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GORGAS > Diarrhoea Illness > Flashcards

Diarrhoea Illness Flashcards

1
Q

How many children die per year from diarrhoea illness and where?

A

1/2 million
Mainy in India and Subsaharan Africa

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2
Q

Average Incidence of diarrhoea in developing countries

A

Average 3 episodes per child per year
Peak between 6mths-18 months

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3
Q

Main risk factors for diarrhoea in children?

A

1) age- mainly less than 5 but peak at 6-18months
2) Malnurtrition
3)Immunosuppression
4)Lack of breastfeeding–the most cost effective intervention
5)Measles
6)No immunisations
7)Lack of safe water, sanitation and hygiene

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4
Q

Acute vs prolonged diarrhoea?

A

Acute is less than 7 days
Prolonged is 7-14days

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5
Q

Osmotic vs secretory

A

Secretory is typically due to a pathogen, pulls electrolytes to the lumen

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6
Q

Inflammatory vs non-inflammatory

A

Inflammatory is typically a bacterial infection (>50 faecal lecuocytes), will need abx
Most diarrhoea is viral

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7
Q

Most important causes of diarrhoea in children?

A

Kids <1yr always think of rota virus
Shigella is typically>1yr
Always think of viruses in children
Rotavirus/adenovirus/St-ETEC, cryptosporidium and campylobacter

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8
Q

What pathogen of E-Coli is typically associated with prolonged diarrhoea in children

A

EPEC

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9
Q

What kind of Dirrhoea in ETEC? (Enteric toxogenic E-Coli)

A

Main pathogen in travellers diarrhoea
Water diarrhoea and can be very severe dehydration in children
High volume and vomiting
Think of diarrhoea

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10
Q

Enterinvasive E-Coli (EIEC)

A

Brisk inflammatory response, very similar to Shigella
Bloody diarrhoea

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11
Q

EAEC?

A

Associated with HIV positive children

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12
Q

EHEC important considerations?

A

Causes HUS

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13
Q

What to consider in acute water diarrhoea?

A

This can be any pathogen- shigella, salmonella and campylobacter are bloody typically but can also be watery

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14
Q

Prolonged diarrhoea in children, what pathogen?

A

EAEC, EPEC, parasite (coccidia)

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15
Q

Most important pathogens for dehydrating diarrhoea?

A

Rotavirus
ETEC
Cholera

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16
Q

Main causes of bloody diarrhoea–most important one

A

Mainly Shigella
Salmonella
Campylobacter
STEC

17
Q

What are the most common diagnostic technique methods?

A

Microscopy–look at faecal lecuocytes and stain for coccidia– most important in resource limited
ELISA for shiga toxin, campylobacter, Rotavirus

18
Q

E-Coli diagnosis?

A

E-Coli can be normal flora, or can be pathogenic
Real time PCR looks for different toxogenic properties of E-Coli

19
Q

When do you use Film Array

A

Only in immunocompromised children
Identifies several different pathogens

20
Q

What do quantitative PCRs help with?

A

Measures the bacteria load
Higher bacteria load means infection rather than colonisation
Differentiates colonisation vs infection

21
Q

What are the three critical signs of dehydration in diarrhoea
What other important signs

A

Thirst
Sensorium- irritable or comatose
Skin turgor: slow, very slow

Sunken eyes/dry mucous membranes/Absent tears

22
Q

What weight loss categories of dehydration?

A

Mild is up to 5% weight loss
Moderate 6-10%
Severe >10%

23
Q

What is rehydration plan A?

A

Education and prevention of diarrhoea
ORS ad libitum
Give ORS drop by drop, as will vomit otherwise
Need ORS with low osmolality

24
Q

What is rehydration Plan B?

A

Observed rehydration
Ad libitum rehydration
100cc/kg in 4-6hrs

25
Q

What is rehydration plan C?

A

This is for severe dehydration
If patient shocked– need blous of saline
If not shocked, 100cc/kg in 3-6hrs with ploy-electrolyte solution or ringers lactate

26
Q

IV rehydration treatment for severe diarrhoea in baby <12 months

A

Administer 30ml/kg in 1hr
Then 70ml/kg in 5hrs
Nacl 0.9% plus dextrose 5% plus KCL

27
Q

IV rehydration in children >12months?

A

Administer 30ml/kg in 30 mins
Then administer 70ml/kg in 2.5hrs

28
Q

What are the new key components to ORS?

A

Low osmolality ORS
Use of zinc for 10-14days in children >6months
Do not give loperamide in children can lead to translocation
Can give ondansetron if you are sure vomiting is due to diarrhoea illness
Not v much evidence for probiotics

29
Q

When do you give abx?

A

Consider in bloody diarrhoea and fever and faecal lecuocytes >50
Antibiotics should cover shigella

30
Q

When do you hand wash?

A

Preparing food
Feeding baby
After changing nappy

31
Q

Why breastfeed infants?

A

Especially in first 6months of life, reduces incidence and mortality of diarrhoea
Right nutrients and passage of maternal antibodies

GORGAS (33 decks)

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