1. Diarrhea
A child with diarrhea

2. 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.

3. Defenses mechanisms Gastric acidity GI peristalsis Normal flora
Immune defenses

4. Pathogenesis of diarrhea
Villous damage
Enterotoxin
Cytotoxin
invasion

5. Causes of gastroenteritis
Viruses
Bacteria
parasites

6. 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

7. 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

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

9. 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

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

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

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

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

14. 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 hrs