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  1. 1. Presented by: Dr. Shady A. M. NegmBachelors Degree School of Dentistry, Pharos University.
  2. 2. Definition
  3. 3. • having 3 or more loose or liquid stools per day, or as having more stools than is normal for that person.(WHO)• Increase in frequency, fluidity or amount• Increase in daily stool weight above 200gmN.BAcute lasts less than 7 - 14 daysChronic lasts more than 2 - 3 weeks
  4. 4. Signs andsymptoms
  5. 5. • Frequent loose, watery stools• Abdominal cramps• Abdominal pain• Fever• Bleeding• Lightheadedness or dizziness from dehydration
  6. 6. Types of diarrhea
  7. 7. Secretory diarrhea
  8. 8. • increase in the active secretion, or there is an inhibition of absorption. (little to no structural damage)• The most common cause is a cholera toxin that stimulates the secretion of anions, especially chloride ions.• intestinal fluid secretion is isotonic with plasma even during fasting.
  9. 9. Osmotic diarrhea
  10. 10. • too much water is drawn into the bowels. This can be the result of maldigestion (e.g., pancreatic disease), in which the nutrients are left in the lumen to pull in water.• caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels).• In healthy individuals, too much magnesium or vitamin C or undigested lactose can produce osmotic diarrhea.• A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products.• In persons who have fructose malabsorption, excess fructose intake can also cause diarrhea.• Diarrhea stops when offending agent (e.g. milk, sorbitol) is stopped
  11. 11. Exudative diarrhea
  12. 12. • occurs with the presence of blood and pus in the stool.• This occurs with inflammatory bowel diseases, such as Crohns disease or ulcerative colitis• other severe infections such as E. coli• ther forms of food poisoning
  13. 13. Motility -related diarrhea
  14. 14. • caused by the rapid movement of food through the intestines (hypermotility). If the food moves too quickly through the gastrointestinal tract, there is not enough time for sufficient nutrients and water to be absorbed. This can be due to a vagotomy or diabetic neuropathy, or a complication of menstruation[citation needed].• treated with antimotility agents (such as loperamide).
  15. 15. Inflammatory diarrhea
  16. 16. • occurs when there is damage to the mucosal lining, which leads to a passive loss of protein-rich fluids, and a decreased ability to absorb these lost fluids.• caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems.• also be caused by tuberculosis, colon cancer, and enteritis
  17. 17. Differential diagnosis
  18. 18. • Diarrhea is most commonly due to viral gastroenteritis with rotavirus accounting for 40% of cases in children under five• In travelers however bacterial infections predominate.• It can also be the part of the presentations of a number of medical conditions such as: Crohns disease or mushroom poisoning.
  19. 19. Infections
  20. 20. A ) viruses, bacteria and parasites :• Norovirus is the most common cause of viral diarrhea in adults, but rotavirus is the most common cause in children under five years old• The bacterium campylobacter is a common cause of bacterial diarrhea, but infections by salmonellae, shigellae and some strains of Escherichia coli (E.coli) are frequent.• Parasites do not often cause diarrhea except for the protozoan Giardia, which can cause chronic infections if these are not diagnosed and treated with drugs such as metronidazole, and Entamoeba histolytica.
  21. 21. B ) Malabsorption :Malabsorption is the inability to absorb food, mostly in the small bowel but also due to the pancreas.• Causes include:1-enzyme deficiencies or mucosal abnormality2-pernicious anemia3-loss of pancreatic secretions4-certain drugs (like orlistat, which inhibits the absorption of fats
  22. 22. Other causes• Inflammatory bowel disease• Irritable bowel syndrome• Diarrhea can be caused by chronic ethanol ingestion.• Ischemic bowel disease. This usually affects older people and can be due to blocked arteries.• Hormone-secreting tumors: some hormones (e.g., serotonin) can cause diarrhea if excreted in excess (usually from a tumor).
  23. 23. Prevention
  24. 24. • A rotavirus vaccine has the potential to decrease rates of diarrhea.There are currently two licensed vaccines against rotavirus..
  25. 25. Management
  26. 26. • In many cases of diarrhea, replacing lost fluid and salts is the only treatment needed. This is usually by mouth – oral rehydration therapy –• in severe cases, intravenously.• Medications such as loperamide (Imodium), bismuth subsalicylate may be beneficial, however they may be contraindicated in certain situations
  27. 27. Medications
  28. 28. • Antibiotics are beneficial in certain type of acute diarrhea they are usually not used except in specific situations.There are concerns that antibiotic may increase the risk of hemolytic uremic syndrome in people infected with Escherichia coli .• Anti motility agents like loperamide are effective at reducing the duration of diarrhea.• bismuth compounds (Pepto-Bismol) decreased the number of bowel movements in those with travelers diarrhea it does not decrease the length of illness. These agents should only be used if bloody diarrhea is not present.• Codeine Phosphate is used in the treatment of diarrhea to slow down Peristalsis and the passage of fecal material through the bowels - this means that more time is given for water to reabsorb back into the body, which gives a firmer stool, and also means that feces is passed less frequently
  29. 29. Is teething associated with diarrhea?
  30. 30. • Experts disagree about whether teething actually causes symptoms — like fussiness, diarrhea, and fever• The symptoms most likely to trouble a teether include: • Drooling (which can lead to a facial rash) • Gum swelling and sensitivity • Irritability or fussiness • Biting behavior • Refusing food • Sleep problems
  31. 31. References
  32. 32. •• "Diarrhea in nontravelers: risk and etiology".• "Astrovirus gastroenteritis". The Pediatric Infectious Disease Journal 21• Williams, George; Nesse, Randolph M. (1996). Why we get sick: the new science of Darwinian medicine. New York: Vintage Books. pp. 36–3• World Health Organization.