1. Acute Diarrhoea and Gastroenteritis in Childhood By: Afifah binti Othman Masrina binti Hj. Mhmad Tahar Current Health Problems in Students’ Home Countries

2. Diarrhoea in the 21 st Century Second most common cause of morbidity and mortality worldwide WHO estimation (2002), diarrhoeal disease results in:  2.5 million people die annually, mostly children  1.6 million children <5yrs old (in developing countries)

3. In the U.S.  211-375 million episodes of diarrhoeal disease occur annually  73 million physicians consultations  1.8 million hospitalization  Over 3000 death In Malaysia (2000)  About 2 million episodes of diarrhoea annually among children < 15 yrs old  5% of total mortality among children <5 yrs old

4. What is Diarrhoea? An increase in the frequency of bowel movements or a decrease in the form of stool (greater looseness of stool) Changes in frequency of bowel movements and looseness of stools can vary independently of each other, changes usually occur in both.

5. Chronic diarrhoea  Generally lasts > 3 weeks  Common causes: IBS, AIDS, bacterial outgrowth of small int., Colon cancer, Chron’s disease Acute diarrhoea  lasts a few days or up to a week IMPORTANT !!! distinguish between acute and chronic diarrhoea >>>different diagnostis tests, different treatments

6. Common Causes of Acute Diarrhoea Infection – highly contagious  Viral gastroenteritis (“stomach flu”) Rotavirus  Usually cause explosive, watery diarrhoea  Typically last only 48- 72hrs  Usually no blood and pus in stool

7.  Bacterial enterocolitis  Sign of inflammation – blood or pus in stool, fever E. Coli bacteria Contaminated food or water Usually affect small kids

8.  Bacterial enterocolitis  Sign of inflammation – blood or pus in stool, fever Salmonella enteritidis bact In contaminated raw or undercooked chicken and eggs

9.  Bacterial enterocolitis  Sign of inflammation – blood or pus in stool, fever Shigella bacteria Campylobacter bacteria

10. Cryptosporidium in contaminated water – can survive chlorination  Parasites Giardia lamblia in contaminated water Usually not associated with inflammation

11. Common Causes of Acute Diarrhoea – cont. Food Poisoning  Brief illness cause by toxins produced by bacteria  Cause abdominal pain, vomitting  Cause SI secrete high amnt of water – diarrhoea  Some bacteria produce toxins in food before intake or in intestine after food is eaten  Symptoms usually appear within sev. hours

12. Food Poisoning Staphylococcus aureus Produces toxins in food before it is eaten Usually food contaminated left unrefrigerated overnight

13. Food Poisoning Clostridium perfringens Multiplies in food Produces toxins in SI after contaminated food is eaten

14. Common Causes of Acute Diarrhoea – cont. Traveller’s Diarrhoea Drugs / medications

15. Complications of Diarrhoea Dehydration  Excessive loss of fluids and minerals (electrolytes) from the body  Common in infants and young children with viral gastroenteritis or bacterial infection  Kidney failure, eg in infection by E.coli Electrolyte deficiency Irritation to anus due to frequent passage of watery stool containing irritating substances

16. Severe or prolonged episode of diarrhoea Fever Repeated vomiting, refusal to drink fluids Severe abdominal pain Diarrhoea that contains blood or mucus Sign of dehydration  Dry, sticky mouth  Few or no tears when crying  Sunken eyes  Lack urine or wet diaper  Dry, cool skin  Fatigue or dizziness When Treatment is Needed?

17. Measurement of BP in upright and supine post – demonstrate orthostatic hypotension, confirm dehydration Moderate – severe diarrhoea, blood electrolytes Examination of small amount of stool under microscope – if inflammation present, further test particularly for bacterial and parasitic infection Tests for Acute Diarrhoea

18. Antibiotics or antiviral medications are not prescribed for cases of diarrhoea caused by virus or bacteria Antibiotics may be given to very young children or children with weak immune system In parasitic infection – antiparasitic medicine usually given TreatmentTreatment

19. Oral rehydration solutions (ORS)  Contain carbohydrate (glucose or rice syrup) and electrolytes (Na, K, Cl, citrate, HCO 3 - )  Infants and children  Infants with mild dehydration – ORS at home (with doctor recommendation)  Infants with moderate – severe dehydration, IV fluids at hospital  Avoid caffeine and lactose containing product Treatment – cont.

20. PreventionPrevention Wash hands thoroughly before and after eating or when preparing the meals. Make sure that the tools used for eating and preparing the meals are clean. Cover our food or put them in the fridge to prevent any contamination.

21. 1.Wikipedia http://en.wikipedia.org/wiki/Main_Page 2.Medical Journal Malaysia VOL 62 http://www.mma.org.my 3.World Health Organization – WHO http://www.who.int/topics/diarrhoea/en/ 4.http://www.medicinenet.com/diarrhea/article.h tmhttp://www.medicinenet.com/diarrhea/article.h tm 5.http://www.mayoclinic.com/health/diarrhea/D S00292http://www.mayoclinic.com/health/diarrhea/D S00292 6.http://www.kidshealth.org/parent/infections/co mmon/diarrhea.html ReferencesReferences