Diarrhoea
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Occurrence of 3 or more loose watery stools in 24 hrs.
Acute diarrhoea: ≥ 3 loose, watery stools within 24 hours
Dysentery: bloody diarrhoea, visible blood and mucus
Persistent diarrhoea: episodes of diarrhoea lasting more than 14 days
Causes
- Viruses: Rotavirus, Norovirus , adenovirus, measles, hepatitis A virus , hepatitis E virus, Ebola
- Bacteria: Vibrio cholera, E. coli , Salmonella, shigella, campylobacter
- Protozoa: giardiasis, malaria, cryptosporia
- Helminthes e.g. strongyloidiasis, schistosomiasis
- Infectious diseases, e.g. measles, malaria, and other fever-causing conditions
- Malnutrition e.g. kwashiorkor
- Drugs e.g. prolonged use of purgatives and broad-spectrum antibiotics
- Unhygienic feeding methods
- Malabsorption syndrome
- Lactose intolerance
- HIV associated-diarrhoeas
- Irritable bowel syndrome
- Metabolic: diabetes, thyroid disease
- Travellers’ diarrhoea
- Inflammatory bowel disease (persistent diarrhoea usually bloody)
Clinical features
- Loose watery stools
- Abdominal cramps
- Dehydration - thirst, sunken eyes, loss of skin elasticity, low urine output
- Signs of malnutrition if diarrhoea persists for >14 days
- Blood in stool (in dysentery)
Investigations
- Stool: Microscopy, C&S
- Other investigations may be necessary according to history and physical examination
Red flags
- Fever
- Extremes of age
- History of travel from a known endemic area
- Dysentery
- Shock, failure to feed, mental confusion
ManagementTreatment
- Prevent or correct dehydration with ORS or IV fluids according to treatment plans A, B or C
- Find and treat the cause if indicated
- Avoid inappropriate use of antibiotics e.g. metronidazole, ciprofloxacin
- Routinely use zinc supplementation, at a dosage of 20 milligrams per day for children older than six months for 10–14 days
- Prevent or treat undernutrition and micronutrient deficiencies
Persistent or chronic diarrhoea:
- Adults only: As above plus codeine phosphate
- 30 mg every 8-12 hours as required
- Child: vitamin A
- 6-11 months: 100,000 IU; 1-6 years: 200,000 IU
Prevention
- Vaccination: measles, rotavirus, polio, hepatitis A virus
- Notify in case of suspected epidemics e.g. cholera, hepatitis A or E virus infections, Ebola
- Encourage handwashing, use of clean drinking water, and proper waste disposal