DIARRHOEA IN CHILDREN Flashcards
What is diarrhea
3 or more loose or watery stools within 24 hours
Important considerations in diarrhea
Usual habit
Increased stool fluidity and frequency
Reasons for increased stool fluidity and frequency in diarrhea
Increased gut motility
Increased gut secretion
Decreased gut absorption
Types of diarrhea
Acute watery diarrhea
Dysentery
Persistent diarrhea
Severe persistent diarrhea
Chronic diarrhea
Duration for persistent diarrhea
> 14 days
Duration for acute watery diarrhea
<14 days
Dysentery
Bloody diarrhoea
Severe persistent diarrhoea
Persistent diarrhoea with signs of dehydration
Features of acute watery diarrhoea
No visible blood in stools
+- Vomiting
Lasts<14 days
Three main classes of E. coli
Commensal strains
Intestinal pathogenic
Extraintestinal pathogenic
Name the intestinal E. coli strains
Enterotoxigenic E. coli (ETEC)
Enteroaggregative or Enteroadherence E. coli (EAEC)
Diffusely adhering E. coli (DAEC)
Enteropathogenic E. coli (EPEC)
Enterohemorrhagic E. coli (EHEC)
Adherence Invasive E. coli (AIEC)
Enteroinvasive E coli (EIEC)
Name the extraintestinal E. coli strains
Uropathogenic E. coli (UPEC)
Neonatal meningitis E. coli (NMEC)
Avian pathogenic E. coli (APEC)
Sepsis associated E. coli (SEPEC)
Intestinal strains of E. coli that cause diarrhea
EPEC
ETEC
EHEC
EIEC
EAEC
DAEC
Disease caused by NMEC
Neonatal meningitis
Disease caused by UPEC
UTIs and pyelonephritis
AIEC
Cron’s disease (persistent intestinal inflammation)
Which E coli strain causes dysentery and watery diarrhoea
EIEC
Which e coli strains cause watery diarrhea and vomiting (Acute watery diarrhea)
EPEC
ETEC
Which E. coli causes haemorrhagic colitis
which presents as bloody diarrhoea?
EHEC
Which E. coli strain causes persistent diarrhea (watery diarrhoea, mucus and vomiting )
EAEC
Causative agents of acute watery diarrhoea
Rotavirus
Norovirus
ETEC, EPEC
Shigella
C. jejuni
Cryptosporidium
V. cholerae
Features of dysentery
Blood in stool
Anorexia
Rapid weight loss
Intestinal mucosal damage
Causative organisms of dysentery
SCEES
Shigella
C. jejuni
EIEC
E. histolytica
Salmonella
Causative organims of persistent diarrhoea
(CEGS)
Cryptosporidium
EAEC
G. lamblia
Shigella
Chronic diarrhoea
Recurrent diarrhea not due to infectious causes but rather metabolic disorders
Features of persistent diarrhoea
14days or more
Starts as acute diarrhea or dysentery
Marked weight loss
Mechanism of viral diarrhoea
Replication within epithelia cells
Villous destruction
Shortening and loss of dissaccharidase enzymes
Replacement with immature enzymes
Water and electrolyte secretion
Mechanisms of bacteria diarrhoea
Mucosal adhesion
Toxin secretion
Mucosal invasion
Mechanism of protozzoal diarrhoea
Mucosal adhesion
Mucosal invasion
Which part of theGUT does cyptosporidium and G. lamblia adhere to
Ileum
Mucosa adhering protozoa
G. lamblia
Cryptosporidium
Mucosa invading protozoa
E. histolytica
E. histolytica invades which part of the gut
Colon
Ileum
Classification of diarrhoea based on mechanisms
Invasive diarrhoea
Secretory diarrhoea
Osmotic diarrhoea
Invasive diarrhoea causing pathogens
(SCEEVEYS)
Shigella
C. jejuni
EIEC
EHEC
Virbio parahaemolitica
E. histolytica
Yersinia enterocolitica
Salmonella
Secretory diarrhea occurs at which part o the gut
Ileum
Invasive diarrhoea occurs in which part of the gut
Distal ileum
Colon
Pathogens that cause secretory diarrhoea
Due to enterotoxin (SEVECS)
Salmonella
ETEC
V. cholera
EPEC
Campylobacter
Shigella
Not due to enterotoxin
Rotavirus
Norovirus
Agents causing both secretory and invasive diarrhoea
Shigella
Salmonella
Campylobacter
Agents causing osmotic diarrhoea
Purgatives
Improperly prepared ORS/ Salt sugar solutions
Lactose in lactose intolerance
Glucose in glucose malabsorption
Effects of diarrhoea
Hypovolaemia
Multiple organ failure
Tissue damage
Abnormal physiology
Acidosis
Hypokalemia
Chemical mediators released in hypoperfusional state that cause tissue damage
Complements
Lipopolysaccharides
Leukotrienes
Interleukins
TNF
Coagulation cascade
Leucocytes
Endorphin
PAF
Abnormal physiology encountered in diarrhoea
Plugged capillaries
Change in blood viscosity
Abnormal starling mechanism
Altered interstitium
Damaged barrier function
Ileus
Coagulation cascade
Effects of potassium depletion
General muscle weakness
Cardiac arrhythmias
Paralytic ileus
Types of dehydration
Isotonic
Hypotonic
Hypertonic
Normal serum sodium level and osmolarity
130-150mEq/l
275-295mOsmol/l
Causes of isotonic dehydration
Diarrhoea
Vomiting
Causes of hypotonic dehydration
Ingestion of large amounts of water
IV hypotonic fluids (
5% glucose infusions)
Effects of hypotonic dehydration
Lethargy
Seizures
At which degree of dehydration does signs of dehydration occure
Lesser degrees- Hypotonic dehydration
Higher degrees- Hypertonic dehydration
Causes of hypertonic dehydration
Ingestion of hypertonic saline
Insufficient water intake
Low sloute drinks
How to perform skin pinch
Pinch skin in longitudinal plane between thumb and bent forefinger
Classes of skin pinches
Normal- goes back immediately
Slowly: fold visible <2sec
Very slowly: visible >2s
WHO degrees of dehydration
No dehydration (<5% loss)
Mild-Moderate dehydration (5-10%loss)
Severe dehydration (>10% loss )
General condition assessment for dehydration
No dehydration: well alert
Mild-moderate: irritable
Severe: lethargic/ unconscious
Eyes assessment for dehydration
NO dehydration: normal
Mild-Moderate: sunken
Severe: sunken
Thirst evaluation for dehydration
No dehydration: drinks normally
Mild-Moderate: drinks eagerly
Severe: drinks poorly or unable to drink
Diarrhoea immunizations
Rotavirus
Norovirus
Cholera
Measles
Prevention of diarrhoea
Hand washing
Food hygiene
Safe disposal of excreta
Good nutrition
Immunizaton
