2. OBJECTIVES
INTRODUCTION
CAUSES
ETIOPATHOGENESIS
CLINICAL FEATURES AND COMPLICATIONS
DIAGNOSIS
EVALUATION OF DEHYDRATION
TREATMENT
PREVENTION
3. Introduction
common cause of death in developing countries
second most common cause of infant deaths
worldwide.
4. DIARRHOEA
DEFINITION – Passage of watery stools atleast 3 times
in a 24h period.
Recent change in consistency is more important.
5.
6. ETIO-PATHOGENESIS
VIRAL – MC – ROTA, ADENO
OSMOTIC DIARRHOEA
LOSS OF MATURE ABSORPTIVE CELLS
INVADE S.I. MUCOSA
VIRAL - MC
ROTA ADENO
7. SECRETORY DIARRHOEA
ULCERATION – SYNTHESIS OF SECRETAGOGUES
ACUTE INFLAMMATION
INVADE LARGE INTESTINE
BACTERIAL - INVASIVE
SHIGELLA, SALMONELLA, YERSINIA, V.PARAHEMOLYTICUS
8. DECREASE ABSORPTIVE SURFACE
CELL INFLAMMATION, CELL DEATH
ELABORATION OF CYTOTOXIN
BACTERIA - CYTOTOXIC
SHIGELLA,EPEC,V.HEMOLYTICUS,C.DIFFICILE
9. ALTERED SALT AND WATER TRANSPORT
ENTEROTOXIN-INCREASE THE CONC. OF INTRACELLULAR
MEDIATORS
COLONISE SMALL INTESTINE
BACTERIA - TOXIGENIC
SHIGELLA,ETEC,VIBRIO
10. DECREASE INTESTINAL ABSORPTIVE SURFACE
FLATTENING OF MICROVILLI
COLONISE & ADHERE SMALL INTESTINE
BACTERIAL ADHERENTS
EPEC,EHEC
12. CLINICAL FEATURES
BLOODY STOOLS – BACTERIAL ETIOLOGY
HUS
ABDOMINAL PAIN – GE
PERITONEAL SIGNS - APPENDICITIS
13.
14.
15. DIAGNOSIS
ATLEAST 3 STOOLS PER 24H
ASSESSING DEHYDRATION
-H/O NORMAL FLUID INTAKE AND OUT PUT
- PHYSICAL EXAMINATION
- PERCENTAGE OF BODY WT LOSS
19. 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
20. TREATMENT
ORT [ ORS: CH-75mmol/l; Na-75; k-20; Cl-65;
base-10; osmolarity-245m osm/l]
ZINC FORTIFIED-ORS
NO SUBSTITUTES
IV REHYDRATION-only for severe dehydration
REHYDRATION PHASE -Give 50 to 100 mL of
ORS/kg plus additional 10 mL/kg per stool and 2
mL/kg per emesis
BREAST FEEDING
21.
22. I.V. REHYDRATION
START I.V.F IMMEDIATELY IF CHILD IS SEVERELY
DEHYDRATED.
CONSIDER ORS IF CHILD CAN DRINK.
I.V.F :
R.L + 5 % DEXTROSE***
R.L**
N.S.* - can be used
ONLY 5 % DEXTROSE – not effective
23. I.V. REHYDRATION
TARGET : 100 ml /kg
< 1 yr :
30 ml/kg in 1 hour
repeat 30 ml/kg in 1 hour
70 ml/kg in 5 hours
>1 yr :
30 ml/kg in 30 min
repeat 30 ml/kg in 30 min
70 ml/kg in 2 and ½ hrs
24. Start giving ORS if child starts drinking: 5 ml/kg/hr
< 1 year : within 3 to 4 hours
>1 year : within 1 to 2 hours
25. IF UNABLE TO GIVE I.V.FLUIDS:
N.G.TUBE
20 ml/kg/hour
reassess after 1 to 2 hours repeated vomitting/
abdominal distension
no improvement after 3 hours
give the fluids more
Start i.v.fluids as soon as possible slowly
26. 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
27. PREVENTION
Good Hygiene
Vaccines
Prevent global warming
Global warming α food borne infections
α contamination of water
ENRICH – ( December 2011 Bulletin from IAP )