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MBBS 3: Pediatrics > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What is diarrhea?

A

3+ loose or watery stools per day, or stooling more frequently than normal.
- Caused by a wide range of pathogens (bacteria, viruses and protozoa) or other factors

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2
Q

Pathophysiology of diarrhea?

A

Incomplete absorption of water and electrolytes from the intestinal lumen
types:
1. secretory
2. osmotic

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3
Q

Secretory pathophysiolgy of diarrhea?

A
  1. Toxins stimulation of small intestinal secretion of chloride ion
  2. fluid movement into the intestinal lumen
  3. overwhelms the absorptive capacity of the colon
    e.g. cholera
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4
Q

Osmotic pathophysiology of diarrhea?

A
  1. unabsorbed nutrients (especially carbohydrates and sugars) or osmotically active medications cause an osmotic gradient
  2. draws water into the intestinal lumen
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5
Q

Most common cause of diarrhea?

A

rotavirus
- occurs in children 6 months to 2 years old
Note: Though cholera is often thought of as a major cause of child deaths, most cases occur among adults and older children

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6
Q

What are the common diarrhea pathogens in Malawi?

A
  1. rotavirus
  2. adenovirus
  3. Cryptosporidium
  4. E. coli
  5. Shigella
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7
Q

Transmission?

A

fecal-oral

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8
Q

3 main forms of diarrhea?

A
  1. Acute watery diarrhea
    - Significant fluid loss, rapid dehydration
    - Lasts hours to days
    e.g. cholera, e coli (ETEC), rota
  2. Dysentery
    - Intestinal damage, nutrient loss
    - bloody diarrhea
    e.g. MCC shigella
  3. Persistent diarrhea
    - Lasts >14 days
    - Persistent more likely in undernourished or kids with other illnesses
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9
Q

Why are young children more vulnerable?

A
  1. Water constitutes a greater proportion of body weight
  2. Higher metabolic rates
  3. Kidneys less able to conserve water
  4. Malnutrition
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10
Q

How is diarrhea prevented in children?

A
  1. Prevent exposure to pathogens
  2. Make the child less susceptible
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11
Q

How to prevent exposure to pathogens?

A
  1. Access to safe Water
  2. Adequate Sanitation
  3. Good Hygiene
    - 88% of diarrheal deaths worldwide are attributed to these causes
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12
Q

How to ensure access to safe water?

A
  1. Treating water at the source
  2. Treating household water
  3. Storing water safely
    - Achieving these three things has been shown to reduce the incidence of diarrheal disease by up to 47%
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13
Q

How to ensure adequate sanitation?

A
  1. Prevents human fecal matter from contaminating environments
  2. Construction of toilets
    - Total sanitation is a major challenge
  3. Stopping open defecation
    Note: Total sanitation: Use of adequate sainitation facilities by all community members is necessary to significantly reduce diarrhoeal disease transmission
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14
Q

How to ensure good hygiene?

A
  1. Hand-washing with soap – 40% reduction in incidence of diarrheal disease
  2. Improves with access to clean & plentiful water
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15
Q

How do you make a child less susceptible to diarrhea?

A
  1. Immunizations
  2. Adequate nutrition
  3. Micronutrient supplementation
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16
Q
A
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17
Q

Which immunizations make the child less susceptible?

A
  1. Rotavirus
    - 100 million episodes of acute diarrhea each year
    - 350,000 to 600,000 child deaths.
  2. Measles
    - Diarrhea is one of the most common causes of death
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18
Q

How nutrition makes a child more susceptible to diarrhea?

A
  1. Undernourished children at higher risk
    - More severe, prolonged, frequent episodes of diarrhea.
  2. Repeated bouts can worsen nutritional status
    - Decreased food intake
    - Reduced nutrient absorption
    - Increased nutritional requirements
  3. Diarrhea can lead to stunting
    - poor nutrient absorption and appetite loss
  4. Risk increases with each episode
    - Diarrhea control, particularly in the first six months of life, may help to reduce stunting prevalence
19
Q

Importance of breastfeeding?

A

Not breastfeeding leads to 6X greater risk of dying from infectious diseases in the first two months of life, including from diarrhea
- Infants who are exclusively breastfed for the first six months of life and continue to be breastfed until two years of age and beyond develop fewer infections and have less severe illnesses than those who are not, even among children whose mothers are HIV-positive

20
Q

Protocol for breastfeeding in mothers with COVID 19?

A

The guidelines recommend continuing breastfeeding with necessary hygiene precautions
- Key is handwashing before contact with infant, cleaning surfaces, wearing a mask if available

21
Q

What is given in micronutrient supplementation to make a child less susceptible to getting diarrhea?

A
  1. vitamin A
  2. zinc
22
Q

Vitamin A supplementation and diarrhea?

A
  • Has reduced childhood mortality from 19% to 54%
  • Reduction in deaths mainly attributed to decreased diarrheal diseases and measles
  • Reduces the duration, severity and complications associated with diarrhea
23
Q

Zinc supplementation and diarrhea?

A

Adequate Zn supplementation leads to reduction in childhood diarrhea cases
- reduction in duration of acute diarrhea
- reduction in treatment failure and death in persistent diarrhea
- reduction in recurrence
- increase ORS uptake and reduces inappropriate drug use with antibiotics and antidiarrhoeal medications

24
Q

Benefits of zinc?

A

because it is a vital micronutrient essential for
1. protein synthesis
2. cell growth and differentiation
3. immune function
4. intestinal transport of water and electrolytes
5. normal growth and development of children both with and without diarrhoea

25
Q

Consequences of zinc deficiency?

A

is associated with an increased risk of gastrointestinal infections, adverse effects on the structure and function of the gastrointestinal tract, and impaired immune function

26
Q

Important points on examination?

A
  1. Assess for emergency signs ABCD
    - Shock (cold hands, capillary refill >3 secs, fast, weak pulse)
  2. Assess for Severe Malnutrition (visible severe wasting or oedema of both feet)
  3. Assesshydration
  4. Abdominal examination looking particularly for surgical problems e.g. distension, tenderness, guarding or a mass
  5. Is there any evidence of sepsis
27
Q

Investigations?

A
  1. Blood glucose if low BCS, or lethargic
  2. Stool culture rarely indicated or available (but important if suspected cholera or bacterial enteritis)
  3. Creatinine, urea and electrolytes/blood gases if acidotic, poor urine output
  4. Blood culture if high fever, long history, suspicion of Typhoid
28
Q

Diagnosis of cholera?

A
  1. Suspect in children over 2 years old who have acute watery diarrhoea and signs of severe dehydration.
  2. Cholera outbreaks are particularly seen in the rainy season.
  3. Cholera classically causes profuse diarrhoea (rice-water stool) with a characteristic odour and vomiting.
  4. It leads rapidly to severe dehydration and patients may be shocked
29
Q

Diagnosis of dysentry?

A
  1. Diarrhoea presenting with loose frequent stools containing blood
  2. Associated with abdominal pain, fever, convulsions, lethargy, dehydration
  3. Most common organism is Shigella
30
Q

4 species of Shigella that cause bloody diarrhea?

A
  1. S. dysenteriae
  2. Shigella flexneri
  3. Shigella boydii
  4. Shigella sonnei
    - S. dysenteriae associated with epidemics
31
Q

Other pathogens besides Shigella that cause dysentry?

A
  1. Campylobacter jejuni
  2. enteroinvasive and enterohemorrhagic E. coli
  3. nontyphoidal Salmonella species
  4. Entamoeba histolytica
  5. Schistosoma mansoni
32
Q

What other condition is dysentry associated with?

A

hemolytic uremic syndrome
- Shigella dysenteriae serotype 1 produce Shiga toxin

33
Q

Presentation of hemolytic uremic syndrome?

A

Presentation at the end of the first week and during the recovery phase of diarrheal or dysenteric symptoms with:
1. microangiopathic hemolytic anemia,
2. thrombocytopenia, and
3. acute renal failure (initially oliguric and then anuric).
Note: Convulsions occur in approximately 10% and stroke or cerebral edema in 5% of cases

34
Q

Pathophysiology of HUS?

A
  1. Shigella bacteria produce and release Shiga toxin
  2. induces damage to the vascular endothelium, primarily in kidneys and brain
  3. inflammation and coagulation
35
Q

What is Microangiopathic hemolytic anemia?

A

nonimmune red blood cell (RBC) destruction due to shearing of the RBCs through platelet microthrombi

36
Q

What is dehydration?

A

a dangerous loss of body fluid caused by illness, sweating or inadequate intake

37
Q

Classification of dehydration?

A
  1. severe
  2. some
  3. no dehydration
38
Q

Signs of severe hydration?

A

2 of the following signs:
1. letharic or unconscious
2. sunken eyes
3. not able to drink or drinking poorly
4. skin pinch goes back very slowly

39
Q

Treatment of severe dehydration?

A

Plan C

40
Q

Signs of some dehydration?

A

2 of the following signs
1. restlessnes, irratable
2. sunken eyes
3. drinks eagerly, thirsty
4. skin pinch goes back slowly

41
Q

Treatment for some dehydration?

A

Plan B

42
Q

Signs of no dehydration?

A

not enough signs to classify as some or severe dehydration

43
Q

What is ORS?

A

gold standard of oral rehydration therapy
- fluid replacement should begin at home by caregive+

MBBS 3: Pediatrics (40 decks)

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