Diarrhea What is diarrhea u An alteration in
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Diarrhea
What is diarrhea u An alteration in a normal bowel habit Characterized by u A decrease in consistency to soft or liquid u An increase in frequency to≥ 3 stools a day u Increased loss of fecal water and electrolytes occurs with the increased excretion of fecal matter
Epidemiology of Diarrhea
Distribution of deaths due to diarrhea in low- and middle-income countries in 5 WHO regions South. East Asia
Types of diarrhea (1) Acute diarrhea l < 14 days in duration l May be caused by infections, medications, food intolerance and intestinal disease
Types of diarrhea (2) Chronic diarrhea > 30 days in duration l Causes include post-infectious episode of irritable bowel syndrome and persistent and/or repeated infections. l
Etiology of acute diarrhea (1) � infectious ü Bacterial: Shigella, Salmonella (typhi, enteritidis) Campyrobacte Yersinia, E. coli, Clostridium(difficile, perfringens) Vibrio (cholerae, parahaemolyticus) Staphylococcus aureus Bacillus cereus
Etiology of acute diarrhea (2) Viral Novovirus(Norwalk virus), rotavirus adenovirus, cytomegalovirus, herpes simplex virus ü Parasitic Cryptosporidium, Microsporidia, Entamoeba histolytica, Cyclospora Giardia lablia ü
Etiology of acute diarrhea (3) � Medications Antibiotics, colchicine, laxatives, Magnesium-containing antacids • Food intolerance Lactose, fructose in soft drinks, sorbitol in diet candy, coffee • Intestinal Disease (acute episode) Celiac disease, inflammatory bowel disease(ulcerative colitis, Crohn’s disease)
Etiology of chronic diarrhea � Chronic diarrhea has a number of other causes �such as Crohn's disease, ulcerative colitis, celiac disease, microscopic colitis and irritable bowel syndrome.
Antibiotic associated diarrhea � Diarrhea that occurs during or shortly after administration of an antibiotic � The use of any antibiotics can alter the commensal gastrointestinal microflora and lead to diarrhea in about 5 -35% of patients. l Most cases are mild and resolve spontaneoulsy
Pathogenesis of Antibiotic associated diarrhea Accelerated gastrointestinal motility (ex. Erythromycin) - Osmotic diarrhea - Opportunistic infections - Alterations in intestinal absorption and/or secretion - Bacterial overgrowth syndromes - C. difficile infection (the most common - bacterium responsible for antibiotic associated diarrhea)
Preventions of Diarrhea (1) � Personal hygiene � Safe food preparation � Hand washing with soap � Do not drink milk or fruit juice that have not been pasteurized � Cook food thoroughly, especially red meat, poultry and eggs � Eat food soon after it is cooked so that germs do not have time to grow
Preventions of Diarrhea (2) � Rinse fresh fruits and vegetables under running water before eating � Keep hot foods hot(60 C) and cold foods cold(4 C) � Keep raw meat and poultry away from other foods � Use separate cutting boards for raw meats and other foods 0 0
Some tips for diarrhea � Make sure you get enough fluids � Dehydration can be a serious problem for children, older people and people with chronic medical conditions the importance of a balanced electrolyte oral rehydration solution � Repeated diarrhea in young children can lead to malnutrition and physical and cognitive growth impairment.
Specific vaccines for Diarrhea Vaccines against… � Cholera (V. cholerae) and enterotoxigenic E. coli in adults and children � Thyphoid fever (S. typhi) in adults and children � Rotavirus in infants.
References � Therapeutic Choices - sixth edition � Therapeutic Choices for Minor Ailments - First edition http: //www. mayoclinic. org/diseasesconditions/diarrhea/symptoms-causes/dxc 20232937 � for distribution of causes of neonatal and under-five deaths (published in Liu et al, Lancet 2014). � http: //www. who. int/bulletin/volumes/86/9/07050054/en/ � CHERG/WHO/UNICEF
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