Acute GastroEnteritis/Acute

Diaarhae

Dr Waqas Manzoor
Senior Registar GastroEnterology
AlTibri Medical College And Hopsital
• Term AGE is commonly used synonymously
with Acute Diahrae,the former term is
misnomer.

• AGE means Inflammation of both stomach

and Small intestine but Gastric involment is
rarely seen in acute Diarrhe
 Diaarhae

• Increase in frequency, volume and often

urgency of the passage of the stool and
descrese in stool consistency

Or

• Increse in stool Mass greater than

200g/24hr
 Types
• Acute: Begin within 2 weeks of presentation

• Acute Persistent: Persists between 2 to 4 weeks

• Chronic:l asts more than 4 weeks

 Normal Mechanism
• Adult Ingests 2Litre of fluid per Day.

• Additional 7Litre fluid from endogenous secretions

from salivary ,Gatric ,Pncreatic,Biliary and Enteric
soucres.

• Healthy small Intestine absorbs 7.5 L fluid

• 1.5 L (1.3 L)fluid absorbs in colon resulting in
stool mass not more than 200g/day

• Max Absorptive Capacity Of small Intestine is

12L
• Colon 4 to 6L
• Total of 18L
 Mechanism Of Diarrhae

• Incresed Fluid Overload to Overhelm the

Absoptive Capacity of Intestines(of more than
12L)

• Impaired Intestinal Epithelial Absorptive Activity

• Descresed Absoprtive Surface

• Altered Motility
 Causes
• Infections (90%)Most Comon Cause:
Viral (Rota, Norovirus, Adenovirus etc)
Bacterial (E.coli, Salmonella ,Shigella etc)
Parasitic (EntameabaHistolytica, Giardiasis)

• Drugs;
Antibiotics, Nsaids, Laxatives etc
• Food Allegies:
Carbohydrate Intolreances(Lactose/Fructose )
Shell fish

• Acute Onset Of Chronic Disease:

Celiac disease
Inflammatory Bowel Disease
Irritable Bowel Syndrome
 High Risk Gruops
• Food Borne

• Immunocompromised

• Instituionalized

• Travellers
 Symptoms
• Diaarhae

• Vomitings

• Abdominal Pain OR cramps

• Mucus / Blood In stool

 Examination

• Presence/Absence of Fever

• Dehydration
(hypotension,Tachycardia,Poor skin
Turgor,Dry Mucous Membranes)
 Investigations
• Labs( Cbc, Urea Creatine ,electrolytes, Blood
Culture)

• Stool Studies
1): Stool Microscopy (Stool for Ova and Parasires)
2): Stool Antigen Tests And Nucleic Acid
Amplification Test
3) : Stool Culture
4): Stool Testing for C.difficile
5) : Sigmoidoscopy or Upper GI Endoscopy and
mucosal biopsy
 Clinical Approach
• Initial Assesment by History and Examination

• Identify Sverity of Diaarhae

• Diagnostic Investigations

• Treatment
 History
(OD PARA)
• Onset
• Duration
• Progression
• Frequency
• Volume
• Blood / Mucus
• Urgency
• Tenesmus
 History

• Co Morbidities
• Food Exposures
• Medicines
• Travel
• Sexual Habits
 Examination
• Vitals(BP Temprature, pulse, respiratory
rate)

• Signs of Dehydration
 Treatment Options

• Rehydration Therapy (Oral/IV)

• Antidiarrhaels

• Antibiotics

• Probiotics

• Dietary Considerations
• Usually Acute Diarrhae is self limited and
resolves within 48 to 72 hrs.

• Stool Culture rarely Informative in

immunocompetent individuals

• Stool and Blood culture should done in

immunocompromised individuals
 Oral Rehydration Therapy

• Informal
(water, salty soups,juices)

• Formal
(ORS) Hypotonic Glucose Electrolyte Solution
 Antidiarrhaeal Agents

• Loperamide (Imodium)

• Racecadrotil (Antiscretory Agent

 Antibiotic Therapy

• Quinolones(e.g Ciprofloxacin)

• Macrolides (e.g azithromycin)

• Rifixamine
 Indication to Use Antibiotic

• Fever greater than 102

• Febrile Dysentry

• Severe Dehydration

• Immunocompromised
 Probiotics
• Type of Good Bacterias in our GI system

• Occurs Naturally in the Body

• Supplements In market(Tablet, capsules,Powder)

that helps to replenish that good Bacterias
 Dietary Considerations

• Rehydration and Maintenance of Hydration

• No need to Withhold food

• Resume Balanced Diet as Appetite returns

•THANKS