Diarrhea What is diarrhea u An alteration in

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Diarrhea

Diarrhea

What is diarrhea u An alteration in a normal bowel habit Characterized by u

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

Epidemiology of Diarrhea

Distribution of deaths due to diarrhea in low- and middle-income countries in 5 WHO

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

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

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

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

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

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

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 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 -

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

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

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

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

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 -

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