DIARRHEA
By: Akshay I
Javare
MSc Nursing II
Year
Diarrhea Definition
Term ‘diarrhea’ (Greek) means ‘to flow through’
Diarrhea is defined as a change in consistency and frequency of
stool, i.e. liquid or watery stools, that occur > 3 times a day.
If there is associated blood in the stools, it is termed as dysentery.
Classification
Diarrhoea is classified as:-
Acute ------------------------------------------ if <1weeks,
Persistent ----------------------------------- if 1–2 weeks,
Chronic -------------------------------------- if >2weeks
1.ON THE BASIS OF DURATION:
a)Acute Diarrhoea-
diarrhoea last for than 14 days.
b)Chronic Diarrhoea
more than 14 days.
ON THE BASIS CLINICAL PRESENTATION :
a) ACUTE WATERY DIARRHOEA-It last for several
days and occur in conditions like cholera
b) ACUTE BLOODY DIARRHOEA-Blood in stool
with or without mucous, is known as Dysentry.
On the basis of Physiology
a. Secretory Diarrhoea
b. Osmotic Diarrhoea
c. Exudative Diarrhoea
d. Motility related
e. Inflammatory Diarrhoea
What is not a diarrhea ?
Frequent defecation but with formed stool.
Semi-liquid stool at breast feeding.
Stool just after feeding (in 1st year infants)
Yellow-green liquid stool on 3rd – 6th days
after birth .
Epidemiology of childhood diarrhea
Globally it is the 2nd most common cause of child deaths.
Diarrhea accounts for 9% of all under five deaths.
A loss of more than 0.71 million child live per year.
It killed more than 1,600 children under five years of age
every day.
Most of these deaths occurs among children less than 2 years.
For a children aged under 5 years a median of 3 episodes of
diarrhea occurred per child year.
Cont.…
In India
Acute diarrheal disease account for about 8% of death
in under 5 years age group.
During the year 2013, about 10.7 million cases with
1,535 deaths were reported in India.
EDIDEMILOGICAL DETERMINANTS
ETIOLOGY
Bacterial
Viral
Parasitic
Others
COMMON CAUSES OF DIARRHEA- VIRUS
Rotavirus
Human caliciviruses: Norovirus spp.;Sapovirus spp.
Enteric adenoviruses
Astroviruses,
Coronaviruses,
Cytomegalovirus,
Picornavirus
COMMON CAUSES OF DIARRHEA-OTHERS
• Metabolic disease
Hyperthyroidism
Diabetes mellitus
Pancreatic insufficiency
• Food allergy
Lactose intolerance
• Antibiotics
• Irritable bowel syndrome
Risk factors
Poor sanitation
Personal hygiene
Non availability of safe drinking water
Unsafe food preparation &practices
Lack of exclusive or predominant breast feeding
Malnutrition (with micronutrient malnutrition vitamin A & zinc deficiency)
Measles
HIV
RISK FACTORS-
AGE
SEASON
SOCIO ECONOMIC STATUS
DIETARY FACTORS
TEETHING
SEASONALITY
Disease Common season
Cholera Winter
Rotavirus diarrhea Winter
Shigellosis Dry summer and rainy season
Modes of transmission
Most of the diarrheal agents are transmitted by the faecal-
oral route.
• Faecal-oral transmission
may be: water- borne;
food –borne: or
direct transmission which implies via fingers, or fomites
or dirt which may be ingested by young children
Physiological disturbance in diarrhea
TOTAL BODY WATER (TBW) 65%-75%
ECF (25%) ICF (45%)
DIARRHEA LOOSE FROM
ECF
WHICH IS RICH IN SODIUM
&
CIRCULATING INTESTINAL SECRETION
BLOOD FLUID
LOW POTTASSIUM
Clinicalfeatures
Vomiting
Diarrhea watery & without blood or visible mucus
Fever
Dehydration(lethargy and even shock)
Transient lactose intolerance --- perianal excoriation
DIAGNOSTIC EVALUATION
• HISTROY
• PHYSICAL EXAMINATION
• STOOL EXAMINATION
• STOOL CULTURE
• BLOOD TEST
Management
4 months or weight less than 5 kg 200 to 400 ml
Age 4 to 11 months or weight 5 to 7.9 kg 400 -600 ml
Age 2-4 years or weight 11 to 15.9 kg 800 to 1200 ml
Age 15 years or older weight 30 kg or more to 2200 to 4400
ml
PHARMACOLOGICAL MANAGEMENT:
a. Antibiotics
b. Binding Agents
c. Anti-motility agents
d. Anti-Secretory Agents
Maintain Nutritional Status:
• Breastfeeding
• semisolid liquids
• soft energy rich food
• avoid irritant food
• zinc supplementation
Health Education
• Avoid bottle feeding
• food hygiene
• well balanced diet
• clean water
• washing and cleaning foods
• fresh cooked food
• hand hygiene
• Preventive measures
Preventive measures
Complications
• Dehydration
• Hypovolemic shock
• Renal Failure
• Thromboembolism
• CCF
• Convulsion
• Malnutrition
• Growth Retardation
Prognosis
• HIGER MORTALITY
• ANTIBIOTIOC RESISTANT
• SEVERE DEHYDRATION
THANK YOU!!!
