Acute diarrhea 2022.pdf1234567890-=-09uytfd

medicine

1. Acute Diarrhea
Dr. Ahmed Hishmat Gado, M.D.
Consultant Physician and Gastroenterologist
Misr International Hospital, Giza
Past Head of Medical Depart. and GI Endoscopy Unit
Director, Bolak EL-Dakror Hospital, Ministry of Health
Member of the Egyptian Fellowship of Medicine
Member of the Arab Board of Health Specializations
Member of the Higher Committee for updating Guidelines,
National Medical Insurance
Member of the Egyptian Med. Licensing Exam. Committee
7/2022

2. Diarrhea
Diarrhea is defined by
the World Health
Organization as having 3 or
more loose or liquid stools per
day.

Acute or chronic

3. Acute diarrhea lasts less than 2 weeks.

Chronic diarrhea lasts longer than 2 - 4
weeks.

4. Acute diarrhea

5. Etiology of acute diarrhea
Infection
•Bacteria – virus – protozoa
Allergy to certain foods or food intolerance
•Milk - orange – watermelon
Drugs
Allopurinol, antibiotics, digoxin, colchicine,
cytotoxic drugs, magnesium-containing antacids,
metformin, NSAIDs, PPIs, selective serotonin
reuptake inhibitors, statins, theophylline, thyroxine,
and high-dose vitamin C.

6. Other causes
•Constipation with 'overflow diarrhea'.
•Acute diarrhea may be the early presentation of a
chronic cause: Inflammatory bowel disease
•Anxiety
•Acute appendicitis
•Acute radiation enteritis
•Intestinal ischemia.

7. Exclude drug or food
Plenty of fluid with sugar and salt to avoid dehydration.
Anti-diarrheal drug therapy
Empiric treatment
IV fluids if severe

Investigations are not always necessary for adults who
present with acute diarrhea
Testing for other pathogens may be carried out
depending on the clinical history.


Management of acute diarrhea

8. Acute infectious diarrhea

9. Acute infectious diarrhea
Bacterial toxins (food poisoning)

Non invasive pathogens (enterotoxigenic
pathogen)

Invasive destructive pathogens

10. Bacterial toxins (food poisoning)

•Enterotoxin are ingested directly with food. The
organism grows in the food rather than small
intestine and cannot be recovered from stool.
•Short incubation period (2-6 hours)
•High attack rate
•Prominent vomiting

هليلب وا ىرشك ةيبرع نم عراشلا ىف لكلاا نم ثدحي ةداع اذه . ىتاي لكا ىللا لك
لابقتسلاا ىلا .ردصملا سفن اودكؤي مهلكو . بحاص ىلع ضبقلاب سيلوبلا موقي
هيبرعلا

11. Non invasive pathogens (enterotoxigenic
pathogen) or secretary diarrhea

•Large number of bacteria must be ingested with
grossly contaminated food or water. They colonize
but do not invade mucosa. Multiply into large
numbers. Produce enterotoxins that binds to
mucosa cells causing hypersectetion of isotonic
fluid at a rate that overwhelms the reabsorptive
capacity of the colon
•Watery voluminous diarrhea, isosmotic with plasma,
results in volume depletion, base deficit acidosis
and potassium deficiency
اريلوكلا لاثم رهشا

12. Invasive destructive pathogens

•Mucosal invasion by organisms induce marked
inflammation
•Fever, systemic symptoms [headache and myalgias],
cramping abdominal pain
•Small amount of stools are passed at frequent
intervals often associated with tenesmus
•Stool contains pus, blood , proteins
فبصلا ىف هرثكب اهارن ىتلا هيوعملا تلازنلاو ايراتنسودلا تلااح لاثم رهشا

13. Etiologic agents of acute infectious
diarrhea
Bacterial toxins (food poisoning): staph. aureus.
Bacillus cerus, clostridium perfringens

Non invasive pathogens (enterotoxigenic
pathogen): vibrio cholera, toxigenic E. Coli

Invasive destructive pathogens: Rota virus,
salmonella, shigella, campylobacter jejuni,
clostridium difficile, enteropathogenic E. Coli
yersenia enterocolitis, Ent. Histolytica, Giardia

14. Irritable Bowel Syndrome
[IBS]

15. Rome IV Diagnostic Criteria for IBS
Recurrent abdominal pain (at least 1
day/week in the last 3 months with symptom
onset at least 6 months before diagnosis)
associated with two or more of the following
criteria:
Related to defecation
Associated with a change in frequency of
stool
Associated with a change in form
(appearance) of stool.

16. Types of IBS
Types
•IBS – Diarrhea type (IBS-D)
•IBS – Constipation type (IBS-C)
•IBS – Mix type
•IBS – unclassified type

17. Good Luck