Incidence

Deaths from infective diarrhea have been

dramatically reduced in the last 2 decades in
Egypt.

But diarrhea remains an important cause of

morbidity in children < 5 yrs age

Definition

Increase:
Fluidity.
Frequency.
Amount.

Of the stools

Infective diarrhea

Bacterial

Viral

Parasitic

Bacterial diarrhea

Shigella.
Salmonella.
E. Coli.
Campylobacter jejuni.
Yersinia enterocoliticus.
Cholera.

Viral diarrhea

Rotavirus.
Adenovirus.
Calicivirus.
Coronavirus.
Astrovirus.

Parasitic diarrhea
Entameba histolitica.
Giardia lamblia.

Non Infective diarrhea

1- Dietetic error.
2- Lienteric diarrhea.
3- Antibiotic induced.
4- Disaccharide intolerance.
5- Gastro-intestinal allergy.
6- Rare causes.

Pathophysiology of Entro-invasive
organisms
The organisms
penetrate the
entrocyte leading to
decrease absorptive
function & exudation
of serum & blood

Pathophysiology of Entrotoxogenic organisms

The organisms
produce toxins which
stimulate the
entrocyte leading to
excess secretion of
water & electrolytes

Biochemical changes

*Vomiting loss of acids, water & electrolytes.

*Diarrhea loss of H2CO3, K, H2O & electrolytes.
Net results:
- Loss of H2CO3 more than acids Acidosis.
- Loss of K Hypokalaemia.
- Loss of H2O & electrolytes Dehydration
ECF volume (may be shock) renal blood flow
++ Renin- Angiotensin Aldosterone system &
oliguria.
- Aldosterone H2O & Na absorption with K loss.
- Oliguria urea & creatinine & retention of acid
metabolites acidosis Shift of H ion
intracellular & Shift of K extacellular more
intracellular hypokalemia.

Clinical picture of Gastro-entritis

Anorexia, nausea & vomiting.

Diarrhea.
Manifestations of Dehydration or shock.
Manifestations of acidosis.
Manifestations of hypokalaemia.
CNS manifestations.
Others e.g. DIC & hyperthermia.

Manifestations of Shock

Cold cyanotic extremities.

Collapsed superficial veins.
Tachycardia.
Severe oliguria.

Manifestations of Hypokalaemia

Abdominal distension.
General weakness.
Flaccidity & hyporeflexia.
Cardiac arhythmia.

CNS manifestations

Irritability.
Drowsiness.
Apathy.
Coma.

Drug therapy
Medications for the vomiting or diarrhea :
Ineffective
May prolong the excretion of bacteria in stools
Side-effects
Unnecessarily to cost
Focus attention away from oral rehydration.

Antibiotics or anti-parasitics
Only for specific bacterial or protozoal infections
(e.g. cholera, shigellosis, giardiasis).

Post-enteritis (persistent) diarrhea

Persistence of diarrhea for more than 2

weeks, caused by:
1. Sugar intolerance.
2. Cows milk allergy.
3. Bacterial colonization.

Sugar intolerance
Destruction of the brush
border with loss
disaccharidases
disaccharide e.g.
lactose in the intestine
osmotic diarrhea &
acidic stools.

Cows milk allergy

Damage of intestinal cells by diarrhea
intestinal allergy more diarrhea &
persistence of the diarrhea.

Bacterial colonization

Bacterial colonization of the upper part of

the small intestine intestinal injury &
mal absorption due to:
1. Direct bacterial invasion.
2. Toxin production.
3. Bacterial deconjugation of bile salts.