gis - k27 diarrhoe 2 .ppt...
TRANSCRIPT
DIARRHOEA
( 2 )( 2 )
ANTIMICROBIAL
Acute Diarrhoea
(WHO)
1. Cholera
2. Shigellosis
3. Amoebiasis
4. Giardiasis
ANTIMICROBIAL (WHO)
1. CHOLERA TETRACYCLIN 12,5 mg/Kg BW - 4 x a day
3 days
2. SHIGELLA DYSENTERY 5 mg TMP + 25 mg SMX/Kg BW - 2 x a day
5 days5 days
3. AMOEBIASIS METRONIDAZOLE 10mg/Kg BW - 3 x a day
5 days
4. GIARDIASIS METRONIDAZOLE 5 mg / Kg BW - 3 x a day
5 days
SIDE EFFECT OF ANTIMICROBIAL
1. CHANGING OF INTESTINAL FLORA
2. OVERGROWTH:
- MONILIA
- ENTEROCOCCUS
- ANAEROB- ANAEROB
- PSEUDOMONAS
3. MUCOSAL INJURY
4. IRRITATION
5. PSEUDOMEMBRANOUS ENTEROCOLITIS
6. BLOOD DYSCRASIA
7. VOMITING
ANTIDIARRHOEAL(United States F.D.A)
A drug that can be shown by objective
measurement to treat or control the symptoms
1. Bowel Movement
2. Stool Consistency
3. Cramps
of diarrhoea
1.UNABSORBED
ANTIMICROBIAL :
-Streptomycin
-Neomycin
-Hydroxyquinolin
-Unabsorbed Sulfa
3. ADSORBENT :
-Kaolin/pectin
-Charcoal
-Atapulgit / smectite
4. ANTISECRETORY :
Antidiarrhoeal
-Unabsorbed Sulfa
2. ANTIMOTILITY :
-- Loperamide
-- Diphenoxylate
4. ANTISECRETORY :
-Salicylate Acid
-Chlorpromazine
5. TRIAL:
-Lactobacillus,
-Fructooligo saccharida
NB : 1 to 4 →→→→ NO RECOMMENDED
KAOLIN
1. Stimulate viral-tissue penetration
2. No benefit in improving stools consistency
3. Suppress the effect of antibiotics
4. Cosmetic effect
5. Malabsorption
IODOHIDROXY QUINOLINE
1. No benefit
2. In Japan ==> Subacute Myelo Optic Neuropathy
( SMON)
DIARRHOEA
DEHYDRATION COMPLICATION
REHYDRATION - ELECTROLYTES
IMBALANCE
-RINGER’S LACTATE
-RINGER’S ACETATE
-ORS
IMBALANCE
- ACIDOSIS METABOLIC
- FEVER
- CONVULTION
- HYPOGLICEMIA
OPIATES & SPASMOLYTICA
1. INCREASE THE DURATION OF FEVER
2. PROLONG PASSAGE OF PATHOGENS
3. DECREASE OF BOWEL PERISTALSIS
4. INCREASE THE DURATION OF 4. INCREASE THE DURATION OF
PROLIFERATION,TOKSIN PRODUCTION &
INVASIVE BY MICROORGANISMS
5. GUT PARALYSIS
ELECTROLYTES - ACID BASE
INITIAL REHYDRATION
DIAGNOSIS TREATMENT
ELECTROLYTES – ACID BASE
INITIAL
ISONATREMIA
DEHYDRATION
REHYDRATION
HYPONATREMIA
DEHYDRATION
DILUTIONAL
REHYDRATION
ACIDOSIS METABOLIC
DEHYDRATION + ACIDOSIS METABOLIC
pH < 7.2
HCO3- = 1-2 mEq/Kg BW
- LUNGS DYSFUNCTION (-)
- HYPOKALEMIA (-)
REHYDRATION
HYPERNATREMIA
DEHYDRATION + HYPERNATREMIA
HYPERNATREMIA
( > 150 mEq/l)
- IVFD STOPPED
- PLAIN WATER
REHYDRATION
HYPONATREMIA
( < 135 mEq/L)
DEHYDRATION + HYPONATREMIA
Sympt
HypoNa
After
Rehydration
Asympt
HypoNa
NaCl 3% Fluid RestrictionRL
Na+(mEq) = (135 – Na+ plasma) x 0,6 x BW (kg)
REHYDRATION
HYPOKALEMIA
Diarrhoea (+) Diarrhoea↓↓
HYPERKALEMIA
Renal Function
DEHYDRATION HYPO/ HYPERKALEMIA
Diarrhoea (+) Diarrhoea↓↓
ECGRL
N abN
K+ oral K+ drip (upto 3 mEq / kgBW / day)
Acute Renal Failure
Fluids
Restriction
FEVER
TEMPERATURE DOWN
COOLING DRUGS
- Unclothed- Unclothed
- Wipe of sweat
- Fanning
- Tepid sponging
1. Paracetamol :
30 mg/Kg/day - 3 doses
2. - Acetyl Salicylic Acid
- Mefenamic Acid
No recommended
CONVULSION
Diazepam: 1 mg/Kg/day
3 - 4 doses iv/per rectal
Hypoglicemia (<50 mg%)
Coma
Dextr. 10% IV� 5 mL /Kg BW
within 5 minutes
Alert
V. CHOLERAE
O1 Non O1
(Non Agglutinable)- Biotype - Eltor
- Classic
- Serotype - Ogawa
- Inaba
- Hikojima O2 - 138
O140 - 142
O139
“Bengal Strain”
ENTEROTOXIN
Absorption of Na+
in Villous Cells are intact
Surface Receptor
Adenyl Cyclase
Secretion of Cl-
in Crypt Cells
C - AMP
VilliBowel Lumen
Absorption
Secretion
Crypt
Secretion
V. CHOLERAE
JEJUNUM
- COPIOUS DIARRHOEA
- FISHY RICE WATER STOOLS- FISHY RICE WATER STOOLS
- FEVER (-)
- ABDOMINAL PAIN (-)
- RAPID DEHYDRATION & SHOCK
- BIOCHEMICAL (+)
- HISTOLOGY (-)
DIAGNOSIS
- CLINIC
CHILDREN > 2 YEARS
SEVERE DEHYDRATION
THE OTHER CHILDREN (+)
- LAB
DARK FIELD MICROSCOPE
CULTURE
Th Water & Electrolytes → Ringer’s
Lactate I.V.
Rehydration & Maintenance
Fecal Sodium
( 88 – 101 mEq/ L)
FEEDING
ANTIMICROBIAL → Tetracycline or
Doxycycline
( 88 – 101 mEq/ L)
DYSENTERY SINDROME = BLOODY DIARRHOEA
1. DYSENTERY
- BACILLARY
- AMOEBIC
2. Enterocolitis
- Cows milk allergy
3. Trichuriasis
4. Others - Entero invasive E coli
- C. jejuni
BACILLARY DYSENTERY
= SHIGELLOSIS
S. DYSENTERIAE
S. FLEXNERI
COLON
S. FLEXNERI
S. BOYDII
S. SONNEI
SHIGELLA
INVASIVE SHIGA TOXIN
INHIBITION OF
PROTEIN SYNTHESIS
CYTOTOXIC
SHIGELLA
- WATERY DIARRHOEA
- BLOODY DIARRHOEA
- TENESMUS
- ABDOMINAL PAIN
- URGENCY
- FEVER
- CONVULSION
- SEPTIC
- HEMOLYTIC UREMIC
SYNDROME- URGENCY SYNDROME
- TOXIC MEGA COLON
- RECTAL PROLAPS
Th
1. WATER & ELECTROLYTES
2. FEEDING
3. - SELF LIMITED
- SEVERE • TMP - SMX- SEVERE • TMP - SMX
• Cefixime:
8 mg/kg/day
2 doses
• nalidixic acid
• ampisilin
SALMONELLOSIS
• TYPHOIDAL ENTERIC FEVER :
-S. TYPHOID TYPHOID FEVER
-S. PARATYPHOID PARATYPHOID FEVER
• NON TYPHOIDAL : SALMONELLA
GASTROENTERITIS
INDICATION OF ANTIMICROBIAL
TREATMENT IN SALMONELLA
GASTROENTERITIS
1. ≤≤≤≤ 3 MONTHS OF AGE
2. OLD DEBILITATED PATIENT
3. DYSENTERY FORM ESPECIALLY 3. DYSENTERY FORM ESPECIALLY
ILLNESS > 5 DAYS
4. IMMUNOCOMPROMISED : STEROID,
MALIGNANCY
5. BACTERIAEMIA
Infant 10 months of age, was admitted to hospital with Infant 10 months of age, was admitted to hospital with
diarrhoeadiarrhoea. .
On examination On examination : : BW = 8 kg; BW = 8 kg; infant well & alert; infant well & alert;
eyes : eyes : sunkensunken ; drinks eagerly; skin pinch goes ; drinks eagerly; skin pinch goes
back:quicklyback:quickly..
Question : Question :
Exercise :
Question : Question :
1.1.Dehydration………..Dehydration………..
2.2.Amount of fluids will be given………Amount of fluids will be given………
3.3.If the baby aren’t able to drink, what kind of If the baby aren’t able to drink, what kind of
intervention is needed? intervention is needed?
44.If the baby is drinks normally, what type of .If the baby is drinks normally, what type of
dehydration?dehydration?