GIT

Question 1

1.Define acute diarrheal disease
2.When u use term dystnery
3.persistent diarrhea

Answer 1

1.Diarrhoea is defined as change in consistency and frequency of stool,i.e. liquid or watery stool that occur >3 times a day.usually subsides within 7 days.
2. In cases of associated blood.
3. Acute persisting for>2wks is persistent diarrhea ( aeromonas)
Chronic diarrhea also last >2 weeks but usually of non infective pathology

Question 2

Two most important consequences of diarrhea?

Answer 2

1. Vicious cycle of malnutrition and diarrhoea
2. Dehydration

Question 3

Aetiology of acute diarrhoea
M/c/c

Answer 3

• Intestinal infections are most common cause of acute diarrhea.
• drugs
  -food allergy
  -systemic infections (UTI and otitis media)
• surgical conditions ( appendicitis and hirschprungs)

Question 4

Organisma implicated in intestinal infections in acute diarrhea
M/c/c
Causes of dysentry

Answer 4

• rota virus = severe dehydrating gastroenteritis
  **(Rota and E.coli account for nearly 50% of episodes) **
• cholera for 5-10% cases
• shigella and salmonella in 3-7% cases.
  -candida albicans causes acute diaarhea in patients with malnutrition and immunocompromised state.
• c.difficle suspected in patients reciving broad spectrum antibiotics.
• enterohemorrhagic E.coli (EHEC) and shigella acounts for majority of dysentry cases.

Question 5

Clinical findings in diarrhea
(Signs of dehydration)

Answer 5

Child is thirsty and irritable.
Dontanelle is depressed
Eye
Tongue and inner side of cheeks appear dry
Kussmaul breathing may be seen due to acidosis.
Low blood pressure
Decreased urine output - good indicator of monitoring.
Skin elasticity is maintained by ECF :
HYPONATREMIC and isonatermic dehydration : skin turgor is lost.
Hypernatremic dehydration : ICF -> ECF : skin appears soggy,doughy and leathery
weaky thready pulse,low BP and cold extremities.
Diarrheal stools containes large amount of potasium:
Abdominal distension,paralytic illeus and muscle hypotonia in severe cases

Question 6

Signs of dehydration
First is minimal - then mild to moderate. - then severe

Answer 6

** Loss of body weight** <3% 3-9% >9%
Mental status alert irritable Lethargic
** Thirst** Drinks normally Thirsty; eager to drink Drinks poorly
** Heart rate** Normal Normal to increased Tachycardia(Weak, thready or impalpable)
Skin turgor Instant recoil Recoil in <2 sec Recoil in >2 sec.
** Capillary refill** Normal Prolonged Prolonged

Question 7

Composition of reduced osmolarity Oral Rehydration Solution (ORS)

Answer 7

Reduced- osmolarity ORS
Sodium - 75 mmolL
Glucose (anhydrous)
Chloride - 65 mmolL
Potassium- 20 mmolL
Citrate- 10 mmolL

Total Osmolarity : 245 mmolL

Question 8

Treatement for acute diarrhea( dehydration) :
Major headings

Answer 8

Most of the cases of under-five acute diarrhoea are infectious in aetiology with more than 50% due to the Rotavirus, which is self-limiting. Treatment includes fluid and electrolyte correction and zinc supplementation.
1. Rehydration
2. Nutritional managemnt
3. Oral supplementation of zinc
4. Drug therapy
5. Prevention

Question 9

Rehydration therapy:
-minimal dehydration

Answer 9

Plan A: no dehydration or minimal dehydration :
No admission required,treated in home after explaining feeding and danger signs to mother.
Oral rehydration therapy to prevent dehydration is given after each loose stools:
Age
<2 years
2-10 years
>10 years
Amount
50-100 mL
100-200 mL
As much fluid as they want

Question 10

Rehydration therapy:

For moderate dehydration.

Answer 10

Plan B: For moderate dehydration.
Treated in health centre/hospital
I)deficit replacement(to correct existing deficits) = 75 mL/kg of ORS to be given.
II) maintenance therapy : when signs of dehydration disappear usually with 4 hours : volume given = diarrheal losses

Question 11

Rehydration therapy:

Severe dehydration

Answer 11

I.V. Fluids ringer lactate with 5% dextrose.

Age: Infants (under 12 months)
First, give 30 mL/kg in 1 hr
Followed by 70 mL/kg in 5 hrs
Total 100 mL/kg in
6 hrs

Age :Older
30 mL/kg in 30 min
70 mL/kg in 2½ hrs

Total 100 mL/kg in
3 hrs

Question 12

Nutritional management
And supplemntation

Answer 12

Early feeding during diarrhea decreasestool volume and facilitates absorption prevents malnutrition
1. breastfeeding should continue.
2. energy dense food with least bulk in small quantities but frequently.
3. Food enriched with fat oil and sugar.

Zinc supplementation is part of standard care.
20mg elemental zinc/day for children >6 months

Question 13

Antibiotics

Answer 13

Not recommended for routine treatment.
Indicated in bacillary dystentrey amebiasis,giardiasis .

Antimotility drugs should never be used