Diarrhea Approach PDF

APPROACH TO A PATIENT WITH ACUTE INFECTIOUS DIARRHEA WITH DEHYDRATION  objective clinical assessment Treatment principle prevention of acute diarrhea Defnition Diarrhoea is a passage of abnormally liquid or unformed stools at an increased frequ...

APPROACH TO A PATIENT WITH ACUTE INFECTIOUS DIARRHEA WITH DEHYDRATION  objective clinical assessment Treatment principle prevention of acute diarrhea Defnition Diarrhoea is a passage of abnormally liquid or unformed stools at an increased frequency. For adults on a typical Western diet, stool weight >200 g/d. Diarrhea may be further defined as acute if 4 weeks in duration. Introduction The World Health Organization (WHO) 2004 Global Burden of Disease update estimated that there are approximately 4.6 billion episodes of diarrheal illness every year worldwide. According to this report, diarrheal diseases represent one of the five leading causes of death worldwide and are the second leading cause of death in children under five years of age. Cont... More than 90% of cases of acute diarrhea are caused by infectious agents. Most cases of diarrhea are associated with contaminated food and water sources. Around 2.4 billion people globally have no access to basic sanitation.  Diarrheal illness occurs at a baseline frequency in developing countries, superimposed with epidemic cases of diarrhea, either dysentery or watery diarrhea. Risk factors Crowding and poor sanitation (daycares, institutions , Individuals in refugee camps) unplanned urban settlements Direct contact with an infected individual Immune suppression (e.g., AIDS, chemotherapy ). Epidemic diarrhea S. dysenteriae and V. cholerae are the most common organisms associated with epidemic diarrhea. Four species of Shigella cause bloody diarrhea; they are distinguished serologically as S. dysenteriae, S. flexneri, S. boydii, and S. sonnei. S. dysenteriae serotype 1 (Sd1) is uniquely responsible for epidemic dysentery. Microbiology Acute watery diarrhea In a non-epidemic situation, enterotoxigenic E. coli is the most common cause. Acute bloody diarrhea Worldwide, Shigella species, particularly S. flexneri, are the most important causes of acute bloody diarrhea. CLINICAL FEATURES Watery diarrhea is characteristically non bloody, whereas dysentery is defined as diarrhea with visible blood. In an outbreak setting, these clinical features can be used to distinguish cholera (watery diarrhea) from epidemic dysentery due to S. dysenteriae serotype 1 (Sd1), as the distinction has therapeutic and public health implications.  A “rice-water” appearance of stool flecked with mucous is suggestive of cholera. Furthermore, diarrhea caused by V. cholerae may present very suddenly with vomiting and abdominal cramping but not frank pain or tenesmus. Fever is uncommon in cholera.  shigellosis is typically characterized by the frequent passage of small liquid stools that contain visible blood, with or without mucous. Abdominal cramps and tenesmus are common, along with fever and anorexia.  the specific infectious causes cannot be determined based on signs or symptoms. Complications Hypovolemia and accompanying electrolyte imbalance  CLINICAL ASSESSMENT — The initial evaluation of adults with acute diarrhea should include a careful history and physical exam in order to assess the type of diarrhea and the severity of hypovolemia Hx Amount and consistency Presence or absence of blood Frequency Tenesmus Fever Abdominal pain Asses for risk factor  PE adults The physical exam should focus on characterizing the degree of volume depletion. Early hypovolemia – signs and symptoms may be absent. Moderate hypovolemia – thirst, restless or irritable behavior, decreased skin turgor, sunken eyes. Severe hypovolemia – diminished consciousness, lack of urine output, cool moist extremities, rapid and feeble pulse, low or undetectable blood pressure, peripheral cyanosis. Pediatrics No dehydration Some dehydration (eager to drink, irritable, skin pinch goes slow) Severe dehydratio (unable to drink,lethargic or unconcious,skin pinch goes very slow). Sympto Mild (10% m weight lost) body weight lost) body weight lost) Mental Restless or fatigued, Apathetic, lethargic, Normal, alert status irritable unconscious Heart Tachycardia or Normal Normal to increased rate bradycardia Quality Weak, thready, Normal Normal to decreased of pulse impalpable Breathin Tachypnea and Normal Normal to increased g hyperpnea Eyes Normal Slightly sunken Deeply sunken Fontanell Normal Slightly sunken Deeply sunken es Tears Normal Normal to decreased Absent Mucous membrane Moist Dry Parched s Skin turgor Instant recoil Recoil 2 seconds Capillary