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GH > WK 7- Acute Diarrhoea > Flashcards

WK 7- Acute Diarrhoea Flashcards

1
Q

What are some causes of acute watery diarrhoea

A
  • Viruses: Rotavirus, Enterovirus
  • Bacteria: E. coli, V. cholerae, Salmonella
  • Parasites: Giardia
  • Other: Malaria, Acute respiratory infections, Surgical conditions
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2
Q

What are some causes of acute bloody diarrhoea

A
  • Bacteria: Shigella, Campylobacter, E. coli, Salmonella
  • Parasites: Entamoebahistolytica
  • Other: Surgical conditions
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3
Q

What are some causes of persistent chronic diarrhoea

A
  • Bacteria: Shigella, Campylobacter, Salmonella
  • Parasites: Giardia, Cryptosporidium, Entamoeba
  • Other: Lactose intolerance, Inflammatory bowel disease
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4
Q

What are some social/demographic causes of acute diarrhoea

A
  • 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
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5
Q

What are some complications of acute diarrhoea

A
  • 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
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6
Q

When taking a history of acute diarrhoea, what information is needed

A
  • 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
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7
Q

What are the 3 main presentations of diarrhoea

A

acute bloody diarrhoea, acute watery diarrhoea or persistent chronic diarrhoea

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8
Q

What needs to be examined in a person with diarrhoea

A

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
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9
Q

What are the signs of mild dehydration

A

normal vitals, just has increased thirst and slightly dry mucosa

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10
Q

What are signs of moderate dehydration

A

weak pulse, tachy, deep and potentially fast resp rate, eyes and anterior fontanelle are sunken, cool skin, irritable behaviour, reduced urine output

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11
Q

What are signs of severe dehydration

A

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

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12
Q

How is ORS useful in treating diarrhoea

A

Sodium and glucose are co-transported across GIT lumen together→ draw water back out of the GIT lumen and into the mucosa

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13
Q

What is the formula for ORS

A

1/2 tsp of salt, 6 tsp of sugar and 1L of water

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14
Q

What are examples of other rehydration fluids

A

breast milk (promote to keep on feeding), homemade fluids (eg. Rice water), IV fluids

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15
Q

How is zinc supplementation useful in diarrhoea

A
  • 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
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16
Q

How is continued feeding an effective tx for diarrhoea

A
  • Aids rehydration
  • Prevents malnutrition
  • Enhances immunity
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17
Q

According to the GAPPD- how can children be protected from diarrhoea

A

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)

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18
Q

According to the GAPPD- how can diarrhoea be prevented in children

A

vaccinate against rotavirus and measles, hand washing, access to clean water and sanitation, prevent HIV in children, cotrimoxazole prophylaxis for HIV-infected children

19
Q

According to the GAPPD, how can diarrhoea be treated

A

improved care seeking and referral, case management at the health facility and community level, antibiotics availability, continued breastfeeding, ROS/rehydration

20
Q

When would the following rehydration methods be used:

  • Oral
  • Nasogastric
  • IV
  • Interosseous
A
  • 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)
21
Q

What kind of diarrhoea is cholera most likely to cause

A

Acute watery diarrhoea

22
Q

How is cholera transmitted

A

person to person

contaminated food or water, corpses of cholera patients, cholera treatment centres

23
Q

How can death from cholera be reduced

A
  • 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
24
Q

What clinical features are found in those with diarrhoea caused by cholera

A

Clinical features –acute, painless and profuse watery diarrhoea, often with vomiting

25
Q

What antibiotics are used in cholera

-how are antibiotics useful in treating diarrhoea

A
  • Reduces→volume of diarrhoea, IV fluid requirement, shortens duration of cholera excretion–> given to those with severe dehydration
  • Dosing: uses erythromycin for those under 12, and doxycycline for those over 12
26
Q

Is there a vaccine available for cholera?

A

Yes

  • short term protective efficacy
  • part of routine response to cholera epidemic
27
Q

What signs are present in severe cholera

-how do you treat

A

Severe dehydration/uncontrollable vomiting

-immediate IV rehydration

28
Q

What signs are present in simple cholera

A

No/mild dehydration, mild/moderate diarrhoea, mild/moderate vomiting
-oral rehydration

29
Q

What are the symptoms of typhoid

A
  • can be non-specific in symptoms so might be missed
  • diarrhoea looks as a yellow-green colour (due to flooding of bile into the bowel→ irritates bowel lining) and doesn’t occur until week 2→ can have abdominal distension and splenomegaly
  • diarrhoea is not predominant feature→ mainly fever, headache, abdo pain and red spot rash (blanching)
30
Q

What organism causes typhoid

A

Salmonella typhi

31
Q

What is the treatment for typhoid

A

can be supportive or via use of antibiotics (Ciprofloxacin, IV Ceftriaxone, Azithromicin)

32
Q

What complications are seen in typhoid

A

bowel perforation, internal bleeding

33
Q

What are examples of waterborne pathogens that can cause diarrhoea

A
  • Giardiasis
  • Salmonella
  • E.coli
  • Typhoid fever
  • Hep A
34
Q

What is the SDG 6

A

Ensure availability and sustainable management of water and sanitation for all

35
Q

How much zinc should be given to a child under 6 months and for how long

A

1/2 tablet for 14 days

36
Q

How much zinc should be given to a child under 6 months and for how long

A

1 tablet per day for 14 days

37
Q

What are the principles involved in outbreak management

A
  • Need to manage the cases, complication, contacts and protect the staff
  • Need to find and treat the source
38
Q

What is the process involved in water treatment

A

flocculation, sedimentation, filtration and disinfection

39
Q

What are the symptoms of Hep A

A

jaundice, pale stool, brown urine, mild dehydration, restlessness, abdo pain, lethargy

40
Q

What are the symptoms of dysentary (bacillary)

A

temp, tachy, lethargic, cold extremities, decreased skin turgor and decreased responsiveness
-blood and mucous in stool

41
Q

What are the symptoms of giardiasis

A

mild dehydration, looks underweight but may be well

-watery foul smelling diarrhoea/semi formed greasy stools, abdo cramps, nausea, belching

42
Q

How is hepatitis transmitted and what are some prevention strategies

A
  • Faecal-oral route

- prevented through hand washing, improving sanitation, preventing exposure to faeces, vaccination

43
Q

How is shigella transmitted and what are some prevention strategies

A
  • Faecal oral route

- prevented through adequate sanitation, access to clean water, prevent exposure to faeces

44
Q

What percentage of body fluid loss is lost in severe dehydration

A

10%

GH (10 decks)

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