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!!!