1. CONSTAPATION & DIARRHEABY
DR.RANDA AL-GHANEM
PEDIATRIC GI CONSULTANT

2. CONSTAPATION

3. DEFINITION
INFREQUENT BOWEL MOVEMENTS (TYPICALLY THREE TIMES OR FEWER PER WEEK)
DIFFICULTY DURING DEFECATION (STRAINING DURING MORE THAN 25% OF BOWEL MOVEMENTS OR A SUBJECTIVE SENSATION OF HARD STOOLS), OR
THE SENSATION OF INCOMPLETE BOWEL EVACUATION.

4. CONSTIPATION IN CHILDREN USUALLY OCCURS AT THREE DISTINCT POINTS IN TIME: AFTER STARTING FORMULA OR PROCESSED FOODS (WHILE AN INFANT), DURING TOILET TRAINING IN TODDLERHOOD, AND SOON AFTER STARTING SCHOOL.
AFTER BIRTH, MOST INFANTS PASS 4-5 SOFT LIQUID BOWEL MOVEMENTS (BM) A DAY. 
BREAST-FED INFANTS USUALLY TEND TO HAVE MORE BM COMPARED TO FORMULA-FED INFANTS.

5. SOME BREAST-FED INFANTS HAVE A BM AFTER EACH FEED, WHEREAS OTHERS HAVE ONLY ONE BM EVERY 2–3 DAYS.
INFANTS WHO ARE BREAST-FED RARELY DEVELOP CONSTIPATION.
 BY THE AGE OF TWO YEARS, A CHILD WILL USUALLY HAVE 1–2 BOWEL MOVEMENTS PER DAY AND BY FOUR YEARS OF AGE, A CHILD WILL HAVE ONE BOWEL MOVEMENT PER DAY.

6. CAUSES
THE CAUSES OF CONSTIPATION CAN BE DIVIDED INTO CONGENITAL, PRIMARY, AND SECONDARY.
THE MOST COMMON CAUSE IS PRIMARY AND NOT LIFE- THREATENING.
 IN THE ELDERLY, CAUSES INCLUDE: INSUFFICIENT DIETARY FIBER INTAKE, INADEQUATE FLUID INTAKE, DECREASED PHYSICAL ACTIVITY, SIDE EFFECTS OF MEDICATIONS, HYPOTHYROIDISM, AND OBSTRUCTION BY COLORECTAL CANCER.
FEMALES ARE MORE OFTEN AFFECTED THAN MALES.

7. PRIMARY
PRIMARY OR FUNCTIONAL CONSTIPATION IS ONGOING SYMPTOMS FOR GREATER THAN SIX MONTHS NOT DUE TO ANY UNDERLYING CAUSE SUCH AS MEDICATION SIDE EFFECTS OR AN UNDERLYING MEDICAL CONDITION.
 IT IS NOT ASSOCIATED WITH ABDOMINAL PAIN, THUS DISTINGUISHING IT FROM IRRITABLE BOWEL SYNDROME.
 IT IS THE MOST COMMON CAUSE OF CONSTIPATION.

8. DIET
CONSTIPATION CAN BE CAUSED OR EXACERBATED BY A LOW FIBER DIET, LOW LIQUID INTAKE, OR DIETING.
MEDICATION
MANY MEDICATIONS HAVE CONSTIPATION AS A SIDE EFFECT. SOME INCLUDE (BUT ARE NOT LIMITED TO); OPIOIDS COMMON PAIN KILLERS , DIURETICS ,  ANTIDEPRESSANTS , ANTIHISTAMINES , ANTI PASMODICS , ANTICONVULSANTS, AND ALUMINUM ANTACIDS.

9. METABOLIC AND MUSCULAR
METABOLIC AND ENDOCRINE PROBLEMS WHICH MAY LEAD TO CONSTIPATION INCLUDE:
 HYPERCALCEMIA, HYPOTHYROIDISM, DIABETES MELLITUS,CYSTIC FIBROSIS, AND CELIAC DISEASE.
 CONSTIPATION IS ALSO COMMON IN INDIVIDUALS WITH MUSCULAR AND MYOTONIC DYSTROPHY.

10. STRUCTURAL AND FUNCTIONAL ABNORMALITIES
CONSTIPATION HAS A NUMBER OF STRUCTURAL (MECHANICAL, MORPHOLOGICAL, ANATOMICAL) CAUSES, INCLUDING: SPINAL CORD LESIONS , ANAL FISSURES, AND PROCTITIS.
CONSTIPATION ALSO HAS FUNCTIONAL (NEUROLOGICAL) CAUSES, INCLUDING ANISMUS, DESCENDING PERINEUM SYNDROME, AND HIRSCHSPRUNG'S DISEASE.
 IN INFANTS, HIRSCHSPRUNG'S DISEASE IS THE MOST COMMON MEDICAL DISORDER ASSOCIATED WITH CONSTIPATION.
ANISMUS OCCURS IN A SMALL MINORITY OF PERSONS WITH CHRONIC CONSTIPATION OR OBSTRUCTED DEFECATION.

11. PSYCHOLOGICAL
VOLUNTARY WITHHOLDING OF THE STOOL IS A COMMON CAUSE OF CONSTIPATION.
THE CHOICE TO WITHHOLD CAN BE DUE TO FACTORS SUCH AS FEAR OF PAIN, FEAR OF PUBLIC RESTROOMS, OR LAZINESS.
 WHEN A CHILD HOLDS IN THE STOOL A COMBINATION OF ENCOURAGEMENT, FLUIDS,FIBER, AND LAXATIVES MAY BE USEFUL TO OVERCOME THE PROBLEM.

12. DIAGNOSIS
THE DIAGNOSIS IS ESSENTIALLY MADE FROM THE PATIENT'S OR PARENTS DESCRIPTION OF THE SYMPTOMS ( INCLUDE BLOATING, DISTENSION, ABDOMINAL PAIN, HEADACHES, A FEELING OF FATIGUE AND NERVOUS EXHAUSTION, OR A SENSE OF INCOMPLETE EMPTYING) AND NUTRETIONAL HISTORY.
DURING PHYSICAL EXAMINATION, SCYBALA (MANUALLY PALPABLE LUMPS OF STOOL) MAY BE DETECTED ON PALPATION OF THE ABDOMEN.

13. DIAGNOSIS
RECTAL EXAMINATION GIVES AN IMPRESSION OF THE ANAL SPHINCTER TONE AND WHETHER THE LOWER RECTUM CONTAINS ANY FECES OR NOT AND FOR POLYPS.
A COLONOSCOPE AND X-RAYS OF THE ABDOMEN, GENERALLY ONLY PERFORMED IF BOWEL OBSTRUCTION IS SUSPECTED.

14. STRAINING WITH MORE THAN ONE-FOURTH OF DEFECATIONS
CRITERIA
THE ROME II CRITERIA FOR CONSTIPATION REQUIRE AT LEAST TWO OF THE FOLLOWING SYMPTOMS FOR 12 WEEKS OR MORE OVER THE PERIOD OF A YEAR:
STRAINING WITH MORE THAN ONE-FOURTH OF DEFECATIONS
HARD STOOL WITH MORE THAN ONE-FOURTH OF DEFECATIONS
FEELING OF INCOMPLETE EVACUATION WITH MORE THAN ONE- FOURTH OF DEFECATIONS
SENSATION OF ANORECTAL OBSTRUCTION WITH MORE THAN ONE- FOURTH OF DEFECATIONS
MANUAL MANEUVERS TO FACILITATE MORE THAN ONE-FOURTH OF DEFECATIONS
FEWER THAN THREE BOWEL MOVEMENTS PER WEEK
INSUFFICIENT CRITERIA FOR IRRITABLE BOWEL SYNDROME

15. PREVENTION
CONSTIPATION IS USUALLY EASIER TO PREVENT THAN TO TREAT. FOLLOWING THE RELIEF OF CONSTIPATION.
MAINTENANCE WITH ADEQUATE EXERCISE, FLUID INTAKE, AND HIGH FIBER DIET IS RECOMMENDED.
 CHILDREN BENEFIT FROM SCHEDULED TOILET BREAKS, ONCE EARLY IN THE MORNING AND 30 MINUTES AFTER MEALS.

16. TREATMENT
THE MAIN TREATMENT OF CONSTIPATION INVOLVES THE INCREASED INTAKE OF WATER AND FIBER.
THE ROUTINE USE OF LAXATIVES IS DISCOURAGED, AS HAVING BOWEL MOVEMENTS MAY COME TO BE DEPENDENT UPON THEIR USE.
ENEMAS CAN BE USED TO PROVIDE A FORM OF MECHANICAL STIMULATION.
HOWEVER, ENEMAS ARE GENERALLY USEFUL ONLY FOR STOOL IN THE RECTUM, NOT IN THE INTESTINAL TRACT.

17. LAXATIVES
- LACTULOSE  AND MILK OF MAGNESIA  HAVE BEEN COMPARED WITH POLYETHYLENE GLYCOL (PEG) IN CHILDREN.
- ALL HAD SIMILAR SIDE EFFECTS, BUT PEG WAS MORE EFFECTIVE AT TREATING CONSTIPATION.
OSMOTIC LAXATIVES ARE RECOMMENDED OVER STIMULANT LAXATIVES.
PHYSICAL INTERVENTION
- CONSTIPATION THAT RESISTS THE ABOVE MEASURES MAY REQUIRE PHYSICAL INTERVENTION SUCH AS MANUAL DISIMPACTION (THE PHYSICAL REMOVAL OF IMPACTED STOOL USING THE HANDS)

18. PROGNOSIS
- COMPLICATIONS THAT CAN ARISE FROM CONSTIPATION INCLUDE  ANAL FISSURES, RECTAL PROLAPSE, AND FECAL IMPACTION. 
- STRAINING TO PASS STOOL MAY LEAD TO HEMORRHOIDS.
- IN LATER STAGES OF CONSTIPATION, THE ABDOMEN MAY BECOME DISTENDED, HARD AND DIFFUSELY TENDER. SEVERE CASES ("FECAL IMPACTION" OR MALIGNANT CONSTIPATION) MAY EXHIBIT SYMPTOMS OF BOWEL OBSTRUCTION (VOMITING, VERY TENDER ABDOMEN) AND ENCOPRESIS, WHERE SOFT STOOL FROM THE SMALL INTESTINE BYPASSES THE MASS OF IMPACTED FECAL MATTER IN THE COLON.

19. HIRSCHSPRUNG`S DISEASE
DEFINITION:-
DEFECT IN ITESTINAL MOTILITY ASSOCIATED WITH
COPLETE ABSENCE OF ENTERIC GANGELIA IN
THE INVOLVED SEGMENT OF THE COLON.
INCIDENCE: 1:5000 LIVEBIRTH
RATIO: 4 MALE : 1 FEMALE
ASSOCIATED WITH:
1-DOWN SYNDROME WAARDENBURG SYNDROME
3- KAUFMANN-MC SYNDROME SMITH LEMLI OPTIZ SYNDROME
5- GOLDBERG SHPRINZEN SYNDROME 6- ONDINE SYNDROME
7- V-U REFLUX AND HYDROURETERS DIVERTICULUMN OF BLADDER
8-CEREBRAL A-V MALFORMATION 9- MICROCEPHALY
10- MYELOMENINGOCELE MEN (TYPE 2)

20. BARIUM ENEMA EXAMINATION SHOWING RECTO-SIGMOID HIRSCHSPRUNG'S DISEASE

21. CLINICAL FINDING:
2/3 OF CASES DIAGNOSED AT 3 MONTHS
VERY SMALL NUMBERS OF PATIENT DIAGNOSED AFTER 5 YEARS
1ST WEEK OF LIFE:
PATIENT IS AVERAGE OF WEIGHT.
FAIL TO PASS MECONIUM
RELUCTANT TO FEED
BILIOUS VOMITING
ABDOMINAL DISTENSION
GRUNTING

22. INFANCY:
PRESENT WITH :
CONSTIPATION
ABDOMINAL DISTENSION
VOMITING
CHILDHOOD:
PRESENT WITH CONSTIPATION OFFENSIVE RIBBON-LIKE STOOL
HYPOCHROMIC ANEMIA
HYPOPROTEINEMIA
ENCOPORESIS

23. DIAGNOSIS:
RECTAL EXAM: NARROW, EMPTY RECTUM AND AS THE FINGER IS WITHDRAWN.
X-RAY:DESTENSION OF GAS AND ABSENCE OF GAS IN PELVIS
RECTAL BIOPSY: PROCEDURE OF CHOISE.
MANOMETRIC STUDY: RECORDING INTERNAL AND EXTERNAL RECTAL PRESSURE.

24. TREATMENT:-
CORRECT DEHYDRATION.
CORRECT ACID-BASE PROBLEMS
PARENTERAL FLUIDS
CORRECT HYPOALBUMINEMIA OR ANY SHOCK
RECTAL IRRIGATION BY NORMAL SALINE SOLUTION
SURGERY:COLOSTOMY.

25. FUNCTIONAL CONSTIPATION
DEFFERENTIATE BETWEEN FUNCTIONAL CONSTIPATION AND HIRSCHSPRUNG
FUNCTIONAL CONSTIPATION
HIRSCHSPRUNG DISEASE
HISTORY
AFTER 2 YEARS
AT BIRTH
ENCOPRESIS
COMMON
VERY RARE
F.T.T
UNCOMMON
POSSIBLE
ENTEROCOLITIS
NONE
ABDOMINAL PAIN
EXAMINATION
ABDOMINAL DISTENSION
RARE
POOR WEIGHT GAIN
ANAL TONE
NORMAL
RECTAL EXAM
STOOL IN AMPULA
AMPULA EMPTY
LAB
ANORECTAL MANOMETRY
DISTENSION OF THE RECTUM CAUSES RELAXATION OF UNIT SPHINCTER
NO SPHINCTER OR PARADOXIAL RELAXATION OR INCREASE IN PRESSURE
RECTAL BIOPSY
NO GANGELIA CELL
BA ENEMA
MASSIVE AMOUNT OF STOOL
NO TRANSITIONAL ZONE
INCREASE ACETYL CHOLENSTRASE STAINING
TRANSITION ZONE, DELAYED EVACUATION

26. DIARRHEA

27. DEFINITION
FROM THE GREEK WORD DIA "THROUGH RHEO "FLOW") IS THE CONDITION OF HAVING AT LEAST THREE LOOSE OR LIQUID BOWEL MOVEMENTS EACH DAY.
IT OFTEN LASTS FOR A FEW DAYS AND CAN RESULT IN DEHYDRATION DUE TO FLUID LOSS.
ACUTE DIARRHEA IS DEFINED AS AN ABNORMALLY FREQUENT DISCHARGE OF SEMISOLID OR FLUID FECAL MATTER FROM THE BOWEL, LASTING LESS THAN 14 DAYS,

28. DEFINITION
SIGNS OF DEHYDRATION OFTEN BEGIN WITH LOSS OF THE NORMAL STRETCHINESS OF THE SKIN AND CHANGES IN PERSONALITY.
THIS CAN PROGRESS TO DECREASED URINATION, LOSS OF SKIN COLOR, A FAST HEART RATE, AND A DECREASE IN RESPONSIVENESS AS IT BECOMES MORE SEVERE.IS DEFIN AS HAVING THREE OR MORE LOOSE OR LIQUID STOOLS PER DAY, OR AS HAVING MORE STOOLS THAN IS NORMAL FOR THAT PERSON.

29. INFLAMMATORY BOWEL DISEASE OTHER CAUSES
TYPES & CAUSES OF DIARRHEA:
SECRETORY
OSMOTIC
EXUDATIVE
INFLAMMATORY
DYSENTERY
INFECTIONS
MALABSORPTION
INFLAMMATORY BOWEL DISEASE
OTHER CAUSES

30. 1) SECRETORY:
SECRETORY DIARRHEA MEANS THAT THERE IS AN INCREASE IN THE ACTIVE SECRETION, OR THERE IS AN INHIBITION OF ABSORPTION.
THERE IS LITTLE TO NO STRUCTURAL DAMAGE.
THE MOST COMMON CAUSE OF THIS TYPE OF DIARRHEA IS A CHOLERA TOXIN THAT STIMULATES THE SECRETION OFANIONS, ESPECIALLY CHLORIDE IONS.
THEREFORE, TO MAINTAIN A CHARGE BALANCE IN THE LUMEN, SODIUM IS CARRIED WITH IT, ALONG WITH WATER.
IN THIS TYPE OF DIARRHEA INTESTINAL FLUID SECRETION IS ISOTONIC WITH PLASMA EVEN DURING FASTING.
 IT CONTINUES EVEN WHEN THERE IS NO ORAL FOOD INTAKE.

31. 2) OSMOTIC
OSMOTIC DIARRHEA OCCURS WHEN TOO MUCH WATER IS DRAWN INTO THE BOWELS.
IF A PERSON DRINKS SOLUTIONS WITH EXCESSIVE SUGAR OR EXCESSIVE SALT, THESE CAN DRAW WATER FROM THE BODY INTO THE BOWEL AND CAUSE OSMOTIC DIARRHEA.
 OSMOTIC DIARRHEA CAN ALSO BE THE RESULT OF MALDIGESTION (E.G., PANCREATIC DISEASE OR COELIAC DISEASE), IN WHICH THE NUTRIENTS ARE LEFT IN THE LUMEN TO PULL IN WATER.
OR IT CAN BE CAUSED BY OSMOTICLAXATIVES (WHICH WORK TO ALLEVIATE CONSTIPATION BY DRAWING WATER INTO THE BOWELS).

32. 2) OSMOTIC CONT,,,
IN HEALTHY INDIVIDUALS, TOO MUCH MAGNESIUM OR VITAMIN C OR UNDIGESTED LACTOSE CAN PRODUCE OSMOTIC DIARRHEA AND DISTENTION OF THE BOWEL.
A PERSON WHO HAS LACTOSE INTOLERANCE CAN HAVE DIFFICULTY ABSORBING LACTOSE AFTER AN EXTRAORDINARILY HIGH INTAKE OF DAIRY PRODUCTS.
IN PERSONS WHO HAVE FRUCTOSE MALABSORPTION, EXCESS FRUCTOSE INTAKE CAN ALSO CAUSE DIARRHEA. IN MOST OF THESE CASES, OSMOTIC DIARRHEA STOPS WHEN OFFENDING AGENT (E.G. MILK, SORBITOL) IS STOPPED.

33. 3)EXUDATIVE:
EXUDATIVE DIARRHEA OCCURS WITH THE PRESENCE OF BLOOD AND PUS IN THE STOOL.
THIS OCCURS WITH INFLAMMATORY BOWEL DISEASES, SUCH AS CROHN'S DISEASE OR ULCERATIVE COLITIS, AND OTHER SEVERE INFECTIONS SUCH AS E. COLI OR OTHER FORMS OF FOOD POISONING.

34. 4) INFLAMMATORY
INFLAMMATORY DIARRHEA OCCURS WHEN THERE IS DAMAGE TO THE MUCOSAL LINING OR BRUSH BORDER, WHICH LEADS TO A PASSIVE LOSS OF PROTEIN-RICH FLUIDS AND A DECREASED ABILITY TO ABSORB THESE LOST FLUIDS.
FEATURES OF ALL THREE OF THE OTHER TYPES OF DIARRHEA CAN BE FOUND IN THIS TYPE OF DIARRHEA.
IT CAN BE CAUSED BY BACTERIAL INFECTIONS, VIRAL INFECTIONS, PARASITIC INFECTIONS, OR AUTOIMMUNE PROBLEMS SUCH AS INFLAMMATORY BOWEL DISEASES.
IT CAN ALSO BE CAUSED BY TUBERCULOSIS, COLON CANCER, AND ENTERITIS.

35. 5) DYSENTERY
IF THERE IS BLOOD VISIBLE IN THE STOOLS, IT IS ALSO KNOWN AS DYSENTERY.
THE BLOOD IS TRACE OF AN INVASION OF BOWEL TISSUE. DYSENTERY IS A SYMPTOM OF, AMONG OTHERS, SHIGELLA,ENTAMOEBA HISTOLYTICA, AND SALMONELLA.

36. 6) INFECTIONS
THERE ARE MANY CAUSES OF INFECTIOUS DIARRHEA, WHICH INCLUDE VIRUSES, BACTERIA AND PARASITES.
NOROVIRUS IS THE MOST COMMON CAUSE OF VIRAL DIARRHEA IN ADULTS, BUT ROTAVIRUS IS THE MOST COMMON CAUSE IN CHILDREN UNDER FIVE YEARS OLD.
 ADENOVIRUS TYPES 40 AND 41, AND ASTROVIRUSES CAUSE A SIGNIFICANT NUMBER OF INFECTIONS.
CAMPYLOBACTER ARE A COMMON CAUSE OF BACTERIAL DIARRHEA, BUT INFECTIONS BY SALMONELLA., SHIGELLA . AND SOME STRAINS OF ESCHERICHIA COLI ARE ALSO A FREQUENT CAUSE.

37. 6) INFECTIONS CONT,,,
PARASITES DO NOT OFTEN CAUSE DIARRHEA EXCEPT FOR THE PROTOZOAN GIARDIA, WHICH CAN CAUSE CHRONIC INFECTIONS IF THESE ARE NOT DIAGNOSED AND TREATED WITH DRUGS SUCH ASMETRONIDAZOLE, AND ENTAMOEBA HISTOLYTICA.
OTHER INFECTIOUS AGENTS SUCH AS: PARASITES AND BACTERIAL TOXINS ALSO OCCUR.
HEALTHY PERSON USUALLY RECOVERS FROM VIRAL INFECTIONS IN A FEW DAYS.
HOWEVER, FOR ILL OR MALNOURISHED INDIVIDUALS, DIARRHEA CAN LEAD TO SEVERE DEHYDRATION AND CAN BECOME LIFE-THREATENING.

38. 7) MALABSORPTION:
 IS THE INABILITY TO ABSORB FOOD FULLY, MOSTLY FROM DISORDERS IN THE SMALL BOWEL, BUT ALSO DUE TO MALDIGESTION FROM DISEASES OF THE PANCREAS.
CAUSES INCLUDE:
ENZYME DEFICIENCIES OR MUCOSAL ABNORMALITY, AS IN FOOD ALLERGY AND  FOOD INTOLERANCE,SUCH AS:
. CELIAC DISEASE (GLUTEN INTOLERANCE).
LACTOSE INTOLERANCE (INTOLERANCE TO MILK SUGAR, COMMON IN NON-EUROPEANS).
 FRUCTOSE MALABSORPTION.

39. 7) MALABSORPTION: CONT,,,
 PERNICIOUS ANEMIA, OR IMPAIRED BOWEL FUNCTION DUE TO THE INABILITY TO ABSORB VITAMIN B12
LOSS OF PANCREATIC SECRETIONS, WHICH MAY BE DUE TO CYSTIC FIBROSIS OR PANCREATITIS
STRUCTURAL DEFECTS, LIKE SHORT BOWEL SYNDROME (SURGICALLY REMOVED BOWEL) AND RADIATION FIBROSIS, SUCH AS USUALLY FOLLOWS CANCER TREATMENT AND OTHER DRUGS, INCLUDING AGENTS USED IN CHEMOTHERAPY.
CERTAIN DRUGS, LIKE ORLISTAT, WHICH INHIBITS THE ABSORPTION OF FAT.

40. 8)INFLAMMATORY BOWEL DISEASE
THE TWO OVERLAPPING TYPES HERE ARE OF UNKNOWN ORIGIN:
ULCERATIVE COLITIS:
 IS MARKED BY CHRONIC BLOODY DIARRHEA AND INFLAMMATION MOSTLY AFFECTS THE DISTAL COLON NEAR THE RECTUM.
CROHN'S DISEASE:
 TYPICALLY AFFECTS FAIRLY WELL DEMARCATED SEGMENTS OF BOWEL IN THE COLON AND OFTEN AFFECTS THE END OF THE SMALL BOWEL.

41. ULCERATIVE COLITIS:

42. ULCERATIVE COLITIS:

43. ULCERATIVE COLITIS:

44. CROHN'S DISEASE:

45. CROHN'S DISEASE:

46. 9) IRRITABLE BOWEL SYNDROME
USUALLY PRESENTS WITH ABDOMINAL DISCOMFORT RELIEVED BY DEFECATION AND UNUSUAL STOOL (DIARRHEA OR CONSTIPATION) FOR AT LEAST 3 DAYS A WEEK OVER THE PREVIOUS 3 MONTHS.
SYMPTOMS OF DIARRHEA-PREDOMINANT IBS CAN BE MANAGED THROUGH A COMBINATION OF DIETARY CHANGES, SOLUBLE FIBER SUPPLEMENTS, AND/OR MEDICATIONS SUCH AS LOPERAMIDE OR CODEINE.
ABOUT 30% OF PATIENTS WITH DIARRHEA-PREDOMINANT IBS HAVE BILE ACID MALABSORPTION DIAGNOSED WITH AN ABNORMAL SEHCAT TEST.

47. 10) OTHER CAUSES DIARRHEA CAN BE CAUSED BY CHRONIC ETHANOL INGESTION.
MICROSCOPIC COLITIS, A TYPE OF INFLAMMATORY BOWEL DISEASE WHERE CHANGES ARE ONLY SEEN ON HISTOLOGICAL EXAMINATION OF COLONIC BIOPSIES.
BILE SALT MALABSORPTION (PRIMARY BILE ACID DIARRHEA) WHERE EXCESSIVE BILE ACIDS IN THE COLON PRODUCE A SECRETORY DIARRHEA.
HORMONE-SECRETING TUMORS: SOME HORMONES (E.G., SEROTONIN) CAN CAUSE DIARRHEA IF EXCRETED IN EXCESS (USUALLY FROM A TUMOR).
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.

48. DIAGNOSTIC APPROACH
THE FOLLOWING TYPES OF DIARRHEA MAY INDICATE FURTHER INVESTIGATION IS NEEDED:
IN INFANTS
MODERATE OR SEVERE DIARRHEA IN YOUNG CHILDREN
ASSOCIATED WITH BLOOD
CONTINUES FOR MORE THAN TWO DAYS
ASSOCIATED NON-CRAMPING ABDOMINAL PAIN, FEVER, WEIGHT LOSS.
IN TRAVELERS
IN FOOD HANDLERS, BECAUSE OF THE POTENTIAL TO INFECT OTHERS.
IN INSTITUTIONS SUCH AS HOSPITALS, CHILD CARE CENTERS, OR GERIATRIC AND CONVALESCENT HOMES.

49. PREVENTION
A ROTAVIRUS VACCINE DECREASE THE RATES OF DIARRHEA IN A POPULATION.
 NEW VACCINES AGAINST ROTAVIRUS, SHIGELLA AND CHOLERA ARE UNDER DEVELOPMENT, AS WELL AS OTHER CAUSES OF INFECTIOUS DIARRHEA.
PROBIOTICS DECREASE THE RISK OF DIARRHEA IN THOSE TAKING ANTIBIOTICS.
 IN INSTITUTIONS AND IN COMMUNITIES, INTERVENTIONS THAT PROMOTE HAND WASHING LEAD TO SIGNIFICANT REDUCTIONS IN THE INCIDENCE OF DIARRHEA.

50. MANAGEMENT
IN MANY CASES OF DIARRHEA, REPLACING LOST FLUID AND SALTS IS THE ONLY TREATMENT NEEDED.
THIS IS USUALLY BY MOUTH – ORAL REHYDRATION THERAPY – OR, IN SEVERE CASES,INTRAVENOUSLY.
 DIET RESTRICTIONS SUCH AS THE BRAT DIET ARE NO LONGER RECOMMENDED.
 RESEARCH DOES NOT SUPPORT THE LIMITING
OF MILK TO CHILDREN AS DOING SO HAS
NO EFFECT ON DURATION OF DIARRHEA.

51. THANK YOU