Diarrhea A child with diarrhea

Objectives: You students will be able to get a detailed history and associated symptoms. get the DD depending on physical finding and proper diagnostic approach. evaluate and manage a child with diarrhea.

Defenses mechanisms Gastric acidity GI peristalsis Normal flora Immune defenses

Pathogenesis of diarrhea Villous damage Enterotoxin Cytotoxin invasion

Causes of gastroenteritis Viruses Bacteria parasites

Rotavirus gastroenteritis Infants & children Destruction of brush border Usually mild to moderate diarrhea If severe: dehydration, shock Diagnosis: exclude other causes Treatment: fluids PO/IV

Salmonella gastroenteritis Cause: salmonella enteritides Source: GIT of animals Presentation: abdominal pain, nausea, vomiting ,diarrhea +/- fever Diagnosis: stool microscopy & culture Treatment: fluids PO/IV Antibiotics: only for severe cases or impaired immunity

Shigellosis Transmission: contaminated food or drink Causes invasive colitis Presentation: abdominal pain, diarrhea, fever+ dysentery Diagnosis: stool microscopy & culture Treatment: fluids – antibiotics

Campylobacter gastroenteritis Source: GIT of animals Causes invasive enterocolitis Transmission: contaminated food or drink Presentation: fever, malaise, abd.pain diarrhea+ blood Diagnosis: stool microscopy & culture Treatment: fluids -- antibiotics

E.Coli gastroenteritis Normal flora of GIT Pathogenic mechanisms: > enterotoxigenic > enteropathogenic > enteroinvasive Diagnosis: by exclusion Treatment: fluids

Cholera Transmission:contaminated food or drink Pathogenesis: enterotoxin Presentation: asymptomatic – mild if severe: dehydration &shock Diagnosis: stool culture Treatment: fluids – antibiotic

Amebiasis Transmission : by cysts Causes invasive colitis Presentation: asymptomatic acute dysentery chronic amebiasis Complications: liver abscess Diagnosis: stool microscopy , serology Treatment: metronidazole

Giardiasis Transmission: Colonize upper small intestine Presentation: asymptomatic – mild to moderate :abdominal. pain , flatulence May become chronic Diagnosis: stool microscopy Treatment: metronidazole

Food poisoning Vomiting within 6 hrs of eating Abd pain , diarrhea after 8 – 16 hrs Abd. Pain , diarrhea after 16 – 48 hrs Abd. Pain, diarrhea , fever 16- 48 hrs