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Presented by:
                Dr. Shady A. M. Negm
Bachelor's Degree School of Dentistry, Pharos University.
Definition
• having 3 or more loose or liquid stools per day, or
  as having more stools than is normal for that
  person.(WHO)
• Increase in frequency, fluidity or amount
• Increase in daily stool weight above 200gm



N.B
Acute lasts less than 7 - 14 days
Chronic lasts more than 2 - 3 weeks
Signs and
symptoms
•   Frequent loose, watery stools
•   Abdominal cramps
•   Abdominal pain
•   Fever
•   Bleeding
•   Lightheadedness or dizziness from
    dehydration
Types of diarrhea
Secretory diarrhea
• increase in the active secretion, or there is
  an inhibition of absorption.
        (little to no structural damage)
• The most common cause is a
  cholera toxin that stimulates the secretion
  of anions, especially chloride ions.
• intestinal fluid secretion is isotonic with
  plasma even during fasting.
Osmotic diarrhea
• too much water is drawn into the bowels. This can be the
    result of maldigestion (e.g., pancreatic disease), in which
    the nutrients are left in the lumen to pull in water.
•   caused by osmotic laxatives (which work to alleviate
    constipation by drawing water into the bowels).
•   In healthy individuals, too much magnesium or vitamin C
    or undigested lactose can produce osmotic diarrhea.
•    A person who has lactose intolerance can have difficulty
    absorbing lactose after an extraordinarily high intake of
    dairy products.
•   In persons who have fructose malabsorption, excess
    fructose intake can also cause diarrhea.
•   Diarrhea stops when offending agent (e.g. milk, sorbitol)
    is stopped
Exudative diarrhea
• occurs with the presence of blood and pus
 in the stool.
• This occurs with
 inflammatory bowel diseases, such as
 Crohn's disease or ulcerative colitis
• other severe infections such as E. coli
• ther forms of food poisoning
Motility -related diarrhea
• caused by the rapid movement of food
  through the intestines (hypermotility). If the
  food moves too quickly through the
  gastrointestinal tract, there is not enough
  time for sufficient nutrients and water to be
  absorbed. This can be due to a vagotomy
  or diabetic neuropathy, or a complication
  of menstruation[citation needed].
• treated with antimotility agents (such as
  loperamide).
Inflammatory diarrhea
• occurs when there is damage to the
 mucosal lining, which leads to a passive
 loss of protein-rich fluids, and a decreased
 ability to absorb these lost fluids.
• caused by bacterial infections, viral
 infections, parasitic infections, or
 autoimmune problems.
• also be caused by tuberculosis, colon
 cancer, and enteritis
Differential diagnosis
• Diarrhea is most commonly due to viral
 gastroenteritis with rotavirus accounting
 for 40% of cases in children under five
• In travelers however bacterial infections
 predominate.
• It can also be the part of the
 presentations of a number of medical
 conditions such as: Crohn's disease or
 mushroom poisoning.
Infections
A ) viruses, bacteria and parasites :
• Norovirus is the most common cause of viral
  diarrhea in adults, but rotavirus is the most
  common cause in children under five years old
• The bacterium campylobacter is a common
  cause of bacterial diarrhea, but infections by
  salmonellae, shigellae and some strains of
  Escherichia coli (E.coli) are frequent.
• Parasites do not often cause diarrhea except for
  the protozoan Giardia, which can cause chronic
  infections if these are not diagnosed and treated
  with drugs such as metronidazole, and
  Entamoeba histolytica.
B ) Malabsorption :
Malabsorption is the inability to absorb food,
 mostly in the small bowel but also due to the
 pancreas.
• Causes include:
1-enzyme deficiencies or mucosal abnormality
2-pernicious anemia
3-loss of pancreatic secretions
4-certain drugs (like orlistat, which inhibits the
  absorption of fats
Other causes
• Inflammatory bowel disease
• Irritable bowel syndrome
• Diarrhea can be caused by chronic ethanol
  ingestion.
• Ischemic bowel disease. This usually affects older
  people and can be due to blocked arteries.
• Hormone-secreting tumors: some hormones (e.g.,
  serotonin) can cause diarrhea if excreted in
  excess (usually from a tumor).
Prevention
• A rotavirus vaccine
  has the potential to
  decrease rates of
  diarrhea.There are
  currently two
  licensed vaccines
  against rotavirus..
Management
• In many cases of diarrhea, replacing lost
 fluid and salts is the only treatment
 needed. This is usually by mouth – oral
 rehydration therapy –
• in severe cases, intravenously.
• Medications such as loperamide
 (Imodium), bismuth subsalicylate may be
 beneficial, however they may be
 contraindicated in certain situations
Medications
• Antibiotics are beneficial in certain type of acute diarrhea
    they are usually not used except in specific
    situations.There are concerns that antibiotic may
    increase the risk of hemolytic uremic syndrome in people
    infected with Escherichia coli .
•   Anti motility agents like loperamide are effective at
    reducing the duration of diarrhea.
•   bismuth compounds (Pepto-Bismol) decreased the
    number of bowel movements in those with travelers'
    diarrhea it does not decrease the length of illness. These
    agents should only be used if bloody diarrhea is not
    present.
•   Codeine Phosphate is used in the treatment of diarrhea
    to slow down Peristalsis and the passage of fecal
    material through the bowels - this means that more time
    is given for water to reabsorb back into the body, which
    gives a firmer stool, and also means that feces is passed
    less frequently
Is teething associated
    with diarrhea?
• Experts disagree about whether teething
  actually causes symptoms — like
  fussiness, diarrhea, and fever
• The symptoms most likely to trouble a
  teether include:

 • Drooling (which can lead to a facial rash)
 • Gum swelling and sensitivity
 • Irritability or fussiness
 • Biting behavior
 • Refusing food
 • Sleep problems
References
• Wikipedia.com
• "Diarrhea in nontravelers: risk and
    etiology".
•   "Astrovirus gastroenteritis". The
    Pediatric Infectious Disease
    Journal 21
•   Williams, George; Nesse,
    Randolph M. (1996). Why we get
    sick: the new science of
    Darwinian medicine. New York:
    Vintage Books. pp. 36–3
•   World Health Organization.
Diarrhea

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Diarrhea

  • 1. Presented by: Dr. Shady A. M. Negm Bachelor's Degree School of Dentistry, Pharos University.
  • 3. • having 3 or more loose or liquid stools per day, or as having more stools than is normal for that person.(WHO) • Increase in frequency, fluidity or amount • Increase in daily stool weight above 200gm N.B Acute lasts less than 7 - 14 days Chronic lasts more than 2 - 3 weeks
  • 5. Frequent loose, watery stools • Abdominal cramps • Abdominal pain • Fever • Bleeding • Lightheadedness or dizziness from dehydration
  • 8. • increase in the active secretion, or there is an inhibition of absorption. (little to no structural damage) • The most common cause is a cholera toxin that stimulates the secretion of anions, especially chloride ions. • intestinal fluid secretion is isotonic with plasma even during fasting.
  • 10. • too much water is drawn into the bowels. This can be the result of maldigestion (e.g., pancreatic disease), in which the nutrients are left in the lumen to pull in water. • caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). • In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea. • A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. • In persons who have fructose malabsorption, excess fructose intake can also cause diarrhea. • Diarrhea stops when offending agent (e.g. milk, sorbitol) is stopped
  • 12. • occurs with the presence of blood and pus in the stool. • This occurs with inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis • other severe infections such as E. coli • ther forms of food poisoning
  • 14. • caused by the rapid movement of food through the intestines (hypermotility). If the food moves too quickly through the gastrointestinal tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to a vagotomy or diabetic neuropathy, or a complication of menstruation[citation needed]. • treated with antimotility agents (such as loperamide).
  • 16. • occurs when there is damage to the mucosal lining, which leads to a passive loss of protein-rich fluids, and a decreased ability to absorb these lost fluids. • caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems. • also be caused by tuberculosis, colon cancer, and enteritis
  • 18. • Diarrhea is most commonly due to viral gastroenteritis with rotavirus accounting for 40% of cases in children under five • In travelers however bacterial infections predominate. • It can also be the part of the presentations of a number of medical conditions such as: Crohn's disease or mushroom poisoning.
  • 20. A ) viruses, bacteria and parasites : • Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years old • The bacterium campylobacter is a common cause of bacterial diarrhea, but infections by salmonellae, shigellae and some strains of Escherichia coli (E.coli) are frequent. • Parasites do not often cause diarrhea except for the protozoan Giardia, which can cause chronic infections if these are not diagnosed and treated with drugs such as metronidazole, and Entamoeba histolytica.
  • 21. B ) Malabsorption : Malabsorption is the inability to absorb food, mostly in the small bowel but also due to the pancreas. • Causes include: 1-enzyme deficiencies or mucosal abnormality 2-pernicious anemia 3-loss of pancreatic secretions 4-certain drugs (like orlistat, which inhibits the absorption of fats
  • 22. Other causes • Inflammatory bowel disease • Irritable bowel syndrome • Diarrhea can be caused by chronic ethanol ingestion. • Ischemic bowel disease. This usually affects older people and can be due to blocked arteries. • Hormone-secreting tumors: some hormones (e.g., serotonin) can cause diarrhea if excreted in excess (usually from a tumor).
  • 24. • A rotavirus vaccine has the potential to decrease rates of diarrhea.There are currently two licensed vaccines against rotavirus..
  • 26. • In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy – • in severe cases, intravenously. • Medications such as loperamide (Imodium), bismuth subsalicylate may be beneficial, however they may be contraindicated in certain situations
  • 28. • Antibiotics are beneficial in certain type of acute diarrhea they are usually not used except in specific situations.There are concerns that antibiotic may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli . • Anti motility agents like loperamide are effective at reducing the duration of diarrhea. • bismuth compounds (Pepto-Bismol) decreased the number of bowel movements in those with travelers' diarrhea it does not decrease the length of illness. These agents should only be used if bloody diarrhea is not present. • Codeine Phosphate is used in the treatment of diarrhea to slow down Peristalsis and the passage of fecal material through the bowels - this means that more time is given for water to reabsorb back into the body, which gives a firmer stool, and also means that feces is passed less frequently
  • 29. Is teething associated with diarrhea?
  • 30. • Experts disagree about whether teething actually causes symptoms — like fussiness, diarrhea, and fever • The symptoms most likely to trouble a teether include: • Drooling (which can lead to a facial rash) • Gum swelling and sensitivity • Irritability or fussiness • Biting behavior • Refusing food • Sleep problems
  • 32. • Wikipedia.com • "Diarrhea in nontravelers: risk and etiology". • "Astrovirus gastroenteritis". The Pediatric Infectious Disease Journal 21 • Williams, George; Nesse, Randolph M. (1996). Why we get sick: the new science of Darwinian medicine. New York: Vintage Books. pp. 36–3 • World Health Organization.