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STG 2017 > DIARRHOEA > Flashcards

DIARRHOEA Flashcards

1
Q

What is Diarhea

A

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

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2
Q

Commonest cause of diarrhea in children

A

Virus

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3
Q

Diseases associated with diarrhea

A

Malaria
Pneumonia
Ear infections
Urinary tract infections

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4
Q

Should enemas and laxatives be given in diarrhea

A

No

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5
Q

What is acute diarrhea

A

Less than 2 weeks

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5
Q

Infections associated with chronic diarrhea

A

Tuberculosis
Opportunistic infections with HIV/AIDS
Amoebiasis

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5
Q

Cuases of chronic diarrhea

A

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

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6
Q

What iss chronic diarrhea

A

More than 2 weeks

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6
Q

Causes of acute diarrhea

A

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

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6
Q

Drug-induced causes of chronic diarrhea

A

Laxatives
NSAIDs

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7
Q

Functional causes of chronic diarrhea

A

Irritable bowel syndrome

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7
Q

Inflammatory causes of chronic diarrhea

A

Ulcerative colitis
Crohn’s disease

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7
Q

Signs of diarrhea

A

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

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8
Q

Endocrine causes of chronic diarrhea

A

Hyperthyroidism
Diabetic autonomic neuropathy

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8
Q

Symptoms of diarrhea

A

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

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9
Q

Diagnostic clues seen in viral diarrhea

A

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

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9
Q

Diagnostic clues seen in bacterial diarrhea

A

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

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10
Q

Diagnostic clues seen in amoebiasis

A

Diarrhea with blood and mucus in stool without fever

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10
Q

Diagnostic clues seen in cholera

A

Profuse diarrhea with rice water stools and vomiting

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11
Q

Diagnostic clues seen in food poisoning

A

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

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12
Q

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

A

HIV

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13
Q

Diarrhea alternating with constipation is seen in …….

A

Bowel malignancy

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14
Q

Assess dehydration based on condition of child

A

Nil (<5%)
Well, alert

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

Severe (>10%)
Unconscious, floppy or lethargic

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15
Q

Assess dehydration based on eyes of child

A

Nil (<5%)
Normal

Mild-moderate (5-10%)
Sunken

Severe (>10%)
Very dry and very sunken

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16
Q

Assess dehydration based on mouth and tongue of child

A

Nil (<5%)
Moist

Mild-moderate (5-10%)
Dry

Severe (>10%)
Very dry

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17
Q

Assess dehydration based on level of thirst of child

A

Nil (<5%)
Drinks normally, not thirsty

Mild-moderate (5-10%)
Thirsty, drinks eagerly

Severe (>10%)
Drinks poorly

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18
Q

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

A

Nil (<5%)
Goes back immediately after pinching

Mild-moderate (5-10%)
Goes back slowly after pinching

Severe (>10%)
Goes back very slowly after pinching

19
Q

Treatment plans for different degrees of dehydration

A

Nil
Treatment plan A

Mild-moderate
Traetment plan B

Severe
Treatment plan C

20
Q

Investigations in diarrhea

A

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

21
Q

Treatment objectives in diarrhea

A

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

22
Q

Non-pharmacological management of diarrhea

A

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

23
Q

First line treatment for bacterial gastroenteritis

A

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

24
Q

Second line treatment for bacterial gastroenteritis

A

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

25
Q

Can cefuroxime suspension be given to neonates

A

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

26
Q

Treatment for amoebic dysentery

A

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

27
Q

Treatment for cholera

A

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

28
Q

How long should ORS be given again if the child vomits

A

After 10 minutes

28
Q

Zinc dosing in diarrhea

A

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

28
Q

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

A

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

29
Q

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

A

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

29
Q

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

A

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

30
Q

For treatment plan B how long is ORS given for initially

A

4 hours

31
Q

For treatment plan B, when is state of hydration reassessed

A

After 4 hours

32
Q

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

A

ORS 200-400ML

33
Q

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

A

ORS 400 to 700ml

34
Q

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

A

ORS 700 to 900ml

35
Q

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

A

ORS 900 to 1400ml

36
Q

Approximate way of calculating required ORS amount for treatment plan B

A

Weight times 75ml

37
Q

Total IV fluid regimen in treatment plan C

A

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

37
Q

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

A

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

38
Q

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

A

After 6 hours in infants
After 3 hours in children

39
Q

When is IV fluids stopped according to treatment plan C

A

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

40
Q

Potassium abnormalities in diarrhoea

A

Hypokalemia due to marked fluid loss

or

HShyperkaliemia from impaired renal function leading

41
Q

Acid base imbalance present in diarrhea

A

impaired renal function leading to acidosis

42
Q

Should infants or children breastfeed or eat during diarrhea

A

Yes

43
Q

Plan C diarrhea treatment plan by fluid therapy

A

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

44
Q

Anti-diarrheal medications not used in children

A

Loperamide
Codeine
Diphenoxylate/atropine
Mist kaolin

45
Q

Antibiotic preparations with kaolin or pectin are beneficial in diarrhea

A

False

46
Q

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

A

Rotavirus

47
Q

Rotavirus diarrhea peaks between which months

A

Dry months (December-March)

48
Q

Symptoms of rotavirus diarrhea

A

Fever
Vomiting
Profuse watery diarrhea
Thirst

49
Q

Signs of rotavirus diarrhea

A

Sunken eyes
Diminisehd skin turgor
Altered consciousness

50
Q

Investigations in rotavirus diarrhea

A

Enzyme immunoassay (EIA) to detect rotavirus antigen

51
Q

Non-pharmacological treatment of rotavirus diarrhea

A

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

52
Q

pharmacological treatment of rotavirus diarrhea

A

ORS
Zinc

53
Q

Prevention of rotavirus diarrhea

A

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

54
Q

Referral criteria for rotavirus diarrhea

A

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

STG 2017 (88 decks)

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