2. DIARRHOEA
 Defined as passage of abnormally liquid or unformed
stools at an increased frequency
 Stool weight more than 200 g/ day
 Classification
•Acute - < 2 weeks
•Persistent- 2 to 4 weeks
•Chronic- > 4 weeks

3.  Two common conditions associated with passage of
stools < 200g/day
1.Pseudo diarrhoea
2.Fecal incontinence

4. Acute Diarrhoea
Causes
90 % - INFECTIOUS AGENTS
10 % - Medications , Toxic ingestions,
Ischeamia

5. Infectious Agents
 Fecal-oral transmission
 Bacterias,Viruses,Parasites

6. Pathogenesis of Bacterial
Diarrhoea
 without mucosal injury
mediated by:
Enterotoxins
Adhesins
 with mucosal injury
mediated by:
Adhesins
Invasins
Cytotoxins

7. PATHOGENESIS VIRUS DIARRHOEA
 VIRUS DIARRHOEA
Effect on villus structure and function
Enzyme damage
Significant effect on digestion and absorption
 Rotavirus
Norwalk virus
Enteric Adenovirus
Astrovirus

8. HIGH RISK GROUPS
1.Travellers – ETEC, EAEC ,Campylobacter,
Shigella
2 . Consumers of certain foods
- picnic,banquet,restaurant
3.Immunodeficiancy persons
4. Institutionalised persons

9. The agents include
1 . Toxin producers
Preformed toxin – B.Cereus , Staph aureus,
C.perfringens
Enterotoxin – V.cholera,ETEC
2. Enteroadherant
EAEC,Giardia,Cryptosporidium

10. 3 . Cytoxin Producers
C. difficile
4 . Invasive
Rota virus,Salmonella,Campylobacter
V. parahmolyticus,Shigella

11. Clinical features
 Preformed & Entero toxin
Profuse watery diarrhoea + vomitting
•Enteroadherant
High fever + Abdominal cramps
•Invasive – Bloody diarrhoea

12. Other Causes
 A/E of certain drugs – Antibiotics,NSAIDs,
Antiarrythmics, Bronchodialaters,Antacids
 Occlusive or Non occlusive colitis
Above 50 years
Lower abdominal pain preceeding
watery, then bloody diarrhoea

13. Approach to Patient
 Most acute diarrhoeas – Mild & self limited
 Indications for evaluation
Profuse diarrhoea with dehydration
Grossly bloody stools
Duration >48 hrs without improvement
Recent antibiotic use

14. Severe abdominal pain in patient >50
years
Elderly
Immunocompromised patients

15. Algorithm for Management

16. History and Physical Exam
 Main goals
 Estimate the level of dehydration
 Identify likely causes on the basis of
history and clinical findings

17. History
 Onset, frequency, quantity, and character of
diarrhea
 Associated symptoms:
nausea, vomiting, fever, abdominal
pain, tenesmus, malaise
 Recent oral intake
 Signs and symptoms of dehydration

18. Physical Exam
 Vitals, vitals, vitals!
 Abdominal exam
 Presence of occult blood
 Signs of dehydration

19. Investigations
 Corner stone of diagnosis – Microbiologic
analysis of stools
 Investigations – Cultures for bacterial &
viral pathogens
- Inspection for ova &
parasites
- Immunoassays

20. Treatement
 Fluid & electrolyte replacemet
Oral sugar & electrolyte solution
I.V rehydration
 Moderately severe, non febrile & non bloody diarrhoea
– Loperamide
 Antibiotics

21.  Empirical therapy
Febrile – Ciprofloxacin 500 mg bid for 3-5 days
Suspected giardiasis – Metronidasole
250 mg qid for 7 days
 Antibiotic prophylaxis
Cotrimoxazole,Ciprofloxacin

22. In Summary
 Extremely common
 Most is viral in origin and self-limited
 A good H&P is crucial
 Warning signs include high fever, severe
abd. pain, dehydration, and bloody stool
 Fluid replacement is most important
 Antibiotics are usually not necessary

23. Good nutrition and hygiene
can prevent most
diarrhea

24. THANK YOU