DIARRHEAL DISEASE

Introduction
• According to WHO and UNICEF, diarrhea is the second leading cause
of death after pneumonia among children under 5.
• Leukemia is the most common type of childhood malignancy
characterized by persistent and uncontrolled production of immature
and abnormal white blood cells.
• It is a disease of abnormal proliferation and maturation of bone
marrow which interferes with the proliferation and maturation of bone
marrow
• Interferes with the production of normal RBC, WBC and platelets
Incidence
• 70-75% cases are acute lymphocytic leukemia
• 20% cases are acute non- lymphocytic leukemia
• 4% cases are chronic myelocytic leukemia and other varieties
Etiology
• Genetic diseases- down syndrome, fanconi’s anemia, bloom syndrome
may predispose the disease
• Environmental factors- ionizing radiation, viral infections like human t
cell lymphoma leukemia virus(htlv) and epstein virus
Classification
• Acute lymphocytic leukemia (ALL)
• Acute non-lymphocytic leukemia (ANLL)
• Chronic lymphocytic leukemia (CLL)- rare in children
• Chronic myelocytic leukemia (CML)- adult type, juvenile type
(congenital leukemia)
Acute lymphocytic leukemia (ALL)
• Primary disorder of the bone marrow elements are replaced by
immature or undifferentiated blast cells and is characterized by
anemia, thrombocytopenia and neutropenia specially granulocytopenia
Pathophysiology
• ALL occurs from growth of abnormal nongranular fragile leukocytes
in the blood forming tissues, particularly in the bone marrow, spleen
and lymph nodes.
• Normal bone marrow is replaced by the leukemic cells. Formation of
RBC and platelets are decreased causing anemia, prolonged and
unusual bleeding, tendency to bruise and petechiae.
 Normal WBC are significantly decreased causing susceptibility to
infections.infilteration of leukemic cells into lymph nodes, spleen and
liver results in enlargement of lymph glands and hepatosplenomegaly
 Expansion and hyperplasia of bone marrow and infiltration of leukemic
cells into bone causes joint pain and bone pain
 nutritional deprivation and generalized weakness occur due to immense
metabolic needs of the proliferating leukemic cells
Clinical manifestations
• It depends upon the type of leukemic cells and the onset is usually
acute or insidious
• Initial manifestations – fever, anorexia, malaise, weakness,
petechiae,purpura,ecymosis and bleeding, pallor, por activity level,
weight loss and muscle wasting
• abdominal pain, bone pain, joint pain and sternal tenderness
• hepatosplenomegaly, hematemesis, melena, hematuria, oral infections
• excessive bleeding from needle prick/ minor injury or minor operation
like tooth extraction may be the first alarming features
• rarely lymphadenopathy
• CNS involvement manifestation
headache, vomiting, drowsiness, unconsciousness, convulsions,
cranial nerve involvement, papilledema, blurred or double vision