Beruflich Dokumente
Kultur Dokumente
Date: 15-04-2010
Diarrhoea
What is diarrhoea?
Burden of diarrhoea
Global Deaths
Terrorism in 2005
2000
Diarrhoea in 2005
2,200,000
Types of diarrhoea
Pathogenesis of Diarrhoea
Secretory Diarrhoea
Osmotic Diarrhoea
Inflammatory Diarrhoea
Motility Diarrhoea
Toxin induced
Lactose intolerance
Shigella, EHEC
Hirschprung disease
Anorectal malformation
Osmotic Diarrhea
IN THE SMALL INTESTINE
Ingestion of non-absorbable solutes
Fluid entry into the small bowel
Intraluminal solutions become iso-osmotic with the plasma
Intraluminal Na+ concentration drop below 80 m osmol
Osmotic Diarrhea
IN THE COLON
Carbohydrate
Metabolized by Bacteria
Na+ and H2O
Short Chain fatty acids
(Organic anions)
Osmotic Diarrhea
Short-Chain Fatty Acids
(Organic Anions)
Promote more fluid in the colon
Obligate retention of inorganic cations
Further increasing the osmotic load
Osmotic Diarrhea
Secretory vs Osmotic
Dehydration
Dyselectrolytaemia
Large Volume Stool
Stool Sodium > 70
70mEq/L
mEq/L
Stool often Alkaline
No effect with
Discontinuation of feeding
Osmolality equals to ionic
constituents
Norwalk-like viruses
Rotavirus
Norovirus
EPEC
Cryptosporidium
ETEC
Adenovirus
Campylobacter
Astrovirus
Vibrio
Shigella
Others
Unknown
Signs of Dehydration
Plan B
Oral rehydration with ORS
75
75ml/kg
ml/kg over 4 hrs
Zinc
Continue feeding
Reassess
ORS
cyclic nucleotides induce fluid secretion
grams/litre
Sodium chloride
2.6
Anhydrous Glucose
13.5
Potassium chloride
1.5
2.9
mmol/litre
Sodium
75
Anhydrous Glucose
75
Chloride
65
Potassium
20
Citrate
10
Total Osmolarity
245
Low OSm.
ORS
290
mmol/L
Blood
210
210--260
mmol/L
Small bowel
Increase in
Gastric emptying
Prevents vomiting
Advantage - Reduced
Osmolarity ORS
Plan C
What is dysentry?
Bloody diarrhea -
What antibiotic?
Co-trimoxazole
CoAmpicillin
Quinolone
Cephalosporin eg.Cefixime
Cholera
Doxycycline
Cryptosporidium
Nitazoxanide
Amoebiasis
Metronidazole
Dehydration
Acute renal failure
Venous Thrombosis - Cerebral, Renal
HUS ( Haemolytic Uraemic Syndrome)
Malabsorption (secondary lactose intolerence)
Intussusception
Disseminated Intravascular Coagulation
Persistent Diarrhoea
Dyselectrolytaemia