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3. Gastrointestinal disorders
Acute diarrhoea
– A cute d ia rrho ea is d efin ed a s a t lea s t 3 liq uid s to o ls per d a y fo r les s tha n 2
w eeks .
– T here a re 2 clin ica l types o f a cute d ia rrho ea : o f ca s es (ro ta virus , 3
• Simple diarrhoea without blood, ca us ed b y virus es in 6 0 %
en tero virus ) , b a cteria ( Vibrio cholerae, en tero t o xigen ic Escherichia coli, n o n -
typh i
Salmonella, Yersinia enterocolitica) o r pa ra s ites (giardiasis). D is ea s es , s uch a s
m a la ria ,
a cut e o t it is m ed ia , upper a n d lo w er res pira t o ry t ra ct in fect io n s , et c. ca n b e
a cco m pa n ied b y this type o f d ia rrho ea .
• Dysentery o r bloody diarrhoea, ca us ed b y b a ct eria ( Shigella in 5 0 % o f ca s es ,
Campylobacter jejuni, en t ero in va s ive o r en t ero h a em o rrh a gic Escherichia coli,
Salmonella) o r pa ra s ites (in tes tin a l a m o eb ia s is ).
– In fectio us d ia rrho ea s a re tra n s m itted b y d irect (d irty ha n d s ) o r in d irect
(in ges tio n o f
co n ta m in a ted w a ter o r fo o d ) co n ta ct.
– T h e h igh m o rt a lit y ra t e fro m d ia rrh o ea l d is ea s es , even b en ign , is d ue t o
a cut e
d ehyd ra tio n a n d m a ln utritio n . T his ca n b e preven ted b y a d eq ua te rehyd ra tio n
an d
n utritio n .
Clinical features
– F irs t a s s es s fo r s ign s o f d eh yd ra t io n . S ee Assessment of diarrhoeal patients
for
dehydration, W H O , pa ge 3 0 5 .
– T hen lo o k fo r o ther s ign s :
• pro fus e w a tery d ia rrho ea (cho lera , en tero to xigen ic E. coli),
• repea ted vo m itin g (cho lera ),
• fever (s a lm o n ella , vira l d ia rrho ea ),
• pres en ce o f red b lo o d in s to o ls : s ee Shigellosis, pa ge 8 6 a n d Amoebiasis, pa ge
88.
– In a pa tien t o ver 5 yea rs w ith s evere a n d ra pid o n s et o f d ehyd ra tio n , s us pect
cho lera .
Treatment
G en era l prin ciples :
– Preven t o r trea t d eh yd ra tio n : rehyd ra tio n co n s is ts o f pro m pt repla cem en t o f
fluid
a n d electro lyte lo s s es a s req uired , un til the d ia rrho ea s to ps .
– A d m in is ter zin c s ulfa te to child ren un d er 5 yea rs .
– Preven t m a ln utritio n .
Acute diarrhoea
– A cute d ia rrho ea is d efin ed a s a t lea s t 3 liq uid s to o ls per d a y fo r les s tha n 2
w eeks .
– T here a re 2 clin ica l types o f a cute d ia rrho ea : o f ca s es (ro ta virus , 3
• Simple diarrhoea without blood, ca us ed b y virus es in 6 0 %
en tero virus ) , b a cteria ( Vibrio cholerae, en tero t o xigen ic Escherichia coli, n o n -
typh i
Salmonella, Yersinia enterocolitica) o r pa ra s ites (giardiasis). D is ea s es , s uch a s
m a la ria ,
a cut e o t it is m ed ia , upper a n d lo w er res pira t o ry t ra ct in fect io n s , et c. ca n b e
a cco m pa n ied b y this type o f d ia rrho ea .
• Dysentery o r bloody diarrhoea, ca us ed b y b a ct eria ( Shigella in 5 0 % o f ca s es ,
Campylobacter jejuni, en t ero in va s ive o r en t ero h a em o rrh a gic Escherichia coli,
Salmonella) o r pa ra s ites (in tes tin a l a m o eb ia s is ).
– In fectio us d ia rrho ea s a re tra n s m itted b y d irect (d irty ha n d s ) o r in d irect
(in ges tio n o f
co n ta m in a ted w a ter o r fo o d ) co n ta ct.
– T h e h igh m o rt a lit y ra t e fro m d ia rrh o ea l d is ea s es , even b en ign , is d ue t o
a cut e
d ehyd ra tio n a n d m a ln utritio n . T his ca n b e preven ted b y a d eq ua te rehyd ra tio n
an d
n utritio n .
Clinical features
– F irs t a s s es s fo r s ign s o f d eh yd ra t io n . S ee Assessment of diarrhoeal patients
for
dehydration, W H O , pa ge 3 0 5 .
– T hen lo o k fo r o ther s ign s :
• pro fus e w a tery d ia rrho ea (cho lera , en tero to xigen ic E. coli),
• repea ted vo m itin g (cho lera ),
• fever (s a lm o n ella , vira l d ia rrho ea ),
• pres en ce o f red b lo o d in s to o ls : s ee Shigellosis, pa ge 8 6 a n d Amoebiasis, pa ge
88.
– In a pa tien t o ver 5 yea rs w ith s evere a n d ra pid o n s et o f d ehyd ra tio n , s us pect
cho lera .
Treatment
G en era l prin ciples :
– Preven t o r trea t d eh yd ra tio n : rehyd ra tio n co n s is ts o f pro m pt repla cem en t o f
fluid
a n d electro lyte lo s s es a s req uired , un til the d ia rrho ea s to ps .
– A d m in is ter zin c s ulfa te to child ren un d er 5 yea rs .
– Preven t m a ln utritio n .
