WK 7- Acute Diarrhoea Flashcards
What are some causes of acute watery diarrhoea
- Viruses: Rotavirus, Enterovirus
- Bacteria: E. coli, V. cholerae, Salmonella
- Parasites: Giardia
- Other: Malaria, Acute respiratory infections, Surgical conditions
What are some causes of acute bloody diarrhoea
- Bacteria: Shigella, Campylobacter, E. coli, Salmonella
- Parasites: Entamoebahistolytica
- Other: Surgical conditions
What are some causes of persistent chronic diarrhoea
- Bacteria: Shigella, Campylobacter, Salmonella
- Parasites: Giardia, Cryptosporidium, Entamoeba
- Other: Lactose intolerance, Inflammatory bowel disease
What are some social/demographic causes of acute diarrhoea
- Inadequate Access to Basic Needs→ clean water -for drinking, cooking, cleaning
- Sanitation
- Food security + safety
- Healthcare
- Environmental + Living Conditions→ natural or man-made disasters, overcrowding or displacement, lack of protection from the element, insecurity
- Cultural + Education→ food preparation, use of latrines (Hole used as a toilet), funeral practices
What are some complications of acute diarrhoea
- Dehydration
- Hypoglycaemia
- Electrolyte disturbances→ normally resolves after given ROS
- Malnutrition
- Anaemia→ can be from bloody diarrhoea or things like malaria
- Predisposition to other infections→ pneumonia and malaria
When taking a history of acute diarrhoea, what information is needed
- Output→ diarrhoea–frequency, volume, duration, vomiting, urine output
- Input→ fluids + feeding
- Special features→ pain (Mainly bacterial if pain is present), blood in stool, recent antibiotic or drug treatment (may be using traditional treatments), assess for dehydration
- Local reports of cholera
What are the 3 main presentations of diarrhoea
acute bloody diarrhoea, acute watery diarrhoea or persistent chronic diarrhoea
What needs to be examined in a person with diarrhoea
Signs of dehydration→ general condition, eyes, thirst, skin pinch→ severe dehydration presents with confusion, lethargy, tachypnea, shock, skin (normally abdominal) pinch retracts extremely slowly, sunken eyes
- Blood in stool
- Signs of malnutrition
- Exclude other causes of diarrhoea
What are the signs of mild dehydration
normal vitals, just has increased thirst and slightly dry mucosa
What are signs of moderate dehydration
weak pulse, tachy, deep and potentially fast resp rate, eyes and anterior fontanelle are sunken, cool skin, irritable behaviour, reduced urine output
What are signs of severe dehydration
weak or absent pulse, tachy, decreased systolic pressure, sunken eyes and anterior fontanelle, anuric, lethargy/LOC, tachypnea
→ need to keep addressing dehydration to determine level of rehydration needed→ 10% loss of body weight
How is ORS useful in treating diarrhoea
Sodium and glucose are co-transported across GIT lumen together→ draw water back out of the GIT lumen and into the mucosa
What is the formula for ORS
1/2 tsp of salt, 6 tsp of sugar and 1L of water
What are examples of other rehydration fluids
breast milk (promote to keep on feeding), homemade fluids (eg. Rice water), IV fluids
How is zinc supplementation useful in diarrhoea
- Supplementation during an acute episode has been shown to: reduce duration -by 25%, reduce volume -by 30%, lower the incidence of diarrhoea in the following 2 to 3 months
- important micronutrient for overall health-> vital in cell growth and protein development
How is continued feeding an effective tx for diarrhoea
- Aids rehydration
- Prevents malnutrition
- Enhances immunity
According to the GAPPD- how can children be protected from diarrhoea
exclusive breast feeding for 6 months, adequate complementary feeding and preventing low birth weight
-children who are not breast fed within first 6 months are more likely to die of pneumonia
(these goals are mainly about nutrition)
According to the GAPPD- how can diarrhoea be prevented in children
vaccinate against rotavirus and measles, hand washing, access to clean water and sanitation, prevent HIV in children, cotrimoxazole prophylaxis for HIV-infected children
According to the GAPPD, how can diarrhoea be treated
improved care seeking and referral, case management at the health facility and community level, antibiotics availability, continued breastfeeding, ROS/rehydration
When would the following rehydration methods be used:
- Oral
- Nasogastric
- IV
- Interosseous
- aim to provide rehydration through oral routes, but if child is refusing to drink, nasogastric rehydration is effective and prevents GIT atrophy
- If need rapid rehydration, IV can be used–> if pt is too dehydrated and vessles are unable to be cannulated, use interosseous needle (give immediate access to circulation)
What kind of diarrhoea is cholera most likely to cause
Acute watery diarrhoea
How is cholera transmitted
person to person
contaminated food or water, corpses of cholera patients, cholera treatment centres
How can death from cholera be reduced
- Reducing mortality→ cholera treatment centres, case management, train health staff
- Reducing epidemic spread→ water and sanitation, hygiene practices, public education
- Co-ordination, ensure regular supplies
What clinical features are found in those with diarrhoea caused by cholera
Clinical features –acute, painless and profuse watery diarrhoea, often with vomiting
