I ASWINI

08immn10
GENERAL OBJECTIVES
To know abut the causes of diarrhoea and thereby
prevent the mortality rate in children.

To know about the management and home remedies

for diarrhoea thereby maintaining heath of children
Specific objectives
Definition of diarrhea.
Types of diarrhea.
Etiology of dirrhea.
Clinical features.
Diagnosis
Complications.
Management .
Nursing management.
Research abstract.
Diarrhoea
Diarrhea is defined by the World Health Organization as
having 3 or more loose or liquid stools per day, or as
having more stools than is normal for that person.
EPIDEMOLOGY: World wide in approximately 2.5 billion
cases of diarrhea occurred which results in 1.5 million
deaths among children under the age of five.Greater than
half of these were in Africa and South Asia.This is down
from a death rate of 5 million per year two decades
ago.Diarrhea remains the second leading cause of death
(16%) after pneumonia (17%) in this age group.
Types of diarrhoea
Acute Diarrhoea
 sudden onset and lasts less than two weeks
 90% are infectious in etiology

 10% are caused by medications, toxin ingestions, and

ischemia
Chronic Diarrhoea
 Diarrhoea which lasts for more than 4 weeks
 Most of the causes are non-infectious

Persistent Diarrhoea
-Diarrhoea lasting between 2 to 4 weeks
Etiology
Bacterial infections.
Viral infections.
Parasites .
Functional bowel disorders.
Intestinal diseases.
Food intolerances and sensitivities.
Reaction to medicines.
Clostridium perfringens
Staphylococcus aureus
Rota virus
 Campylobacter bacteria
Shigella bacteria
Clinical features
Stools
Loose
Blood stained
Offensive smell
Steatorrhea (floating, oily, difficult to flush)
Sudden onset of bowel frequency
Crampy abdominal pain
Urgency
Fever
Loss of appetite
Loss of weight
Contd….
Signs of dehydration in infants and young children
include:
dry mouth and tongue
no tears when crying
no wet diapers for 3 hours or more
sunken eyes, cheeks, or soft spot in the skull
high fever
listlessness or irritability
Children with any of the following symptoms should
see a health care provider:
signs of dehydration
diarrhea for more than 24 hours
a fever of 102 degrees or higher
stools containing blood or pus
stools that are black and tarry
If children have diarrhea, parents or caregivers should
not hesitate to call a health care provider for advice.
Diarrhea is especially dangerous in newborns and
infants, leading to severe dehydration in just a day or
Pathophysiological mechanism of diarrhoea
Osmotic
eg Lactose intolerance
Secretory
eg Cholera
Mixed secretory-osmotic
eg Rotavirus
Mucosal inflammation
eg Invasive bacteria
Motility disturbance
Diagnosis
 Medical history and physical examination. The doctor will ask about eating
habits and medication use and will perform a physical examination to look for
signs of illness.
 Stool culture. A sample of stool is analyzed in a laboratory to check for
bacteria, parasites, or other signs of disease and infection.
 Blood tests. Blood tests can be helpful in ruling out certain diseases.
 Fasting tests. To find out if a food intolerance or allergy is causing the diarrhea,
the doctor may ask a person to avoid foods with lactose, carbohydrates, wheat,
or other ingredients to see whether the diarrhea responds to a change in diet.
 Sigmoidoscopy or colonoscopy. These tests may be used to look for signs of
intestinal diseases that cause chronic diarrhea. For sigmoidoscopy, the doctor
uses a thin, flexible, lighted tube with a lens on the end to look at the inside of
the rectum and lower part of the colon. Colonoscopy is similar to
sigmoidoscopy, but it allows the doctor to view the en
complications
Dehydration
 Excessive loss of fluids and minerals (electrolytes) from the
body
 Common in infants and young children with viral
gastroenteritis or bacterial infection
 Kidney failure, eg in infection by E.coli
Electrolyte deficiency
Irritation to anus due to frequent passage of watery
stool containing irritating substances
When treatment is needed?
 Severe or prolonged episode of diarrhoea
 Fever
 Repeated vomiting, refusal to drink fluids
 Severe abdominal pain
 Diarrhoea that contains blood or mucus
 Sign of dehydration
 Dry, sticky mouth
 Few or no tears when crying
 Sunken eyes
 Lack urine or wet diaper
 Dry, cool skin
 Fatigue or dizziness
Management
Aims/Goals of management:
Prevent, identify and treat dehydration
Eradicate causative pathogens
Tetracycline, Ciprofloxacin
Prevent spread by early recognition and
institution of infection-control measures
immunization, chemoprophylaxis, good hygiene,
improve sanitation
Management contd…..
Replace the fluids and electrolytes which are lost
Drug therapy has very little place
Antibiotic
Antisecretory
Antimotility
Nutritional management
Follow-up to ensure recovery
Recent reasearch abstract
 Abstract
 Aims: To examine the effect of the daily use of micronutrients (including zinc) or the same
micronutrients plus heat inactivated lactic acid bacteria (LAB), on diarrhoea in children
compared to placebo.
 Methods: A triple blind randomised clinical trial in an urban slum of Karachi, Pakistan.
Micronutrients (including zinc), micronutrients (including zinc and LAB), or placebo, were
provided daily for two months to 75 young children (aged 6–12 months) identified at high
risk for diarrhoea related mortality on the basis of history of at least one episode of
diarrhoea in the preceding two weeks. The longitudinal prevalence of diarrhoea was defined
as the percentage of days a child had diarrhoea out of the days the child was observed.
 Results: Mean longitudinal prevalence of diarrhoea in the micronutrient–zinc group was
15% (SD = 10%) child-days compared to 26% (SD = 20%) child-days in the placebo group
and 26% (SD = 19%) child-days in the micronutrient–zinc–LAB group. The difference
between the micronutrient–zinc–LAB and placebo groups was not significant.
 Conclusion: The daily provision of micronutrients (including zinc) reduces the
longitudinal prevalence of diarrhoea and thus may also reduce diarrhoea related mortality
in young children; heat inactivated LAB has negative effects in these children.
conclusion
 Two recent advances in managing diarrhoeal disease – newly formulated oral
rehydration
 salts (ORS) containing lower concentrations of glucose and salt, and success
in using zinc
 supplementation – can drastically reduce the number of child deaths. The new
methods,
 used in addition to prevention and treatment of dehydration with appropriate
fluids,
 breastfeeding, continued feeding and selective use of antibiotics, will reduce
the duration
 and severity of diarrhoeal episodes and lower their incidence. Families and
communities
 are key to achieving the goals set for managing the disease by making the new
 recommendations routine practice in the home and health facility
1. Wikipedia
http://en.wikipedia.org/wiki/Main_Page
2. Medical Journal Malaysia VOL 62
http://www.mma.org.my
3. World Health Organization – WHO
http://www.who.int/topics/diarrhoea/en/
4. http://www.medicinenet.com/diarrhea/article.htm
5. http://www.mayoclinic.com/health/diarrhea/DS002
92
6. http://www.kidshealth.org/parent/infections/commo
n/diarrhea.html
THANK U