Diarrheal Diseases Flashcards by Iseoluwa Ojo

Watery Diarrhea: _______ or more _______ or _______ stools in _______

Dysentery: Presence of _______ and/or _______ in stools

Persistent Diarrhea: Diarrhea lasting for ____________ or more

3 ; liquid ; watery ; 24 h

blood ; mucus

14 days

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Diarrhoea is a leading cause of death among children under five globally.

faeco-oral

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Season: Tropics

Throughout; dry

rainy

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Temperate climate

winter

warm

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Predisposing factors

breastfeed exclusively ; 6 months ; 2 years.

feeding ; wash hands

contaminated ; Malnutrition

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Aetiology of diarrhea

Watery diarrhea :???

Dysentery: ??

Persistent diarrhea:???

Rota virus
E.coli
Cholera

Shigelliosis
Ameobiasis

Causes are mostly unknown

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Transmission

Most of the diarrheal agents are transmitted by the _______ route

Some viruses (such as rotavirus) can be transmitted through _________

Nosocomial transmission is (possible or impossible?)

Shigella (the bacteria causing ________) is mainly transmitted _________________

fecal-oral

air; possible

dysentery; person-to-person

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PERSON-AT-RISK

Cholera: ______ years and above, (common or uncommon?) in very young infants

Shigellosis: more common in young children aged _________ years

Rotavirus diarrhea: more common in young infants and children aged __________

E. coli diarrhea: can occur at ______ age

Amebiasis: more common among ________

2 years ; uncommon

below 5 years

1-2 years

any ; adults

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Types of Vibrio Cholera

Two major biotypes of Vibrio cholera that
cause diarrhea are:
 __________
 __________

Two common serotypes of Vibrio cholera
that cause diarrhea are:
 Inaba  Ogawa

Classical
ElTor

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Vibrio Cholerae O139

Vibrio cholerae in _____-group ____ was first isolated in 1992 and by 1993 had been found throughout the ______ subcontinent. This epidemic expansion probably resulted from a single source after a _______________ event that changed the serotype of an epidemic V. cholerae O1 El Tor strain to O139.

O-group 139

Indian subcontinent.

lateral gene transfer (LGT)

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TYPES OF SHIGELLA
The major serotypes of Shigella that cause
diarrhea are:
 Dysenteriae type 1 or __________________
 Shigella __________________
 Shigella __________________
 Shigella __________________

Shigella shiga
 Shigella flexneri
 Shigella sonnei
 Shigella boydii

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TYPES OF E. COLI
Six major types of Escherichia coli cause
diarrhea:

List them

 Enterotoxigenic E. coli (ETEC)
 Enteroinvasive E. coli (EIEC)
 Enteropathogenic E. coli (EPEC)
 Enterohemorrhagic E. coli (E. coli O157:H7)  Enteroaggregative E. coli (EAggEC)
 Diffuse adherent E. coli (DAEC)

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History for diarrhea

Diarrhea

duration; number; blood

fever, cough

feeding practices

Urine output

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CLINICAL FEATURE: CHOLERA
__________ stool
Marked __________
__________ vomiting
_______ fever or abdominal pain
Muscle cramps
__________ shock
__________ urine

Rice-watery
dehydration
Projectile
No
Hypovolemic
Scanty

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CLINICAL FEATURE: E. COLI DIARRHEA

__________ stools
__________ is common
Dehydration
__________ Fever
__________ abdominal pain

Watery
Vomiting
moderate to severe
Mild

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CLINICAL FEATURE: ROTAVIRUS DIARRHEA

__________ onset

Prodromal symptoms, including _______, __________, and __________ precede diarrhea

Stools are __________ or __________; the color is greenish or yellowish– typically looks like ____________________

_______ to _______ dehydration

Fever– __________ grade

Insidious

fever ; cough ; vomiting

watery ; semi-liquid;

yoghurt mixed in water

Mild to moderate

moderate grade

CLINICAL FEATURE: SHIGELLOSIS

(Frequent or Rare?) passage of ________ amount of stools, mostly mixed with ________ and ________

________ to ________ grade fever

(Mild, moderate , or Severe?) abdominal cramps
__________ – pain around anus during defecation
Usually _______ dehydration

Frequent ; scanty

blood ; mucus

Moderate to high

Severe; Tenesmus–

CLINICAL FEATURE: AMEBIASIS
_________ and _________ stools containing mostly _________ and sometimes _________

(Upper or Lower?) abdominal cramp
_______ grade fever
_______ dehydration

Offensive ; bulky stools

mucus ; blood

Lower ; Mild

LABORATORY DIAGNOSIS

________ microscopy
_________ microscopy of stool for cholera
Stool ________
_______ for rotavirus
Immunoassays, bioassays or DNA probe
tests to identify E. coli strains

Stool microscopy

Dark field microscopy

cultures

ELISA

Clinical Assessment

Dehydration

dehydration

prevent ; treat

Assessment of dehydration in a malnourished child
Reliable parameters are

History of ________
______ mucous membranes
Rapid and weak _______
History of ________

diarrhea

Dry; pulse

urine output.

Investigations:

Acidic

Treatment of Doarrhea

__________
_____________
_________________

Rehydration
Medication
Nutrition

Treatment plan A- For patients with no sign of dehydration

50-100

100-200

as much as desired

Treatment plan B: for patients with Mild and Moderate dehydration Give ORS(_________________________) with cup and spoon every ________ or via NG tube. Dose – _____ml/kg over 4 hours Reassess often. If severe dehydration is observed start _________ immediately. After ___________, revaluate and reclassify. For infants <6months of age who are not breastfeeding add _______mls of water.

oral rehydration salt solution 1-2min 75; IV fluid 4hours 100-200

Treatment plan C: for patients with severe dehydration - Give ________mls/kg IV.

100

Probiotics -____________ feed supplements e.g. __________. They improve intestinal microbial balance and promote health Also found in such foods as _____,__________,_________

live microbial; lactobacilli yogurt, milk, soy drinks.

Nutrition _______ energy rich foods/ day during diarrhea and _________ meal X _____weeks or more for malnourished children. (Stop or Continue?) breast feeding

6; one extra 2weeks; continue

Micronutrients Zinc 10-20mg/day for 10–14 days.)- reduces ___________ of acute diarrhoea by 25% and Rx failure or death by 40% in persistent diarrhoea. Give Vit A (esp. in areas of low Vit A levels) - The relative risk of dying from diarrhoea increases______ fold in children with Vit A deficiency. Restart _______________ after rehydration Change to _________ formula If the stool pH is low or diarrhoea restarts after reintroducing formula.

duration two; formula feed lactose free

COMPLICATIONS: WATERY DIARRHEA List 6

Dehydration Electrolyte imbalances Tetany Convulsions Hypoglycemia Renal failure

COMPLICATIONS: DYSENTERY Electrolyte imbalances Convulsions Hemolytic uremic syndrome (HUS) Leukemoid reaction Toxic megacolon Protein losing enteropathy Arthritis Perforation

Shshsh

Prevention ________ and __________ vaccinations Promotion of early and exclusive ___________ and __________ supplementation Promotion of hand washing with ———- Improved water supply quantity and quality, including treatment and safe storage of household water Community-wide ________ promotion.

Rotavirus and measles breastfeeding ; vitamin A soap; sanitation

VACCINES An oral cholera vaccine is available, which gives immunity to 50-60% of those who take the vaccine, and this immunity lasts ________________. No vaccines are available against ________ A vaccine against ___________ diarrhea has been withdrawn recently from the market.

only a few months. shigellosis; rotavirus