Diarrhea and Constipation PDF

 Diarrhea (Diarrhoea) Is an increased frequency of bowel evacuation by the passage of three or more loose or liquid stools per day. Infectious origin -Most common: Viral. -Less common: bacterial. A- Acute Diarrhea 1- Viral Etiology Rotavirus It’s highly contagi...

 Diarrhea (Diarrhoea) Is an increased frequency of bowel evacuation by the passage of three or more loose or liquid stools per day. Infectious origin -Most common: Viral. -Less common: bacterial. A- Acute Diarrhea 1- Viral Etiology Rotavirus It’s highly contagious and is the most common cause of diarrhea especially those under 2 years and in winter season. Rout of transmitting: Likely: fecal-oral rout. Less likely: sneezing and coughing. The acute phase is usually within 2–3 days. Oral vaccine for rotavirus is currently available since 2006. So, so infection is now much less common 2- Bacterial Etiology It’s a food-borne infections (previously known as food poisoning). It’s Caused by eating contaminated food or drink. Common Pathogens: ☹ Campylobacter. more associated with contaminated Chicken and egg than beef meat. ☹ Salmonella Associated with recooked rice, especially if it ☹ B. cereus spp. has been kept warm or has been reheated. 3- Protozoan Etiology Infections are not much common. Common Pathogens: ☹ Entamoeba histolytica (amoebic dysentery). ☹ Giardia lamblia (giardiasis). Diagnosis is made by sending stool samples to the laboratory. Treatment is usually with metronidazole and Tinidazole. Drugs causing diarrhea 1)Laxatives 2)Antacids containing magnesium 3) antineoplastic 4)Antineoplastic drugs Antibiotics a) Clindamycin b) Tetracyclines c) Sulfonamides 1. Misoprostol (cytotec). 2. PPIs. 3. Digoxin in toxic level Clinical features of acute diarrhea Symptoms are normally rapid in onset. Nausea and vomiting might be present before or with the onset of acute diarrhoea. Abdominal cramping, flatulence and tenderness. Cough and cold may occur if rotavirus is the cause (stomach flu). Usually Watery in nature, B- Chronic Diarrhea Common Etiologies Irritable-bowel syndrome (IBS). (Most common cause) Inflammatory bowel disease (IBD) (Crohn’s disease or ulcerative colitis). Malabsorption syndromes (such as coeliac or celiac disease, lactose intolerance) Patient assessment with diarrhea 1- Age young children or age > 65 are at risk of dehydration. 2- Duration Diarrhea of >1 day duration in children 12 years old Use of loperamide in children 16 years old 4- Miscellaneous Products with weak EBM Adsorbents: Like Pectokaolin® (pectin +kaolin) Their effectiveness is still unproven and questionable. Probiotics are microorganisms that have been used for many years to replace colonic microflora. The efficacy of probiotics in preventing antibiotic-associated diarrhea (AAD) is still controversial!!  Zinc: combined with ORS significantly: will reduce the severity and duration of acute diarrhea in developing countries only by unknown mechanism. Why give zinc for 14 days ? Additional advice for patients suffering from diarrhea 1. Drink plenty of clear fluids, such as water, also try Rice-water as it is effective remedy for diarrhea 2. Avoid drinks high in sugar as these can prolong diarrhea. 3. Avoid milk and milky drinks temporarily, as a temporary lactose intolerance occurs due to damage done by infecting organisms to the cells lining the intestine, making diarrhea worse.