MOD 4- Acute Diarrhea in Children

Question 1

Globally, Diarrhea is the_____________ leading cause of mortality and morbidity among children less than 5years old

• WHO, World Health Statistics, 2011

Answer 1

second

Question 2

Most Common Microorganisms for Acute Endemic Diarrhea among U5 Children in Developing World

< 2 years

Answer 2

Rotavirus

EPEC,ETEC

Astrovirus, Caliciviruses, enteric Adenovirus

Shigella flexneri, Shigella dysnteriae type 1

Campylobacter jejuni

ETEC, EAEC

Question 3

Most Common Microorganisms for Acute Endemic Diarrhea among U5 Children in Developing World

Answer 3

2-5 years

ETEC

S. flexneri, S. dysenteriae type 1

Rotavirus

Non-typhi Salmonella

Giardia lamblia

Question 4

ROTAVIRUS Vaccine

• Oral route
• 2 types

Answer 4

1. Monovalent human RV
2. Pentavalent Human Bovine RV

Question 5

Monovalent human RV

Answer 5

1: 6 weeks

2-dose

Question 6

Pentavalent Human Bovine RV

Answer 6

1: 6-14 weeks

3-dose

Question 7

What is the minimum interval of doses for Rota virus vaccine and why? :

Answer 7

4 weeks

*Avoid exceeding deadline of last dose due to danger of Intussuscepcion

Question 8

Strategies for
Diarrheal Disease Control

Answer 8

BREASTFEEDING
-Safe and sterile
-Easily digested and absorbed
-Contains antibodies and substances that protect the baby from infection
üImmunizations against ROTAVIRUS
üImproved water supply and sanitation facilities
üPromotion of personal and domestic hygiene: HANDWASHING
•

Question 9

Clinical Types of Acute Diarrhea

Answer 9

1. [*] Simple Diarrhea (w/o blood)
2. [*] Dysentery (w/ blood)

Question 10

• loose stools of >10 ml/kg/day (infants)

> 200g/24hrs (adults) for <14 days

Answer 10

[*] Simple Diarrhea (w/o blood)

Question 11

• small volume, frequent, bloody stools with mucus, tenesmus, and urgency

Answer 11

[*] Dysentery (w/ blood)

Question 12

• Disturbed intestinal solute transport and water reabsorption
• Can be explained by the ff mechanisms:

Answer 12

1.Secretory
2.Osmotic
3.Motility abnormalities
4.Reduced surface area
5.Mucosal invasion
–

Question 13

Mechanisms of Diarrhea

Decreased absorption, increased secretion, electrolyte transport

Answer 13

Secretory

Question 14

What are example of secretory diarrhea?

Answer 14

Cholera,

toxigenic E. Coli,

tumors

Question 15

Maldigestion,

transport defects,

ingestion of unabsorbable substance

Answer 15

Osmotic

Question 16

What is the pathophysio of Secretory Diarrhea?

Answer 16

The intestinal epithelial cell
solute transport system is in
active state of secretion

Often caused by a
secretagogue (ex. cholera
toxin) binding to a receptor on
the surface epithelium of the
bowel

Large volume of stool

Persist even with fasting

Question 17

What is the pathophysio of Osmotic Diarrhea?

Answer 17

Occurs after ingestion of a
poorly absorbed solute

Solute may be normally not
well absorbed(Mg,
phosphate, lactulose) ornot
well absorbed because of a
disorder (lactose w/ Lactase
deficiency)

à increase
osmotic solute load

Question 18

What is the danger in Children with diarrhea?

Answer 18

Danger in Children
q Dehydration —> Shock –>DEATH
q Metabolic acidosis from stool
bicarbonate losses
q Electrolyte imbalance ( hyper or
hyponatremia, hypokalemia)

Question 19

What is more danger to infants of diarrhea?

Answer 19

MORE Danger in Infants

• Incomplete colonic salvage
• Immature renal tubules: poor concentration ability
• Increased insensible loss due to higher BSA (as compared to adults)
• High fevers (adds to dehydration)
• Increased intestinal response to toxins

Question 20

What is the mgt in diarrhea?

Answer 20

• I.Address the DEHYDRATION
• II.Assess presence of ELECTROLYTE IMBALANCE
• III.Investigate the cause
• IV.Treat accordingly

Question 21

What is the pathophysio of diarrhea?

Answer 21

•Pathophysiology

• –Intestinal villous cells – responsible for absorption of luminal contents, are damaged during diarrhea
• –Crypt cells secrete electrolytes
• –Water follows osmotic gradient caused by secretions and malabsorbed contents