DIARRHOEA

1. Dr. Muhammad Razzaq malik

2. DIARRHOEA It is the passage of liquid and watery stool more than three times a day. It is the recent change in consistency of stools rather than the number of stools. Dr. Muhammad Razzaq malik

3. PERSISTANT DIARRHOEA Diarrhoea of presumed infectious origin that begins acutely and lasts for 14 days or more. Dr. Muhammad Razzaq malik

4. DYSENTERY Presence of blood and pus in the stools, abdominal cramps and fever. Gross blood in the stools is the most reliable sign. Dr. Muhammad Razzaq malik

5. DD Biggest single killer of children Causing nutritional loss, Growth retardation Dehydration and death ( >10% loss of fluid)` 4 B cases of diarrhoea in the world 2.2 M deaths out of which 2 M deaths / yr <5 50 % deaths due to dehydration 14 % Persistant diarrhoea 15 % dysentery DD are impt. Contributors of pool of malnutrition Dr. Muhammad Razzaq malik

6. FACTORS Contaminated water supply Contaminated food Unsanitary disposal of human waste Poor personal and domestic hygiene Dr. Muhammad Razzaq malik

7. PAKISTAN Very high mortality in Pakistan 700,000 children deaths during one year 228,000 deaths due to diarrhoea Diarrhoea leading to malnutrition Reduced resistance leading to repeated infections Wrong management of diarrhoea is a major cause of malnutrition & death No health education / counseling Dr. Muhammad Razzaq malik

8. CAUSES OF DIARRHOEA Rota virus E Coli Shigella Compylobacter jejuni Vibrio cholerae Salmonellosis Protozoa E. Hisyolytica Giardia lumblia Cryptosporidium Dr. Muhammad Razzaq malik

9. Death due to DD Dr. Muhammad Razzaq malik

10. ASK Duration of diarrhoea; Consistency of stool; Presence of blood in the stool; Presence of fever, convulsions, or other problems (e.g., cough, recent measles); Pre-illness feeding practices; Type and quantity of fluids (including breast milk) and food consumed during the illness; and Drugs or other remedies taken. Dr. Muhammad Razzaq malik

11. LOOK General condition: alert; restless or irritable; floppy, lethargic or unconscious; severely undernourished? Eyes: sunken, or very sunken and dry? Are there tears when the child cries? Mouth and tongue: moist, dry, or very dry? When water is offered to drink : is it taken normally, eagerly, or is the patient unable to drink? Respiration. Dr. Muhammad Razzaq malik

12. Dr. Muhammad Razzaq malik

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15. Dr. Muhammad Razzaq malik

16. PLAN-A-1 Give the child more fluids than usual to prevent dehydration Home food-based fluids like gruels, cooked rice, soups, potatoes and yoghurt-like drinks If this is not possible , give plain water Use ORS solution for the treatment and prevention of dehydration, Give as much as free fluids as child can take Continue fluids until diarrhoea stops Dr. Muhammad Razzaq malik

17. PLAN-A-2 Give the child plenty of food to prevent under nutrition Continue BF Give usual milk if not BF, If < 6 months, dilute milk can be added / given If > 6 months, give freshly prepared solid foods like cereals, pulses, vegetables along with oil Give fresh fruit juices, smashed banana for K‾ Encourage child to eat, offer food 6 times a day Give same food after dia. stops Dr. Muhammad Razzaq malik

18. PLAN-A-3 Take the child to health worker if child does not get better in 3 days or develop any of the following Many watery stools Repeated vomiting Marked thirst Eating or drinking poorly Fever Blood in stool Dr. Muhammad Razzaq malik

19. Composition of Oral Rehydration Salt (ORS) Dr. Muhammad Razzaq malik

20. Composition of Oral Rehydration Salt (ORS) Dr. Muhammad Razzaq malik

21. Composition of Oral Rehydration Salt Solution Dr. Muhammad Razzaq malik

22. O R Sol Sodium 90 m.mol / L Potassium 20 Chloride 80 Citrate 10 Glucose 111 ORS should preferably be given with a teaspoon or in small sips from a cup or tumbler. Dr. Muhammad Razzaq malik

23. ORS Educate mother how much ORS is given after each stool & give 2 packets Age < 2 years---50-100 ml Age 2 -10 years---100-200 ml 10 years or more– as much as wanted Show mother how to mix ORS Show mother how to give ORS Give 1 TSF every 1-2 minutes If child vomits, give ORS slowly after waiting for 10 minutes Dr. Muhammad Razzaq malik

24. ORS (4 hrs)=(wtx75) Dr. Muhammad Razzaq malik

25. food Give plenty of food to prevent under- nutrition Continue breast feeding Continue foods like milk, Nutrient rich foods Increase food intake after diarrhoea stops Never restrict food during diarrhoea Dr. Muhammad Razzaq malik

26. Education of mother Explain to the mother that she should take her child to a health worker if the child does not get better in 3 days or; Starts to pass may stools; Has repeated vomiting; Becomes very thirsty; Is eating or drinking poorly; Develops a fever; Has blood in the stool. Dr. Muhammad Razzaq malik

27. Good weaning practices Wash hands before preparing food and before feeding the child Prepare food in a clean place. Wash uncooked food in clean water before feeding it to child. Cook or boil food well when preparing it. Prepare weaning foods immediately before they will be eaten. Cover foods that are left over. Keep foods in a cool place If cooked food is prepared more than 2 hours in advance of feeding, reheat it until it is thoroughly hot before giving it to the child. Dr. Muhammad Razzaq malik

28. Prevention of Deaths Due to D.D Improved mother & child nutrition Optimal BF practices ORT Zinc supplementation during diarrhoea. Immunization of all children against measles Appropriate drug therapy Increased access to safe water supply Proper sanitation facilities Improved personal & domestic hygiene. Dr. Muhammad Razzaq malik

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37. Preparing ORS Dr. Muhammad Razzaq malik

38. Dr. Muhammad Razzaq malik

39. Home made ORS Dr. Muhammad Razzaq malik

40. MCQ Glucose is added to rehydrating solution because it: Changes taste for easy drinking Increases absorption of salt and water Increases absorption of amino acids For sweet taste of the solution All of the above Dr. Muhammad Razzaq malik

41. MCQ Following are present in ORS except: Sodium bicarbonate Sodium chloride Potassium chloride Calcium chloride Glucose Dr. Muhammad Razzaq malik

42. MCQ The freshly ORS should not be used for more than: 2 hours 8 hours 12 hours 24 hours 30 hours Dr. Muhammad Razzaq malik

43. MCQ Home made ORS is made of in one liter of water: -10 gm salt, 10 gm sugar 5 gm salt, 20 gm sugar 20 gm salt, 5 gm sugar 5 gm salt, 50 gm sugar All of the above Dr. Muhammad Razzaq malik

44. MCQ Estimated fluid deficit in severe dehydration is: 40 ml / kg 65 ml / kg 75 ml / kg 100 ml / kg 150 ml / kg Dr. Muhammad Razzaq malik

45. MCQ Which of the following is not true about oral rehydrating solution: Mild to moderate dehydration can be corrected by ORS at home The solution at home should be made daily In BF child, nursing should be delayed till dehydration is corrected Patients should be given as much ORS as they want ORS should not be given to a child who is unconscious. Dr. Muhammad Razzaq malik

46. MCQ Ideal intravenous fluid for correction of dehydration due to diarrhoea is : Normal saline Ringer lactate Dextrose saline 5% dextrose Oral rehydrating solution Dr. Muhammad Razzaq malik

47. MCQ All of the following viral infections produce diarrhoea except Enterovirus Adenovirus Rota virus Retrovirus Norwalk virus Dr. Muhammad Razzaq malik

48. MCQ Diarrhoea is more common during weaning because of Declining level of maternally acquired antibodies Lack of active immunity in infants Introduction of contaminated food Eruption of teeth Cessation of breast feeding Dr. Muhammad Razzaq malik