1. GROUP 1+GROUP 4

2.  Alteration in normal bowel movement characterized by an increase in the water content,volume or frequency  Diarrhea range in severity from acute self – limited episodes to a severe life-threatening illness.  worldwide, approximately 2.5 billion episodes of acute diarrhea occur each year, causing significant morbidity and mortality among all age groups, especially children under 5 years of age, in whom it causes 1.9 million deaths annually

3.  Acute diarrhea (less than 14 days) is most commonly due to viral gastroenteritis with rotavirus, most common in children under five. In travelers, however, bacterial infections predominate. [ Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea.peak infectionus period in winter. [

4.  Persistant diarhea(more than 14 days)  Chronic diarrhrea(more than month) Common causes include ulcerative colitis, Crohn's disease, microscopic colitis, celiac disease, irritable bowel syndrome and bile acid malabsorption.

5. Secretory Diarrhea  Mechanism, Secondary enhanced secretion by intestinal mucosa Stool, often, large, watery volume with loss of electrolytes  Common causes, bacterial or viral or bacterial enteritis, gastric hypersecretion, carcinoid, stimulant laxatives, bile acid malabsorption, celiac disease and mucosa

6. Osmotic Diarrhea  Mechanism. Secondary to the presence of hyperosmolar gradient in the intestinal lumen  Common causes,, carbohydrate malabsorption (lactase deficiency), fat malabsorption (pancreatic insufficiency) short bowel syndrome

7. Exudative (or Inflammatory) Diarrhea Mechanism, Secondary to inflammation or infiltration or invasion of the intestinal mucosa common causes, IBD, invasive infection (ciostridium difficile toxin, enterotoxigenic Escherichia col. cytomegalovirus, Shigella), ischemic colitis radiation enterocolitis and neoplasm

8. Motility (or Motor) Diarrhea  Mechanism. Secondary to autonomic nerve dysfunction  Common causes diabetic neuropathy postvagotomy, hyperthyroidism, irritable bowel syndrome (lBs) Addison disease Traveler's Diarrhea GTP) is an acut. diarrhea caused by eatine food or dinking.

9. Diarrhea caused by drug antiboitic(tetracycline,clindamycin…) PPI,Mg contaning antacid,laxative,Broad spectrium antibiotic)…

10. 1- Dehydration 2-shock:- Hypovolemic shock due dehydration and or septic shock due to gram-ve septicemia) are common complication of sever bacterial gastroenteritis. Clinically poor peripheral perfusion (Cold extremities, skin mottling, Tachycardia), Hypotension are evident. 3- Acute Renal Failure the main manifestation clinically sever oliguria (Urine than1ml/kg/ hour) or and diagnosis is confirmed by evaluation of renal function (elevated blood urea and creatinine levels) 4- Metabolic acidosis it occurs due to severe diarrhea( lossof alkalies) severe dehydration (renal Failure). The clinical menfestation is rapid respiration (acidotic breathing). In severe cases, altered consciousness becomes evident 5-Hypokalemia It ts the common of sever diarrhea and dehydration. Abdominl distension is the main clinical manifestation.potassium is below 3, S MEquLiter (Normal Level level is 5.s mEqua iter

11.  There are many different symptoms of diarrhea. You may experience only one of these or any combination of all of them. The symptoms depend on the cause. It’s common to feel one or more of the following:  nausea  abdominal pain  cramping  bloating  Dehydration(fatigue. dry mucous membranes. increased heart rate. a headache. Lightheadedness. decreased urination…ect)  fever  bloody stools  a frequent urge to evacuate your bowels  a large volume of stools  sunken eyes, sunken fontanel and sleepiness in chlidern

12.  Mild dehydration:4% weight loss  Moderate dehydration:8% weight loss  Severe dehydration:12% weight loss  Fatal:above15% weight loss

14.  Diarrhea of < 1 day in children below 1 year….. Need referral ( but in babies under 3 months refer immediately)  Diarrhea of 3 years….referral  Diarrhea of <3 days duration in older children and adults….need referral  Diarrhea of more than 24 hours in people with diabetes…referral

15. Blood test: A complete blood count test can help determine what's causing your diarrhea. ( Whatever bacteria or parasite) Fexible sigmoidoscopy or colonoscopy might: allowa examin the lining of your colon and provide biopsies if no cause is evident for persistent diarrhea. X-rays or CT scans: are performed to rule out structural abnormalities as the cause of diarrhea, particularly when pain is a prominent symptom

16. The treatment based on:  the severity of the diarrhea and related condition  the frequency of the diarrhea and related condition  the degree of your dehydration status  medical history  The age  The ability to tolerate different procedures or medications  expectations for improvement of your condition

17. 1)Oral Rehydration Therapy & Rehydration ‏2) Dietary modifications 3) Antimicrobial Agents ‏4) Antidiarrheal Agents ‏A) Antimotility Agents (Loperamide and Diphenoxylate/ Atropine) ‏B) Antisecretory Agents (Bismuth Subsalicylate) ‏ C) Adsorbent Agents 0Aluminum Hydroxide, Attapulgite, Methyl cellulose and Kaolin-Pectin) D)alternative therapies OLactase Enzyme, Probiotics and Zinc