GIT Flashcards
1
Q
Definition of acute diarrhea
A
Passage of liquid/ watery stool
3 or more in 12 hours
or single soft or watery stool
contain blood, mucus, &pus
2
Q
Etiology and complication of acute diarrhea
A
- Etiology
- rota virus
- e.coli
- shigella
- camphylobacter
- food, drug, laxative - Complication
- dehydration: shock
- electrolyte disturbance: hypo/hyper Na, K
- ph disturbance: acidosis
- PEM
- convulsion
3
Q
Management of acute diarrhea
A
- Prophylactic
- promote BF
- improve weaning
- rota virus immunization
- improve hygeine - Ttt
- ORS
- diet selection: lactose free
- zinc supplement
- drug:
a) antimicrobial
> trimethoprim 10-50mg/kg
> metronidazole
b) antidiarrhea
> constipating drug
> antimotility drug
4
Q
Composition of ORS
A
- NaCl 3.5g/L
- correct Na loss
- facilities water solution - KCl 1.5g/L
- correct potassium loss
- prevent hypokalemia - Trisodium citrate 2.9g/L
- correct the acidosis - Glucose 20g/L
- facilitate Na absorption by glucose sodium co- transport
5
Q
Vomiting with diarrhea, why and how to deal?
A
- vomit due to acidosis, hypokalemia, hypovolemia
- anti emetic not effective (due it act peripheral)
- vomiting may stop by:
> spontaneously
> after correct of dehydration with ORS
> if persistent give ORS by nasogastric tube
6
Q
Risk factor of persistent diarrhea.
A
- young age
- artificial feeding
- malnutrition
- low immunity
- abuse of drug
7
Q
Clinical picture of severe dehydration
A
- lethergy, unconsciousness
- deep sunken eyes
- absent tear
- deep breath
- unable to drink
- mouth & tougue pearched (kering)
- tachycardia
- skin recoil more then 2 sec
- pulse: weak
- prolonged capillary refill
- cold extremities
- minimal urine output
8
Q
Management of severe dehydration
A
- admission to hospital
- close monitor for IV fluid
-type of fluid,
> polyelectrolyte solution
> ringer lactate
- amount: 100ml/kg
- rate:
> shock therapy: 30ml/kg for 30 min
> deficit : 70ml/kg for 2.5 hourj
- Observation
- pulse for sign of shock
- consciousness
- other sign: weight, skin, urine
9
Q
Clinical picture of some dehydration
A
- fatigue
- slightly sunken eye
- tear decrease
- fast breathing
- eager to drink
- mouth and tongue dry
- increase HR
- skin recoil less than 2 sec
- pulse: decrese
- prolonged capillary refill
- cool extremities
- decrease urine output
10
Q
Management of some dehydration
A
- Under observation at hospital
- Duration: 4hours and reasses
- Fluid: ORS
- amount: 75ml/kg
- method: cup/ spoon
- rate : one spoon (5ml) every 2 min - Observe:
- if vomiting: wait 10 minute, slower the rate
- if refusal: if persistent, start NGT
- if sign dehydration persistent, start IV fluid
11
Q
Definition of diarrhea
A
Excessive loss of fluid and electrolyte in stool
12
Q
Type of diarrhea
A
- Acute water diarrhea
- watery stool
- 3 or more time in 12 hours - Dysentry
- small volume
- frequent bloody stool
- with mucus, tenesmus, urgency - Persistent diarrhea
- episodic
- began acutely
- last at least 14 days - Chronic diarrhea
- prolonge course
- start gradually
13
Q
Mechanism of diarrhea
A
- Secretory
- caused by secretagogue ( cholera toxin)
- watery
- large amount
- persist even no feeding - Osmotic
- poorly absorb solute
- lesser volume
- stop after fasting - Motility disorder
- slow motility
- cause bacteria overgrowth the diarrhea
14
Q
Management diarrhea without dehydration
A
- Home management
- Fluid
- 1/4- 1/2 cup ( baby lower 2 years)
- 1/2- 1 cup ( baby more 2 years) - Other:
- plain water
- helba, anise
- avoid sugar contain - Food:
- breast feed continue
- formula
- easily digestible food - Follow up
- diarrhea no better in 3 days
- vomit appear
- fever more than 2 days
- dehydration appear
- food, drink refusal
15
Q
DD of vomiting
A
- systemic infection
- GERD
- gastroenteritis
- otitis media
- over feeding
- gasteritis
