Acute Diarrhoea and Gastroenteritis in Childhood

1. Current Health Problems in Students’ Home Countries Acute Diarrhoea and Gastroenteritis in Childhood By: Afifah binti Othman Masrina binti Hj. Mhmad Tahar

2. Diarrhoea in the 21st Century • Second most common cause of morbidity and mortality worldwide • WHO estimation (2002), diarrhoeal disease results in: • 2.5 million people die annually, mostly children • 1.6 million children <5yrs old (in developing countries)

3. In the U.S. • 211-375 million episodes of diarrhoeal disease occur annually • 73 million physicians consultations • 1.8 million hospitalization • Over 3000 death • In Malaysia (2000) • About 2 million episodes of diarrhoea annually among children < 15 yrs old • 5% of total mortality among children <5 yrs old

4. What is Diarrhoea? • An increase in the frequency of bowel movements or a decrease in the form of stool (greater looseness of stool) • Changes in frequency of bowel movements and looseness of stools can vary independently of each other, changes usually occur in both.

5. Chronic diarrhoea Generally lasts > 3 weeks Common causes: IBS, AIDS, bacterial outgrowth of small int., Colon cancer, Chron’s disease Acute diarrhoea lasts a few days or up to a week • IMPORTANT !!! • distinguish between acute and chronic diarrhoea • >>>different diagnostis tests, different treatments X

6. Usually cause explosive, watery diarrhoea • Typically last only 48-72hrs • Usually no blood and pus in stool Rotavirus Common Causes of Acute Diarrhoea • Infection – highly contagious • Viral gastroenteritis (“stomach flu”)

7. E. Coli bacteria • Contaminated food or water • Usually affect small kids • Bacterial enterocolitis • Sign of inflammation – blood or pus in stool, fever

8. Salmonella enteritidis bact • In contaminated raw or undercooked chicken and eggs • Bacterial enterocolitis • Sign of inflammation – blood or pus in stool, fever

9. Shigella bacteria Campylobacter bacteria • Bacterial enterocolitis • Sign of inflammation – blood or pus in stool, fever

10. Cryptosporidium • in contaminated water – can survive chlorination • Giardia lamblia • in contaminated water • Usually not associated with inflammation • Parasites

11. Common Causes of Acute Diarrhoea – cont. • Food Poisoning • Brief illness cause by toxins produced by bacteria • Cause abdominal pain, vomitting • Cause SI secrete high amnt of water – diarrhoea • Some bacteria produce toxins in food before intake or in intestine after food is eaten • Symptoms usually appear within sev. hours

12. Food Poisoning • Staphylococcus aureus • Produces toxins in food before it is eaten • Usually food contaminated left unrefrigerated overnight

13. Food Poisoning • Clostridium perfringens • Multiplies in food • Produces toxins in SI after contaminated food is eaten

14. Common Causes of Acute Diarrhoea – cont. • Traveller’s Diarrhoea • Drugs / medications

15. Complications of Diarrhoea • Dehydration • Excessive loss of fluids and minerals (electrolytes) from the body • Common in infants and young children with viral gastroenteritis or bacterial infection • Kidney failure, eg in infection by E.coli • Electrolyte deficiency • Irritation to anus due to frequent passage of watery stool containing irritating substances

16. When Treatment is Needed? • Severe or prolonged episode of diarrhoea • Fever • Repeated vomiting, refusal to drink fluids • Severe abdominal pain • Diarrhoea that contains blood or mucus • Sign of dehydration • Dry, sticky mouth • Few or no tears when crying • Sunken eyes • Lack urine or wet diaper • Dry, cool skin • Fatigue or dizziness

17. Tests for Acute Diarrhoea • Measurement of BP in upright and supine post – demonstrate orthostatic hypotension, confirm dehydration • Moderate – severe diarrhoea, blood electrolytes • Examination of small amount of stool under microscope – if inflammation present, further test particularly for bacterial and parasitic infection

18. Treatment • Antibiotics or antiviral medications are not prescribed for cases of diarrhoea caused by virus or bacteria • Antibiotics may be given to very young children or children with weak immune system • In parasitic infection – antiparasitic medicine usually given

19. Treatment – cont. • Oral rehydration solutions (ORS) • Contain carbohydrate (glucose or rice syrup) and electrolytes (Na, K, Cl, citrate, HCO3-) • Infants and children • Infants with mild dehydration – ORS at home (with doctor recommendation) • Infants with moderate – severe dehydration, IV fluids at hospital • Avoid caffeine and lactose containing product

20. Prevention • Wash hands thoroughly before and after eating or when preparing the meals. • Make sure that the tools used for eating and preparing the meals are clean. • Cover our food or put them in the fridge to prevent any contamination.

21. References • Wikipedia http://en.wikipedia.org/wiki/Main_Page • Medical Journal Malaysia VOL 62 http://www.mma.org.my • World Health Organization – WHO http://www.who.int/topics/diarrhoea/en/ • http://www.medicinenet.com/diarrhea/article.htm • http://www.mayoclinic.com/health/diarrhea/DS00292 • http://www.kidshealth.org/parent/infections/common/diarrhea.html