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1. East Africa university Faculty of Medicine Department of Public Health Semester six Batch three Group two Subject: family Health Assignment : DIARRHEA Lecturer: LAILA MUSE Time: Afternoon Date; 21/11/2015 الْسَّــلا مُ علَيكمْ ورَحمةُ اللهِ وبَركاتُه

2. Group name Ahmed Mohamed Shire Farxiyo c/risaaq c/qadir Ahmed mire siciid Faadumo cumar salaad

3. Definition In the normal state, approximately 10 L of fluid enter the duodenum daily, of which all but 1.5 L are absorbed by the small intestine. The colon absorbs most of the remaining fluid, with only 100 mL lost in the stool. From a medical standpoint, diarrhea is defined as a stool weight of more than 250 g/24 h

4. The causes of diarrhea are myriad. In clinical practice, it is helpful to distinguish acute from chronic diarrhea, as the evaluation and treatment are entirely different

5. Causes of acute infectious diarrhea • Noninflammatory Diarrhea • Viral - Norwalk virus, Norwalk-like virus, Rotavirus • Protozoal - Giardia lamblia, Cryptosporidium • Bacterial - Preformed enterotoxin production Staphylococcus aureus, Bacillus cereus, Clostridium perfringens Enterotoxin production; Enterotoxigenic E coli (ETEC), Vibrio cholerae

6. Inflammatory Diarrhea • Viral – Cytomegalovirus • Protozoal - Entamoeba histolytica • Bacterial - Cytotoxin productio; Enterohemorrhagic E coli, Vibrio parahaemolyticus, Clostridium difficile. Mucosal invasion; Shigella, Campylobacter jejuni Salmonella, Enteroinvasive E coli ,Aeromonas Plesiomonas,Yersinia enterocolitica,Chlamydia Neisseria gonorrhoeae, Listeria monocytogenes

7. Causes of chronic diarrhea • Osmotic diarrhea CLUES: Stool volume decreases with fasting; increased stool osmotic gap 1. Medications: antacids, lactulose, sorbitol 2. Disaccharidase deficiency: lactose intolerance 3. Factitious diarrhea: magnesium (antacids, laxatives)

8. Inflammatory conditions • Fever, hematochezia, abdominal pain 1. Ulcerative colitis 2. Crohn's disease 3. Microscopic colitis 4. Malignancy: lymphoma, adenocarcinoma (with obstruction and pseudodiarrhea) 5. Radiation enteritis

9. Noninflammatory Diarrhea Watery, nonbloody diarrhea associated with periumbilical cramps, bloating, nausea, or vomiting (singly or in any combination) suggests small bowel enteritis caused by either a toxin-producing bacterium (enterotoxigenic E coli [ETEC], Staphylococcus aureus, Bacillus cereus, C perfringens) or other agents (viruses, Giardia) that disrupt the normal absorption and secretory process in the small intestine.

10. Inflammatory Diarrhea The presence of fever and bloody diarrhea (dysentery) indicates colonic tissue damage caused by invasion (shigellosis, salmonellosis, Campylobacter or Yersinia infection, amebiasis) or a toxin (C difficile, E coli O157:H7). Because these organisms involve predominantly the colon, the diarrhea is small in volume (< 1 L/d) and associated with left lower quadrant cramps, urgency, and tenesmus.

11. Fecal leukocytes are present in infections with invasive organisms E coli O157:H7 is a toxigenic,noninvasive organisms that may be acquired from contaminated meat or unpasteurized juice and has resulted in several outbreaks of an acute, often severe hemorrhagic colitis. In immunocompromised and HIV-infected patients, cytomegalovirus may result in intestinal ulceration with watery or bloody diarrhea

12. Evaluation • In over 90% of patients with acute diarrhea, the illness is mild and self-limited and responds within 5 days to simple rehydration therapy or antidiarrheal agents • Patients with signs of inflammatory diarrhea manifested by any of the following require prompt medical attention: • high fever (> 38.5 °C), bloody diarrhea, • abdominal pain, or diarrhea not subsiding after 4–5 days. • Similarly, patients with symptoms of dehydration must be evaluated (excessive thirst, dry mouth, decreased urination, weakness, lethargy)

13. Treatment • Diet :The overwhelming majority of adults have mild diarrhea that will not lead to dehydration provided the patient takes adequate oral fluids containing carbohydrates and electrolytes. • Patients will find it more comfortable to rest the bowel by avoiding high-fiber foods, fats, milk products, caffeine, and alcohol. • Frequent feedings of fruit drinks, tea, "flat" carbonated beverages, and soft, easily digested foods (eg, soups, crackers) are encouraged

14. Rehydration In more severe diarrhea, dehydration can occur quickly, especially in children. Oral rehydration with fluids containing glucose, Na+, K+, Cl–, and bicarbonate or citrate is preferred in most cases to intravenous fluids because it is inexpensive, safe, and highly effective in almost all awake patients

15. Antibiotic Therapy Empiric treatment-fluoroquinolones (eg, ciprofloxacin, 500 mg twice daily) for 5–7 days. These agents provide good antibiotic coverage against most invasive bacterial pathogens, including Shigella, Salmonella, Campylobacter, Yersinia, and Aeromonas. Alternative agents are trimethoprim-sulfamethoxazole, 160/800 mg twice daily, or erythromycin, 250–500 mg four times daily

16. DIARRHEA CHART ON *DIARRHEA present SMALL INTERTINE MALOBSORTION , WATERY DIARRHEA, NUSEA ,VOMITING , FATIGUA ,ABDOMINAL CALMS. SEVERE Diarrheal • Treat diarrheal before referral unless the patient has another severe classification. • Give Support therapy-Ringer lactate solution /O.RS • Give General therapy: rest, nursing and diet • Symptomatic therapy: fever and Watery diarrhea • Refer to hospital • Give ORS,RINGER LACTALE,{R.L} TETERCILINE CUPSOLE, • CIPROFLEXCINE 500MG IN ADULTS GENTMYCIN 20MG INJECTION CHILDREN diarrheal * Watery STOOL *NO DIARRHEA MODARATE DIARRHEA • Advise Symptomatic therapy: diarrhea and dysentery