Management of acute diarrhea

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Acute diarrhea in primary care. * SYNDROME

Increased DIARRHEAL = No, volume or fluidity of stools

an individual in relation to their normal bowel habit. Diarrhea

Acute: duration <3 weeks, chronic> 3 weeks. It is a problem

health imp. x its high morbidity and mortality and x be 2nd because of

and school absenteeism .* Causes: There are multiple causes.

Impossible and unnecessary to the etiological dw. Can be: 1.Vírica: V. Norwalk, Rotava., Adenova., Herpes, viral hepatitis, mononucleosis, HIV. 2.Parasitaria: Entamoeba histolytica, Giardia lamblia, Cryptosporidium, Isospora belli, Blastocystis hominis. 3.Tóxica: Fungi, toxins (fish / seafood), heavy metals, botulism, glutamate monosódico.4.Bacteriana: St. aureus, Clostridium sp, E.coli, Vibrio cholerae, Salmonella sp, Shigella sp, Campylobacter, Yersinia sp 5. iatrogenic: laxatives, Antibiotics (amox.-clavulanate), antiHTA (bbloqueantes), indomethacin, digitalis, theophylline, caffeine, alcohol, antacids, metformina.6.Otras: diverticulitis, fecal impaction, intestinal ischemia, IBD, malabsorption syndrome, food allergy, carcinoma colon apenitis. MICROBIOLOGICAL ASPECTS: dw d only in 25% cases, 58% bacterial (Salmonella and Campylobacter.), 23% parasitic (Giardia lamblia) 18% viruses (rotaviruses and adenoviruses). PRODUCTION FACILITY: 1.Mecanismo toxigenic -> secretory or watery diarrhea: a level of ID, table secreting abundant watery diarrhea, low abd pain., No fever, dehydration. Pathogens: Vibrio cholerae, E.coli enteropatóg., S. aureus, Clostridium perfringens, rotavirus, Norwalk virus, Cryptosporidium, Giardia lamblia, Isospora belli.2.Mecanismo invasive -> inflammatory diarrhea: at the colon, dysentery syndrome, frequent bowel movements and little, stools with mucus, blood and leukocytes, fever, abdom.cólico pain, rectal tenesmus. GErmen: Salmonella sp, Shigella, enteroinvasive E.colli, Vibrio parahaemolyticus, Yersinia enterocolitica, Campylob, Entamoeba. DIAGNOSIS: History (AF, AP and predisposing factors, present illness: Initial symptoms, similar backgrounds, common medications, sexual habits, recent travel. Exploracion: genral assessment (HR, BP, T ª..), children: ENT, abdomen, assessment rectal.PPCC touch: input not usually spelled out. If you suspect severe DA: parasites in stool, stool culture and serial SOH. If no improvement within 7 days: FOBT, fecal parasites and coprocultiv. serialized, leukocyte heces.TRATAMIENTO: 1.Reposición fluid: oral rehydration unless cd is severe it will be iv.Liquidos oral glucose and electrolytes and hyperosmolar, alkaline homemade lemonade (2l water 7limones, 1cucharada salt, baking 1cucharada, 4 of sugar. Avoid foods with lactose. unrelieved Vomiting: metoclopramida.Dolor abdominal avoid spasmolytic, if needed: acetaminophen or metamizol.FARMACOS ANTIDIARRHEALS: If you suspect severe DA F antimotility not give or astringents (not in children or invasive DA). Overall are unnecessary.

1.Loperamida: inhibits peristalsis and GI secretion, increases sphincter tone in anal.Usar DA no cd serious fluid replacement is not suficiente.2.Difenoxilato: = d action mechanism but + secundarios.3.Fosfato effects of aluminum: effect on DA astringente.Dar cd is suspected that the origin is a toxina.4.Sucralfato: antiulceroso.Efecto astringente.Minima absorcion.5.Derivados of Tannin: astringente.ANTIBIOTICOS effect: initially not indicados.Cd stool culture is positive giving adequate. It is used empirically as presents: septic, inflammatory diarrhea + suspected shigella or E. coli enteroinvasive, risk factors, if suspected severe DA coprocultivo.Antibiotico after making ideal administration vo, absorbable, active against most of germs, preserve the saprophytic flora of the colon. Quinolones! (Norfloxacin and cirpofloxacino) eded contraindicated in joint growth, pregnancy and lactation. Alternatives: Amox-clavulanate, cotrimoxazol.Según causal agent: Salmonella -> Ciproflox, Norfloxacin, Amox-clav., Cotrimoxazol.Shigella idem C.jejuni - »Erythromycin, Yersinia -> Tetracycline, Vibrio cholerae -> Tetracycline, doxycycline, C.Difficile -» Vancomycin, E.coli idem that salmonella, Giardia lamblia - »Metronidazole, Tinidazole. REFERRAL TO HOSPITAL: cd there are signs of serious dehydration, invasive diarrhea, hypo-hyperthermia, hypotension, tachycardia, tachypnea, leukocytosis, leucopenia, coagulation abnormalities (petechiae), no resolution in 7 days, significant rectal bleeding, advanced age, illness severe underlying refractory vomiting. GENERAL ADVICE TO TRAVELERS: carefully wash fruits and vegetables, bottled drinks, fruit peel personally, if doubt not eat fruit, meat and overcooked or cooked fish, monitor water ice cubes, washing hands.

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