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Diarrhoea
Vomiting
Constipation
Pica
Worm infestation
Diarrhoea
Diarrhoea
Definition:
An increase in the fluidity, volume and freuency of
stools!
Acute diarrhea:
"hort in duration #less than $ %ee&s'!
Chronic diarrhea:
( %ee&s or more
Diarrhoea
Annual incidence of Diarrhoeal episodes in children 5
year old in developing countries
3.2 episodes per child ,
2 billion episodes globally
Annual mortality from diarrhoea in children 5 Years in
developing countries
.! million deaths
Decreased from ".5 million deaths in last 2#
years
Etiology of Diarrhea(infant)
Acute Diarrhea $hronic Diarrhea
%astroenteritis &ost infections
'ystemic infection 'econdary disaccaridase
deficiency
Antibiotic association (rritable colon syndrome
)verfeeding *il+ protein intolerance
Types of Diarrhoea
0smotic
"ecretory
1.udative
,otility disorders
Assessment of Dehydration
Degree of Dehydration
Factors Mild < 5% Moderate
5-10%
Severe >10%
General
Condition
Well, alert Restless,
thirsty, irritable
Drowsy, cold
extremities,
lethargic
Eyes
Normal Sunken Very sunken, dry
Anterior
fontanelle
Normal depressed Very depressed
Tears
Present Absent Absent
Mouth +
tongue
oist Sticky Dry
Skin turgor
Slightly
decrease
Decreased Very decreased
Pulse (N=110
1!0 "eat#$in%
Slightly
increase
Rapid, weak Rapid, sometime
impalpable
&P (N='0#(0
$$ )g%
Normal Deceased Deceased, may be
unrecordable
*es+iratory
rate
Slightly
increased
!ncreased Deep, rapid
,rine out+ut
Normal Reduced arkedly reduced
Compications of diarrhoea
Dehydration
,etabolic Acidosis
Gastrointestinal complications
2utritional complications
3reatment of Diarrhoea
Plenty of fluids
oral rehydration solution using ingredients found in household
can be given!
Ideally these drin&s should contain:
. starches and/or sugars as a source of glucose and energy,
. some sodium and
. preferably some potassium!
1ffective 04"
Breastmilk
Gruels #diluted mi.tures of coo&ed cereals and %ater'
Carrot Soup
Rice ater ! congee
3reatment of Diarrhoea
$reparation .ethod-
!roper hygiene.
Vomiting
Vomiting in children
Definition-
3he forceful e.pulsion of contents of the stomach and
often, the pro.imal small intestine!
Causes of vomiting
Neonate/ Infant
0
With "e#er
Sepsis, meningitis,
UTI
Tonsillitis, otitis
media,
gastroenteritis
0
!" no signs sepsis
Pyloric stenosis/
outlet obstruction
Metabolic
Neurologic
Endocrine
Child/ adolescents
0
With "e#er $but
otherwise well%
astroenteritis, esp
if also ha!e
diarrhoea
0
With lethargy&
altered mental
status
Neurologic
Metabolic
Endocrine
"rugs, to#ins,
alcohol
Physiology of vomiting
Thorough e#amination
Upper I radiology (
*arium s%allo%/ meal,
-.+, ultrasound
abdomen, endoscopy
Metabolic in!estigations (
blood gas, ammonia,
blood and urine organic
acids
,anagement
Congenital
-! Anorectal defects
$! 2eurogenic
>! Colonic neuropathies
(! Colonic defects
Acuired
-! 9unctional
$! Anal lesions
>! 2eurologic conditions
(! ,etabolic
6! 1ndocrine
<! Drug induced
@! Ao% fiber diet
)! Psychiatric problems
Drugs causing constipation
Antimotility drugs
Anticholinergics
Antidepressants
0piates
Antacids
PhenothiaBines
,ethylphenidate
7istory
9amily 7/o:
GP1:
2eurological 1.amination!
Physical findings to distinguish bet%een
functional and organic constipation
9ailure to thrive
Abdominal distension
"acral agenesis
$!,aintenance:prevention of re:accumulation
I! Diet
III! Aa.ative
,anagement in Children
D
Disimpaction- 1ither by oral or rectal
medication,including enemas
D
.aintenance-
1a2ati*e-lactulose,sorbitol,magnesium hydro.ide,
mineral oil are safe E effective
Beha*ioral modification:
D
3oilet training#unhurried time in the toilet for 6:-* min
after each meal' for initial months #$:> yrs of age'
D
Geep diary of stool freuency, consistency, pain, soiling,
la.ative dose
D
4e%ard system #positive re:inforcement'
,aintenance
#smotic la2ati*es
Aactulose/sorbitol/magnesium hydro.ide:
#smotic enema:
1a*age-
1u+ricant-
Stimulants-
"enna:
Cisacodyl:
-:> tabs/dose#6mg'
Pica
Pica
Detailed history
4elationship to feeding, vomiting and diarrhoea,
fever, micturition
0nset, duration, aggravating and relieving factors,
prior treatment
Peritonitis
4ecurrent Abdominal Pain
Common:
Parasites
9aecal loading
9unctional abdominal pain
Aess common:
Infections
Inflammatory disorders
4enal cause
9unctional Abdominal Pain
Dietary modification
4eassuring follo%:up
Pointers to 0rganic Pain in Children
Widely prevalent
Contaminated food
Contaminated %ater
8nsanitary
conditions
,alnutrition
Improperly coo&ed
meals
Improper hygiene
Pre:school
"chool going
children
Adolescent girls
Women of child:
bearing age
Abdominal pain
2ausea/vomiting
Diarrhea
General malaise E
%ea&ness
Anemia
Intestinal obstruction
Complications
AlbendaBole
,ebendaBole
Aevamisole
Pyrantel pamoate
Ivermectin
D62),* (7D(A
8!
Drugs for De%orming
Drug Available strengths Mode of action
Albendazole 200, 400 mg
Absorbed by intestinal cells of the worms; blocks glucose
utake ! inhibits formation of A"#
$evamisole "ablets 40 mg; %yru 40 mg&'ml
(inds to acetylcholine recetors ! inhibits roduction of
succinate dehydrogenase, causing sastic aralysis !
assive
elimination of worms
Mebendazole
)00 ! '00 mg tablets
%usension )00 mg&' ml
%ame as albendazole
#yrantel
*hewable tablets 2'0 mg
%usension '0 mg&ml
(inds to acetylcholine recetors ! aralyses the worms
by
deolarizing neuromuscular +unctions
,vermectin *hewable tablets - mg
*auses aralysis in many nematodes through influ. of
chloride ions across cell membranes ! disrution of
neural
transmission mediated by /A(A
Than& 4ou for
*eing Patient
Till the End