Diarrhoea
- 2. Diarrhea is a condition in which there is : - Unusual frequency of bowel movements (more than 3 times a day). - Changes in the amount ( more than 200g a day). - Change in consistency( liquid stool). It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. WHO defines : Having 3 or more loose or liquid stools per day, or as having 3 or more loose stool.
- 3. * Acute diarrhea * Chronic diarrhea
- 4. An attack of loose motion with sudden onset which usually lasts 3 to 7days but may last up to 10 14 days. It is caused by an infection of the large intestine, but may be associated with infection of gastric mucosa and small intestine. The term acute gastroenteritis is most frequently used to describe acute diarrhea.
- 5. It is termed when the loose motion is occurring for 3 weeks or more. It is usually related to underlying organic diseases with or without mal- absorption. Diarrhea with watery stools and visible blood in the stools is called dysentery. Persistent diarrhea refers to the episodes of acute diarrhea that last for 2 weeks or more and may be due to infective origin.
- 6. The main causes of this disease are lack of knowledge of hygiene and sanitation, home environment, feeding practices of the parents and under five years of children. It can be caused by chronic ethanol ingestion. Chronic mild diarrhea in infants and toddlers may occur with no obvious cause and with no other ill effects ,this condition is called toddlers diarrhea.
- 7. About 1/3 of total hospitalized children are due to diarrheal diseases and 17% of all deaths in indoor pediatric patients are related to this condition. The morbidity rate in terms of diarrhea episodes per year per child under the age of 5 years is about 1.7.
- 8. Diarrhea is mostly infectious. A large numbers of organism are responsible for acute diarrhea. The infectious agent causing diarrhea with enteric infection include the followings: Viruses: Rota virus, adenovirus, enterovirus, Norwalk group viruses, measles virus etc.
- 9. Man is the main reservoir of enteric pathogen, so most transmission originates from human factors. For some enteric pathogens and viral agents animals are important reservoir.
- 10. The disease is most common specially between 6months to 2years. The incidence is higher during weaning period, i.e. 6 to 11 months of age. It occurs due to combined effects of reduced maternal antibodies, lack of active immunity and introduction of contaminated food or direct spread through childs hands.
- 11. Diarrhoea is more common in artificial feeding, specially with contaminated cows milk or unhygienic preparation of tin milk. Malnutrition leads to infection leads to infection and infection leads to Diarrhoea. The predisposing factors of Diarrhoea include prematurity, Immunodeficiency conditions, lack of personal hygiene, inadequate food hygiene, infant feeding practices, illiteracy, poor socio-economic status etc.
- 12. Bacterial diarrhea is more frequently occur in summer and rainy season, whereas viral diarrhea ( specially rotavirus ) found in winter.
- 13. It is mainly feco-oral route. It is water- borne, food-borne disease or may transmit via fingers, fomites, flies or dirt.
- 14. Stools are usually loose watery in consistency. It may be greenish or yellowish-green in color with offensive smell. It may contain mucus, pus or blood and may expelled with force, preceded by abdominal pain. Frequency of stools varies from 2 to 20 per day or more. The child may have low grade fever, thirst, anorexia. Behavioral changes like irritability, restlessness, weakness, lethargy, sleepiness, delirium, stupor and flaccidity are usually present.
- 15. Physical changes like loss of weight, poor skin turgor, dry mucus membranes, dry lips, pallor, sunken eyes, depressed fontanels are also found. Vital signs are changed as low blood pressure, tachycardia, rapid respiration, cold limbs and collapse. Decreased or absent urinary output. Convulsions and loss of consciousness may also present in some children with diarrheal diseases.
- 16. History taking and physical assessment. Stool examination can be done for routine and microscopic study and identification of causative organisms. Blood examination can be performed to detect electrolyte imbalance, acid- base disturbances, hematocrit value, TC,DC,ESR etc. The suspected associated cause should be ruled out for adequate management.
- 17. Rehydration Therapy: The management of diarrhea is a vast majority of children is best done with ORS solution and continued feeding. ORS means drinking of solution of clean water, sugar and mineral salt to replace the water and salt lost from the body during Diarrhoea, especially when accompanied by vomiting, i.e. gastroenteritis.
- 18. When the child is having diarrhea with some dehydration, management should be done under supervision of health worker with ORS. The appropriate amount of ORS solution to be given in the first 4 hours are as follows: Age less than 4 months or weight less than 5 kg- 200 to 400ml. Age 4 to 11months or weight 5 to 7.9 kg 400 to 600 ml. Age 12 to 23 months or weight 8 to 10.9 kg 600 to 800ml. Age 2 to 4 years or weight 11 to 15.9 kg 800 to 1200ml. Age 5 to 14 years or weight 16 to 29.9 kg 1200 to 2200 ml. Age 15years or older or weight 30kg or more to 2200 to 4000ml.
- 19. Improvement of food hygiene and environmental hygiene. These includes: Safe water, adequate sewage disposal, hand washing practices, clean utensils, avoidance of exposures of food to dust and dirt, fly control, washing of fruits and vegetables etc. Avoidance of bottle feeding is most significant practice needed for prevention of diarrhea. Boiling or filtering to be practiced for safe drinking water. Prevention of LBW and prematurity, exclusive breast feeding, appropriate weaning practices, balanced diet, immunization are significant aspects of child care.
- 20. Dehydration Hypovolemic shock Renal failure Paralytic ileus Thromboembolism Convulsions Over dehydration Hypoglycemia Consumptive coagulopathy Toxic mega colon Malnutrition Growth retardation Mental subnormalities
- 21. Mortality is higher in neonate and infants than the older children. Malnourished children are having poor prognosis and greater mortality. Antibiotic resistant type E.Coli and shigella cause very severe illness and poor prognosis. Presence of severe dehydration ,electrolyte imbalance and pneumonia have poor prognosis.