DIARRHOEA

• Type 1: Separate hard lumps, like nuts and hard to pass • Type 2: Sausage shaped but lumpy

Type 6: Fluffy pieces with ragged edges, a mushy stool Type 7: Watery, no solid pieces

A change in normal bowel habit resulting in increased frequency of bowel movements and the passage of soft or watery stools  May be accompanied by colicky pain  SYMPTOM – not a disease

 Abrupt onset of >3 loose stools/day and lasts no longer than 14 days  Dietary insults  Bacterial/viral infection  Majority resolve within 2-3 days without specific treatment

 Pathological cause  Lasts >14 days  Possibly flare up of previously diagnosed condition eg IBS  Needs further investigation

 Acute gastroenteritis  Between 1-3 bouts per year

 Just under 1 episode/year  22% food related  Traveller’s diarrhoea

-Age -Nutritional status  The younger the child, the higher risk for severe, life-threatening dehydration

• Change in the balance between the absorption and secretion of water and electrolytes • Due to:  Osmotic force that drives water into the gut lumen, eg after ingestion of nonabsorbable sugars  Proportional to the intake and responsive to fasting OR  Enterocytes actively secreting fluid eg enterotoxin-induced diarrhoea  Not responsive to fasting  Ion transporters activated by eg bacteria resulting in pathogens -Invading enterocytes or -Producing enterotoxins which damage cells or - Inducing cytokine secretion to produce prostaglandins which stimulate secretion

 Directly attack mucosal cells which causes diarrhoea  Stools may contain blood and Pus  Fever  Eg Shigella, Salmonella, Yersinia, Enteroinvasive E coli

 Do not directly damage gut  Bacteria produce enterotoxins that disrupt secretion  Watery diarrhoea  Eg S aureus, B cereus, C perfingens, Enterotoxigenic E coli

• Short-term Diarrhoea  Mechanism not fully understood  Enterocytes become secretory resulting in watery diarrhoea

• Symptoms (Accompanying symptoms, Rapid onset, Absence of stool formation?) • Trigger factors ( “bad”/unusual food; alcohol; drugs; contaminated water) • Time/ Intensity ( Dehydration in major risk groups) • Faecal studies ( Identify pathogen) • Serum albumin • Faecal alpha 1 antitrypsin ( Intestinal biopsy)

-Infectious gastroenteritis -Toddlers diarrhoea -Food intolerance -Coeliac disease

-Infectious gastroenteritis -Drugs (Antibiotics)

-Infectious gastroenteritis -IBS -IBD -Drugs -XS alcohol - Spicy food -Coeliac disease ( Immune system attacks own tissue when you eat GLUTEN)

-Infectious gastroenteritis -large bowel cancer -Faecal impaction -Drugs -Ischaemic colitis ( inflammation of LI/C)

-Rotavirus • Onset 12-48 hr

-Campylobacter (onset 2-5 days) -Followed by Rotavirus

-E.coli (1-6 days) -Salmonella (12-24 hours) - Shigella(1-7days) -Clostridium difficile (usually starts during AB therapy) -Clostridium perfringens (12-18 hours) -Bacillus cereus(1-16 hours) -Staphylococcus aureus (1-7 hours)

 Antibiotics – most common- broad spectrum  Laxatives  Metformin  Ferrous sulphate (iron)  NSAIDs  Colestyramine  Antacids – Mg Salts  Beta blockers  Digoxin  Misoprostol

Good hygiene: Wash hands  After visiting the toilet  Before touching food  After gardening  After playing with pets  Between handling raw and cooked food

• Prevention and reversal of fluid and electrolyte depletion • Management of dehydration (if present) • Most settle spontaneously (at around 3 days) • Oral rehydration therapy (ORT) • Rapid control of symptoms required?

• Prescribed dose >12 years: Initially 4 mg, followed by 2 mg after each loose stool (for up to 5 days max); usual dose 6–8 mg daily; maximum 16 mg per day (8 caps).