1. Acute diarrhoea causes,diagnosis and management presented by: Reem alssafar.

2. Definition: True diarrhoea is an increase in stool weight to more than 250g in 24h of loose stool. True diarrhoea is an increase in stool weight to more than 250g in 24h of loose stool. In acute diarrhoea the onset is sudden for few days(less than 14 days)

3. Causes of acute diarrhea: 1. Infectious: contaminated food is the most frequent source of organisms causing diarrhea. a.Bacteria: staphylococcus aureus, E.coli, campylobacter, salmonella, shigella, clostridium difficle. a.Bacteria: staphylococcus aureus, E.coli, campylobacter, salmonella, shigella, clostridium difficle. b.Viruses: Rotavirus, Norwalk agent, enterovirus,hepatitis-associated virus. b.Viruses: Rotavirus, Norwalk agent, enterovirus,hepatitis-associated virus. c.Fungi: Candida,Actinomyces,Histoplasma. c.Fungi: Candida,Actinomyces,Histoplasma.

4. d.Parasites: Giarrdia lamblia, Entamoeba hitoltica, Cryptosporidium, Stongyloides. d.Parasites: Giarrdia lamblia, Entamoeba hitoltica, Cryptosporidium, Stongyloides. 2.Diatary: nonabsorbable sugar substitutes (sorbitol),food intolerance or allergy,milk and excessive caffeine. 3.Cemical poisons: Heavy metals, mushroom poisoning.

5. 4.Drugs: laxatives,magnesium-containing antacids, antibiotics, cholinergic agent, lactulose and quinidine. 5.Visceral cause: appedicitis,diverticulitis,ischmic colitis, pseudomembranous colitis.

6. diagnosis The diagnoses of acute diarrhea can be made by history and physical examination. History: History: onset, duration, amount and frequency, blood in stool, nature of stool. symptoms associated with acute diarrhea: symptoms associated with acute diarrhea: Fever, abdominal pain, N and V, apatite. Ask about; drugs and dilatory intake.

7. Physical examination: Look for signs of dehydration, temperature and abdominal tenderness. abdominal tenderness.

8. recov -ery DxSympt.I.Psourceorganism <24h Cultrue organism In vomitus or remaing food diarrhea,vomit Dehydrat. And Hypotension.1-6hcotaminated Food and water (meat)Staph.a 10-12 days Stool culture watery diarrhea+/- h.colitis12-48h Cattle-meat, milk E.coli 2-3 days Culture organism in stool and food diarrhea,vomitdehydration1-5h Environment contamin.food (rice) Bacillus cereus

9. 2_3 days Culture organism in faeces and food Watery diarrhoea and cramping pain 8_22 hours Environment_ contaminated food Clostrid. Perfrin. 10_14 days Demonstrate toxin in food or faeces Brief diarrhoea and paralysis due to neuromuscular blockade 18_24 hours Environment_ bottled or cannd food Clostrid. Botulin. 3-6 d but may be 3-6 d but may be up to 2 weeks Stool culture Abrupt diarrhoea, fever and vomiting 12_48 hours Cattle and poultry_eggs, meat Salmonel. Spp

10. 3-5 days Stool culture Diarrhoea+blood, fever,malaise and abdominal pain 48-96 hours Cattle and poultry_meat, milk Campylo- bacter jejuni 7-10days Stool culture Acute watery, bloody diarrhoea 24-48 hours Man- contaminated food and water Shigella spp

11. Causes of traveller΄s diarrhoea: Bacteria-70-90% of cases: Enterotoxigenic Escherichia coli Shigella sp. Salmonella sp. Campylobacter jejuni Viruses-10%Rotavirus Norwalk virus family

12. Protozoa-<5% Giardia intestinalis Entamoeba histolytica Cryptosporidium parvum Childhood diarrhea is a common problem encountered by primary care providers. Acute diarrheais typically viral in etiology, Is usually self-limited, and requires no specific therapy. For these reasons, diagnostic therapy may be warranted and stool cultures or other diagnostic testing is generally required.Otherwise,simple supportive care to prevent dehydration and electrolyte abnormalities is all that is needed for acute diarrhea illness.

13. Management: Diarrhea No systemic signs Symptomatic treatment Stool culture not needed Systemic illness: *Fever >39c *Bloody diarrhoea Lasting>2 weeks *Dehydration *Consider non-infectious Causes *Admit to hospital *Give oral fluids *Consider presumptive Antimicr. Therapy Special circumstances: *Food poisoning outbreak *Overseas travel Recent antibiotic use *Immunocompromised host Routine stoolculture and microscopy Confer with microbiologist

14. Prompt, direct faecal Smear(then culture) Polymorphs seen Likely culture: *Shigella *Campylobacter *E coli No polymorphs Likely culture: *Salmonella *E coli *C difficile Parasites seen Specific therapy

15. Symptomatic Rx: *Adults and older children should drink sufficient quantity of (clear liquid, sodium and glucose-containing oral rehydration solution). *In infants (ORS) should be used as substitute for flliuds in feeds. *Intravenous (Normal saline or lactated Ringer solution) in moderate-sever dehydration. *Adsorbents:are claimed to adsorb toxic substances that induce diarrhoea in infective cases e.g : (Furapac suspension)dose 60-90ml PO 6 hourly.

16. Rx of the cause: *Bacterial and viral Infection: Most are self-limiting and not require antimicrobial therapy. Give antibiotic only for sever symptoms: -Salmonella bacteraemia:ciprofloxacin 200-400mg/12 h iv. -Severe shigella infection: ciprofloxacin 500mg/12h po -Severe campylobacter: ciprofloxacin 0.25-0.5g/6h -E.coli: ciproflxacin 500mg 2/day.

17. *parasite infection: -Amebiasis: mitronidzole750mg PO for 20 days. -Giardiasis: mitro. 250mg POfor 5-7 days. -Strongyliodiasis: thiabendazole 25 mg /kg 2/ day for 3 days. * Psuodomembranous colitis(c.difficle): metronidozle 250-500mg PO. * Diarrhea related to medication use: Symptoms usually respond to discontinuation of the offending agent.

18. Thank you