Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Acute Diarrheal Disease PowerPoint PPT presentation
and frequency of stools i.e, liquid or watery stools that
occur more than 3 times a day.
In a vast majority of cases these acute episodes
subside within 7 days.
Persistent diarrhoea: Acute diarrhoea persisting for
more than 2 weeks ( 5 to 15% cases )mostly due to
infections.
Chronic diarrhoea: Insidious onset diarrhoea of more
than two weeks duration in children mostly due to non
-infectious conditions causing malabsoption (IBD)
If there is associated blood in stools it is termed as dysentery.
Diarrhoea accounts for over 20% of all deaths in underfive
children.
Globally it affects 3 to 5 billion cases and causes about 2
million deaths a year.
Consequences of diarrhoea in children: malnutrition
,dehydration, electrolyte imbalance, acid base imbalance
ETIOLOGY
Most common: Intestinal infections( bacterial, viral or parasitic)
Other causes:
? Certain drugs(antibiotics,NSAIDs,PPIs,cytotoxic drugs)
? food allergy
? systemic infections( urinary tract infection and otitis media)
? surgical conditions( appendicitis or Hirschsprung disease).
Rotavirus remains the leading cause of severe gastroenteritis
worldwide.
In India- rotavirus and enterotoxigenic E.coli
Bacterial: E.coli, Shigella, Vibrio cholerae,
Salmonella, Campylobacter, Bacillus cereus,
Clostridium difficile, S.aureus.
Viral: Rotavirus, Norovirus, enteric adenovirus,
coronavirus
Parasitic: Giardia lamblia, Cryptosporidium parvum,
Entamoeba, Isospora
RISK FACTORS
Poor sanitation and personal hygiene
Non availability of safe drinking water
Unsafe food preparation practices
Low rates of breastfeeding
Low immunization
Young children (less than 2 years)
Malnutrition
Hypo or achlorhydria
selective IgA deficiency
HIV infection, immunodeficiency
Chronic use of antibiotics (clostridium difficle)
Travel
PATHOGENESIS
60% of a child's body weight is water -ECF and ICF
compartments
Diarrheal losses comes from ECF which has relatively high
sodium and low potassium
In 50% cases concentration of sodium in plasma remains
normal
In 40 to 45% cases excessive sodium is lost in stools -
hyponatremia and fall in ECF osmolality- movement of
water from ECF to ICF compartment - Further shrinkage
of ECF volume.
In both hyponatremic and isonatremic dehydration, skin
turgor or elasticity is lost.
In 5% cases, especially when child is given fluids with extra
salt ,serum sodium increases - ECF osmolality increases -
water moves from ICF to ECF -skin appears soggy duffy or
leathery.
Therefore a severe case of hypernatremic dehydration is
likely to be underestimated.
As ECF compartment is depleted ,blood volume decreases-
weak thready pulse, low BP and cold extremities.
Low hydrostatic pressure in Renal glomeruli- filtration of
urine decreases
Since intestinal secretions are alkaline, considerable
bicarbonate is lost in diarrhoeal stools -acidosis-
kussmaul's breathing .
CLINICAL FEATURES
? Thirsty
? Irritable
? Decreased skin turgor
? Fontanelle ( if open ) ? is depressed
? Eyes appear sunken
? Tongue and inner side of cheeks appear dry
? Decreased urine output
? Urine passed at longer intervals
? Weak and Thready pulses
? Low blood pressure
? Cold extremities
?Due to hypokalemia-Abdominal distension,paralytic
ileus,muscle hypotonia,ST depression,Flat T wave
? Kussmauls breathing
Decreased skin turgor
Depressed fontanelle
Assessment of child with
acute diarrhea
Goals of assessment
1. Determine the type of diarrhea ie.,acute
watery diarrhea , dysentery or persistent
diarrhea
2. Look for dehydration and other
complications
3. Assess for malnutrition
4. Rule out nondiarrheal illness
5. Assess feeding ( both preillness and
during illness )
History
Should include information on
1. Onset of diarrhea, duration and number of
stools per day
2. Blood in stool
3. Number of episodes of vomiting
4. Presence of fever, cough , and other significant
symptoms
5. Type and amount of fluids and food taken
during the illness and the pre illness feeding
practices
6. Drugs and local remedies
7. Immunization history
Examination
Assessment of degree of dehydration
Features of malnutrition
Systemic infection
Fungal infection
Features
No dehydration
Some dehydration
Severe dehydration
Sensorium
Alert
Irritable
Lethargic/
unconscious
Thirst
Not thirsty; drinks
Thirsty; drinks
Drinks poorly or not
normally
eagerly
able to drink
Skin turgor
Goes back quickly
Goes back slowly
Goes back very slowly
Eyes
Normal ; tears
Sunken ; tears absent Very sunken ; tears
absent
Oral mucosa
Moist
Dried
Very dry
Definition
No signs of
If 2 or more of the
If 2 or more of the
dehydration
above signs including above Signs including
atleast one key sign
atleast one key sign
are present
Heart rate
Normal
Normal; maybe
Tachycardia;
increased
bradycardia in most
severe cases
Pulse and extremities Normal,warm
Normal- decreased
Weak thready or
volume,cold
impalpable,cold
Severity of dehydration
No dehydration - < 50 ml/kg
Some dehydration ? 50 ? 100 ml / kg
Severe dehydration > 100 ml/ kg
1.Look for features of malnutrition-
Anthropometry
Examination for wasting
Edema
Signs of vitamin deficiency
2.Systemic infection (cough,high grade
fever,fast breathing etc.)
3.Fungal infection- Oral thrush,perianal
satellite lesions
Laboratory investigations
Stool microscopy(cholera, giardiasis)
Stool culture
Hemogram
Blood gas estimation
Serum electrolytes
Renal function tests
This post was last modified on 12 August 2021