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DIARRHOEA
Alkaline
Acid
Alkaline
Gastrointestinal system
Food passes into the upper part of the small intestine,
called the duodenum, where digestion and absorption of
nutrients continues
Unabsorbed portion then moves down into
the large intestine, and removed from the
body as faecal matter
The Digestive Process
Peristalsis
The Small Intestine
Duodenum
Jejunum
Ileum
The small intestine receives digestive juices
from the liver and the pancreas, completes
the digestion of the nutrients in food,
absorbs the different products of digestion,
and moves the remaining residues to the
large intestine for excretion
The Small Intestine
Gastritis
vs
Gastroenteritis?
The Large Intestine
Caecum
Ascending
colon
Transverse colon
Descending colon
Sigmoid
colon
Rectum
Anal canal
•The reabsorption of water and
electrolytes (e.g. sodium,
potassium, and chloride)
•The formation of faeces
(‘stools’)
•Peristalsis moves bolus towards
rectum
•The storage of (solid) faeces
The Large Intestine
Electrolytes
H2O
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Enterocyte / intestinal
absorptive cells – have a
secretory role. Control ion,
water, lipid, sugar uptake.
Secrete mucin which dissolves in
Water to form mucus
Produce hormones
such as serotonin
The Large Intestine
Constipation vs Diarrhoea
Excess H2O
reabsorbed
Peristalsis
sluggish
Constipation
Constipation vs Diarrhoea
Less H2O
reabsorbed
Peristalsis
rapid
Diarrhoea
Diarrhoea – some facts
Greek διάρροια, meaning "flowing through”
Western society
• Adults: 100 – 200g/day
• Children: 10g/kg/day
Diarrhoea – stool weight >200g/day (subjective analysis!)
Complications
• Dehydration & Electrolyte loss (hypoK, hypoMag)
• Infant mortality
• Vascular collapse (cholera)
99% of all fluid intake (+ GI secretions) are absorbed
• Small changes can cause diarrhoea
In most diarrhoea, >1 mechanism at work
• Osmotic load, secretions, less time/surface area 12
Unabsorbable dietary
material
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ACUTE vs CHRONIC Diarrhoea
ACUTE CHRONIC
Viral infection Drugs
Bacterial infection Irritable Bowel Syndrome (IBS)
Parasitic infection Diet (CHO intol.)
Food poisoning Inflammatory Bowel Disease
Drugs Surgery
Malabsorption syndromes
Tumours
Endocrine tumours
Endocrine disorders
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Dietary factors
DIETARY FACTOR SOURCE
Caffeine Coffee, tea, cola, headache OTC’s
Fructose (> gut’s capacity)
Juice (apple, pear), grapes, honey, dates, nuts, figs, fruit soft drinks, prunes
Hexitols, sorbitols, mannitol
Sugar-free gum, mints, sweet cherries, prunes
Lactose Milk, ice cream, frozen yoghurt, yoghurt, soft cheeses
Magnesium (Mg) Antacids
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Type of diarrhoea Definition
Acute watery diarrhoea Presence of ≥ 3 loose, watery stools within the
past 24 hours
Acute bloody diarrhoea
(or dysentery)
Presence of visible blood and mucous in
diarrhoeal stools
Persistent diarrhoea Episodes of diarrhoea that last for > 14 days
Defined by the WHO as having three or more loose or liquid stools per day, or as having
more stools than is normal for that person
Types of Diarrhoea
Osmotic Diarrhoea
Too much water is drawn into the colon
Drinks with high sugar or salt are highly osmotic
Stops when offending agent stops (alcohol, milk)
Caused by excess magnesium or vitamin C, or undigested
lactose (bowel distension)
• HypoMg = tetany
Lactose intolerance from very high dairy product intake
Excess fructose intake (in fructose malabsorption) – use
fructose foods with a high glucose content (less diarrhoea)
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Secretory Diarrhoea
Increase in active secretion; inhibition of absorption
Cholera toxin the most common cause (chloride ions; Cl-)
Sodium (Na+) follows, and then H2O
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Exudative Diarrhoea
Presence of blood and pus in the stool. This occurs with
inflammatory bowel diseases, such as Crohn's disease
or ulcerative colitis, and other severe infections such as
E. coli or other forms of food poisoning
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Motility-related Diarrhoea
Rapid movement of food through the intestines
(hypermotility)
Hyper-peristalsis
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Inflammatory Diarrhoea
Damage to the mucosal lining or brush border, which
leads to a passive loss of protein-rich fluids and a
decreased ability to absorb these lost fluids.
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Dysentery
Generally, if there is blood visible in the stools, it is not
diarrhoea, but dysentery
Blood indicates invasion of bowel tissue
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Infectious Diarrhoea (‘gastroenteritis’)
Viruses and parasites
• Norovirus the most common cause of viral diarrhoea in adults
• Rotavirus is the most common cause in children under 5 years
• Also Adenovirus and astroviruses
Bacterial diarrhoea
• Campylobacter spp. Salmonella spp. (chicken!) are common causes
• Shigella spp. and some strains of Escherichia coli (both mechanisms)
In the elderly, a toxin produced by Clostridium difficile often
causes severe diarrhoea
Mild, self-limiting (infants vulnerable)
Traveller’s Diarrhoea
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Tissue-damaging Toxin-secreting
Inflammatory Bowel Disease
The two overlapping types here are of unknown origin:
Ulcerative colitis – chronic bloody diarrhoea and
inflammation mostly affects the distal colon near the rectum.
Crohn's disease typically affects fairly well demarcated
segments of bowel in the colon and often affects the end of
the small bowel
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Irritable Bowel Disease (IBS)
Abdominal discomfort relieved by defecation and
unusual stool (diarrhoea or constipation) for at least 3
days a week over the previous 3 months
Approx 30% of patients with diarrhoea-predominant IBS
have bile acid malabsorption
Manage with a combination of dietary changes, soluble
fibre supplements, and/or medications such as
loperamide or codeine
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Warning!
Blood or pus
Abdominal tenderness
Fever
Signs of dehydration
Chronic diarrhoea
Weight loss
Tachycardia
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Aggression factors in diarrhoea
Action on escherichia coli - Rateau study (rabbit model)
• 1/3 of the goblet cells became degranulated
• Accelerated mucus degradation
• Leak of water and electrolytes
• Brush border enzymes were most affected
Mucus
H2O Na+ CI- HCO3-
Saccharase
Ileum infected
by E.Coli
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Restoration of brush border
Action on escherichia coli - Rateau study
- Reduces degranulation of the goblet cells
- Re-establishes a positive absorption balance
- Reverses the fluid flow
- Protects
membrane
enzymes Reduction in cell abnormalities
Reduction in water electrolyte leakage
Maintenance of
enzyme activity
Ileum protected
by anti-diarrhoeal
Diagnostic approach
Diarrhoea in the following situations may require further
investigation:
In infants
Moderate or severe diarrhoea in young children
Presence of blood
Lasts >2 days
Associated non-cramping abdominal pain, fever, weight
loss, etc
Travelers
Food handlers (infect others)
Hospitals, child care centres, geriatric/ convalescent homes
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Management of Diarrhoea
Replacing lost fluid, salts (ORS/ORT) usually sufficient
Intravenously in severe cases (Ringer’s)
Anti-infective agents (mostly viral)
Research does not support the limiting of milk to children
(no effect on duration of diarrhoea)
• WHO recommends that children continue to eat as sufficient
nutrients to support continued growth and weight gain
Continuing eating aids recovery of normal intestinal function
Antidiarrhoeals
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Fluids
Oral Rehydration Solution (ORS) (NaCl) help prevent
dehydration
• 400ml ORS after each bowel movement
• Salted rice water, salted yoghurt drinks, vegetable and chicken
soups with salt
• Water in which cereal has been cooked, unsalted soup, green
coconut water, weak tea (unsweetened), and unsweetened fresh
fruit juices with salt
• Clean plain water can also be given
Drinks high in simple sugars (soft drinks, fruit juices) are
not recommended in children under 5 years of age as
they may increase dehydration
• Rich solution in the gut draws water from the rest of the body,
just as if the person were to drink sea water
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Medications
Antibiotics are beneficial only in specific types of acute
diarrhoea
Antibiotic-associated diarrhoea is a common drug S/E
Bismuth compounds reduce bowel movements in
travellers' diarrhoea, but not the length of illness
Anti-motility agents reduce the duration of diarrhoea
Codeine slows down peristalsis and the passage of
faecal material through the bowels
Codeine, loperamide have antisecretory actions
ABsorbents & ADsorbents
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Diarrhoea in children
Breastfed infants – loose stools common
Gastroenteritis the most common cause
Common mechanisms:
• Osmotic, Secretory, Inflammatory, Malabsorptive
Causes of Acute diarrhoea:
• Antibiotics, bacteria, food (allergy, poisoning), parasites, viruses
Causes of Chronic diarrhoea:
• Anatomic abnormalities, dietary (lactose intol.), immunocompromise,
inflammatory disorders, malabsorption disorders
Certain drugs are not recommended
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Physico-chemical characteristics of
Diosmectite
Diosmectite
• A powder, the particles of which are tiny (+ 1µ)
• Each particle consists of a pile of lamellae or leaves
Stacked layers Layer structure
1 nm
1 of 3 µ
Silica Alumina Silica
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Physico-chemical characteristics of
Diosmectite
Because of its physico-chemical characteristics, Diosmectite has a:
• High aDsorption capacity
• Potent coating capacity
The key physico-chemical properties are:
• The tiny size of the particles
• Their formation into sheets
• Their layer structure
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Physico-chemical characteristics of
Diosmectite
Diosmectite’s Binding Capacity
Staphylococcus haemolytic toxin
Staphylococcus cytotoxic toxin
Strychnine
Study of binding capacity of diosmectine for different toxins
Diosmectite binding sites
Escherichia coli toxin
1
2
3
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Physico-chemical characteristics of
Diosmectite
The adsorption (binding) capacity is due to :
• The ionic structure
• The specific polar nature of diosmectite ‒ In the gastrointestinal tract, the negative electrical charges of clay's
mineral surfaces attract selectively the positively charged toxic molecules, preventing them from crossing the intestinal epithelium and entering the bloodstream.
These interactions may occur at three different sites:
1. Within the layers for single ions
2. Between the layers for flat or small molecules
3. On the periphery for macromolecules
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Physico-chemical characteristics of
Diosmectite
Plastic viscosity:
thixotropism
Liquid state : rupture of bonds
Agitation
Basal
State of raised plastic viscosity
New bonds which contract the molecules together in suspension in an immobile liquid
Semi-solid gel state
Spreading
Agitation
This presentation contains forward-looking statements about the company’s operations
and financial conditions. They are based on Litha Healthcare Group Limited’s best
estimates and information at the time of writing. They are nonetheless subject to
significant uncertainties and contingencies many of which are beyond the control of the
company. Unanticipated events will occur and actual future events may differ materially
from current expectations due to new business opportunities, changes in priorities by the
company as well as other factors. Any of these factors may materially affect the
company’s future business activities and its ongoing financial results.
DISCLAIMER
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