🔘 Atisara (Diarrhoea)

ATISARA (DIARRHOEA):-

💫 ACCORDING TO AYURVEDA (ATISARA):-

👉🏻 Introduction:-

- Atisara is disease of intestinal disturbances; involves

water & electrolyte imbalances, malnutrition and undernutrition.

- Atisara is not only affects health of children 

but also considered responsible for infant mortality especially in tropical and sub-tropical countries.

- The traditional text of Ayurveda described various treatment options for the management of Atisara including medicine and it is believed that drugs possess Madhura, Mridu, Laghu, Surabhi sampurna, Sheetala & Sanshamaka

 properties may offer relief in Atisara.

- Ayurveda described that Deepan and Pachan drugs may break the samprapti of Atisara.

👉🏻 Derivation:-

 • अतिशयेन सारयति (रेचयति) मलम् इति अतिसारः।

- Atisara word is derived from root word 'Ati' and 'Sru'.

• Ati means in excessive quantity

• Sru means Sarana or passing

- So Atisara means drava mala is passed frequently so many times. 

👉🏻 Definition:-

• अतिसरणम् अतिसारः। (डल्हण)

• संशम्यापां धातु शकृन्मिश्रो सरत्यतीवातिसार। (Su.U.40/6)

- The disease in which frequent loose watery stool is passed is called as Atisara.

👉🏻 Marga vyadhi:- Abhyantara marga

👉🏻 Srotasa:-

- Annavaha srotasa

- Udakavaha srotasa

👉🏻 Synonyms:-

- Udaramaya

- Annagandhi

- Trikanda shotha etc.

👉🏻 Samanya Nidana:-

• गुर्वतिस्निग्धरुक्षोष्णद्रवस्थूलातिशीतलैः । विरुद्धाध्यशनाजीर्णैरसात्म्यै श्चापि भोजनैः॥

स्नेहायेरतियुक्तैश्च मिथ्यायुक्तैर्विषाद्भयात् । 

शोकाद दुष्टाम्बुमद्यातिपानात् सात्म्यर्तुपर्ययात् ॥

जलातिरमणैर्वेगविघातैः कृमिदोषतः । 

नृणां भवत्यतीसारो लक्षणं तस्य वक्ष्यत ॥

(Su.U. 40/3-5)

- Intake of food items which are excessively oily, unctous, very dry, hot, spicy, watery, bulky or Chilled and hard to digest.

- Intake of incompatible food items.

- Overeating

- Imbalance diet

- Due to abnormal seasonal changes

- Intake of food which is prepared by adding excessive fat or oil in it.

- Intake of food which is rotten or poisoned.

- Overwhelming emotions like extreme fear or sorrow.

- Intake of contaminated water or liquid.

- Enjoying water by swimming etc. for longer period of time.

- Intake of water in large quantity.

👉🏻 Purvaroopa:-

• हन्नाभिपायूदरकुक्षि तोदगात्रावसादानिलसन्निरोधाः ।

विट्सङ्ग आध्यानमथाविपाको भविष्यतस्तस्य पुरःसराणि॥

(Su.U. 40/8-9)

- Pricking type of pain around heart, umbilicus, flanks, abdomen and at the anus.

- General weakness

- Abdominal distension

- Constipation

- Indigestion

👉🏻 Samanya Lakshana:-

- Frequent passing of watery loose faecal matter

- Uncontrolled defecation with pain around the umbilicus

- Exhaution and fatigue

- Roughness of skin

- Pain in the chest

- Loss of tolerance to sound

- Dyspnoea

👉🏻 Samanya Samprapti:-

• संशम्यापां धातुरन्तः कृशानुं, व!मिश्रो मारुतेन प्रणुन्नः ।

वृद्धोऽतीवाध: सरत्येष यस्माद, व्याधिं घोरं तं त्वतीसारमाहुः ॥ (Su.U. 40/6)

- Due to repeated acceptance of relevant predisposing factors, vata dosha aggravates and forces Ap dhatu - body fluid which is already in imbalance form to koshtha.

- This Ap dhatu mixes with faecal material vto make it unformed or loose.

- This loose faecal material is expelled frequently via anus.

- This condition is called as Atisara.

👉🏻 Samprapti ghataka:-

- Dosha:- Vata, Pitta, Kapha

- Dushya:- Rasa, Rakta, Mansa, Meda

- Srotasa:- Annavaha, Udakavaha

- Adhisthana:- Amashaya, Pakwashaya

- Srotodushti:- Atipravrutti

- Swabhava:- Ashukari and Chirakari

- Agni dushti:- Jathadagni, Rasa dhatwagni

👉🏻 Types of Atisara:-

✓ According to Charaka:- 6 types

1. Vataja Atisara

2. Pittaja Atisara

3. Kaphaja Atisara

4. Sannipatika Atisara

5. Shokaja Atisara

6. Bhayaja Atisara

✓ According to Sushruta:- 6 types

1. Vataja Atisara

2. Pittaja Atisara

3. Kaphaja Atisara

4. Sannipatika Atisara

5. Shokaja Atisara

6. Aamaja Atisara

1) Vataja Atisara:-

✓ Nidana:- 

• अथावरकालंवातलस्य वातातपव्यायामात्रनिषेविणो रूक्षाल्पप्रमिताशिनस्तीक्ष्णमद्यव्यवायनित्यस्योदावर्तयतश्चवेगान्वायुः प्रकोपमापद्यते ।  

(Cha.Chi. 19/5)

• Vata dominant atisara occurs if a person with vata dominant constitution indulges in following:- 

- Exposure to strong wind, excess sunlight and physical exercise.

- Indulgence in dry and rough or less quantities of food (pramitashana) or irregular meals or strong alcoholic drinks or excessive sexual intercourse

- Suppression of natural urges.

✓ Samprapti:-

• यक्ता चोपहन्यते, स वायुः, कुपितोऽनावुपहते मूत्रस्वेदौपुरीषाशयमुपहत्य ।

ताभ्यां पुरीषं द्रवीकृत्य, अतीसाराय प्रकल्पते ॥

(Cha.Chi. 19/5)

- Due to above said nidana sevana, aggravate vata, afflicting the power of digestion (or reducing the agni). 

- With the depletion of agni, the aggravated vata forces urine and sweat to the colon (purishashaya) and liquefying the stool.

- It produces Vataja Atisara.

✓ Roopa:-

• अरुणं फेनिलं रुक्षमल्पमल्पं मुहुर्मुहुः । 

शकृदामं सरुक्शब्दं मारुतेनातिसार्यते॥

(Ma.Ni. 3/6)

- Faecal matter is reddish, frothy and dry.

- It is passed repeatedly in smaller quantity with pain and sound.

2) Pittaja Atisara:-

✓ Nidana:-

• पित्तलस्य पुनरम्ललवणकटुक क्षारोष्णतीक्ष्णातिमात्रनिषेविणः प्रतताग्निसूर्यसन्तापोष्णमारुतोपहत गात्रस्यक्रोधेर्ष्याबहुलस्य पित्तंप्रकोपमापद्यते ।

(Cha.Chi. 19/6)

• A person of pittaja constitution, by indulging in the following etiological factors, gets afflicted by pittaja atisara:-

• Excessive intake of sour, saline, pungent, alkaline (kshara), hot and sharp (teekshna) ingredients

• Affliction of the body by excessive exposure to the heat of strong fire, hot rays of the sun and hot wind

• Excessive disposition to negative emotions such as anger, jealousy, etc.

✓ Samprapti:-

• तत् प्रकुपितं द्रवत्वादूष्माणमुपहत्य पुरीषाशयविसृतमौष्ण्याद् ।

द्रवत्वात् सरत्वाच्च भित्वा पुरीषमतिसाराय प्रकल्पते॥

(Cha.Chi. 19/6)

- Due to nidana sevana, aggravated pitta supprasses the power of agni.

- Then aggravated pitta having arrived at the colon and disintegrates the stool because of heat liquidity and mobility.

- It produces Pittaja Atisara.

✓ Roopa:-

• पित्तात् पीतं नीलमालोहितं वा । तृष्णामूर्छादाहपाकज्वरातः॥ 

(Su.U. 40/11)

- Gudapaka (due to excessive in pitta and rakta, paka is developed)

- The faeces is yellow and bluish

- Tha patient has burning sensation and perianal suppuration in such cases

- Severe thirst

- Excessive sweating

- Pain in abdomen

- Fever

- Stupor

- Atyanta gandhayukta mala

- The motions are massive, forceful and uncontrolled.

3) Kaphaja Atisara:-

✓ Nidana:-

• श्लेष्मलस्य तु  गुरुमधुरशीतस्निग्धोपसेविनः सम्पूरकस्याचिन्तयतो दिवास्वप्नपरस्यालसस्य श्लेष्माप्रकोपमापद्यते ।

(Cha.Chi. 19/7)

• A person of kaphaja type of constitution indulging in the following factors experiences the manifestation of kaphaja atisara:

- Consumption of heavy, sweet, cold and unctuous ingredients in excess

- Inactivity of the mind and indolence

- Habitually sleeping during the day time

✓ Samprapti:-

• स स्वाभावाद् गुरुशीतमधुरस्निग्धः स्रस्तोऽग्निमुपहत्य ।

सौम्यस्वाभावात् पुरीपाशयमुपहत्योपक्लेश पुरीषमतिसाराय कल्पते॥

(Cha.Chi. 19/7)

- Due to nidana sevana, kapha gets aggravated.

- Kapha moves downward and afflicts the Agni because of cooling property.

- Then having arrived at the colon, liquifies the stool and produces Kaphaja Atisara.

✓ Roopa:-

• स्निग्धंश्वेतंपिच्छिलं तन्तुमदामंगुरुदुर्गन्धं श्लेष्मोपहितमनुबद्ध शूलमल्पाल्पमभीक्ष्णमतिसार्यतेसप्रवाहिकं ।गुरूदरगुदबस्तिवङ्क्षणदेशःकृतेऽप्यकृतसञ्ज्ञःसलोमहर्षःसोत्क्लशोनिद्रालस्यपरीतःसदनोऽन्नद्वेषीचेतिश्लेष्मातिसारः ।।

(Cha.Chi. 19/7)

- The stool is unctuous, white, slimy, fibrous, mixed with mucus as well as undigested food particles, heavy, foul-smelling and mixed with phlegm

- The patient suffers from continuous, griping, colic pain

- The patient evacuates stool frequently in small quantities

- The patient suffers from heaviness in the abdomen, in the region of urinary bladder and in the pelvic region

- The patient feels the urge for passing stool even after having evacuated

- Suffers from horripilation, nausea, excessive sleep, indolence, prostration and dislike for food

4) Sannipataja Atisara:-

✓ Nidana:-

• अतिशीतस्निग्धरूक्षोष्ण गुरुखरकठिन विषमविरुद्धासात्म्यभोजनादभोजनात्कालातीतभोजनाद्यत्किञ्चिदभ्यवहरणात्प्रदुष्टमद्यपानीयपानादतिमद्यपानादसंशोधनात्प्रतिकर्मणांविषमगमनादनुपचाराज्ज्वलनादित्यपवनसलिलातिसेवनादस्वप्नादतिस्वप्नाद्वेगविधारणादृतुविपर्ययादयथाबलमारम्भाद्भयशोकचित्तोद्वेगातियोगात्कृमिशोषज्वरार्शोविकारातिकर्षणाद्वाव्यापन्नाग्नेस्त्रयोदोषाः प्रकुपिताभूयएवाग्निमुपहत्यपक्वाशयमनुप्रविश्यातीसारं सर्वदोषलिङ्गंजनयन्ति ||

(Cha.Chi. 19/8)

• The causative factors of sannipataja atisara (diarrhea caused by the simultaneous vitiation of all the three doshas) are as follows:

- Intake of excessively cold, unctuous, hot, heavy, coarse and hard ingredients

- Intake of irregular meals, ingredients of food having mutually contradictory properties and unwholesome food

- Intake of food long after the scheduled time

- Intake of food without caring for its wholesomeness

- Drinking of alcohol and other drinks which are polluted, toxic or harmful

- Drinking of alcohol in excess

- Not resorting to elimination therapies (in appropriate seasons)

- Inappropriate administration or non administration of therapeutics

- Excessive exposure to fire, hot rays of the sun, strong wind and bath etc., in strong current of water

- Not sleeping or sleeping in excess

- Suppression of natural urges

- Not resorting to appropriate regimens during different seasons

- Over courageous attitude

- Excessive exposure to fear, grief and anxiety

- Excessive emaciation due to worm-infection, consumption, fever and piles (bleeding).

✓ Samprapti:-

• त्रयो दोषाः प्रकुपिता भूय एवाग्निमुपहत्य पक्वाशय ।

मनुप्रविश्यातीक्षारं सर्वदोषलिङ्गं जनयन्ति॥

(Cha.Chi. 19/8)

- Due to nidana sevana, all three doshas are aggravated.

- Because of that agni gets vitiated by dosha prakopa.

- These aggravated doshas further afflict the agni and entered into Pakwashaya and produces Sannipataja Atisara.

✓ Roopa:-

- Sannipataja Atisara having rakta as the prevalent aggravated element. It produces dark yellowish, green, blue coloured loose motions which are extensively painful or totally painless.

- Insipid mouth

- Loss of digestive power

- Delirium

- Lassitude

5) Shokaja Atisara:-

✓ Nidana:- Due to excessive shoka.

✓ Roopa:-

- Depressed, sad mental status

- Loss of sleep

- Restlessness

- Giddiness

- Dryness of the mouth

- Loathing of food

- Foamy, soft, smooth, watery loose motions

6) Bhayaja Atisara:-

✓ Nidana:- Due to excessive fear (Bhaya)

✓ Roopa:-

- Paleness of body

- Delusion and tremors

- Fever

- Foamy loose motions

✓ Samprapti of Shokaja and Bhayaja Atisara:-

- Due to continuous fear or shoka vata etc. vitiated Tridoshas are spread in all over the body.

- It vitiates the ushna and rakta of the body and in end produces kshobha. Which results in Bhayaja or shokaja Atisara.

7) Aamaja Atisara:-

✓ Roopa:-

- Indigested food passes in partially digested form in the form of faeces.

- Faecal material is sticky, mucoid and foul smelling.

8) Raktaja atisara:-

✓ Nidana:-

- In Pittatisara, if ushna, tikshna, vidahi etc. Pitta prakopaka ahara-vihara should be adopted then Raktatisara will be produced.

✓ Roopa:- 

- Blood stained loose motions

- Severe thirst

- Severe burning sensation

- Pain in abdomen

- Fever

- Suppuration of anus

👉🏻 Upashaya:-

- Opposite to all Nidana (Causitive factors)

👉🏻 Pathyaapathya:-

✓ Pathya:-

Ahara:-

- Intake of light, easy to digest type of food

- Intake of buttermilk

- Drinking water boiled in earthen pot

- Purana Shashtika shali

- Vilepi, laja manda, masura, mudga, jambu, dadima, bilva, tinduka, jeeraka, dhanyaka, kadali etc.

- Takra, Ajadugdha

Vihara:-

- Langhana

- Nidra

- Vishrama

✓ Apathya:-

Ahara:-

- Intake of hard to digest, hot, acidic food

- Masha, ati jalapana, guru snigdha ahara

- Badara, tambula, madhya, draksha

- Dadhi, Khira, Puri, Samosa, kachori

Vihara:-

- Snana

- Avagahana

- Abhyanga

- Nasya karma

- Vyayama

- Aatapa sevana

- Diwasvapna, Ratrijagarana

- Maithuna karma

- Swedana, dhumapana, vegadharana

- Krodha erc.

- Physical exertion

👉🏻 Upadrava:-

- Edema

- Pain in abdomen

- Fever

- Thirst

- Dyspnoea

- Cough

- Inspid mouth

- Vomiting

- Stupor

- Hiccough

- Delirium

- Severe restlessness

- Incoherent speech

- Abdominal distension

👉🏻 Udarka:-

- Arsha

- Grahani

👉🏻 Sadhyasadhyatva:-

√ Vataja, Pittaja and Kaphaja Atisara:- Sukha sadhya

√ Sannipataja, Shokaja, Bhayaja Atisara:- Kruchrasadhya

√ Ashadha Atisara Lakshana:-

- Colour of faecal material resembles to fruit of Jambu, yakruta khanda, ghrita, taila, vasa, majja, veshvara, dudha, dadhi, in which mamsa is washed.

- Colour of faecal material resembles to copper blue, green, orange, grey, black, red, resembling like black kajal or feather of peacock.

- Faecal material appears as clear like water or turbid and fibrous.

- Faecal material smells like dead body, fish, fermented decaying food.

- Presence of flies on faecal material 

- Faecal material is mostly watery in nature or with very small amount of faeces.

- Incurable when patient suffers from severe dyspnoea, abdominal pain, thirst, burning sensation,hiccough, pain in bones, restlessness etc. 

👉🏻 Chikitsa:-

✓ Samanya Chikitsa sutra:-

• तमसाध्यतामसम्प्राप्तं चिकित्सेद् यथाप्रधानोपक्रमेण हेतूपशयदोषविशेषपरीक्षयाचेति ।।

(Cha.Chi. 19/10)

- The patient who has not yet reached the stage of absolute incurability should be properly treated after the examination of causative factors, upashaya (pacifying factors) and nature of the aggravation of specific dosha. 

- In this condition, the most aggravated dosha should be treated in the beginning followed by the treatment of the other less aggravated doshas.

• आमपक्वक्रमं हित्वा नातिसारे किया यतः।

अतः सर्वातिसारेषु ज्ञेयं पञ्चामलक्षणम् ॥

(Chakradatta 3/1)

- In Atisara without knowing the condition of Amavastha and Pamwavastha, chikitsa is not possible.

- So in all types of Atisara, it is necessary to knowing the lakshanas of ama and pakwa mala.

- In Amavastha, for balavana rogi Langhana is the best treatment. Because Langhana alleviates the aggravated dishas and ama pachana both actions.

✓ Vishesha Chikitsa:-

1) Vataja Atisara:-

- Vataja Atisara is of 2 types:-

a. Aamatisara (undigested food passed in stool)

b. Pakwatisara (digested stool)

√ Sama and nirama mala pariksha:-

- In sama mala, it is durgandhita, picchila and apakwa anna yukta and sinking in the water.

- In nirama mala, it will not sink in water and devoid of above features.

a. Aamatisara:-

√ Sangrahi Aushadha nishedha in aamatisara:-

- Do not try to stop diarrhoea when undigested food is being expelled. i.e. Sangrahi or stambhaka aushadha or Kashaya rasa dravya are to ne avoided initially.

- Haritaki can be administered to expelled the doshas.

√ Aamatisara with madhya dosha:-

- Pramathya for deepana-pachana

√ Aamatisara with alpa dosha:-

- Langhana is the best treatment in aamatisara

√ Pramathya used are:-

1. Pippalyadi pramathya

2. Hriveradi pramathya

3. Musta parpataka

4. Vacha, ativisha

b. Pakwatisara:-

- Sangrahi and Stambhana aushadha prayoga

- Khada yusha

- Dhanya yusha

- Dadhisara

- Mamsarasa prayoga (Titira, draksha, vartaka etc.)

√ Purisha kshaya Chikitsa:- 

- Mamsa rasa prayoga i.e. Masha, dadima, Dhanyaka, ghrita, Sunthi

√ Vibandha nashaka yoga:-

- Eranda moola kalka siddha kshira

- Baala bilva kalka siddha kshira

√ In Gudabhramsha:-

- Changeri ghrita

- Chavyadi ghrita

- Sneha basti

- Amla rasa yukta ghrita

- Pichu prayoga after manual replacement of rectum.

√ Formulations for Vatatisara:-

- Panchamula siddha takra

- Putikadi kwatha

- Pathyadi kwatha

- Vachadi kwatha

- Agastisutaraja rasa

- Kanak sundara rasa

2) Pittaja Atisara:-

- Langhana

- Pachana

- Trishna nigrahana with musta, parpataka, ushira, sariva, chandana, kiratatikta, udichya siddha jala prepared by Shadangapaniya vidhi.

- In strong patient, virechana is administered to expel dosha.

- Ativisha, vatsaka, kutaja kalka mixed with madhu and tandulodaka cures Pittaja Atisara.

- Ajadugdha prayoga

- Anuvasana basti in case of shula i.e. Shata pushpadi anuvasana basti

√ Pichha Basti:-

- Green stalks of shalmali is covered with green kusha and coated with black mud.

- This pinda is placed over the cow dung fire

- Aftee the mud is dried up, the stalk of shalmali is removed

- This is triturated in khalwa tantra and then 9 mushti (1 pala) of shalmali is mixed with 1 prastha of shruta Dugdha and filtered.

- Now ghrita, taila and yashtimadhu churna are added to this milk in adequate quantity and this mixture is used for basti after proper snehana.

- After coming out the basti, patient should take bath and eat rice with milk or mamsa rasa.

Indications:-

- Pittaja Atisara

- Kaphaja Atisara

- Grahani

- Jwara

- Atiyoga of niruha basti

√ Formulations for Pittaja Atisara:-

- Shadangapaniya

- Dhanya chatushka kwatha

- Kiratatiktadi kwatha

- Madhukadi churna

- Bilwadi kwatha

- Piyushavalli rasa

- Kamadudha rasa

- Pravala pamchamrita rasa

- Sutashekhara rasa

3) Kaphaja Atisara:-

- Langhana

- Pachana

- Aamatisaraghna deepaniya dravyas

- Eating apakwa bilva phala

- Ajajyadi churna with dhataki and matuunga swarasa

- Rasanjanadi with madhu and nagara

- Kapitthadi churna with trikatu, madhu and sharkara

- Piccha Basti

- Baalabilwadi churna

√ Formulations for Kaphaja Atisara:-

- Chavyadi Kwatha

- Hingwadi churna

- Ajachyadi churna

- Rasanjanadi churna

- Kapitthadi churna

- Lokanath rasa

- Lakshmivilasa rasa

4) Sannipataja Atisara:-

- First of all vata should be controlled then pitta and after pitta the kapha should be controlled.

- However amongst all these whichever dosha is maximum aggravated or strongest should be treated first.

√ Formulations for Sannipataja Atisara:-

- Kutaja Putapaka

- Samangadi Kwatha

- Kutajavaleha

- Ankotavataka

- Chaursama modaka

5) Agantuja (Bhayaja - Shokaja) Atisara:-

• मारुतोभयशोकाभ्यांशीघ्रंहिपरिकुप्यति |

तयोःक्रियावातहरीहर्षणाश्वासनानिच ||

(Cha.Chi. 19/12)

- Vatahara chikitsa

- Harshana

- Aashvasana chikitsa

- Deepana,grahi dravya prayoga

- Abhraka bhasma or Varatika bhasma should be mixed with Sunthi churna and madhu.

6) Raktaja atisara:-

- Ajadugdha mixed with madhu and sharkara in case of Trishna

- Neelakamala, mocharasa, samanga, kamala keshara churna mixed with Ajadugdha and should be given. Along with it before food 20gm butter adding with 6gm madhu and 3gm sharkara should be given.

- Shatavari kalka + Milk

- Krishna tila kalka mixed with 4 times sharkara

- Pichha Basti

- Vatsakadi kwatha

- Guda bilwa

- Mamsa rasa prayoga

- Kutaja kwatha

- Darvyadi ghrita

- Pittaja Atisara chikitsa

√ Formulations for Raktatisara:-

- Raktapitta kulakandana rasa

- Kutaja rasakriya

- Kutajavaleha

👉🏻 Important formulations useful in Atisara:-

1) Rasa / Bhasma / Parpati:-

• Matra:- 125-250 mg

• Anupana:- Takra, madhu

- Jatiphala rasa

- Purna chandrodaya rasa

- Chintamani rasa

- Rasa parpati

- Pamchamrita Parpati

- Ramabana rasa

2) Vati:-

• Matra:- 250-500 mg

• Anupana:- Takra

- Jatiphaladi vati

- Sanjivani vati

- Kutajashtaka vati

- Atisarahara vati

- Chincha bhallataka vati

- Visha tindukadi vati

3) Churna:-

• Matra:- 2-6 gm

• Anupana:- Madhu, guda

- Narayana churna

- Jatiphaladi churna

- Dadimashtaka churna

- Laghugangadhara churna

- Kapitthashtaka churna

4) Asava / Arishta:- 

• Matra:- 20-40 ml

• Anupana:- Samabhaga jala

- Kutajadya arishta

- Ahiphenasava

- Karpurasava

- Jirakadhyarishta

5) Avaleha:-

• Matra:- 10-20 gm

• Anupana:- Madhu, ksheera

- Dadimavaleha

- Kutajadhyavaleha

- Vijayavaleha

- Ativishavaleha

6) Ekala aushadha:-

- Kutaja, Mocharasa, bilwa, ahiphena, karpura, jatiphala, nagarmotha, bhanga, dadima etc.

💫 ACCORDING TO MODERN (DIARRHOEA):-

👉🏻 Introduction:-

Diarrhoea is a condition in which there is:- 

- Unusual frequency of bowel movements (more than 3 times a day)

- Changes in the amount (more than 200g a day)

- Change in consistency (liquid stool)

- It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide.

👉🏻 Definition:-

- Diarrhoea is the condition of having at least three loose or liquid bowel movements each day or as having more stools than is normal for that person.

- It often lasts for a few days and can result in dehydration due to fluid loss.

👉🏻 Types of Diarrhoea:-

1) Acute Diarrhoea:-

- Acute Diarrhoea is defined as an

abnormally frequent discharge

of semisolid or fluid fecal matter from the bowel, lasting

less than 14 days.

- It is caused by an infection of the large intestine, but may be 

associated with infection of gastric mucosa and 

small intestine. 

- The term “acute gastroenteritis” is most frequently used to describe acute diarrhoea.

2) Chronic Diarrhoea:-

- Chronic diarrhoea is termed when the loose motion is occurring for 3 weeks or more.

- It is usually related to underlying organic diseases with or without malabsorption.

- If Diarrhea with watery stools and visible blood in the stools it is called dysentery.

- Persistent diarrhea refers to the episodes of acute 

diarrhea that last for 2 weeks or more and may be due to infective origin.

✓ Other types:-

1. Short duration watery diarrhoea

2. Short duration bloody

diarrhoea

3. Persistent diarrhoea (lasting

more than 2 week – watery/

bloody)

👉🏻 Causes of Diarrhoea:-

• Usually infection:-

- Viral

- Bacterial-

shigella

- Parasitic - Giardia

• Non infectious:-

- lactose intolerance

- IBS

- Coeliac disease

- Ulcerative colitis

• Due to Medications:-

- Ampicilline

- Amoxicilline

- Clindamycin

- Cephalexin

- The main causes of this disease are lack of 

 knowledge of hygiene and sanitation, home 

environment, feeding practices of the parents and under five years of children.

- It can be caused by chronic ethanol ingestion.

- Chronic mild diarrhoea in infants and toddlers may occur with no obvious cause and with no other ill

effects ,this condition is called toddler’s diarrhea.

👉🏻 Epidemiology:-

- About 1/3 of total hospitalized children are due to diarrheal diseases and 17%of all deaths in indoor pediatric patients are related to this condition.

- The

morbidity rate in terms of diarrhea episodes per year per child under the age of 5 years is about 1.7.

👉🏻 Reservoir of infection:-

- Man is the main reservoir of enteric pathogens ,so most transmission originates from human factors. 

- For some enteric pathogens and viral agents 

animals are important reservoir.

👉🏻 Mode of transmission:-

- It is mainly feco-oral route.

- It is water- borne,food-

borne disease or may transmit via fingers,fomites,flies or dirt.

👉🏻 Clinical features:-

- Stools are usually loose watery in consistency.

- It may be greenish or yellowish-green in color with offensive smell.

- It may contain mucus, pus or blood and may expelled with force,preceded by abdominal pain.

- Frequency of stools varies from 2 to 20 per day or more.

- The child may have low grade fever ,thirst, anorexia.

- Behavioral changes like irritability, restlessness, weakness, lethargy, sleepyness, delirium, stupor and flaccidity are usually presengors.

- Physical changes like loss of weight, poor skin turgor, dry mucus membranes,drylips, pallor, sunken eyes,depressed fontanelles are also found.

- Vital signs are changed as low blood 

pressure, tachycardia, rapid respiration, cold limbs and collapse.

- Decreased or absent urinary output.

- Convulsions and loss of consiousness may also present in some children with diarrheal diseases.

👉🏻 Diagnosis:-

- History taking and physical assessment.

- Stool examination can be done for routine and microscopic study and identification of causative organisms. 

- Blood examination can be performed to detect electrolyte imbalance, acid- base 

disturbances, hematocrit value, TC,DC,ESR etc.

- The suspected associated cause should be ruled out for adequate management.

- Fever, severe abdomen, tenderness – Colitis

- Vomiting+ Diarrhoea – Toxin

- Fever + headache – Infection

- Diarrhoea with blood – E. histolytica

👉🏻 Prognosis:-

- Mortality is higher in neonate and infants than the older children.

- Malnourished children are having poor prognosis and greater mortality.

- Antibiotic resistant type E.Coli and shigella cause very severe illness and poor prognosis.

- Presence of severe dehydration ,electrolyte 

imbalance and pneumonia have poor prognosis

👉🏻 Complications:-

- Dehydration

- Hypovolemic shock

- Renal failure

- Paralytic ileus

- Thromboembolism

- CCF

- Convulsions

- Overdehydration

- Hypoglycemia

- Consumptive coagulapathy

- Toxic megacolon

- Malnutrition 

- Growth retardation

- Mental subnormalities

👉🏻 Dietery management:-

- Diet to be planned to prevent malnutrition and allow normal nutritional requirement.

- Food items may include energy rich food with rice,potatoes,wheat,pulses,vegetables, oil, curd, fish, high fiber content foods and soft drinks should be avoided.

- Breast feeding to be continued during diarrheal episodes even along with ORS.

- Cereal mixture like rice- milk, dalia- sagu, or khichri can be given to the infants more than 6 months of age.

- If the infant is non breast fed,cow’s or buffalo’s milk should not be diluted with water.

- Feeding to be given in small quantity frequently every 2 to 3 hours.

👉🏻 Prevention:-

1) Improvement of food hygiene and environmental hygiene:-

- Safe water,adequate sewage disposal, hand washing practices,clean utensils, avoidance of exposures of food to dust and dirt, fly control, washing of fruits and vegetables etc.

2) Avoidance of bottle feeding is most significant practice needed for prevention of diarrhoea.

3) Boiling or filtering to be practiced for safe drinking water.

4) Prevention of LBW and prematurity,exclusive breast feeding, appropriate weaning practices, balanced

diet, immunization are significant aspects of child care.

👉🏻 Treatment:-

- IV – severe dehydration

- Antibiotic – Bloody diarrhoea, high

fever

- Loperamide -Loperamide usually

starts to work within 1 hour

- Lowing intestinal motility and by

affecting water and electrolyte movement through the bowel.

- Bismuth subsalicylate -

slowing down the movement

of the gut.

- Most of cases self limiting and

requires fluid therapy only.

✓ Fluid:-

- Standard home solutions such

as salted rice water, salted

yogurt

- Oral rehydration solution (ORS)

(a slightly sweetened and salty

water) can be used to prevent

dehydration.

- The appropriate amount of ORS solution to be given in the first 4 hours are as follows:-

1. Age less than 4 months or weight less than 5 kg-

200 to 400ml.

2.Age 4 to 11months or weight 5 to 7.9 kg – 400 to 600ml.

3. Age 12 to 23 months or weight 8 to 10.9 kg – 600 to 800ml.

4. Age 2 to 4 years or weight 11 to 15.9 kg – 800 to 1200ml.

5. Age 5 to 14 years or weight 16 to 29.9 kg – 1200 to 

2200 ml.

6. Age 15years or older or weight 30kg or more to 2200 to 4000ml

✓ Rice water:-

- Rice water has a

binding effect in the digestive

tract, resulting in firmer, bulkier

stools.

- Yogurt Probiotics are made up of

good bacteria

- This good bacteria helps in

many ways, including fighting off

bad bacteria

✓ Antimotility drug – Opiates (morphine , codeine)

✓ Bismuth subsalicylate –

Stimulation of absorption of

fluids and electrolytes by the

intestinal wall

✓ Antispasmodic – dicyclomine

and hyoscine – Anticholinergic drug

with high affinity for muscarinic

receptors located on the smooth

muscle cells of the GI tract.

✓ Anticholinergic action smooth

muscle relaxing

✓ In case of Bloody diarrhoea, high fever:-

Antibiotic:-

- Norfloxacin – 400 mg/BD

- Ciprofloxacin – 500mg/BD

- Levofloxacin – 500mg/OD