Download MBBS (Bachelor of Medicine and Bachelor of Surgery) 4th Year (Final Year) Pediatrics Acute Diarrhoeal Disease Handwritten Notes
DIARRHOEAL
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DISEASES
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Definition
? Diarrhoea is defined as the passage of loose, liquid or
watery stools.
? Stools passed more than 3 times a day.
? Recent change in consistency and character of stools
important than number of stools.
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ETIOLOGY
? Viruses
? Bacterial causes
? Others
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VIRUSES
Many DIARRHOEAL diseases are caused by
viruses
? Rotaviruses ?leading cause of severe,
dehydrating diarrhoea in children aged less
than 5 years globally.
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? Astroviruses
? Adenoviruses
? Calciviruses
? Coronaviruses
? Norwalk group of viruses
? Enteroviruses
? Cytomegalovirus
z BACTERIAL CAUSES
? V. Cholerae 01
? Salmonel a
? Shigel a
? Enterotoxigenic E.coli
? Campylobacter jejuni
Less known pathogens
? Yersinia enterocolitica
? V.parahaemolyticus
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OTHERS
? Amoebiasis
? Giardiasis
? Cryptosporidium
? Malnutrition
? Inborn errors in metabolism
? Septicaemia
? Neceotizing enterocolitis
? AIDS (persistent diarrhoea)
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NON INFECTIVE CAUSES
? Osmotic diarrhoea (lactose intolerance)
? Food intolerance
? Antibiotic induced
? Inflammatory bowel disease
? Celiac disease
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PATHOGENESIS
1. Osmotic diarrhoea
2. Secretory diarrhoea
Rota virus produce diarrhoea by
both mechanisms
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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
1. Intestinal vil us damaged eg. Infection
2. Consumption of a lot of sugar or related ones
z MARKERS OF OSMOTIC DIARRHOEA
? Stool sodium less than 50 mEq/L
? Stool reaction acidic
? Stool reducing substance positive pH less than 5.5
? Discontinuation of feed results in improvement
? Perianal excoriation
? Volume of stool less than 200ml/day
Eg. lactose intolerance
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SECRETORY DIARRHOEA
? Cells in vil i absorptive and in crypts secretory
? 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
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MARKERS OF SECRETORY
DIARRHOEA
? Dehydration occurs rapidly and is often severe
? Dyselectrolytaemia is more common
? Stool sodium greater than 70mEq/ml
? 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
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4 clinical types
1. Acute watery diarrhoea
2. Acute bloody diarrhoea
3. Persistent diarrhoea
4. Diarrhoea with severe malnutrition
(Marasmus and Kwashiorkor)
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ACUTE WATERY DIARRHOEA
? Lasts for hours to days
? Main danger dehydration
? Weight loss occurs if feeding not continued
? Caused by V. Cholera, E. Coli, Rotavirus
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ACUTE BLOODY DIARRHOEA
? Also called dysentery
? Main danger damage of the intestinal mucosa sepsis
and malnutrition, dehydration
? Marked by visible blood in stools
? Most common cause shigella
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PERSISTENT DIARRHOEA
? Last 14 days or longer
? Main danger is malnutrition and serious non
-intestinal obstruction
? Dehydration may also occur
? Persons with other illness such as AIDS are
more likely to develop persistent diarrhoea
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DIARRHOEA WITH SEVERE
MALNUTRITION
? Main danger severe systemic infection,
dehydration, heart failure, and vitamin
and mineral deficiency
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Thank you
This post was last modified on 11 August 2021