Acute diarhoea.pptx

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1. Defi : passage of three or more stools in a day , of consistency softer than usual for the child , or one watery stool is defined as diarrhea . In diarrhea there is excessive lose of water and electrolytes . diarrhea

2. Clinical types Acute watery diarrhea Acute bloody diarrhea Persistent diarrhea Chronic diarrhea Diarrhea with sever malnutrition

3. Severity of diarrhea 1/ Mild diarrhea 3-5t/day , no dehydration 2- mod.diarrhea 10t/24hours ,mild dehydration 3- sever diarrhea many t/24hours ,mod to sever dehydration

4. Incidence: 3-4 episodes of diarrhea per child per year . Maximum in the first year of life. Causes 2,5 lac deaths per year <5 year. In america 125 deaths per year .

5. Etiology Infection Bacteria Ecoli (25% ) invasive , entero toxic , entero pathogenic , entero hemorrhagic Salmonella ( 10%) Shigella ( 5%) Vibreo cholera ( 5-10 %)

6. Staphylococcus aureus Campylo bacter jejuni Yersenia entro colitica

7. Viruses Rota virus Enteric adenovirus Parasites Entamoeba histolytica Giardia lumblia Cryptosporidium Fungi Candida albicans

8. Parenteral infections Otitis media Pneumonia UTI -Dietary factors Over feeding Food poisoning Food allergy -Drugs Antibiotics

9. Epidemiology Transmission → feco _ oral (contaminated food and water)

10. Factors increasing susceptibility to diarrhea are : 1- lack of breast feeding . 2- Exposure to unsanitary conditions. 3- malnutrition . 4- measles and level of parents education.

11. Mechanism is different by various organisms. ETEC LT → Adenyl cyclase →CAMP →secretion of chloride and inhibition of sodium absorption. ST→ guanylate cyclase system →secretion of chloride and inhibition of sodium absorption. Invassion , Ecoli , shigella , salmonella →necrosis of enterocytes →diarrhea , blood in stool .

12. Rota virus →invasion on enterocytes →cause →lactase loss→osmotic diarrhea. Vibrio cholera → Adher and multiply on the intestinal mucosa → adenylate cyclase→CAMP → decreased sodium and chloride absorption →water and electrolyte loss. 2- Osmotic diarrhea 3- decreased surface absorption 4- changes of intestinal motility

13. Effects of diarrhea 1- lose of water(dehydration) Lose of skin turgor Weak or absent puls Tachy cardia Sunken fontanel Sunken eyes Husky voice

14. Cyanosis of fingers Dry mucus membranes Cold skin Oliguria , anuria, uremia 2- lose of nutrients Hypoglycemia, convulsions , coma Lose of weight.

15. 3- lose of bicarbonate Vomiting Deep and rapid respiration Irritability (increased O2 demand of brain) Myocardial contractility decreased 4- K lose Abd : distention paralytic ileus

16. Biochemical Isotonic{70%} (serum sodium level between 130-150mmol/l ) Hypotonic{20%} ( serum sodium level less than 130mmol/L Hypertonic{10%} ( serum sodium level more than 150mmol/L

17. Investigations 1- blood count 2- stool examination for PH and reducing substances Cyst of giardia and entamoeba Bioassay for E.coli Leukocytes and RBCS Culture and sensitivity Elisa test for rotavirus

18. Serum electrolytes (Na , k) and bicarbonate (Hco 3 ) 4- urine examination and culture 5- blood culture (salmonellosis or shigellosis) 6- x-ray of chest

19. Complication 1- Dehydration and shock 2- metabolic acidosis 3- paralytic ileus 4- convulsion and coma 5- malnutrition 6- acute renal failure 7- persistent diarrhea

20. 8- Super added infections 9- Thrush 10- Diaper dermatitis 11- DIC 12- Death TREATMENT

21. Antibiotic therapy Antibiotic is used for cholera , shigella , amebiasis and giardia . Dietary management Feeding should be continued to prevent body catabolism and weight lose . Breast feed should continued as much as want the infant in addition to ORS . Malnourished or prematur infant with diarrhea must be persumed to have sepsis and should receive systemic antibiotic

22. Probiotic Micro organism colonise on the bowel . Reduces the duration of acute diarrhea . Zinc therapy : zinc loses during diarrhea < 6mo 10mg/day >6mo 20mg/day (10-14 day)

23. Prevention Breast feeding up to 2 years Health education Three “Cs” clean hands , clean water and clean environment

24. Dehydration

25. Definition : loss of water and electrolyte

26. Mild: weight loss less than 5 % Mod: weight loss between 5-10% Sever: more than 10% WHO Classification No sign of dehydration Some dehydration Sever dehydration

27. Sign and symptom of no sign of dehydration The child is alert,normaly drinks,nomal skin pinched. Sign and symptom of some dehydration ( patient is irritable, thirsty,eagerly drinks ,sunken eye and slow skin pinched less than 2 seconds ) Sever de hydration( lethargic or unconscious, u nable to drink sunken eye , and very slow skin pinched ( more than 2 seconds). Sign and symptom of no sign of dehydration The child is alert,normaly drinks,nomal skin pinched. Sign and symptom of some dehydration ( patient is irritable, thirsty,eagerly drinks ,sunken eye and slow skin pinched less than 2 seconds ) Sever de hydration( lethargic or unconscious, unable to drink sunken eye , and very slow skin pinched ( more than 2 seconds). 2 or more sings and symptoms of some and sever Dehydration diagnosis the dehydration. IF THERE IS NO ANY SIGNS AND SYMPTOMS OF THEM , THAT IS NO SIGN OF DEHYDRATION

28. Treatment is done according to the level of De hydration . No sign of dehydration ( planA ) Some dehydration ( planB ) Sever dehydration ( planC )

29. PLAN A Treatment at home 3 components… Advise extra fluids , vegetable soup, yogurt…. Continue feeding, / breast feeding/solid food. Give ORS 50-100 cc/each purging up to 1 year and 100-200 cc/purging 1-2 year and more than 200cc/purging Above 2 years or as much as want.

30. PLAN B ORS 75 ML/KG/ 4H Reasess AFTER 4H and decide accordingly may be need to repeat this amount or goes to plan A or planB .

31. PLAN C IV THERAPY , in children LESS THAN 1 YEAR 100 ML/KG in 6h OF Ringer lactate or narmal saline, 30 ML/Kg in 1h AND 70 ML/Kg in NEXT 5h, IN children from 1YEAR and above 30 ML / kg in ½ h and 70 ML/Kg in 2,5 h.if the child is able to drink give ORS 5ml/kg/h. IF IV THERAPY IS NOT POSSIBLE, give ORS by NGT 20ml/kg /h for 6h.