By L. Nemrok. Randolph College.

Laboratory diagnosis Perform stool or urine analysis to identify and specify the eggs in the stool or urine buy 0.4mg flomax otc. Kato Katz thick fecal smear technique is needed for chronic disease stage of the iintestine and liver generic 0.2 mg flomax free shipping. Diagnostic yields are improved by repeated stool samples and from biopsies at sigmoidoscopy purchase flomax 0.4mg free shipping. Treatment Drug of choice C: Praziquantel: 40mg/kg (O) as a single dose or in 2 divided doses. Mansoni infections  Medicines will usually arrest progression of clinical features, but will not reverse them  Surgical interventions may be necessary. They are grouped into 4 species: Shigella dysenteriae, Shigella flexneri, Shigella boydii, and Shigella sonnei, also known as groups A, B, C, and D, respectively. Shigellosis is spread by means of fecal-oral, ingestion of contaminated food or water. Diagnosis  Sudden onset of severe abdominal cramping, high-grade fever, emesis, anorexia, and large-volume watery diarrhea; seizures may be an early manifestation. Laboratory diagnosis Perform microscopic stool examination isolation of Shigella from feces or rectal swab specimen. Treatment Drug of choice A: Ciprofloxacin (O): Adult, 500mg 12 hourly for 5 days Children (where the benefit outweighs the risk); 5-10mg/kg/dose. Note  Nalidixic acid is neurotoxic so should be used with caution in older patients; it is contraindicated in epilepsy and renal failure. Diagnosis  After a 24 to 48 hours incubation period, cholera begins with the sudden onset of painless watery diarrhea that may quickly become severe with profuse watery stools (rice water), vomiting, severe dehydration and muscular cramps leading to hypovolemic shock and death  The stool has a characteristic “rice water” appearance (non bilious, gray, slightly cloudy fluid with flecks of mucus, no blood and inoffensive odor) Laboratory Diagnosis Dark field microscopy on a wet mount of fresh stool for identification of motile curved bacillus. V) fluid immediately to replace fluid deficit; Use lactated Ringer solution or, if that is not available, isotonic sodium chloride solution. V in 3 hours—30 mls/kg as rapidly as possible (within 30 min) then 70 mls/kg in the next 2 hours. If signs of some dehydration are present, continue as indicated below for some dehydration. If no signs of dehydration exist, maintain hydration by replacing ongoing fluid losses. Although the disease is self limiting, an effective antibiotic will reduce the volume of diarrhea and shorten the period during which Vibrio cholera is excreted. Antibiotic prophylaxis may be given to all close contacts in the same dosage as for treatment. For confirmation at the beginning of an outbreak, take rectal swab or stool specimen, handle properly and transport carefully to laboratory. This situation typically implies an increased frequency of bowel movements, which can range from 4-5 to more than 20 times per day. The augmented water content in the stools is due to an imbalance in the physiology of the small and large intestinal processes involved in the absorption of ions, organic substrates, and thus water. Childhood acute diarrhea is usually caused by infection; however, numerous disorders may cause this condition, including a malabsorption syndrome and various enteropathies. Acute- onset diarrhea is usually self-limited; however, an acute infection can have a protracted course. Diarrheal episodes are classically distinguished into acute and chronic (or persistent) based on their duration. Acute diarrhea is thus defined as an episode that has an acute onset and lasts no longer than 14 days; chronic or persistent diarrhea is defined as an episode that lasts longer than 14 days. It is most practical to base treatment of diarrhea on the clinical types of the illness, which can easily be determined when a patient is first examined. Four 47 | P a g e clinical types of diarrhea can be recognized, each reflecting the basic underlying pathology and altered pathology:  Acute Watery Diarrhoea (including Cholera): which lasts several hours or days. The main danger is dehydration and malnutrition if feeding is not continued  Bloody Diarrhoea (Dysentery): the main dangers are damage of intestinal mucosa, sepsis, and malnutrition. Other complications including dehydration may also occur  Persistent (Chronic) Diarrhoea: Last for 14 days or longer, the main danger is malnutrition and serious non-intestinal infections, dehydration may also occur  Dirrhoea with Severe Malnutrition (Marasmus or Kwashiorkor): the main dangers are severe systemic infection, dehydration, heart failure, vitamin and mineral deficiency. Note: The basis for the management of each type of dirrhoea is to prevent or treat dangers that present. Management of diarrhea in adults The principles of management of diarrhea in adult are the same as in children in correction of fluid deficit. However, the most common cause for diarrhea in adult is food poisoning which is normally self-limiting.

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