1. Diarrhea

2. Diarrhea
Definition:
Stool that contains more water than normal

3. Leading cause of death in developing Countries.
3.2 million deaths/Year in those <5y of age, with average 3.3 episodes of Diarrhea/year, may reach to 9/year. In some areas, death mostly occurs in the 1st 2 years of life (80%), the main causes are: dehydration, malnutrition & serious infection.
Diarrhea represents an economic burden on the developing countries which includes bed-occupancy (about 1/3 of hospital beds in some countries occupied by patients with Diarrhea), also I.V. fluid (expensive), Rx. & ineffective drugs

4. Types of Diarrhea:
- Acute watery: <14 days, some times associated with vomiting.
- Dysentery: diarrhea + visible blood in the faces associated with rapid weight loss due to anorexia.
- Persistent Diarrhea: >14days,episodes of watery Diarrhea or dysentery associated with dehydration & malnutrition.
- Chronic Diarrhea: is not due to infection but chronic diseases (crohn`s, coeliac,..) so it is not included here.

5. Epidemiology: Transmission is promoted by specific behaviors:
1 Failing to breast–feed exclusively for the 1st
4-6 months of life.
2. Using infant feeding bottles.
3. Storing cooked food at room temperature.
4. Using drinking water contaminated with fecal bacteria.
5. Failing to wash hands after defecation, disposing of
feces, or before handling food.

6. Etiology:- According to prevalence: Rota Virus
ETEC enterotoxigenic E-coli.
Shigella.
Campylobacter jejuni.
E.histolytica.
V.cholerae
Cryptosporidi
Salmonella

7. Causes of Malnutrition in diarrhea
1. Reduced food intake due to:-
- Anorexia (especially in dysentery)
- Vomiting: with a low discourage attempts at
feeding.
- Withholding of food :based on traditional
believes about Rx. Of D.(Rest the bowel).
- Giving food with reduced nutrient value: gruel,
soup in the believe that a diluted food is easier
to digest.

8. 2. Decreased absorption of nutrients:
- Damage to the absorptive (villous) epithelial cells.
- Disaccharide’s deficiency owing to impaired
production of enzyme by the damage villous
(may lead to mal-absorption of disaccharide
sugar especially lactose)
- Reduced internal concentration of bile acids
that affects the fat absorption.
- Rapid transit of food through the GIT, leaving an
insufficient time for digestion and absorption

9. 3. Increased nutrition requirements due to:
- Metabolic demands with fever
- Damaged appetite
-The need to replace serum protein lost through
the damaged mucosa as in dysentery.

10. Prevention of Diarrhea:
Giving only breast milk for the first 4-6 months of life (Exclusive BF).
Avoiding the use of infant feeding bottles.
Improving practices related to the preparation & storage of weaning food to decrease contamination
Using clean water for drinking.
Washing hands (after defecation/disposing feces & before eating or preparing food.
Safe disposing of feces including those of infants (its risky, contaminated & not sterile as misbelieved).

11. Measures that strengthen the defense :
Continue to breastfeed for at least 2 years of life.
2. Improving nutritional status by improving nutritive value & increase amount of weaning food.
3. Immunization against measles.

12. Control of Diarrheal Diseases
CDD

13. I- Assessment General condition Eye Mouth Thirst Tears Pinched Skin
Well, alert
Irritable,* restless
Lethargic,* unconscious
Eye
Normal
Sunken
Very sunken
Mouth
Moist
Dry
Very dry
Thirst
Not thirsty
Drinks * Eagerly
Can not * drink
Tears
Present
Absent
Pinched Skin
Goes back quickly
Goes back* slowly
Very slowly *

14. Rx.1:-Assess: Condition: Well ,alert Irritable,* restless
Lethargic or *
unconscious
Eyes:
Normal
Sunken
Very sunken
Tears:
Present
Absent
Mouth
Moist
Dry
Very dry
Thirst:
Not thirsty
Drink eagerly *
Unable todrink*
Pinched skin
Goes back quickly
Goes bacslowly*
Very slowly* A B c
No dehydration
some dehyd.
Severe dehyd.
At home
PHC (ORS)
Hospital (I.V.)
if<2y. Keep on BF
if>2y.give much fluid
preferably salty
Increase food intake
(Not roughage, not diluted, not sweat)add 1spoon oil
ml ORS or fluid after each loose motion according to age
teach the mother how to prepare& administer
consult after 3 days if:
-doesn’t get better
-vomiting
-increase diarrhea
-fever
-blood with stool
Wt. * 70 in the 1st 4 hr. then assess & behave accordingly
Wt.* 100
1/3 during1/2hr.
2/3 during 2hrs.
+ORS
then assess

15. Why CDD? If there is fever think of malaria if the area is endemic
If there is fever & blood think of shigellosis
If the stools are watery look for cholera in the area
If there is blood with stool dysentery) & Rx shigellosis failed then think of parasite (Amoebiasis)
If diarrhea lasted > 14 days think of Giardiasis
Never give antibiotics apart from these conditions
Never give anti-diarrhea,anti-spasmodic,or anti-emetic
Why CDD?
To decrease morbidity & mortality in an easy, rapid way with less facilities & with the participation of all health workers at different levels & also the family.