Diarrhea ( Causes ,Symptoms,Agent factors,Diagnosis,Treatment,Dietary management,prevention and complications):-

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 DIARRHEA:-

¢Diarrhea is described as an increase in the frequency of bowel movements or a decrease in the consistency of stools that causes the discharge of watery, loose stools.
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¢The severity of diarrhea is determined by the size and number of stools passed within a period of time.
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¢It is a common cause of death in developing countries and  the second most common cause of infant deaths  worldwide.
¢WHO defines :

  Having 3 or more loose or liquid stools per day.

TYPES OF DIARRHEA

¢Acute diarrhea
¢
¢It is an attack of loose stool with  sudden onset which usually lasts 3 to 7days but  may last up to 10 – 14 days.
¢It is caused by an  infection of the large intestine, but may be  associated with infection of gastric mucosa and  small intestine.
¢The term “acute gastroenteritis” is  most frequently used to describe acute diarrhea.
 
¢Chronic diarrhea
¢
¢It is termed when the loose stool is  occurring for 3 weeks or more. It is usually related to  underlying organic diseases with or without  malabsorption.
¢Diarrhea with watery stools and visible blood in the stools  is called dysentery.
¢Persistent diarrhea refers to the episodes of acute  diarrhea that last for 2 weeks or more and may be due to  infective origin.

 
EPIDEMIOLOGY 
¢About 1/3 of total hospitalized children are due to  diarrheal diseases and 17% of all deaths in indoor  pediatric patients are related to this condition.
¢Diarrheal disease is the second leading cause of death in children under five years old. It is both preventable and treatable.
¢Each year diarrhea kills around 525 000 children under five.
¢A significant proportion of diarrheal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.
¢Globally, there are nearly 1.7 billion cases of childhood diarrheal disease every year.
¢Diarrhea is a leading cause of malnutrition in children under five years old.
 
 CAUSES OF DIARRHEA
¢The main causes of this disease are lack of  knowledge of hygiene and sanitation, home  environment, feeding practices of the parents and  under five years of children.
¢It can be caused by chronic ethanol ingestion.
¢Chronic mild diarrhea in infants and toddlers may  occur with no obvious cause and with no other ill  effects ,this condition is called toddler’s diarrhea.
 
AGENT FACTORS
¢Diarrhea is mostly infectious. A large numbers of  organism are responsible for acute diarrhea.
¢The  infectious agent causing diarrhea with enteric  infection include the followings: 
Viruses: 
Rota virus, adenovirus, enterovirus, viruses,measles virus etc.
Bacteria: 
Campylobacter jejuni, E.coli, Shigella,   Salmonella, 
cholera  vibrio etc.
Parasites: 
E.histolytica, G.lambia, Cryptosporidium, 
Fungi: 
Candida albicans
 

 
ENVIRONMENTAL FACTORS
¢Bacterial diarrhea is more frequently occur in  summer and rainy season,whereas viral diarrhea (  specially rotavirus ) found in winter.
 
CLINICAL MANIFESTATIONS
¢Stools are usually loose watery in consistency.It  may be greenish or yellowish-green in color with  offensive smell. It may contain mucus, pus or blood  and may expelled with force,preceded by  abdominal pain. 
¢Frequency of stools varies from 3 to 20 per day or  more.

¢The child may have low grade fever,thirst, anorexia.
¢Behavioral changes like irritability, restlessness, weakness, lethargy, sleepiness.
¢Physical changes like loss of weight, poor skin turgor, dry mucus membranes, dry lips, sunken eyes,depressed fontanelles are  also found. 
¢Vital signs are changed as low blood  pressure,tachycardia,rapid respiration,cold limbs  and collapse. 
¢Decreased or absent urinary output. 
¢Convulsions and loss of consiousness may also  present in some children with diarrheal diseases.
 
 DIAGNOSIS: 
¢History taking and physical assessment.
¢Stool examination can be done for routine and  microscopic study and identification of causative  organisms. 
¢Blood examination can be performed to detect  electrolyte imbalance,acid- base  disturbances.
 
DIETARY MANAGEMENT:-
¢Diet to be planned to prevent malnutrition and allow  normal nutritional requirement. 
¢Food items may include energy rich food with  rice, potatoes, wheat, pulses and high  fiber content foods and soft drinks should be avoided. 
¢Breast feeding to be continued during diarrheal  episodes even along with ORS. 
¢Cereal mixture like rice- milk, dalia- sagu, or khichri can be given to the infants more than 6 months of age.
¢If the infant is non breast fed,cow’s or buffalo’s milk  should not be diluted with water. 
¢Feeding to be given in small quantity frequently every 2 to 3 hours.
¢BRAT Diet
¢KYB Diet
¢Soluble fiber
¢Foods containing high levels of soluble fiber include dried beans, oats, oat bran, rice bran, barley, citrus fruits, apples, strawberries, peas, and potatoes.
¢Foods high in insoluble fiber include wheat bran, whole grains, cereals, seeds, and the skins of many fruits and vegetables.
 
 
PREVENTIVE MEASURES:   
¢Improvement of food hygiene and environmental  hygiene.These includes: 
qSafe water,adequate sewage disposal, hand washing  practices,clean utensils,avoidance of exposures of food  to dust and dirt,fly control, washing of fruits and  vegetables etc. 
qAvoidance of bottle feeding is most significant practice  needed for prevention of diarrhea. 
qBoiling or filtering to be practiced for safe drinking water. 
qPrevention of LBW and prematurity,exclusive breast  feeding,appropriate weaning practices,balanced  diet,immunization are significant aspects of child care.
 
COMPLICATIONS:
¢Dehydration
¢Hypovolemic shock
¢Renal failure
¢Thromboembolism
¢Convulsions
¢Overdehydration
¢Hypoglycemia
¢Toxic megacolon
¢Paralytic ileus
¢Malnutrition
¢Growth retardation
Mental subnormalities
     

       
 
 
 

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