ACUTE DIARRHOEAL DISEASES

FirstRanker.com

Definition

• Diarrhoea is defined as the passage of loose, liquid or watery stools.
• Stools passed more than 3 times a day.

--- Content provided by‌ FirstRanker.com ---

• Recent change in consistency and character of stools important than number of stools.

ETIOLOGY

• Viruses
• Bacterial causes
• Others

VIRUSES

Many DIARRHOEAL diseases are caused by viruses

--- Content provided by⁠ FirstRanker.com ---

• Rotaviruses -leading cause of severe, dehydrating diarrhoea in children aged less than 5 years globally.

• Astroviruses
• Adenoviruses
• Calciviruses
• Coronaviruses

--- Content provided by​ FirstRanker.com ---

• Norwalk group of viruses
• Enteroviruses
• Cytomegalovirus

BACTERIAL CAUSES

• V. Cholerae 01
• Salmonella

--- Content provided by‌ FirstRanker.com ---

• Shigella
• Enterotoxigenic E.coli
• Campylobacter jejuni
• Less known pathogens
• Yersinia enterocolitica

--- Content provided by‍ FirstRanker.com ---

• V.parahaemolyticus

OTHERS

• Amoebiasis
• Giardiasis
• Cryptosporidium
• Malnutrition

--- Content provided by⁠ FirstRanker.com ---

• Inborn errors in metabolism
• Septicaemia
• Necrotizing enterocolitis
• AIDS (persistent diarrhoea)

NON INFECTIVE CAUSES

• Osmotic diarrhoea (lactose intolerance)

--- Content provided by‌ FirstRanker.com ---

• Food intolerance
• Antibiotic induced
• Inflammatory bowel disease
• Celiac disease

PATHOGENESIS

1. Osmotic diarrhoea

--- Content provided by​ FirstRanker.com ---

2. Secretory diarrhoea

Rota virus produce diarrhoea by both mechanisms

OSMOTIC DIARRHEA

Mechanism

When intestine contains lot of unabsorbed food adds to the osmotic load of intestine; it osmotically drags fluid into the intestine and hence produce diarrhoea.

Occurs in

--- Content provided by‌ FirstRanker.com ---

1. Intestinal villus damaged eg. Infection
2. Consumption of a lot of sugar or related ones

MARKERS OF OSMOTIC DIARRHOEA

• Stool sodium less than 50 mEq/L
• Stool reaction acidic
• Stool reducing substance positive pH less than 5.5

--- Content provided by⁠ FirstRanker.com ---

• Discontinuation of feed results in improvement
• Perianal excoriation
• Volume of stool less than 200ml/day

Eg. lactose intolerance

SECRETORY DIARRHOEA

• Cells in villi absorptive and in crypts secretory

--- Content provided by‍ FirstRanker.com ---

• Toxin of cholera affect secretory cells and there is outpouring of fluids and hence diarrhoea
• Since there is active secretion, the diarrhoea stool is rich in sodium and thus produce severe dehydration rapidly

MARKERS OF SECRETORY DIARRHOEA

• Dehydration occurs rapidly and is often severe
• Dyselectrolytaemia is more common
• Stool sodium greater than 70mEq/ml

--- Content provided by FirstRanker.com ---

• Stool pH above 5.5;stool reducing substance negative
• No effect with discontinuation of feeding
• Volume of stool high greater than 200ml/day

Eg.cholera

CLINICAL TYPES

4 clinical types

--- Content provided by⁠ FirstRanker.com ---

1. Acute watery diarrhoea
2. Acute bloody diarrhoea
3. Persistent diarrhoea
4. Diarrhoea with severe malnutrition (Marasmus and Kwashiorkor)

ACUTE WATERY DIARRHOEA

• Lasts for hours to days

--- Content provided by‌ FirstRanker.com ---

• Main danger dehydration
• Weight loss occurs if feeding not continued
• Caused by V. Cholera, E. Coli, Rotavirus

ACUTE BLOODY DIARRHOEA

• Also called dysentery
• Main danger damage of the intestinal mucosa sepsis and malnutrition, dehydration

--- Content provided by​ FirstRanker.com ---

• Marked by visible blood in stools
• Most common cause shigella

PERSISTENT DIARRHOEA

• Last 14 days or longer
• Main danger is malnutrition and serious non -intestinal obstruction
• Dehydration may also occur

--- Content provided by‌ FirstRanker.com ---

• Persons with other illness such as AIDS are more likely to develop persistent diarrhoea

DIARRHOEA WITH SEVERE MALNUTRITION

• Main danger severe systemic infection, dehydration, heart failure, and vitamin and mineral deficiency

Thank you