1. DIARRHEA
symp | mang| classifn| all medical aspects
PREPARED BY
MARTIN SHAJI
PHARM D

2. Diarrhea describes loose, watery #stools that occur more frequently
than usual. Diarrhea is something everyone #experiences. Diarrhea
often means more-frequent trips to the toilet and a greater volume of
stool.
In most cases, diarrhea #signs and #symptoms usually last a couple of
days. But sometimes diarrhea can last for weeks. In these #situations,
diarrhea can be a sign of a #serious #disorder, such as #inflammatory
#bowel #disease, or a less serious #condition, such as #irritable bowel
#syndrome.
Introduction

3. SUMMARY
Introduction
Definition
Epidemiology
Aetiology / causes
Types / classification
Pathogenesis
Signs and symptoms
When to see a doctor
High risk groups
Test and diagnosis
Complications
Algorithm
Prevention
Conclusion

4. Definition | Classification
• Stool weight more than 200 g/ day
• Classification-
Acute - < 2 weeks-
Persistent- z to 4 weeks-
Chronic- > weeks
Diarrhea is loose, watery stools (bowel movements). You have diarrhea
if you have loose stools three or more times in one day. Acute diarrhea
is diarrhea that lasts a short time. It is a common problem

5. Epidemiology
Annual incidence of diarrheal disease episodes in children less than
five years old in developing countries thus stands at 2 billion
diarrheal episodes globally with a median incidence rate of 3.2
episodes per child.
community based studies the ratio between male children under
five to female children under five suffering from acute diarrhea in
1.2 and 1.4 respectively. It is however important to note that
some countries (e.g., in South Asia) have greater care seeking for
boys than girls

6. • Two common conditions associated with passage of stools
<200g/day
1.Pseudo diarrhea
2.Fecal incontinence

7. CAUSES
Diarrhea occurs when the food and fluids you ingest pass too
quickly or in too large an amount — or both — through your colon.
Normally, your colon absorbs liquids from the food you eat, leaving
a semisolid stool. But if the liquids from the foods you eat aren't
absorbed, the result is a watery bowel movement.

8. A number of diseases and conditions can cause diarrhea. Common
causes of diarrhea include:
Viruses. Viruses that can cause diarrhea include Norwalk virus,
cytomegalovirus and viral hepatitis. Rotavirus is a common cause of
acute childhood diarrhea.
Bacteria and parasites. Contaminated food or water can transmit
bacteria and parasites to your body. Parasites such as Giardia
lamblia and cryptosporidium can cause diarrhea.

9. Common bacterial causes of diarrhea include campylobacter,
salmonella, shigella and Escherichia coli. Diarrhea caused by bacteria
and parasites can be common when traveling in developing countries
and is often called traveler's diarrhea.
Medications. Many medications can cause diarrhea. The most
common are antibiotics. Antibiotics destroy both good and bad
bacteria, which can disturb the natural balance of bacteria in your
intestines. This disturbance sometimes leads to an infection with
bacteria called Clostridium difficile, which also can cause diarrhea.

10. Lactose intolerance. Lactose is a sugar found in milk and other
dairy products. Many people have difficulty digesting lactose and
experience diarrhea after eating dairy products.
Your body makes an enzyme that helps digest lactose, but for most
people, the levels of this enzyme drop off rapidly after childhood.
This causes an increased risk of lactose intolerance as you age.
Fructose. Fructose, a sugar found naturally in fruits and honey and
added as a sweetener to some beverages, can cause diarrhea in
people who have trouble digesting it.

11. Artificial sweeteners. Sorbitol and mannitol, artificial sweeteners found
in chewing gum and other sugar-free products, can cause diarrhea in
some otherwise healthy people.
Surgery. Some people may experience diarrhea after undergoing
abdominal surgery or gallbladder removal surgery.
Other digestive disorders. Chronic diarrhea has a number of other
causes, such as Crohn's disease, ulcerative colitis, celiac disease,
microscopic colitis and irritable bowel syndrome.

12. Signs and symptoms associated with diarrhea may include:
Frequent, loose, watery stools
Abdominal cramps
Abdominal pain
Fever
Blood in the stool
Bloating
Signs and symptoms

13. High Risk Groups
1.Travellers — ETEC, EAEC ,Campylobacter,Shigella
2 . Consumers of certain foods- picnic,banquet,restaurant
3.lmrnunodeficiancy persons
4. Institutionalised persons

14. Pathogenesis of Bacterial Diarrhoea
•without mucosal injury mediated by:
Enterotoxins
Adhesins
•with mucosal injury mediated by:
Adhesins
Invasins
Cytotoxins

15. Pathogenesis Virus Diarrhoea.
VIRUS DIARRHOEA
Effect on villus structure and function
Enzyme damage
Significant effect on digestion and absorption
• Rotavirus
Norwalk
virus Enteric
Adenovirus
Astrovirus

16. When to see a doctor
If you're an adult, see your doctor if:
Your diarrhea persists beyond two days
You become dehydrated — as evidenced by excessive thirst, dry mouth
or skin, little or no #urination, severe weakness, dizziness or
lightheadedness, or dark-colored urine
You have severe abdominal or rectal pain
You have bloody or black stools
You have a fever above 102 F (39 C)

17. In children, particularly young children, diarrhea can quickly lead to
dehydration. Call your doctor if your child's diarrhea doesn't improve
within 24 hours or if your baby:
Hasn't had a wet diaper in three or more hours
Has a fever above 102 F (39 C)
Has bloody or black stools
Has a dry mouth or cries without tears
Is unusually sleepy, drowsy, unresponsive or irritable
Has a sunken appearance to the abdomen, eyes or cheeks
Has skin that doesn't flatten if pinched and released

18. Preparing For Your Appointment
Start by seeing your family doctor or a general practitioner if you
have any signs or symptoms that worry you. If you have persistent
diarrhea, your doctor may refer you to a doctor who specializes in
the digestive system (gastroenterologist).
Because appointments can be brief, and because there's often a lot
of ground to cover, it's a good idea to be well prepared. Here's
some information to help you get ready and what to expect from
your doctor.

20. Tests And Diagnosis
Tests and procedures used to determine what's causing your
diarrhea may include:
Physical exam. You'll have your temperature measured to check for a
fever. Your blood pressure and pulse may also be measured to check
for signs of dehydration. Your doctor may also examine your
abdomen for abdominal pain.
Review of your medications. Your doctor may ask about any
medications you're taking, including over-the-counter drugs. Also,
tell your doctor about any supplements you take

21. Blood test. A complete blood count test may help determine
what's causing your diarrhea.
Stool test. Your doctor may recommend a stool test to
determine whether a bacterium or parasite is causing your
diarrhea.

22. Treatments And Drugs
Most cases of diarrhea clear on their own within a couple of days
without treatment. If you've tried lifestyle changes and home
remedies for diarrhea without success, your doctor may recommend
medications or other treatments.
Antibiotics
Antibiotics may help treat diarrhea caused by bacteria or parasites. If
a virus is causing your diarrhea, antibiotics won't help

23. Treatment to replace fluids
Your doctor likely will advise you to take steps to replace the fluids and
salts lost during diarrhea. For most people, replacing fluids means drinking
water, juice or broth. If drinking liquids upsets your stomach or causes
diarrhea, your doctor may recommend getting fluids through a vein in
your arm (intravenously).
Water is a good way to replace fluids, but it doesn't contain the salts and
electrolytes — minerals such as sodium and potassium — you need in
order to maintain the electric currents that keep your heart beating.
Disruption of your body's fluid and mineral levels creates an electrolyte
imbalance that can be serious. You can help maintain your electrolyte
levels by drinking fruit juices for potassium or eating soups for sodium.

24. Adjusting medications you're taking
If your doctor determines that an antibiotic medication caused your
diarrhea, your doctor may modify your treatment plan by lowering
your dose or switching to another medication.
Treating underlying conditions
If your diarrhea is caused by a more serious disease or condition,
such as inflammatory bowel disease, your doctor will work to
control that condition. You may be referred to a specialist, such as a
gastroenterologist, who can help devise a treatment plan for you.

25. Lifestyle And Home Remedies
Preventing viral diarrhea
Wash your hands frequently to prevent the spread of viral diarrhea.
To ensure you or your child is washing your hands thoroughly,
always:
Wash frequently. Wash your hands before and after preparing food.
In addition, wash your hands after handling uncooked meat, using
the toilet, changing diapers, sneezing, coughing and blowing your
nose.

26. Lather with soap for at least 20 seconds. After putting soap on your
hands, rub your hands together for at least 20 seconds. This is about
as long as it takes to sing "Happy Birthday" twice through.
Use hand sanitizer when washing isn't possible. Use an alcohol-
based hand sanitizer when you can't get to a sink. Apply the hand
sanitizer as you would hand lotion, making sure to completely cover
the fronts and backs of both hands. Use a product that contains at
least 60 percent alcohol

27. Preventing diarrhea from contaminated
food
To guard against diarrhea caused by contaminated food:
Serve food right away or refrigerate it after it has been cooked or reheated.
Leaving food out at room temperature can encourage growth of bacteria.
Use the refrigerator to thaw frozen items. Or try putting plastic-wrapped
frozen items in a bowl of cold water to thaw. Don't leave frozen items on
the counter to thaw.

28. Preventing traveler's diarrhea
Diarrhea commonly affects people who travel to countries where
inadequate sanitation and contaminated food and water are
encountered. To reduce your risk:
Watch what you eat. Eat hot, well-cooked foods. Avoid raw fruits
and vegetables unless you can peel them yourself. Also avoid raw
or undercooked meats and dairy foods.

29. Watch what you drink. Drink bottled water, soda, beer or wine
served in its original container. Avoid tap water and ice cubes.
Use bottled water even for brushing your teeth. Keep your
mouth closed while you shower. Beverages from boiled water,
such as coffee and tea, are probably safe. Remember that
alcohol and caffeine can aggravate diarrhea and dehydration

30. Ask your doctor about using antibiotics. If you're traveling to a
developing country for an extended period of time, ask your
doctor about starting antibiotics before you leave on your trip. In
certain cases, this may reduce the risk that you'll develop
traveler's diarrhea.
Check for travel warnings. The Centers for Disease Control and
Prevention maintains a travelers' health website where disease
warnings are posted for foreign countries. If you're planning to
travel outside of the United States, check there for warnings and
tips for reducing your risk.

31. • Extremely common
• Most is viral in origin and self-limited
• A good H&P is crucial
• Warning signs include high fever, severe and. pain, dehydration,
and bloody stool.
Fluid replacement is most important. Antibiotics are usually not
necessary
Conclusion