Acute Diarrhoea

Acute Diarrhoea 

INV - 
Stool microscopy and bacterial culture. Hospitalized pts on abs - test stool sample for C. Difficile toxin, CBC for TC increase, Tempk > 38.5 C

Treatment 
A. Diet - Tea, Soft digestible foods. Give bowel rest by avoiding high fibre foods, fats, milk, alc, coffee

B. Rehydration - ORS 50 - 200 ml/ kg/ 24 hrs

C. Antidiur - CI - bloody diar, high fever, sys toxicity, 
Use - in mild to moderate diar, to decrease the stool number, liquidity and urgency
1. Loperamide - 4 mg initially, f/b 2 mg after each loose stool (max 8 mg/ day)
2. Bismuth salicylate (Pepto -bismol) - 2 tab / 30 ml orally qid 
3. Diphenoxlate and Atropine- CI as anti cholinergic - leads to toxic megacolon
4. Antobiotics - 
Emperic - FQ - CIpro 500, Oflox 400, Levo 500 od for 1-3 days.
Doxy 100 mg bd
Rifaximin 200 mg tid x 3 days, Azithro 500 mg tid x 3 days 
Specific - in Shigella , cholera

Chronic Diarrhoea

DIARRHOEA
Chronic - 

Causes
1. Medications

2. Osmotic Diarrhoea 
Osmotic gap between stool measured and estimated > 50
a. Carbohydrate malabsorption - chronic post - prandial dirrhoea, distension, bloating, flatulence - diary ( lactose), fruits ( fructose), artificial sweeteners ( sorbitol)
processed foods n soft drinks, alcohol. Resolve during fasting.
Inv - Elimination trial for 2-3 weeks / H2 breath test
b. Laxatives - Antacids

3. Secretory Diarrhoea
watery with normal anion gap. eg bile salt malabs

4. Inflammatory - IBD - but occurs with pain, fever, weight loss, hematochezia

5. Malabs syndromes - weight loss, diarrhoea, steatorrhoea

6. Chronic infns - Giardia

7. Metabolic - Thyroid, DM


CF - 
diarrhoea - continuous / intermittent, relation to meals, at night / fasting ( secretory and not malabs)


INV - 
1. Routine - CBC, SE, LFT, Calcium, Phosphorous, ALb, TSH, Vit A and D, ESR, CRP
2. Stool - Ova, Cyst, FOBT, Stool Antigen Assays, Fecal fat ( malabs)
3. Endoscopic exam and mucosal biopsy 
4. CT 


TR- 
1. Loperamide - 4mg initially, then 2mg after each loose stool ( max 8 mg / day)
2. Diphenoxylate with atropine - 1 tid / qid
3. Codeine 
4. Clonidine - 0.1 - 0.3 mg bd in secretory diarrhoea ( inhibits secretion) 
5. Octreotide - 50 - 250 mcg s/c tid
6. Bile salt binders - Cholestyramine 2- 4 mg od/ tid in bile salt diarrhoea 

PTRA Antibiotics.

PTRA Antibiotics.
2day vs 5 day Cephalexin 500 mg qid. Equal.
1 L NS irrigation, 
povidone iodine prep, 
Only skin sutures with simple 3-0, 4-0 Nylon.

Abdominal trauma 
Cefotaxime/ Cefoxitin/ Ampi + Aminogly + Clinda 
2nd gen Cephalosporin sufficient.

2nd gen Cephalosporin - Cefoxitin, Cefprozil (Refzil - O), Cefuroxime 500 mg bd (Ceftum)

.................
not known use in PTRA 

3rd generation - Cefixime ( Taxim - O)