DIARRHOEA Flashcards by Qúophy Calbert

What is Diarhea

Diarrhea is the passage of frequent loos watery stool 3 or more times a day

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Commonest cause of diarrhea in children

Virus

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Diseases associated with diarrhea

Malaria
Pneumonia
Ear infections
Urinary tract infections

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Should enemas and laxatives be given in diarrhea

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What is acute diarrhea

Less than 2 weeks

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Infections associated with chronic diarrhea

Tuberculosis
Opportunistic infections with HIV/AIDS
Amoebiasis

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Cuases of chronic diarrhea

Chronic infections
Functional
Inflammatory disease
Malabsorption syndromes
Malignancy
Endocrine disorders
Drug-induced causes

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What iss chronic diarrhea

More than 2 weeks

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Causes of acute diarrhea

Viruses: norovirus, rotavirus
Bacteria: E. coli, Campylobacter, Shigella, Salmonella, Vibrio cholerae
Protozoal: E. histolytica
Drugs: penicillins

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Drug-induced causes of chronic diarrhea

Laxatives
NSAIDs

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Functional causes of chronic diarrhea

Irritable bowel syndrome

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Inflammatory causes of chronic diarrhea

Ulcerative colitis
Crohn’s disease

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Signs of diarrhea

Anemia
Weight loss
Anorexia
Oral lesions
Skin lesions
Signs of dehydration
Enlarged thyroid
Abdominal mass
Rectal mass

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Endocrine causes of chronic diarrhea

Hyperthyroidism
Diabetic autonomic neuropathy

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Symptoms of diarrhea

Frequent watery stools
Blood or mucus in stool
Associated vomiting
Reduced urine output
Presence of fever

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Diagnostic clues seen in viral diarrhea

Diarrhea with vomiting, low grade fever with no mucus in stools

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Diagnostic clues seen in bacterial diarrhea

Diarrhea with vomiting, fever, blood or mucus in stools abdominal cramps

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Diagnostic clues seen in amoebiasis

Diarrhea with blood and mucus in stool without fever

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Diagnostic clues seen in cholera

Profuse diarrhea with rice water stools and vomiting

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Diagnostic clues seen in food poisoning

Diarrhea with excessive vomiting (especially if in more than one member of the household or group)

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Diarrhea presenting with oral and or skin lesions, weight loss over a long period is seen in ………..

HIV

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Diarrhea alternating with constipation is seen in …….

Bowel malignancy

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Assess dehydration based on condition of child

Nil (<5%)
Well, alert

Mild-moderate (5-10%)
Irritable, restless

Severe (>10%)
Unconscious, floppy or lethargic

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Assess dehydration based on eyes of child

Nil (<5%)
Normal

Mild-moderate (5-10%)
Sunken

Severe (>10%)
Very dry and very sunken

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Assess dehydration based on mouth and tongue of child

Nil (<5%) Moist Mild-moderate (5-10%) Dry Severe (>10%) Very dry

Assess dehydration based on level of thirst of child

Nil (<5%) Drinks normally, not thirsty Mild-moderate (5-10%) Thirsty, drinks eagerly Severe (>10%) Drinks poorly

Assess dehydration based on how the child's skin fells after pinching

Nil (<5%) Goes back immediately after pinching Mild-moderate (5-10%) Goes back slowly after pinching Severe (>10%) Goes back very slowly after pinching

Treatment plans for different degrees of dehydration

Nil Treatment plan A Mild-moderate Traetment plan B Severe Treatment plan C

Investigations in diarrhea

FBC BUE/Cr Stool C/S Stool routine examination Blood film for malaria parasites

Treatment objectives in diarrhea

To prevent dehydration To replace lost fluid To maintain nutrition by ensuring adequate dietary intake during illness To maintain personal hygiene To eliminate infecting organism

Non-pharmacological management of diarrhea

Keep surroundings clean Improve personal hygiene Adequate fluid intake Maintain adequate nutrition

First line treatment for bacterial gastroenteritis

Oral Ciprofloxacin 500mg 12 hourly for 5 days in adults 15mg/kg for 5 days in children

Second line treatment for bacterial gastroenteritis

IV Cefuroxime 750mg 8 hourly for adults 25mg/kg 12 hourly for Children 25mg/kg 12 hourly for neonates > 7 days 25mg/kg 8 hourly for neonates < 7 days then Oral Cefuroxime for 5-7 days 250mg 12 hourly in adults and children > 12 years 15mg/kg (max 250mg 12 hourly) for 2-12 years 10mg/kg (max 125mg 12 hourly) 3months to 2 years

Can cefuroxime suspension be given to neonates

No, it can only be used in children above 3 months

Treatment for amoebic dysentery

PO Metronidazole 800mg 8 hourly for 5 days in adults 400mg 8 hourly for for 5 days in 8-12 years 200mg 8 hourly for 5 days in 4-7 years 100mg 8 hourly for 5 days in 0-3 years

Treatment for cholera

Tetracycline for 3 days 500mg 6 hourly in adults or Doxycycline for 3 days 100mg 12 hourly in adults or Erythromycin for 5 days 500mg 8 hourly in adults and children >13 years 250-500mg 6 hourly for 6-12 years 250mg 6 hourly for 2- 6 years 125mg 6 hourly for 1 month to 2 years 12.5mg/kg 6 hourly for neonates

How long should ORS be given again if the child vomits

After 10 minutes

Zinc dosing in diarrhea

10mg for 10-14 days in children < 6months 20mg for 10-14 days in children > 6 months

Plan A treatment of diarrhea by fluid therapy in children 2-10 years

1000ml or more of ORS basic amount 100-200ml of ORS for every extra stool passed

Plan A treatment of diarrhea by fluid therapy in children <2 years of age

500ml or more of ORS basic amount 50-100ml of ORS for every extra stool passed

Plan A treatment of diarrhea by fluid therapy in children over 10 years

2000ml or more of ORS basic amount 100-200ml of ORS for every extra stool passed

For treatment plan B how long is ORS given for initially

4 hours

For treatment plan B, when is state of hydration reassessed

After 4 hours

Plan B treatment of diarrhea by fluid therapy in children <6kg or up to 4months

ORS 200-400ML

Plan B treatment of diarrhea by fluid therapy in children 6 to 10kg or 4-12 months

ORS 400 to 700ml

Plan B treatment of diarrhea by fluid therapy in children 10-12kg or 1 to 2 years

ORS 700 to 900ml

Plan B treatment of diarrhea by fluid therapy in children 12-19kg or 2 to 5 years

ORS 900 to 1400ml

Approximate way of calculating required ORS amount for treatment plan B

Weight times 75ml

Total IV fluid regimen in treatment plan C

100ml/Kg R/L or Normal saline or Cholera replacement fluid (5:4:1)

According to treatment plan C, when is ORS given and how much is given

5ml/kg/hour as soon as child can drink 3-4 hours in infants 1-2 hours in children

According to treatment plan C, when is reassessment for dehydration done

After 6 hours in infants After 3 hours in children

When is IV fluids stopped according to treatment plan C

Do not stop the IV fluids until the child has been observed to retain the ORS for at least 1 hour and there is improvement in the clinical condition

Potassium abnormalities in diarrhoea

Hypokalemia due to marked fluid loss or HShyperkaliemia from impaired renal function leading

Acid base imbalance present in diarrhea

impaired renal function leading to acidosis

Should infants or children breastfeed or eat during diarrhea

Yes

Plan C diarrhea treatment plan by fluid therapy

Infants (<12 months) 30ml/kg in 1 hour then 70ml/kg in 5 hours Children (12months to 5 years) 30ml/kg in 30mins then 70ml/kg in 2.5 hours

Anti-diarrheal medications not used in children

Loperamide Codeine Diphenoxylate/atropine Mist kaolin

Antibiotic preparations with kaolin or pectin are beneficial in diarrhea

False

Most common cause of severe diarrhea in children less than 5 years

Rotavirus

Rotavirus diarrhea peaks between which months

Dry months (December-March)

Symptoms of rotavirus diarrhea

Fever Vomiting Profuse watery diarrhea Thirst

Signs of rotavirus diarrhea

Sunken eyes Diminisehd skin turgor Altered consciousness

Investigations in rotavirus diarrhea

Enzyme immunoassay (EIA) to detect rotavirus antigen

Non-pharmacological treatment of rotavirus diarrhea

Home-based fluids Adequate nutrition (give an extra meal per day for 2 weeks after the episode )

pharmacological treatment of rotavirus diarrhea

ORS Zinc

Prevention of rotavirus diarrhea

Two (2) doses of Rotavirus vaccine, given at 6 - 10 weeks The 2nd dose should be given by 16 weeks, and not later than 24 weeks

Referral criteria for rotavirus diarrhea

Poor response to rehydration process (passing more stools than drinking) Poor drinking Blood in stool Poor feeding Altered consciousness/convulsions Diarrhoea and vomiting continuing for > 3 days

DIARRHOEA Flashcards

(67 cards)