DOC I HAVE DIARRHEA
Diarrhea is a symptom defined as an increase in the volume, water content and frequency of bowel movements.
Diarrhea is a symptom of many gastrointestinal disorders:
1.Infections:
Bacterial infections such as:
a.Shigella
b.Salmonella and typhoid
c.cholera
Viral infections such as:
a,enterovirus
b.rotavirus
Protozoan infections such as:
a.amoebic
b.giardia
2.Toxins from bacteria in contaminated food:
a.E.coli food poisoning (enterotoxins)
b.staphaloccal food poisoning (preformed toxins)
3.Antibiotic usage:
pseudomembraous enterocolitis
4.Food Intolerance
a.Lactose or sugar intolerance
b.Gluten sensitive enteropathy:
celiac disease, nontropical sprue
5.Inflammatory diseases of the intestine:
a.crohn's disease or regional ileitis
b.ulcerative colitis
6.Malabsorption syndromes
a.malabsorption of bile acids
b.pancreatic steatorrhea
c.ileal resection
7.Cancers:
a.colon
b.rectal cancers
8.Tumors especially hormonal producing tumors:
a,gastrinoma
b.Zollinger-Ellison syndrome
c.glucaglonoma
d.carcinoid tumors
9.Drug induced:
a.excessive use of laxatives
b.magnesium antacids which absorbs water into intestine
c.stimulant cathartics
10.Rapid intestinal movement:
a.Irritable bowel syndrome
b.resection of bowels in tumors or fistula
c.vagotomy
d.other surgery of intestine
rhea with blood and mucus
Diarrhea is investigated by:
1.full investigation of the possible underlying causes
2.Macroscopic and microscopic examination of the stools:
e.g rice water is typical of cholera
3.culture and sensitivity to antibiotic of the stools
4.Full blood count and electrolytes
Treatment of Diarrhea is by:
1.Because of the excessive fluid loss, correction of fluid and electrolyte balance is the most important part of treatment.
Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.
The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or light headedness
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.
2.Specific treatment if available for underling conditions eg.antibiotic the choice of which depends on the sensitivity of bacteria to the antibiotic.
3.Relief of symptoms include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).
The following steps may help relieve the symptoms of Diarrhea.
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes. 4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.
Prognosis of diarrhea depends on the cause:
Usual outcome of acute diarrhea is excellent if treated early.
For chronic diarrhea, the underlying cause must be treated.
Outcome is usually excellent with appropriate treatment.
Prevention of Infections causing Diarrhea is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated
Wednesday, June 22, 2011
Monday, June 20, 2011
A Family Doctor's Tale - SHIGELLA DYSENTERY
DOC I HAVE SHIGELLA DYSENTERY
Shigella Dysentery is an acute invasive infection of the lining of the intestines caused by a bacteria of the genus Shigella resulting in leakage of fluid from the cell into the intestine(diarrhea), abdominal pain and vomiting.
The causes of Shigella Dysentery are:
4 subspecies of Shigella has been recognised as causative agents:
1.Group A :Shigella dysenteriae
2.Group B :Shigella flexneri
3.Group C :Shigella boydii
4.Group D :Shigella sonnei (most common in North America, Europe and Japan
Humans are the only known reservoir of Shigella infection.
Transnission occurs most often by close personal contact through hands or soiled clothing or fecal-oral contamination.
The bacteria pass through the gastric acid barrier relatively easily and proliferate in lower ileum and colon.
Multiplication of bacteria occurs within the epithelial cells followed by micro-abscesses on the villi of intestine.
Stools can contain red blood cells and white blood cells.
There may blood in the stools.
Since the infection is superficial, bacteremia is rare and perforation of the colon seldom occurs.
The symptoms of Shigella Dysentery are:
Incubation period is one to two days.
In the early phases lasting one to three days, the main symptoms of Shigella Dysentery are:
1. watery diarrhea with blood and mucus
2. cramping abdominal pain
3. fever up to 40 degrees centigrade
4. headache and bodyaches
5. serious fluid loss especially in children
6. loss of appetite and energy
In the later stages:
1.bowel movements quantity decreases but still contain blood and mucus
2.fever has subsided
3.decreased appetite and energy
4.weight loss
5.convulsions may occur in children
Shigella Dysentery can be transmitted by:
Shigella Dysentery can be highly contagious. The germs are commonly transmitted by people with unwashed hands.
People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.
Doctors generally diagnose Shigella Dysentery based on
1.the symptoms and a physical examination.
2.stool sample to test for shigella and microscopic examination.
Microscopic examination shows the presence of red blood cells and polymorphs white blood cells.
Treatment of Shigella Dysentery is by:
1.Because of the excessive fluid loss, correction of fluid and electrolyte balance is the most important part of treatment.
Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.
The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.
2.Antibiotics is necessary,the choice of which depends on the sensitivity of bacteria to the antibiotic.
3.Relief of symptoms include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).
The following steps may help relieve the symptoms of Shigella Dysentery
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes.
4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.
Prognosis of Shigella Dysentery is:
50% of Shigella dysentery develop full blown symptoms as above
25% will only have watery diarrhea
Symptoms usually improve within one to 2 days after the onset of treatment.
Outcome is usually excellent with appropriate treatment.
Prevention of Shigella Dysentery is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated
Shigella Dysentery is an acute invasive infection of the lining of the intestines caused by a bacteria of the genus Shigella resulting in leakage of fluid from the cell into the intestine(diarrhea), abdominal pain and vomiting.
The causes of Shigella Dysentery are:
4 subspecies of Shigella has been recognised as causative agents:
1.Group A :Shigella dysenteriae
2.Group B :Shigella flexneri
3.Group C :Shigella boydii
4.Group D :Shigella sonnei (most common in North America, Europe and Japan
Humans are the only known reservoir of Shigella infection.
Transnission occurs most often by close personal contact through hands or soiled clothing or fecal-oral contamination.
The bacteria pass through the gastric acid barrier relatively easily and proliferate in lower ileum and colon.
Multiplication of bacteria occurs within the epithelial cells followed by micro-abscesses on the villi of intestine.
Stools can contain red blood cells and white blood cells.
There may blood in the stools.
Since the infection is superficial, bacteremia is rare and perforation of the colon seldom occurs.
The symptoms of Shigella Dysentery are:
Incubation period is one to two days.
In the early phases lasting one to three days, the main symptoms of Shigella Dysentery are:
1. watery diarrhea with blood and mucus
2. cramping abdominal pain
3. fever up to 40 degrees centigrade
4. headache and bodyaches
5. serious fluid loss especially in children
6. loss of appetite and energy
In the later stages:
1.bowel movements quantity decreases but still contain blood and mucus
2.fever has subsided
3.decreased appetite and energy
4.weight loss
5.convulsions may occur in children
Shigella Dysentery can be transmitted by:
Shigella Dysentery can be highly contagious. The germs are commonly transmitted by people with unwashed hands.
People can get the germs through close contact with infected individuals by sharing their food, drink, or eating utensils, or by eating food or drinking beverages that are contaminated with the germs.
Doctors generally diagnose Shigella Dysentery based on
1.the symptoms and a physical examination.
2.stool sample to test for shigella and microscopic examination.
Microscopic examination shows the presence of red blood cells and polymorphs white blood cells.
Treatment of Shigella Dysentery is by:
1.Because of the excessive fluid loss, correction of fluid and electrolyte balance is the most important part of treatment.
Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.
The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.
2.Antibiotics is necessary,the choice of which depends on the sensitivity of bacteria to the antibiotic.
3.Relief of symptoms include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).
The following steps may help relieve the symptoms of Shigella Dysentery
1.Allow your gastrointestinal tract to settle by not eating for a few hours.
2.Sip small amounts of clear liquids or suck on ice chips if vomiting is still a problem.
3.Give infants and children oral rehydration solutions to replace fluids and lost electrolytes.
4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Avoid dairy products, caffeine, and alcohol until recovery is complete.
6.Get plenty of rest.
Prognosis of Shigella Dysentery is:
50% of Shigella dysentery develop full blown symptoms as above
25% will only have watery diarrhea
Symptoms usually improve within one to 2 days after the onset of treatment.
Outcome is usually excellent with appropriate treatment.
Prevention of Shigella Dysentery is by:
You can avoid infection by:
1.washing your hands thoroughly for 20 seconds after using the bathroom or changing diapers
2.washing your hands thoroughly for 20 seconds before eating
3.disinfecting contaminated surfaces such as counter tops and baby changing stations
4.Avoid eating or drinking foods or liquids that might be contaminated
Saturday, June 18, 2011
A Family Doctor's Tale - MEGACOLON
DOC I HAVE MEGACOLON
Megacolon is the dilatation and often hypertrophy of part or all the colon associated with constipation.
There is predominance of occurrence of 8 males to 1 female.
There is a familial history.
Two main causes of Megacolon are
1.Congenital(also known as Hirsprung Disease)
The Congenital Megacolon occur in newborns due to the absence of autonomic ganglia from the distal segment of the colonic wall, varying in length(about 1 to 2 cm from rectosigmoid junction to entire colon).
Aganglionic colon provides a functional block to defecation, thus the colon proximal to the affected portion becomes grossly dilated and hypertrophied.
2.Acquired
a.Sliding megacolon:
The acquired idiopathic form is a functional disturbance of the colon in older children or adults resulting from persistent failure or inadequate rectal evacuation.
b.Paraesopphageal :
when the gastroesophageal junction is below the the diaphragm and part of the stomach herniates upwards along the esophagus.
The most common symptoms of Megacolon are :
Congenital:
1.gross abdominal distension in severe cases
2.Constipation alternating with diarrhea due to bacterial overgrowth in milder cases
3.Respiratory distress may be present in infants due the pressure of the abdomen on the lung space.
4.weight loss
5.Rectum is usually empty on examination
Acquired:
1.Onset is slower with constipation
2.gross abdominal distension
3.Rectal examination shows a lax sphincter and full rectum
The Diagnosis of Megacolon is:
Megacolon is diagnosed through one or more medical tests:
Congenital:
1.lower gastrointestinal endoscopy.
Colonoscopy show presence of narrowed distal segment and transition to dilated part of colon.
2.colon biopsy showed neuronal lesion.
3.Rectosphincteric manometric studies show absence of anal sphincter response
Acquired:
1.colonoscopy showed gross rectal dilatation but no narrowed segment
2.colonic biopsy is normal
The Treatment of Megacolon is by:
The main treatment is :
Congenital:
1.colostomy may be required as a life saving measure
2.This is followed by later surgical resection of short segment or longer segment of the colon
Acquired:
1.Evacuation of impacted stools
2.suppositories or microenema to clear rectal feces daily
3.mild laxatives to help induce passing of stools
4.Retraining of toilet habits
The Complications of untreated Megacolon are:
1.dehydration in infants during severe gastroenteritis episodes
2.obstruction of the intestines
3.toxic megacolon
Prognosis of Megacolon is :
1. good to excellent in acquired form if treated medically
2.surgery is needed in the congenital form
Prevention in acquired megacolon is to
1.have good toilet and bowel habits .
2.Avoid constipation by taking more fruits and vegetables and fibre.
3.Enough physical exercise to help the intestine move easier.
Megacolon is the dilatation and often hypertrophy of part or all the colon associated with constipation.
There is predominance of occurrence of 8 males to 1 female.
There is a familial history.
Two main causes of Megacolon are
1.Congenital(also known as Hirsprung Disease)
The Congenital Megacolon occur in newborns due to the absence of autonomic ganglia from the distal segment of the colonic wall, varying in length(about 1 to 2 cm from rectosigmoid junction to entire colon).
Aganglionic colon provides a functional block to defecation, thus the colon proximal to the affected portion becomes grossly dilated and hypertrophied.
2.Acquired
a.Sliding megacolon:
The acquired idiopathic form is a functional disturbance of the colon in older children or adults resulting from persistent failure or inadequate rectal evacuation.
b.Paraesopphageal :
when the gastroesophageal junction is below the the diaphragm and part of the stomach herniates upwards along the esophagus.
The most common symptoms of Megacolon are :
Congenital:
1.gross abdominal distension in severe cases
2.Constipation alternating with diarrhea due to bacterial overgrowth in milder cases
3.Respiratory distress may be present in infants due the pressure of the abdomen on the lung space.
4.weight loss
5.Rectum is usually empty on examination
Acquired:
1.Onset is slower with constipation
2.gross abdominal distension
3.Rectal examination shows a lax sphincter and full rectum
The Diagnosis of Megacolon is:
Megacolon is diagnosed through one or more medical tests:
Congenital:
1.lower gastrointestinal endoscopy.
Colonoscopy show presence of narrowed distal segment and transition to dilated part of colon.
2.colon biopsy showed neuronal lesion.
3.Rectosphincteric manometric studies show absence of anal sphincter response
Acquired:
1.colonoscopy showed gross rectal dilatation but no narrowed segment
2.colonic biopsy is normal
The Treatment of Megacolon is by:
The main treatment is :
Congenital:
1.colostomy may be required as a life saving measure
2.This is followed by later surgical resection of short segment or longer segment of the colon
Acquired:
1.Evacuation of impacted stools
2.suppositories or microenema to clear rectal feces daily
3.mild laxatives to help induce passing of stools
4.Retraining of toilet habits
The Complications of untreated Megacolon are:
1.dehydration in infants during severe gastroenteritis episodes
2.obstruction of the intestines
3.toxic megacolon
Prognosis of Megacolon is :
1. good to excellent in acquired form if treated medically
2.surgery is needed in the congenital form
Prevention in acquired megacolon is to
1.have good toilet and bowel habits .
2.Avoid constipation by taking more fruits and vegetables and fibre.
3.Enough physical exercise to help the intestine move easier.
Thursday, June 16, 2011
A Family Doctor's Tale - PSEUDOMEMBRANOUS ENTEROCOLITIS
DOC I HAVE PSEUDOMEMBRANOUS ENTEROCOLITIS
Pseudomembranous Enterocolitis is an inflammatory disease of the small and large intestine often associated with antibiotic use and with serious illnesses requiring chemotherapy or postoperative conditions.
The causes of Pseudomembranous Enterocolitis are:
The illness is believed to be due to the eradication of normal bowel flora from excessive use of antibiotics resulting in exposure to Clostridium difficile and its toxins.
The involved bowel mucosa is friable(thin) and has yellow green plagues which coalesce and form a thin membrane on the mucous lining.
The membrane consists of fibrin, mucus, and inflammatory cells.
The submucosa is edematous and necrotic in the advanced stage.
Besides clostridium, staphalococcus aureus has been isolated in cases of Pseudomembranous Enterocolitis.
The symptoms and signs of Pseudomembranous Enterocolitis are:
The disease may be suspected from the clinical picture of abdominal discomfort especially a history of prolonged antibiotic usage.
The main symptoms of Pseudomembranous Enterocolitis are:
1. watery diarrhea with blood,pus and mucus
2. cramping abdominal pain and distension
3. fever up to 39 degrees centigrade
4. headache and bodyaches
5. serious fluid loss and dehydration
6. metabolic acidosis
Signs:
Typical pseudomembrane seen on sigmoidoscopy</p>
The diagnosis of Pseudomembranous Enterocolitis is made by :
1.Doctors generally diagnose Pseudomembranous Enterocolitis based on the symptoms and history
3.typical pseudomembrane seen on sigmoidoscopy
The treatment of Pseudomembranous Enterocolitis is:
1.Because of the excessive fluid loss, correction of fluid and electrolyte balance is the most important part of treatment.
Prompt treatment may be needed to prevent dehydration which is the loss of fluids from the body. Important salts or minerals, known as electrolytes, can also be lost with the fluids. Dehydration can be caused by diarrhea, excessive urination, excessive sweating, or by not drinking enough fluids because of nausea, difficulty swallowing, or loss of appetite.
The symptoms of dehydration are
excessive thirst
dry mouth
little or no urine or dark yellow urine
sunken eyes
severe weakness or lethargy
dizziness or lightheadedness
Mild dehydration can be treated by drinking liquids.
Severe dehydration may require intravenous fluids and hospitalization.
Untreated severe dehydration can be life threatening especially in babies, young children and the elderly.
2.Stop all antibiotics if still administered
3.Relief of symptoms include an antispasmodic drug to stop abdominal cramps, medicine to harden the stools such as kaolin and slow down the intestinal movement (lomotil or loperamide).
4.Get plenty of rest.
5.surgery may be necessary if perforation of intestine has occurred.
Prognosis of Pseudomembranous Enterocolitis:
Outcome is usually excellent with early diagnosis and appropriate treatment.
Prevention of Pseudomembranous Enterocolitis is by:
No prolonged antibiotics.
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