| ID | 25 |
|---|---|
| Name | DIARRHOEA |
| Cause | A number of diseases and conditions can cause diarrhea, including: Viruses. Viruses that can cause diarrhea include Norwalk virus (also known as norovirus), enteric adenoviruses, astrovirus, cytomegalovirus and viral hepatitis. Rotavirus is a common cause of acute childhood diarrhea. Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. |
| Signs Symptoms | Belly (abdominal) cramps. Stomach pain. Swelling (bloating) Upset stomach (nausea) Urgent need to go to the bathroom. Fever. Bloody stools. Loss of body fluids (dehydration) |
| Diagnosis | Diagnosis: A. In acute cases of diarrhoea-Clinical history, physical examination & laboratory test of stool (macroscopical, bacteriological & biochemical) are usually enough to diagnose the diseases. In case of massive fluid loss, serum electrolyte assay may be very helpful. B. In chronic cases- - Blood count (for infection & anemia) & culture (for Salmonella typhi and paratyphi, other bacteria). - Stool for routine exam (for cyst, ova, parasites) & culture (for salmonella, shigella, v. cholera and camphylobacter). - Sigmoidoscopy particularly in suspected ulcerative colitis, carcinoma, or amoebic colitis. - Biopsy & radiological examination. |
| Investigations | Blood test. A complete blood count test, measurement of electrolytes and kidney function tests can help indicate the severity of your diarrhea. Stool test. ... Hydrogen breath test. ... Flexible sigmoidoscopy or colonoscopy. ... Upper endoscopy. |
| Management | Management of diarrhoea: 1. Correction of dehydration & other physiological changes induced by diarrhoea: a. Mild and moderate dehydration & electrolyte loss should be corrected with oral saline. ORS should be given in an amount at least equal to that lost in diarrhoea or until no more can be taken. If the patient refuses or cannot drink adequate amount of ORS, it may be administered by con tinuous nasogastric infusion. Severe dehydration & electrolyte imbalance should be corrected with parenteral fluid. (Fluid therapy- for detail, see in the paediatric section), b. Malnutrition & vitamin deficiencies- should be corrected with proper & nutritious diet & vitamin supplements. For detail see in the paediatric section. 2. Diet: Initially low residual liquid diet followed by frequent semi-solid diet as the patient can tolerate. 3. Antidiarrhoeal agents: Antidiarrhoeal drugs must be used with great caution in inflammatory bowel disease & amoebiasis because of the risk of ‘toxic’ dilatation of colon & should avoid in bacillary dysentery, since they may prolong or worsen the course of acute illness. Loperamide- among antidiarrhoeal agents it is most commonly used, 4mg initially then 2mg after each loose stool (maximum 16mg/day) is effective in acute & chronic diarrhoea. In case of children it should be avoided. 4. Antimicrobial agents: Antimicrobial treatment is considered empirically in acute diarrhoeal patients with moderate to severe fever, tenesmus, or bloody stools. The drugs of choice for empiric treatment are: Fluoroquinolones- e.g ciprofloxacin 500mg, or ofloxacin 400mg, or norfloxacin 400mg, twice daily, or levofloxacin 500mg once daily for 5-7 days. Or, Cotrimoxazole 960mg twice daily; or doxycycline, 100mg twice daily for 5-7 days. In case of noninflammatory diarrhoea, Rifaximin (a nonabsorbable oral antibiotic) 200mg three times daily for 3 days, can be used empirically. 5. Treatment of complications accordingly. 6. Psychotherapy: Diarrhoea of psychogenic origin are usually chronic in nature which require antidepressant drugs along with proper survey for anxiety producing mechanism. 7. Prevention of diarrhoea: Diarrhoeal diseases are associated with overcrowding and insanitary conditions with poor personal hygiene. Infection results from ingestion of food or water contaminated with infected human faeces. Infection is spread by direct contamination of food or drink through unwashed hands soiled with faeces and also by house flies. So all sorts of possibility causing diarrhoea should be cut off initially to prevent the final breakout |
| Introduction | Diarrhoea is a very common problem and popularly used terminology among our people. In spite of that, the meaning of the term ‘diarrhoea1 is different among the different group of people. Generally, the term in used to mean ‘increased stool frequency and loose watery stools’. But, accademically diarrhoea is defined as the ‘passage of stool more than three times a day’ or ‘when the stool is liquid or semisolid, passage of stool irrespective of frequency is defined as diarrhoea’. Some gastroenterologists define diarrhoea as the pessage of more than 200gm of stool in 24 hours, so assessment of stool volume is helpful in evaluation of patients condition. Passage of frequent but formed stool is not usually considered as diarrhoea. Urgency of defaecation and faecal incontinence is a common feature of any variety of diarrhoea. |
| History | |
| Etiology | Etiology: A. Acute Infectious diarrhoea: Noninflammatory diarrhoea: Viral- e.g Rota virus (infant specially), Norwalk virus, Entero-virus. Bacterial- Preformed enterotoxin production e.g Staphylococcus aureus, Bacillus cereus, Cl. perfringens; Endogenous enterotoxin production e.g Escherichia coli (ETEC), Vibrio cholerae. Protozoal (Parasitic)- e.g Giardia lamblia, Cryptosporidium, Cyclospora. Inflammatory diarrhoea: Viral- e.g Cytomegalovirus. Bacterial- Cytotoxin production e.g Enterohaemorrhagic E coli (EHEC), vibrio parahaemolyticus, Cl. difficile; Mucosal invasion e.g Shigella, Campylobacter jejuni, Salmonella, Enteroinvasive E. coli (EIEC), Aeromonas, Plesiomonas, Yersinia enterocolitica, Chlamydia, Neisseria gonorrhoeae, Listeria monocytogenes. B. Chronic diarrhoea: Chronic infections: Prarasites: Giardia lamblia, Entamoeba histolytica, Strongyloidiasis stercoralis, Capillaria philippinensis AIDS-related: Viral: Cytomegalovirus, HIV infection (?); Bacterial: Cl. difficile, Mycobacterium avium complex; Protozoal: Microsporida, Cryptosporidium, Isospora belli. Inflammatory bowel diseases & conditions: Ulcerative colitis, Crohn disease, Microscopic colitis, Malignancies (lymphoma, adenocarcinoma), Radiation enteritis. Malabsorption syndromes: Small bowel mucosal disorders: Celiac sprue, Tropical sprue, Whipple disease, Crohn disease, Eosinophilic gastroenteritis, Small bowel resection (short bowel syndrome), Small infestinal diverticual. Lymphatic obstruction: Lymphoma, Carcinoid, Infectious (tuberculosis), Kaposi sarcoma, Sarcoidosis, Retroperitoneal fibrosis. Pancreatic disease: Chronic pancreatitis, Pancreatic carcinoma, cystic fibrosis. Medications: Antacids, Laxatives, SSRIs, Cholinesterase inhibitors, NSAIDs, Proton pump inhibitors, Angiotensin-II receptor blockers, Metformin, Allopurinol Motility disorders: Irritable bowel syndrome. Postsurgical complications: Vagotomy, partial gastrectomy, blind loop with bacterial overgrowth. Systemic disorders: Scleroderma, Diabetes mellitus, Hyperthyroidism. Factitious diarrhoea: About 15% of patients suffer from chronic or relapsing diarrhoea caused by surreptitious laxative abuse leading to dilution of stool. Others: Such as, food allergy, post haemorrhoidectomy, episiotomy, acute psychological stress etc. |
| Clinical Features | |
| Preventions | access to safe drinking-water; use of improved sanitation; hand washing with soap; exclusive breastfeeding for the first six months of life; good personal and food hygiene; health education about how infections spread; and. rotavirus vaccination. |
| Treatment | Lifestyle and home remedies Diarrhea usually clears up quickly without treatment. To help cope with symptoms until the diarrhea goes away, try to do the following: ADVISE Drink plenty of liquids, including water, broths and juices. Avoid caffeine and alcohol. Add semisolid and low-fiber foods gradually as bowel movements return to normal. Advise soda crackers, toast, eggs, rice or chicken. Restricts certain foods such as dairy products, fatty foods, high-fiber foods or highly seasoned foods for a few days. Advise anti-diarrheal medicines. Nonprescription anti-diarrheal medicines, such as loperamide and bismuth subsalicylate, might help reduce the number of watery bowel movements and control severe symptoms. Certain medical conditions and infections — bacterial and parasitic — can be worsened by these medicines because they prevent body from getting rid of what's causing the diarrhea. Some of these medicines are not recommended for children. Advise probiotics. These microorganisms may help restore a healthy balance to the intestinal tract by boosting the level of good bacteria. |
| Complications | Dehydration electrolyte imbalance kidney failure organ damage |
| Prognosis | |
| Types | Types of diarrhoea: 1. Acute diarrhoea: Passing of liquid or watery or soft bloody stools, usually more than 3 times a day with acute onset and persisting for less than 2 weeks. Most common causes are infectious agents, bacterial toxins or drugs. Acute diarrhoea, according to presenting character may be- i. Noninflammatory diarrhoea (a watery, nonbloody diarrhoea), which mainly involves small intestine, where tissue invasion does not occur and foecal leukocytes are not present on investigation; ii. Inflammatory diarrhoea (bloody diarrhoea with fever), which mainly involves large gut with tissue invasion and foecal leukocytes are present in stool with invasive organisms. 2. Chronic or relapsing diarrhoea: Non-acute onset of diarrhoea with increased frequency of defecation and loose, watery or pellety stools, diarrhoea rarely occurs at night and is most severe before and after breakfast, at other times the patient may be constipated. Chronic diarrhoea can be categorised as disease of the colon or small bowel, or malabsorption. |
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