including gastroenteritis, fever, burns and more. It describes methods for assessing dehydration severity based on weight loss, clinical signs/symptoms, and skin pinch test. Mild dehydration shows thirst and sunken eyes; moderate shows lethargy and poor drinking; severe shows collapse and sunken fontanel. Oral rehydration solution is given as treatment, with recipes provided for making solutions with salt, sugar and water.
Dysentery refers to the presence of blood in stool and is caused by bacterial or amoebic infection of the colon. Common bacterial causes include Shigella, E. coli, and Salmonella, while Entamoeba histolytica is the primary amoebic cause. Symptoms include fever, diarrhea that progresses from watery to bloody and mucousy, abdominal discomfort and pain, and tenesmus. Complications can include dehydration, electrolyte imbalances, and intestinal perforation. Treatment involves oral rehydration, continuation of diet, zinc supplementation, and antibiotics such as ciprofloxacin or metronidazole depending on the causative organism.
This document provides information on acute gastroenteritis in children. It defines acute diarrhea as the passage of loose or watery stools three or more times in a 24 hour period for up to 14 days. It notes that diarrhea is a leading cause of death among children under 5 years old globally and in India. The document discusses the causes, clinical presentation, assessment and management of acute diarrhea including use of oral rehydration solution and zinc supplementation. It also covers prevention of diarrhea and malnutrition in children.
This document discusses acute gastroenteritis (AGE), also known as infectious diarrhea, in pediatric patients. It defines AGE and different types of diarrhea such as acute, chronic, and intractable. The most common causes of AGE in children are rotavirus, Salmonella, Campylobacter, and other bacterial, viral, and parasitic pathogens. Signs and symptoms include diarrhea, vomiting, fever, and dehydration. Treatment involves oral rehydration, monitoring for dehydration, and nutritional support. Nursing care focuses on fluid and electrolyte management, preventing spread of infection, and supporting nutrition.
Fever is a common reason children see doctors and causes concern for parents. A fever is defined as a temperature over 37.2°C before noon or 37.7°C after noon. Fever occurs due to infection, inflammation or injury and raises the hypothalamic temperature set point. While sometimes indicating a minor self-limiting infection, fever can also signal a serious disorder. The document discusses evaluating fever, defining related terms like bacteremia and sepsis, the pathophysiology of fever production, and methods for safely measuring a child's temperature.
Acute diarrhea is defined as sudden onset of loose or watery stools lasting less than 14 days. It is a major cause of death in children worldwide. Rotavirus is a leading cause of acute diarrhea in infants and young children. Management involves oral rehydration therapy based on the degree of dehydration. For mild dehydration, oral rehydration solution is given at home. Moderate dehydration is treated with oral and/or intravenous fluids in a healthcare setting. Severe dehydration requires intravenous fluids in a hospital. Early feeding and zinc supplementation are also recommended. Antibiotics may be used in certain infections but are not routinely recommended.
This document discusses chronic diarrhea, defining it as diarrhea lasting more than 2 weeks. It outlines different types of diarrhea based on duration, including acute (<2 weeks), prolonged (7-14 days), and persistent (>14 weeks). The causes of chronic diarrhea are discussed for different age groups, including post-gastrointestinal infections, cow's milk protein intolerance, and celiac disease in infants. Pathophysiological causes of chronic diarrhea include secretory, osmotic, steatorrheal, inflammatory, and dysmotility mechanisms. The importance of a thorough history and physical exam is emphasized to guide diagnostic testing and treatment approaches, which may be curative, suppressive, or empirical depending on the underlying cause.
This document provides an overview of the approach to chronic diarrhea. It defines chronic diarrhea as diarrhea lasting over 2-3 weeks and discusses etiology, risk factors, symptoms, examination findings, diagnostic workup and management. The diagnostic workup involves screening tests, intestinal function tests, biopsy and special investigations. Management includes supportive measures, identifying and treating the underlying cause, elimination diets and nutritional rehabilitation. Prevention focuses on improved nutrition, hygiene, breastfeeding and access to clean water.
Drowning occurs when a person experiences respiratory impairment from submersion or immersion in liquid. There are several types of drowning including wet, dry, secondary, and immersion syndrome. The pathophysiology involves hypoxemia, hypothermia, and fluid and electrolyte disturbances depending on if the drowning occurred in freshwater versus saltwater. Management at the scene focuses on airway, breathing, circulation and rapid removal from the water. Prognosis depends on the extent of cerebral hypoxia and injury, time to resuscitation, and need for continued resuscitation efforts.
This document summarizes information on several types of pediatric poisonings including paracetamol, iron, ethanol, methanol, and ethylene glycol. It describes the pathophysiology, signs and symptoms, toxicity levels, and treatment approaches for each type of poisoning. The key points are that paracetamol is metabolized by the liver and can cause liver damage/failure in overdose. Iron toxicity causes gastrointestinal and liver damage. Ethanol intoxication affects the central nervous system, liver, and metabolism. Methanol and ethylene glycol are metabolized to toxic compounds that can cause blindness, acidosis, and kidney damage. Activated charcoal and decontamination are not effective for methanol, while hemodial
Management and complications of acute diarrhea in childrenRITURAJANMBBS
This document provides information on the management and complications of acute diarrhea. It discusses assessing patients with acute diarrhea by determining the type, examining for dehydration and complications, and assessing nutrition. It also covers taking a relevant history, examining the patient, assessing hydration status, laboratory investigations to identify the etiological organism, stool examination, and management including oral rehydration therapy. The management is based on rehydration, correcting electrolyte imbalance, ensuring adequate feeding and supplementation with zinc.
Trophic feeding, by dr Amal Ahmed Khalil ,Port Said University, mohamed osama hussein
Trophic feeding is the practice of feeding small volume of enteral feeds in order to stimulate the development of the immature gastrointestinal tract of the preterm infant. This practice has also been termed as minimal enteral nutrition (MEN).
This document summarizes meningitis in children, including the definition, causes, signs and symptoms, diagnosis, treatment, and prevention. Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. It most commonly affects infants and children under 5 years old. Bacteria such as pneumococcus, meningococcus, and H. influenzae are common causes. Signs include fever, headache, neck stiffness, and altered mental status. Diagnosis involves lumbar puncture and culture of spinal fluid. Treatment involves antibiotics and supportive care. Vaccines can help prevent certain bacterial types. Complications may include neurological deficits if not treated promptly.
This document summarizes dehydration in children. It defines dehydration as a loss of fluid from the extracellular space at a rate exceeding intake. Children are more susceptible to dehydration due to their higher body water content and metabolic rates. Common causes of dehydration in children include viral and bacterial infections causing vomiting and diarrhea. Signs of dehydration include sunken eyes, decreased urination, and irritability. Treatment depends on the severity of dehydration and includes oral rehydration for mild to moderate cases and intravenous fluids for severe cases. Care must be taken with hyponatremic and hypernatremic dehydration to slowly correct electrolyte imbalances.
This power-point includes content on brief introduction and classification & management of pneumonia based on Integrated Management of Neonatal & Childhood Illness (IMNCI).
This document discusses seizures in children, including febrile seizures. It defines seizures and different types, like generalized seizures and focal seizures. It covers the epidemiology, causes, clinical presentation and diagnosis of seizures. Complications, both acute and chronic, are outlined. Investigations and management approaches are also summarized. The document focuses in particular on febrile seizures, their definition, causes, types, evaluation and treatment in children presenting with fever and seizures.
This document provides an overview of pediatric poisoning for emergency medical providers. It reviews the initial assessment and management of pediatric ingestions, focusing on activated charcoal, whole bowel irrigation, and enhancing excretion to prevent absorption. Common ingestions like acetaminophen, alcohols, and antihistamines are discussed. The document also addresses caustic ingestions and emphasizes supportive care and avoiding interventions that could worsen injury.
Here are the steps to calculate fluid and electrolyte deficits and replacement for this infant:
1. Percent dehydration = (Pre-illness weight - Current weight) / Pre-illness weight x 100 = (7kg - 6.3kg) / 7kg x 100 = 10%
2. Fluid deficit = Percent dehydration x Pre-illness weight = 10% x 7kg = 0.7L
3. Na+ deficit = Fluid deficit x Proportion from ECF x Na+ concentration in ECF
= 0.7L x 0.6 x 145 mEq/L = 72.6 mEq
4. K+ deficit = Fluid deficit x Pro
1. Diarrhea is a common disease in childhood that can be caused by infections, non-infectious factors, or a combination of both. Infectious causes include viruses like rotavirus and bacteria like E. coli, while non-infectious causes include improper diet, weather factors, and feeding issues.
2. The pathogenesis of infectious diarrhea involves mechanisms like enterotoxins produced by bacteria that increase intestinal fluid secretion, or viruses and bacteria that directly invade and damage the intestinal mucosa. This leads to reduced nutrient absorption and an osmotic diarrhea.
3. Clinical manifestations of diarrhea range from mild cases involving changes in stool frequency and consistency, to more severe cases accompanied by dehydration
Pediatrics notes about "Pediatric Drowning". These notes were published in 2018.
You can download them from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
A Child with Vomiting (problem based approach)Sariu Ali
This document discusses the causes, evaluation, and management of vomiting in children. It begins by distinguishing vomiting from regurgitation and describes the physiology and control of vomiting. It then discusses obtaining a thorough history, including details on the vomiting episodes, associated symptoms, past medical history, and physical examination findings. The document outlines potential investigations that may be guided by the history and examination, including blood tests, imaging studies, and other tests. It concludes by stating that management involves rehydration, correcting electrolyte imbalances, encouraging oral intake, and treating any underlying causes.
This document provides information on assessing and treating dehydration in children. It defines dehydration as an excess loss of water and body fluids, and lists various causes including gastroenteritis, fever, burns and more. It describes methods for assessing dehydration severity based on weight loss, clinical signs/symptoms, and skin pinch test. Mild dehydration shows thirst and sunken eyes; moderate shows lethargy and poor drinking; severe shows collapse and sunken fontanel. Oral rehydration solution is given as treatment, with recipes provided for making solutions with salt, sugar and water.
Dysentery refers to the presence of blood in stool and is caused by bacterial or amoebic infection of the colon. Common bacterial causes include Shigella, E. coli, and Salmonella, while Entamoeba histolytica is the primary amoebic cause. Symptoms include fever, diarrhea that progresses from watery to bloody and mucousy, abdominal discomfort and pain, and tenesmus. Complications can include dehydration, electrolyte imbalances, and intestinal perforation. Treatment involves oral rehydration, continuation of diet, zinc supplementation, and antibiotics such as ciprofloxacin or metronidazole depending on the causative organism.
This document provides information on acute gastroenteritis in children. It defines acute diarrhea as the passage of loose or watery stools three or more times in a 24 hour period for up to 14 days. It notes that diarrhea is a leading cause of death among children under 5 years old globally and in India. The document discusses the causes, clinical presentation, assessment and management of acute diarrhea including use of oral rehydration solution and zinc supplementation. It also covers prevention of diarrhea and malnutrition in children.
This document discusses acute gastroenteritis (AGE), also known as infectious diarrhea, in pediatric patients. It defines AGE and different types of diarrhea such as acute, chronic, and intractable. The most common causes of AGE in children are rotavirus, Salmonella, Campylobacter, and other bacterial, viral, and parasitic pathogens. Signs and symptoms include diarrhea, vomiting, fever, and dehydration. Treatment involves oral rehydration, monitoring for dehydration, and nutritional support. Nursing care focuses on fluid and electrolyte management, preventing spread of infection, and supporting nutrition.
Fever is a common reason children see doctors and causes concern for parents. A fever is defined as a temperature over 37.2°C before noon or 37.7°C after noon. Fever occurs due to infection, inflammation or injury and raises the hypothalamic temperature set point. While sometimes indicating a minor self-limiting infection, fever can also signal a serious disorder. The document discusses evaluating fever, defining related terms like bacteremia and sepsis, the pathophysiology of fever production, and methods for safely measuring a child's temperature.
Acute diarrhea is defined as sudden onset of loose or watery stools lasting less than 14 days. It is a major cause of death in children worldwide. Rotavirus is a leading cause of acute diarrhea in infants and young children. Management involves oral rehydration therapy based on the degree of dehydration. For mild dehydration, oral rehydration solution is given at home. Moderate dehydration is treated with oral and/or intravenous fluids in a healthcare setting. Severe dehydration requires intravenous fluids in a hospital. Early feeding and zinc supplementation are also recommended. Antibiotics may be used in certain infections but are not routinely recommended.
This document provides information on acute pediatric gastroenteritis. It defines gastroenteritis and discusses its main causes such as rotavirus, norovirus, and various bacteria. Signs and symptoms include diarrhea, vomiting, fever and dehydration. Management involves oral rehydration with WHO oral rehydration solution. For severe dehydration, intravenous fluids are used. Antibiotics generally are not needed unless for specific infections. Probiotics and zinc supplementation may shorten the duration of diarrhea.
This document provides information on the management of acute diarrhea in children. It defines acute diarrhea and dysentery. The most common causes are viral, bacterial, and parasitic infections acquired through the fecal-oral route. Rotavirus is the leading cause and can cause dehydration. Signs and symptoms include diarrhea, vomiting, fever and abdominal pain. Complications include dehydration, electrolyte disturbances, and malnutrition. Management involves fluid resuscitation, continued feeding, zinc and vitamin A supplementation, and antibiotics for bacterial infections. Close monitoring of hydration and electrolytes is important.
Diarrhea is defined as an increase in stool frequency or liquidity. For infants it is considered diarrhea if there are more than 3 watery stools per day, while for older children it is 3 or more loose stools per day. The causes of diarrhea include viral, bacterial, and parasitic infections. Rotavirus is the most common cause of acute diarrhea in children. Treatment involves oral rehydration with solutions like ORS as well as continued feeding. For some cases antibiotics or zinc may be used. Prevention strategies include vaccines, handwashing, safe water, and breastfeeding.
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.
This document provides information on gastrointestinal disorders in children. It begins with an introduction to common GI problems in children such as diarrhea, gastroesophageal reflux, hepatitis, and malnutrition. It then discusses specific conditions in more detail, including the definition, causes, symptoms, and treatment of diarrhea. Nursing management of diarrhea is also outlined, focusing on restoring fluid balance, preventing spread of infection, and health education. The document concludes with a discussion of prognosis and references a research study on risk factors for dehydrating diarrhea in infants.
This document provides an overview of acute diarrhea in children, including definitions, epidemiology, causes, pathophysiology, signs and symptoms, complications, diagnosis, and management. It discusses the major infectious causes of diarrhea like rotavirus. It outlines the approach to assessing dehydration and managing rehydration. Complications are addressed. Differential diagnosis and management of specific cases like dysentery are also covered. Nutritional support and prevention strategies are highlighted. Key references on the topic are provided.
This document discusses the causes, types, symptoms, diagnosis and management of diarrhea. It outlines the various infectious and non-infectious causes including bacterial, viral and parasitic pathogens. The pathophysiology involves increased secretion and decreased absorption. Diagnosis involves history, physical exam, stool tests and other investigations. Management focuses on fluid replacement with oral rehydration solution and intravenous fluids as needed. Antibiotics are used for invasive bacterial causes while ensuring adequate nutrition is also important.
Diarrheal disease is one of the most common illnesses among children in developing countries, causing millions of deaths annually. It is usually transmitted through the fecal-oral route. Common causes include rotavirus, E. coli, cryptosporidium, and campylobacter. Symptoms include watery diarrhea, dysentery, and persistent diarrhea. Complications can include dehydration, malnutrition, and even death. Treatment involves oral rehydration, continued feeding, and zinc supplementation. Dehydration is classified as none, some, or severe. Rehydration management differs based on the dehydration classification and involves oral rehydration solution or intravenous fluids. Prevention emphasizes nutrition, immunization, hygiene,
- Acute gastroenteritis (AGE) is a common condition in children that causes diarrhea and vomiting. It is usually caused by viruses like rotavirus. While causative agents do not change management, evaluation focuses on differentiating AGE from other potential causes and assessing dehydration severity. Management involves oral rehydration for mild cases and intravenous fluids for moderate to severe dehydration to correct fluid and electrolyte losses. Antibiotics are not routinely used while oral medications like racecadotril and ondansetron may assist rehydration in some cases. Close monitoring is important to watch for complications or need for further treatment.
10. ac. diarrhoea, vomiting & rec abd painWhiteraven68
Diarrhea is defined as 3 or more loose stools per day. It is a major cause of morbidity and mortality in children in developing countries. There are different types of diarrhea including acute and chronic. Common causes of acute diarrhea include gastroenteritis, food poisoning, and antibiotics. Chronic diarrhea has causes such as lactose intolerance and inflammatory bowel disease. Assessment of diarrhea involves history, physical exam, and testing to identify dehydration and the underlying cause. Management depends on the degree of dehydration and may include oral rehydration, IV fluids, and antibiotics for severe cases.
Diarrhoea is defined as having three or more loose or liquid stools per day. Worldwide, approximately 2.5 billion cases of diarrhea occur each year resulting in 1.5 million child deaths. Rotavirus is the most common cause of diarrhoea in children under 5. Diarrhoea can be acute lasting less than 14 days or chronic lasting more than 14 days. Management involves oral rehydration therapy with increased fluids for mild cases or IV fluids for severe cases. Education of mothers on prevention through hygiene and sanitation is important to reduce incidence of diarrhoea.
Acute gastroenteritis and fluid managementProfMaila
This document provides guidelines for the management of acute gastroenteritis and fluid replacement. It discusses the epidemiology, causes, signs and symptoms, and pathophysiology of acute gastroenteritis. Management involves treating dehydration and fluid/electrolyte imbalances. For dehydration, oral rehydration solution is recommended. Fluid replacement is based on the degree of dehydration. Ongoing losses must be replaced. Zinc and vitamin A can help reduce severity and duration. Electrolyte abnormalities like hypokalemia are also addressed.
This document presents a case study of a 7-month-old girl with severe dehydration due to diarrhea and vomiting. The child shows several signs of severe dehydration including lethargy, depressed fontanelles, and capillary refill time over 4 seconds. Severe dehydration is estimated at over 10% body weight loss. Management of severe dehydration involves rapid intravenous rehydration to replace fluid deficit and ongoing losses, followed by monitoring for complications like overhydration or electrolyte imbalances. Proper treatment of dehydration is important to reduce morbidity and mortality in infants and children.
1. The document discusses watery diarrhea, its causes, clinical features, assessment, management, treatment, prevention and complications. 2. The main causes listed are Vibrio cholerae, ETEC, food poisoning and viruses. Clinical features include rice water stools and phases of evacuation, collapse and recovery. 3. Management involves assessing and treating dehydration with oral rehydration solution or intravenous fluids, administering antibiotics like doxycycline or tetracycline, and preventing complications and further spread through sanitation and hygiene practices.
1. Diarrhoeal diseases are caused by a variety of pathogens including bacteria, viruses, and parasites. They result in infections of the gastrointestinal tract known as gastroenteritis. Common symptoms include watery or bloody diarrhea.
2. Diarrhea is defined as 3 or more loose stools in a 24 hour period and is a major cause of mortality in young children in developing countries, resulting in dehydration.
3. Treatment involves oral or intravenous rehydration depending on the severity of dehydration. Additional treatments include continued feeding, zinc supplementation, and antibiotics in cases of invasive bacteria.
presentation.presentation slides by ptxyakemichael
This document discusses diarrhea and vomiting in pediatric patients. It begins by defining diarrhea and vomiting and listing learning objectives. It then covers etiology, risk factors, clinical manifestations, complications, medical management including rehydration therapy, nursing management, and preventative measures for diarrhea. For vomiting, it defines vomiting, discusses physiology and causes. It also covers differential diagnosis and clinical manifestations of vomiting and red flag symptoms. Diagnostic evaluation for acute vomiting is also mentioned.
APPROACH TO A CHILD WITH CHRONIC DIARRHEA.pptxArijit Bhowmik
1) Diarrhea is defined as increased stool output or stool water content. Chronic diarrhea lasts longer than 2 weeks. It results from altered intestinal water and electrolyte transport.
2) The main pathophysiologic mechanisms of diarrhea include osmotic diarrhea caused by unabsorbed solutes, secretory diarrhea caused by toxins or hormones activating chloride secretion, and other causes like mutations, reduced surface area, or altered motility.
3) Evaluation of chronic diarrhea involves phases including history, physical exam, stool/blood tests, endoscopy, and hormonal studies. Management depends on identified causes but often includes rehydration, nutritional support, antibiotics, and addressing any underlying conditions.
Acute gastroenteritis is characterized by changes in stool frequency and consistency lasting less than 14 days. It is commonly caused by viruses, bacteria, and parasites. Treatment involves oral rehydration with solutions like ORS to prevent and treat dehydration. Antimicrobial therapy may be given for specific bacterial infections when indicated. Proper management focuses on rehydration and nutrition while symptoms resolve.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. DR. VIRENDRA KUMAR GUPTA
ASSISTANT PROFESSOR
Department Of Pediatric Gastroentero-hepatology & Liver
Transplantation
NIMS MEDICAL COLLEGE & HOSPITAL ,
JAIPUR
APPROACH TO
DIARRHEA
4. DIARRHOEA
Diarrhoea defined as excessive loss of fluid and electrolyte in
stool.
For infants stool output >10 ml/kg/24 hr and >200g/24hr for
older children.
When there is an in frequency, volume or liquidity ( Recent
change in consistency) of the bowel movement relative to the
usual habit of each individual
Nelson Textbook of Pediatrics, 20th ed
5. DEFINITIONS
• Acute diarrhea
Duration <2 wks, usually of infectious origin
• Prolonged diarrhea
Diarrhea of duration 7-14 days of presumed infectious etiology. It
may be an indicator for children with a high risk of progression to
Persistent diarrhea
• Chronic diarrhea
Diarrhea of more than 2 weeks duration.
• Dysentry
Bloody diarrhea, visible blood and mucus present.
Nelson Textbook of Pediatrics, 20th ed
6. Persistent diarrhea
Persistent diarrhea (PD) is an episode of diarrhea of presumed
infectious etiology, which starts acutely but lasts for more than 14
days, and excludes chronic or recurrent diarrheal disorders such as
tropical sprue, gluten sensitive enteropathy or other hereditary
disorders [WHO] (INDIAN PEDIATRICS, JAN 2011)
passage of >=3 watery stools per day for >2 weeks in a child who
either fails to gain weight or loses weight.(ESPGHAN)
7. WHAT IS NOT A DIARRHOEA?
1.Frequent formed stools
2.Pasty stools in breastfed child
3.Stools during or after feeding
4.PSEUDODIARRHOEA:Small volume of stool frequently
(IBS)
20. Treat Diarrhea at Home.
4 Rules of Home Treatment:
GIVE EXTRA FLUID
CONTINUE FEEDING
WHEN TO RETURN [ADVICE TO
MOTHER]
GIVE ORAL ZINC FOR 14 DAYS
PLAN – A
21. TELL THE MOTHER:
Breastfeed frequently and for longer at each feed
If exclusively breastfeed give ORS for replacement of stool
losses
If not exclusively breastfed, give one or more of the
following:
ORS, food- based fluid (such as soup, rice water,
coconut water and yogurt drinks), or clean water.
TEACH THE MOTHER HOW TO MIX AND GIVE
O.R.S
AMOUNT OF FLUID TO GIVE IN ADDITION TO THE
USUAL FLUID INTAKE:
Up to 2 years:
2 years or more:
50 to 100 ml after each loose stool.
100 to 200 ml after each loose stool.
Give extra fluid
22. Continue usual feeding, which the child was
taking before becoming sick 3-4 times
(6 times)
Up to 6 months of age:
Exclusive Breast feeding
6 months to 12 months of age:
add Complementary Feeding
12 months and above:
Family Food
Continue feeding
23. Advise mother to return immediately if
the child has any of these signs:
Not able to drink or breastfeed or drinks poorly
Becomes sicker
Develops a fever
Blood in stool
[IF IT WAS NOT THERE EARLIER]
When to Return
[Advice to mother]
24. Plan-B is carried out at ORT Corner in
OPD/ clinic/ PHC
Treat ‘some’ dehydration with ORS (50-
100 ml/kg
Give 75 ml/kg of ORS in first 4 hours
If the child wants more, give more
After 4 hours:
PLAN – B
25. PLAN -C
Signs of sever dehydration
Child not improving after 4 hours
Refer to higher center –give ORS on way /keep
warm /BF
When child comes back follow up as other children
26. Start I. V. Fluid immediately
Give 100 ml/ kg of Ringer’s Lactate
Age First give
30ml/ kg
in
Then give
70 ml/ kg
in
1 hour 5 hours
Under 12
months
12 months and
older
½ hour 2½ hour
PLAN – C
27. Fluid therapy in severe
dehydration
Use intravenous or intraosseus route
Ringers Lactate with 5% dextrose or ½ normal saline with 5% dextrose at
15 ml/kg/hour for the first hour
* do not use 5% dextrose alone
Continue monitoring every 5-10 min.
Assess after 1 hour
If no improvement or
worsening
Consider septic
shock
If improvement(pulse
slows/faster capillary refill
/increase in blood pressure)
Consider severe dehydration with
shock
Repeat Ringers Lactate 15 ml/kg
over 1 h
Switch to ORS 5-10ml/kg/hr orally
or by nasogastric tube for up to
10 hrs
29. Safe & effective
Can alone successfully rehydrate 95-97% patients
with diarrhea,
Reduces hospital case fatality rates by 40 - 50%
Cost saving
Reduces hospital admission rates by 50% and
cost of treatment by 90%
BUT
30. > 50% Goa, Himachal, Meghalaya, Tripura,
Manipur
West Bengal, J&K, Mizo,
> 40%
Chhattisgarh
> 20% Bihar, Orissa, Uttaranchal,
Punjab, Gujarat, MP, Southern States
< 20%
Jharkhand,
Rajasthan, UP, Assam,
Nagaland
Recent NFHS 3 data
ORS use rates are dismally low in some
regions
31. STANDARD ORS SOLUTION LOW
OSMOLARITY ORS
(MEQ OR MMOL/L)
GLUCOSE 111 75
SODIUM 90 75
CHLORIDE 80
POTASSIUM 20
65
20
CITRATE 10 10
OSMOLARITY 311 245
Composition of standard and low
osmolarity ORS solutions
32. LAB.EVALUATION AND IMAGING
STOOL CULTURE- salmonella
shigella
yersinia
campylobacter
pathogenic E.coli-serotyping
RAPID STOOL TEST: for inflammatory markers
Hematological tests: white blood cell band count >100/mm3.
C-reactive protein cut point of >12 milligrams/dl
Biochemical tests: BUN
Ser.bicarbonate <17 mEq/L
GRBS
USG
33.
34. TREATMENT
ANTIEMETIC-Ondansetron 0.5mg/kg/dose
NO ANTIMOTILITY MEDICATION :
Diarrhea may function as an evolved expulsion
defense mechanism
Can cause HUS in EHEC infection.
ADSORBANTS AND ANTISECRETORY AGENTS:
Bismuth – inc.salicylate levels
PROBIOTICS - Lactobacillus GG and
Saccharomyces boulardii
ANTIBIOTICS FOR A/C GE
41. HISTORY TAKING
What is the complaint
Onset – sudden? Gradual?
Duration
Stool- frequency, consistency, volume, presence of blood or mucus, pain
Relation to particular food stuff
Fever
Abdominal pain – peri-umblical? Left lower quadrant?
Features of any systemic diseases
History of weight loss
Any known systemic disease
Food taken & History of gastroenteritis in others sharing same food
history of food allergy/ abdominal surgery
42. HISTORY
Confirm this is diarrhea (compare with usual habit of child )
Onset acute or insidious – infectious, acute secretory diarrhea
Age of onset
Neonatal – lactose intolerance, congenital diarrhea
- Cow milk protein intolerance
Early childhood- Celiac disease
late childhood - IBD, IBS
Duration of symptom
Does the child have weight loss or failure to gain weight- malabsorption,
pancreatic enzyme insufficiency
43. Nature of diarrhea
Urine like stool- Congenital chloride diarrhea
- Microvillus inclusion disease
Explosive watery diarrhea - Carbohydrate malabsorption
Loose bulky stool - Celiac disease
Pasty and yellowish offensive – Exocrine pancreatic insufficiency
Fatty, floating stools- Malabsorption syndromes
Blood, pus, mucous- chronic inflammatory diarrhea
Relation with diet/ dietary history
Carbonated drink and fruit juice – Chronic non specific diarrhea
Sucrose diet – sucrose intolerance
Wheat diet – Celiac disease
Fatty diet – Pancreatic insufficiency
Milk – Lactose intolerance, Cow milk protein intolerance
HISTORY
44. HISTORY
Abdominal pain – IBD, IBS
Patient undergo abdominal surgery – Short gut or bacterial over growth
syndrome
Fever, red eye, oral ulcer – IBD
Arthritis – IBD, Whipple disease
Drug history – Laxative (Factitious diarrhea)
Recurrent respiratory and skin infection - immunodeficiency, Cystic fibrosis
Family history of food allergy, asthma or allergic rhinitis.
Family history of celiac disease, crohn’s disease, cystic fibrosis
Prolonged use of antibiotic, pseudomembranous colitis
45. PHYSICAL EXAMINATION
Level of hydration
Look for tongue
Sunken eyes
Skin turger
Temperature, Blood pressure, Pulse rate, rr
Pallor
features of malnourishment -Anthropometry ,Loss of subcutaneous fat,
Muscle wasting, Loose skin appearance
Abdominal tenderness
Features of liver / pancreatic disease
Other features of relevant systemic diseases
46. Abdominal distension – Gas - due to bacteria
– Ascites – protein loss
Oedema – Protein lossing enteropathy
Clubbing – Coeliac diseae, cystic fibrosis
Perianal excoriation – carbohydrate malabsorption
Perianal and circumoral rash – acrodermatitis enteropathica
Hepatosplenomegaly with lymphadenopathy – HIV
Oral thrush – Immunodeficiency
Features of associated vitamin deficiencies
Glossitis, Cheilosis, Stomatitis, Vit B deficiency
Peripheral neuropathy - Vit B12and Thiamine deficiency
Ricketic change, osteomalacia, easy fracture – vit. D and Ca deficiency
Koilonychia – Iron deficiency
47. EXAMINATION- NUTRITION,
Anthropometry
CAUSE
Anemia, bitot spots
aphthous ulcers,
bleeding gums, tongue goitre
Lymp
h
nodes
clubbing
Hyperpigmentation skin, pyoderma,
dermatitis herpetiformis
Rickets
Pedal edema
Wasting, loss of s/c fat
Hepatomegaly, Bowel
sounds, distension, perianal
& rectal o/e
arthritis
flushin
g
49. Stool examination-
Take liquid contents
Stored in refrigerator
colonic inflammation
Blood or mucus
Microscopic examination- >20 wbc/hpf
Fecal calprotectin concentration-100ug/gm stool
PH <5 .5 & presence of reducing substance – carbohydrate malabsorption
Stool electrolytes and osmolality - Secretory diarrhea
Microscopy for ova and parasite- in endemic areas
Acid fast staining
Cryptosporidium/cyclospora
Stool culture- dysentry, fecal leucocytes +, HUS, immunocompromised
children.
50. FAT MALABSORPTION TESTS
1. STOOL FOR FAT GLOBULES
Qualitative test
Rapid and inexpensive
SudanIII stain- DRUMMEY’S method
Orange fat globule - seen in microscope
<100 globule with diameter <4-8 u / HPF – moderate steatorrhoea
>100 globule with diameter <6-75 u / HPF – severe steatorrhoea
2. 72 hours fat extraction test (quantitative)
“Gold standard”
however cant differentiate between pancreatic and intestinal causes
Before the test, the patient is put on a high fat diet, consuming between 50-150 g/day of fat
for three days. Stool fat is estimated by VAN DE KAMER METHOD.
Steatorrhoea if >15% fat output (<6 mo of age) >7%(>6 mo of age)
Limited use in clinical practice due to issues with
collection/processing
51. 3. Classical steatocrit
Semi-quantitative screening test
Steatocrit >2.1% indicates steatorrhoea of >10gm/d
4. Fat soluble vitamin – Vit. D – Ca, Po4,
Alk PO4,
– Vit K – PT INR
S. carotene- Dietary carotene is the only source and serum level
depends on normal fat absorption.
normal- 100IU/dl
52. CARBOHYDRATE MALABSORPTION TEST
1. D-XYLOSE ABRORPTION TEST
Indicates malabsorption secondary to mucosal dysfunction (proximal small
intestinal- jejunum)
After overnight fasting-Oral load with 25 g D-xylose (adult dose) 5gm(children)
5 hr urine collection done ( atleast 25% excretion <4g/ <15%- abnormal)
1 hr and 2 hr serum samples (normal > 20 mg/dl at 1 hr, > 25 mg/dl at 2hr)
Normal- in pancreatic insufficiency
Abnormal- CD, Tropical sprue, Chron’s disease, pellagra, advanced AIDS
Falsely low- vomiting, gastric stasis, ascites, edema, bacterial overgrowth, impaired
renal functions
Drugs that decrease urinary excretion of D xylose- aspirin, indomethacin,digitalis,
neomicin, opiates.
Almost obsolete test.
53. 2. Breath Hydrogen test
For specific carbohydrate malabsorption and bacterial overgrowth
Overnight fast
Suspected sugar 1-2 gm/kg max. 50 gm given
Not digest or absorb in small intestine
In colon by fermentation hydrogen and carbon dioxide is formed, absorbed
into blood and excreted in breath.
<20 ppm is normal. 20-80 ppm indeterminate. >80ppm- malabsorption.
Unreliable results- smokers, pulmonary disease, hyperventilation.
False negatives- Hydrogen non excretors, antibiotics 2 weeks prior.
54. PROTEIN MALABSORPTION TESTS
Indirect methods
Fecal -1 antitrypsin concentration
normal- 0.8 mg/gm stool.
Protein losing enteropathy- >2.6mg/gm stool
cant be done in < 1 week of age
Hypoalbuminemia
Serum proteins with short half lives can be used as nutritional markers.
Prealbumin(transthyretin)
Somatomedin C
Retinal binding protein
Transferrin
55. TESTS FOR PANCREATIC INSUFFICIENCY
Serum trypsinogen
Fecal chymotrypsin <150 mg/kg in older children
Fecal elastase-1
Gold standard- Direct estimation of bicarbonate (secretin) or
amylase/lipase/trypsin (CCK) after stimulation using either secretin or CCK
or test (Lundh) meal
Limited by availability, invasiveness, expense
Cystic fibrosis is most common cause of exocrine pancreatic insufficiency in
children so a sweat chloride test must be performed.
56. IMAGING STUDIES & ENDOSCOPY
Plain X- ray abdomen
Air fluid levels- ileus, obstruction
Calcification- Chr. Pancreatitis
USG- e/o cholestasis, cirrhosis, thickening of small
bowel – crohn’s disease
Barium contrast small bowel series
Anatomical lesions, transit time
stenosis, decreased folds, segmentation, dilation
CT/MR abdomen
Detect bowel and pancreatic lesions
Small bowel endoscopy with jejunal aspirate and culture,
Colonoscopy
ERCP / MRCP- Detect ductal abnormalities
57. ENDOSCOPY AND SMALL BOWEL BIOPSY
-when SI mucosal disease is suspected
-when d-xylose test is abnormal
Visual assessment
Decreased folds, scalloping, mosaic
pattern, inflammatory changes
58. MANAGEMENT OF CHRONIC DIARRHEA
Nutritional management
Specific treatment
Drugs & probiotics
General supportive treatment
59. • acrodermatitis
• Spontaneous improvement with nutritional rehabilitation
seen in- Secondary lactose intolerance, short bowel
syndrome
• Nutritional support is an essential component of long term
management of other disorders with chronic diarrhea and
malabsorption- Pancreatic insufficiency,
abetalipoproteinemia, intestinal lymphangiectasia
• In moderate to severe malnutrition, caloric intake is
progressively increased to >=50% above recommended
dietary allowances.
NUTRITIONAL MANAGEMNT
Definite treatment- celiac disease,
enteropathica
60. o and facilitate
Elemental diets- overcome food intolerance
nutrient absorption
o In case the child cant be fed by oral route, enteral nutrition
may be delivered by nasogastric or gastrostomy tube.
o Continuous enteral nutrition is effective in children with
reduced absorptive function, such as short bowel
syndrome, because it extends the time of nutrient
absorption through the still functional surface area.
o In extreme wasting- parenteral nutrition may be required.
• Supplement with minerals, vitamins esp Zn- promotes ion
absorption, restores epithelial proliferation, stimulates
immune response
63. ANTIBIOTICS
Antimicrobial therapy is required for
• Clostridium difficile enterocolitis
•Giardia- Metronidazole, nitrazoxanide
•Cryptosporidium- Nitrazoxanide
•If bacterial agent is detected- specific antibiotic treatment
Small intestinal bacterial overgrowth- metronidazole with ampicillin or
trimethoprim- sulfamethoxazole.
Emperically given antibiotics in the treatment of associated systemic
infections that are seen in almost 30% to 40% of such children
Oral- Cefixime
Ciprofloxacin
Azithromycin
IV- Cefotaxim
Ceftriaxone
64. PROBIOTICS
• DEFINITION- Live micro-organisms that, when administered in
adequate amounts, confer a health benefit on the host
MECHANISM OF ACTION
65. INDICATIONS:
•Persistent diarrhea: The use of probiotics appear to hold promise as
adjunctive therapy but there is insufficient evidence to recommend their
use. (Cochrane reviews. 2010)
•Chronic diarrhea:
•
•
•
Cl. Difficile associated diarrhea prevention: level B evidence
IBS: level B evidence
IBD: role in UC, no role in CD
66. ANTIMOTILITY DRUGS & ANTISECRETORY DRUGS
Antimotility drug- LOPERAMIDE.
4mg f/b 2 mg (adult dose)
MOA- reduces gastric motility.
not recommended in under 4 yr age
Indications:
•
•
• Chronic diarrhoea in HIV/AIDS- can still be used, with greater emphasis
placed on adjunct therapies [Cochrane Database of Systematic Reviews
2008]
Treatment of diarrhea- predominant IBS [Digestion 2006]
S/E: Abdominal cramps, rashes, paralytic ileus, toxic megacolon
• Antimotility drug- CODEINE
Opium alkaloid
MOA- acts on u receptors and decreases stool frequency by peripheral action
on small intestine and colon.
S/e- nausea, vomiting, dizziness, dependance producing liability is low but
present
67. Enkephalinase inhibitors- RACECADOTRIL
•Decreases intestinal secretion . No
effect on motility
•The advantage over standard opiates
is no rebound constipation or
prolonged intestinal transit time. [GUT
2002]
•INDICATION
Short term treatment of secretory
diarrheas
S/E- nausea, flatulance, drowsiness
enkephalinase
Enkephalins inactive
delta receptors
Decrease c-AMP
Decreases electrolyte
and water secretion
Dose- 1.5 mg/kg TDS
68. Somatostatin analogue- OCTREOTIDE
MOA- reduce intestinal secretion by decreasing gut hormones e.g. VIP and
direct effect, either on the ENS or on the enterocyte itself. [GUT 2002]
Antimotility action
Indications:
•HIV enteropathy
•IBS
•Hormone secreting tumors- VIPoma, carcinoid tumours, and gastrinoma
[Aliment Pharmacol Ther. 2001]
Adrenergic agonist- CLONIDINE
MOA- antisecretory and antimotility effects
Indications:
•Moderate and severe diarrhea-predominant IBS. [Clin Gastroenterol
Hepatol. 2003]
•Short bowel syndrome and high-output proximal jejunostomy that
require chronic parenteral fluid infusion. [J Parenter Enteral Nutr. 2006]
69. ABSORBANTS
Ispaghula / Psyllium
•They contain a natural colloidal mucilage and form a
gelatinous mass by absorbing water.
•They modify the consistency and frequency of stools and
give an impression of improvement without actually
decreasing water or electrolyte loss.
•No good evidence to support the use of bulking agents
(eg, psyllium) or adsorbents (eg, charcoal, kaolin plus
pectin) in chronic diarrhea- . [Aliment Pharmacol Ther. 2001]
•Irritable bowel syndrome – useful in both constipation and
diarrhea phases of IBS and also decrease abdominal pain