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    Diarrhea

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    Diarrhea is defined as abnormally liquid or frequent stools. It can be acute (less than 2 weeks), persistent (2-4 weeks), or chronic (more than 4 weeks). Diarrhea occurs via two main pathological pathways - osmotic diarrhea due to poor absorption of solutes, and secretory diarrhea where secretion exceeds absorption. Acute diarrhea is usually infectious in origin and caused by bacteria, viruses or parasites. Common causative agents transmitted via the fecal-oral route include Salmonella, Campylobacter, Shigella, E. coli, norovirus and rotavirus. Non-infectious causes include medications, ischemia, and toxins. Clinical features depend on the

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    Diarrhea

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    ash ash
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    Diarrhea is defined as abnormally liquid or frequent stools. It can be acute (less than 2 weeks), persistent (2-4 weeks), or chronic (more than 4 weeks). Diarrhea occurs via two main pathological pathways - osmotic diarrhea due to poor absorption of solutes, and secretory diarrhea where secretion exceeds absorption. Acute diarrhea is usually infectious in origin and caused by bacteria, viruses or parasites. Common causative agents transmitted via the fecal-oral route include Salmonella, Campylobacter, Shigella, E. coli, norovirus and rotavirus. Non-infectious causes include medications, ischemia, and toxins. Clinical features depend on the

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    PHYSIOLOGY

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    Diarrhea (2)

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    Diarrhea is defined as abnormally liquid or frequent stools. It can be acute (less than 2 weeks), persistent (2-4 weeks), or chronic (more than 4 weeks). Diarrhea occurs via two main pathological pathways - osmotic diarrhea due to poor absorption of solutes, and secretory diarrhea where secretion exceeds absorption. Acute diarrhea is usually infectious in origin and caused by bacteria, viruses or parasites. Common causative agents transmitted via the fecal-oral route include Salmonella, Campylobacter, Shigella, E. coli, norovirus and rotavirus. Non-infectious causes include medications, ischemia, and toxins. Clinical features depend on the

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    Download as pptx, pdf, or txt
    222 views24 pages

    Diarrhea

    Uploaded by

    ash ash
    Diarrhea is defined as abnormally liquid or frequent stools. It can be acute (less than 2 weeks), persistent (2-4 weeks), or chronic (more than 4 weeks). Diarrhea occurs via two main pathological pathways - osmotic diarrhea due to poor absorption of solutes, and secretory diarrhea where secretion exceeds absorption. Acute diarrhea is usually infectious in origin and caused by bacteria, viruses or parasites. Common causative agents transmitted via the fecal-oral route include Salmonella, Campylobacter, Shigella, E. coli, norovirus and rotavirus. Non-infectious causes include medications, ischemia, and toxins. Clinical features depend on the

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    DIARRHEA

    Presented by Ezza Nur Adzliyanni Binti Azali 082013100005

    DIARRHEA
    Diarrhea is defined as passage of abnormally liquid or unformed stools at an increased frequency. Stool weight >200 g/d. It is further defined
    i. Acute if <2 weeks ii. Persistent if 24 weeks iii. Chronic if >4 weeks

    PATHOPHYSIOLOGY

    Osmotic Diarrhea Absorption of water in the intestine is dependent on adequate absorption of solutes.
    Excessive amounts of solutes are retained in the intestinal lumen

    Water will not be absorbed

    i. Ingestion of a poorly absorbed substrate: ii. Malabsorption

    Secretory Diarrhea
    Diarrhea occurs when secretion of water into the intestinal lumen exceeds absorption.

    ACUTE DIARRHEA
    Diarrhea that comes on suddenly and goes away over a period of a couple of weeks. >90% caused by infectious agents. Remaining 10%
    i. Medications ii. Toxic ingestions iii. Ischemia

    A. Infectious Agents
    Feco-oral transmission Systemic manifestations
    Reiter's syndrome
    Arthritis Urethritis Conjuctivitis
    Salmonella, Campylobacter, Shigella, and Yersinia. Enterohemorrhagic E. coli and Shigella

    Hemolytic-uremic syndrome - High mortality rate

    Others:
    Viral hepatitis Listerosis Toxic shock syndrome

    Five high-risk groups

    Travelers

    Enterotoxigenic or Enteroaggregative E.coli Campylobacter Shigella Giardia

    Chicken

    Consumers of certain foods

    : Salmonella, Shigella, Campylobacter Undercooked hamburger : Enterohemorrhagic E. coli Fried rice or reheated food : Bacillus cereus Mayonnaise or creams : Staph.aureus/Salmonella Eggs : Salmonella Uncooked foods : Listeria Seafood (esp raw) : Vibrio sp, Salmonella, Acute hepatitis A

    Immunodeficient persons

    Primary immunodeficiency : IgA deficiency, common variable hypogammaglobulinemia, chronic granulomatous disease
    Secondary immunodeficiency : AIDS, pharmacologic suppression

    Day care attendees and their family members


    Institutionalized persons

    Shigella Giardia Cryptosporidium

    C.difficile

    CLINICAL FEATURES

    Pathogen
    Bacillus cereus Staph.aureus Clostridium perfringens Vibrio cholerae Enterotoxigenic Escherichia coli Klebsiella pneumoniae Aeromonas species Enteropathogenic E.coli Enteroadherent E. coli Giardia C. difficile Hemorrhagic E. coli Rotavirus and norovirus Salmonella Campylobacter Aeromonas species Vibrio parahaemolyticus Yersinia

    Incubation Period
    1-8 hr 8-24 hr 872 h

    1-8 days

    13 d 1272 h 13 d 12 h11 d

    B. Medications
    Antibiotics Anti hypertensives Antidepressants Antacids Bronchodilators Chemotherapeutic agents Cardiac antidysrhythmics NSAIDs Laxatives

    C. Ischemic colitis
    Acute lower abdominal pain preceding watery then bloody diarrhea
    Acute inflammatory changes in the sigmoid or left colon while sparing the rectum.

    D. Toxins
    i. Organophosphate insecticides ii. Amanita and other mushrooms iii. Arsenic

    APPROACH TO PATIENT WITH ACUTE DIARRHEA

    Mild and self-limited.


    Indications for evaluation include :

    Abdominal pain (severe) in patients >50 years Antibiotic use (recent) Bloody stools (grossly) New Community outbreaks Duration >48 h without improvement Profuse diarrhea with Dehydration Elderly (>70 years) Fever 38.5C (101F)
    Immunocompromised patients

    INVESTIGATIONS
    Microbiologic analysis of the stool :
    i. Cultures for bacterial and viral pathogens. ii. Direct inspection for ova and parasites. iii. Immunoassays for certain - Bacterial toxins (C. difficile) - Viral antigens (rotavirus) - Protozoal antigens (Giardia, E. histolytica)

    Flexible sigmoidoscopy with biopsies and upper endoscopy with duodenal aspirates and biopsies may be indicated.
    Structural examination by sigmoidoscopy, colonoscopy or abdominal CT scanning i. To exclude IBD ii. Initial approach in patients with suspected non-infectious acute diarrhea.

    MANAGEMENT

    Fluid and electrolyte replacement

    Mild case : Fluid alone Severe case : Oral sugar-electrolytes solutions

    IV rehydration

    Dehydrated patients, especially infants and the elderly.

    Antimotility and Antisecretory agents

    Moderately severe non febrile and non bloody diarrhea. To control symptoms. Avoided with febrile dysentery, which may be exacerbated or prolonged by them.

    Quinolone (500 mg bid for 35 d) Metronidazole (250 mg qid for 7 d)

    Reduce severity and duration of diarrhea. Treat empirically without diagnostic evaluation.

    Antibiotic prophylaxis

    If travelling to high-risk countries Immunocompromised Hemochromatosis IBD

    **Antibiotic is indicated whether or not causative org is discovered in patients who are i. Immunocompromised ii. Have mechanical heart valve or recent vascular grafts iii. Elderly

    THANK YOU

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