Cholera: the simplified version

Symptoms Symptoms Acute diarrhea duration less than 2 weeks

onset: onset: Abrupt frequent, small fecal discharge Abrupt frequent, small fecal discharge Cramping abdominal pain, tenesmuse Cramping abdominal pain, tenesmuse stool: increased stool: increased Routin Ex Routin Ex severe cases: dehydration, electrolyte disturbances, metabolic acidosis, collapse hypovolumia, tetany. severe cases: dehydration, electrolyte disturbances, metabolic acidosis, collapse hypovolumia, tetany. Symptoms volume liquidity flecks of blood, mucus WBC, RBC, pus, destroyed epithelium

Symptoms Chronic diarrhea duration more than 2 months

Symptoms Onset: Onset:gradual/insidious Diarrhea of variable severity Diarrhea alternate with constipation Colicky abdominal pain, distention

stool stool watery, bloody, steatorrhea contains: inflammatory cells/mucus/pus/indigested food severe/long-standing cases: severe/long-standing cases: weight loss, malnutrition, edema, multy vits deficiency, malabsorption, wasting, edema, bone pain weight loss, malnutrition, edema, multy vits deficiency, malabsorption, wasting, edema, bone pain

Accompanied Symptoms severe dehydration severe dehydration (cholera, pancreatic cholera-WDHA, etc.) (cholera, pancreatic cholera-WDHA, etc.) fever fever (Acute bacillery dysentery, Typhoid, TB enteritis, etc.) (Acute bacillery dysentery, Typhoid, TB enteritis, etc.) tenesmus (Acute dysentery, proctitis, etc.) tenesmus (Acute dysentery, proctitis, etc.) markedly weight loss markedly weight loss (cancer of gut, malabsorption, etc.) (cancer of gut, malabsorption, etc.) Arthralgia/Arthritis Arthralgia/Arthritis (IBD, connective tissue diseases, etc.) (IBD, connective tissue diseases, etc.) masses (malignant cancer of GI, TB, peritonitis, etc.) masses (malignant cancer of GI, TB, peritonitis, etc.)

Diagnostic Procedures Information P.E. Findings fever, dehydration, malnutrion, anemia, ulticaria, jaundice, arthralgia, abdominal masses, Tenesmus, digital rectal examination. fever, dehydration, malnutrion, anemia, ulticaria, jaundice, arthralgia, abdominal masses, Tenesmus, digital rectal examination. Lab findings

Diagnostic Procedures information in epidemics (Dysentery, v. Cholerae, Typhoid, food poisonning, enteritis) in epidemics (Dysentery, v. Cholerae, Typhoid, food poisonning, enteritis) food allergy food allergy past illness(antibiotic related diarrhea, etc.) past illness(antibiotic related diarrhea, etc.) medication take(corticosteroids, laxatives, etc.) medication take(corticosteroids, laxatives, etc.) predisposing conditions (surgical resection, parasitic infection, etc.) predisposing conditions (surgical resection, parasitic infection, etc.)

Lab findings Blood Urine Stool Microscopy Tolerance tests Breath tests Culture of Jejunal aspirates 5 HIAA (urinary excretion) Vit B 12 absorption test X-ray Barium Endoscopy Suction biopsy technique (Jejunal mucosa histology

blood blood RBC RBC WBC WBC Culture Culture Specific Antigen/Antibody (widal test, etc.) Specific Antigen/Antibody (widal test, etc.) Serum testings Serum testings (carotin/iron, Ferritin/albumin/folic acid) (carotin/iron, Ferritin/albumin/folic acid) (vitB12/glucose/gut hormone/Ca2+,K+,Cl-, Na+) (vitB12/glucose/gut hormone/Ca2+,K+,Cl-, Na+) Lab findings

Urine Urine Protein Protein cast cast Stool Stool appearance appearance (watery, bloody, bulky, sticky, malodorous, steaterrhea, foul-smelling)

Lab findings Microscopy Microscopy RBC, WBC polymorphonuclear (PMN):Shigella, solmonella, E coli mononuclear (M) motile amebic trophozoites Gram ’ s stain (+) staphylococcal enteritis Gram ’ s stain (+) staphylococcal enteritis Culture: salmonolla, shigella, v. cholera Culture: salmonolla, shigella, v. cholera Fat determination Fat determination

Lab findings Tolerance tests Tolerance tests (d-xylose; Glucose/lactose/sucrose) (d-xylose; Glucose/lactose/sucrose) Breath tests Breath tests 14C Glycine-cholate, xylose 14C Glycine-cholate, xylose Culture of Jejunal aspirates Culture of Jejunal aspirates (Bacterial overgrowth) (Bacterial overgrowth) (increased Bile and deconjugation) (increased Bile and deconjugation) 5 HIAA (urinary excretion) 5 HIAA (urinary excretion) Vit B 12 absorption test Vit B 12 absorption test

Lab findings X-ray Barium X-ray Barium meal meal enema enema Endoscopy Endoscopy Duodenoscopy (ERCP) Duodenoscopy (ERCP) Colonoscopy Colonoscopy Sigmoidoscopy Sigmoidoscopy Suction biopsy technique (Jejunal mucosa histology) Suction biopsy technique (Jejunal mucosa histology)