Acute Diarrhea 678
Acute Diarrhea 678
Acute Diarrhea 678
By
Shahira Aly El-Etreby
Prof. of Internal Medicine
Hepatology & Gastroenterology unit
Faculty of Medicine
Mansoura University
ILOS:
Background
Definition
Classification of diarrhea
Assessment of severity
Treatment
Fluid loads through the intestine
Each day approximately 9 to 10 L of fluid pass into the jejunum.
nutrients are taken up, and the ileum absorbs most of the rest.
The colon absorbs more than 90% of the fluid load reaching it,
Etiology
Etiology
1. Infectious agents.
2. Bacterial toxins (Preformed or Produced in the gut).
3. Medications.
Etiology:
1. Non-inflammatory: Watery, non-bloody. Usually mild and self-limited.
2. Inflammatory: Blood or pus, fever.
Investigations:
leukocytosis, anemia, high ESR & CRP, C. difficile toxin in stool.
Colonoscopy: Pseudomembranes, raised yellow or off-white plaques scattered over
the rectal mucosa.
sensitivity.
4. C. difficile assay if recent hospitalization or antibiotics.
NAAT: Nucleic acid amplification (e.g., PCR assays) that screen for a panel of
pathogens, including viruses, protozoa, and bacteria, within 1–5 hours. If the
PCR assay detects a bacterial pathogen, stool culture is recommended for
confirmation and antibiotic sensitivity testing.
Treatment:
1. Diet: Bowel rest (Avoid high-fiber foods, fats, milk products, and
caffeine). Drink tea, applesauce, and “flat” carbonated beverages. Eat
soft, easily digested foods (e.g., soups, crackers, bananas, rice, toast).
2. Rehydration:
a. Oral rehydration is preferred whenever possible.
b. Intravenous fluids (lactated Ringer injection) in severe dehydration.
4. Antibiotic therapy:
Most cases of acute diarrhea are self-limited and require no medical evaluation. Nearly
half of the cases last for less than 1 day.
Most common cause of acute diarrhea is infectious diarrhea , the mainstay of treatment
is hydration either oral rehydration solution or IV fluids according to severity. May be
there is need to use of antibiotics.
Review Questions
Acute diarrhea is defined as passage of more than 3 stools per
for duration less than:
A. 2 weeks.
B. 3 weeks.
C. 2-4weeks.
D. 4 week.
E. 5 days.
Review Questions
A 30 year old male presents with acute, profuse, watery
diarrhea with some blood after returning from a work trip in
Tanzania . He had been taking oral hydration salts. Which
one of the following is the most appropriate treatment?
A. Ciprofloxacin.
B. Loperamide.
C. Metronidazle.
D. Prednisolone.
E. Vancomycin.
Review Questions
A 19 year old student presents with 15 week history of diarrhea.
He has lost 2 kg of his weight. A smear of a duodenal biopsy
reveals many trophozoites. What is the best treatment
option?
A. Ciprofloxacin
B. Gluten free diet
C. Metronidazole.
D. Prednisolone.
E. Quinine .
Review Questions
An 80 years female presents with confusion associated with a
chest infection. She received standard treatment, and four
days later she developed green, bloody diarrhea. Which of
the following organisms is most likely to be responsible for
her diarrhea:
A. Campylobacter jejuni.
B. Clostridium defficile.
C. Escherichia coli.
D. Methicllin resistant staphylococcus aureus.
E. Vancomycin resistant enterococuss.