Diarrhoea | Causes , Clinical Features and Management | Kajal’s Health Blog

 Diarrhoea

Diarrhoea is when your bowel  movement become loose or watery.   the definition  of diarrhoea is Passing of three or more loose or watery stools within 24 hours is called diarrhoea.
Diarrhoea | Causes , Clinical Features and Management | Kajal's Health Blog

Types of Diarrhoea:

A. Acute watery diarrhoea :Acute watery diarrhoea may last up to one or two days and goes away on its own ,which is common condition that affects people of all age .             
B.Persistent diarrhoea(chronic diarrhoea): diarrhoea lasting four or more is known as chronic diarrhoea or persistent diarrhoea.

Causes of Diarrhoea :

A. Acute watery diarrhoea:
       a.  Rota virus
      b .Enterotoxigenic E.coli
      c .Vibrio cholerae 
      d. Campylobacter jejuni 
      e .Salmonella 
      f.  cryptosporidium
      g.  Enteropathogenic E.coli
 

B. Choronic diarrhoea :

      a. Enteroadherent E.coli 
      b. shigella
      c. cryptosporidium
      d. Giardia lamblia 
      e. Entomoeba hystolytica 
 

Clinical features (sign and symptoms): 

The stool may also contain mucus ,pus ,blood ,or excessive amount of fat in addition to frequent watery bowel movement 
Following symptoms may occur with diarrhoea:
a. Frequent watery stool in large volume .
b. Dehydration 
c. vomiting 
d. fever
e. Abdominal pain
f. Blood in the stool 
g. Hypovolemia 
h. Convulsion 
i. Shock 
 Persistent diarrhoea may also lead to death.
Dehydration can be classified and managed as per IMCI guidelines as follow:
 

 

Points

 

No

Dehydration

 

Some

Dehydration

 

Severe

Dehydration

1.   Look of Condition

Well alert

Restless,

Irritable

Lethargic

Unconscious

·      Eyes

·      Tears

·      Mouth, tongue

·      Thirst

Normal

Present

Moist

Drinks Normally

Sunken

Absent

Dry

Thirsty, Drinks Eagerly

Very Sunken with Dry

Absent

Very Dry

Drinks slowly or not able to drink

2.   Skin Pinch

Goes back

Quickly

Goes back

Slowly

Goes back

Very Slowly

3.   Decide

The patient has no signs of dehydration.

If two or more signs, patient has some dehydration.

If two or more signs, patient has severe dehydration.

4.   Treatment

Plan ‘A’

Plan ‘B’

Plan ‘C’

 

We have included the Treatment Plan in the ending of this post.

Management: (in case of child ) 

A.fluid and electrolyte correction:
  • Oral rehydration solution
  • I/V fluid
B. Nutritional Therapy
  • Breast feeding      
  • Yoghourt
  • avoid soft drink
  • Extra meal each day for at least one month

C. Anti-microbial agents

  •  Metronidazole  for G.lamblia
  • Ciprofloxacin

D.  Use of antimotility drug eg.loperamide

E.   Treatment of associated features

F.    Persistent vomiting 
       eg. Metochlopramide 0.3 mg/kg/day
G.   Abdominal  distension
  • Nill per oral

H.   Treatment as per  IMCI  guidelines [ We have already classified Dehydration as per IMCI guidelines in our post.]

Now, let’s have a look towards Treatment Plans as per IMCI guidelines.
Treatment plan ‘A’:
A. Describe and show the amount to be given after each stool using a local measure show the mother how to mix ORS.

B.Show her how to give ORS. Give a teaspoonful every 1-2 minutes for a child under 2 years.

C.Give frequent sips from a cup for an older child.

D. If the child vomits wait for 10 minutes. Then give the solution more slowly for example, a spoonful every 2-3 minutes.
E. If diarrhea continues after the ORS packets are used up, tell the mother to give other fluids as described above or return for more ORS.
F.Continue breast feeding.
G. Give fresh fruit juice or mashed banana to provide potassium.

H. Encourage the child to eat, after food at least 6 times a day.

Treatment plan ‘B’:
   All the cases with treatment plan ‘B’ need to be treated in health center or hospital observation.  
 
  • Give 75 ml/kg/BW of ORS in the first 4 hours
    • Reassess with 4 hours.
  • If no signs of dehydration ,plan ‘A’
  • If some of dehydration repeat plan ‘B’
  •  If severe plan’C’

 

Treatment Plan ‘C’:

    

IMCI Dehydration Treatment Plan 'C'

Prevention of diarrhoea:

 
 • Breast feeding.
• Prevention of malnutrition including improved
weaning practice.
• Use of safe water for drinking and washing purpose.

 

  • Hand washing before eating, after defecation

     

  • Use of sanitary latrines and safe disposal of excreta.

 

 

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