Cholera: the simplified versionCholera: the simplified version

SymptomsSymptoms

Acute diarrheaAcute diarrhea

duration less than duration less than 2 weeks2 weeks

onset:onset: Abrupt frequent, small fecal dischargeAbrupt frequent, small fecal discharge Cramping abdominal pain, tenesmuseCramping abdominal pain, tenesmuse

stool: increasedstool: increased

Routin ExRoutin Ex

severe casessevere cases: : dehydration, electrolyte disturbadehydration, electrolyte disturbances, metabolic acidosis, collapse hypovolumia, tetnces, metabolic acidosis, collapse hypovolumia, tetany.any.

SymptomsSymptoms

volumeliquidity

flecks of blood, mucusWBC, RBC, pus, destroyed epithelium

SymptomsSymptoms

Chronic diarrheaChronic diarrhea

duration more than duration more than 2 months2 months

SymptomsSymptoms

Onset:Onset:

gradual/insidiousgradual/insidious

Diarrhea of variable severityDiarrhea of variable severity

Diarrhea alternate with Diarrhea alternate with constipationconstipation

Colicky abdominal pain, Colicky abdominal pain, distentiondistention

stoolstoolwatery, bloody, steatorrheawatery, bloody, steatorrheacontains:contains:inflammatory cells/mucus/pus/indigesinflammatory cells/mucus/pus/indiges

ted foodted food severe/long-standing cases:severe/long-standing cases:

weight loss, malnutrition, edema, muweight loss, malnutrition, edema, multy vits deficiency, malabsorption, walty vits deficiency, malabsorption, wasting, edema, bone painsting, edema, bone pain

Accompanied SymptomsAccompanied Symptoms

severe dehydration severe dehydration (cholera, pancreatic cholera-WDHA, etc.)(cholera, pancreatic cholera-WDHA, etc.) fever fever (Acute bacillery dysentery, Typhoid, TB enteritis, et(Acute bacillery dysentery, Typhoid, TB enteritis, et

c.)c.) tenesmus (Acute dysentery, proctitis, etc.)tenesmus (Acute dysentery, proctitis, etc.) markedly weight loss markedly weight loss (cancer of gut, malabsorption, etc.)(cancer of gut, malabsorption, etc.) Arthralgia/Arthritis Arthralgia/Arthritis (IBD, connective tissue diseases, etc.)(IBD, connective tissue diseases, etc.) masses (malignant cancer of GI, TB, peritonitis, etc.masses (malignant cancer of GI, TB, peritonitis, etc.

))

Diagnostic ProceduresDiagnostic Procedures

InformationInformation

P.E. FindingsP.E. Findings

fever, dehydration, malnutrion, anemia, ulfever, dehydration, malnutrion, anemia, ulticaria, jaundice, arthralgia, abdominal mticaria, jaundice, arthralgia, abdominal masses, Tenesmus, digital rectal examinatioasses, Tenesmus, digital rectal examination.n.

Lab findingsLab findings

Diagnostic ProceduresDiagnostic Proceduresinformationinformation

• in epidemics (Dysentery, v. Cholerae, Typin epidemics (Dysentery, v. Cholerae, Typhoid, food poisonning, enteritis)hoid, food poisonning, enteritis)

• food allergyfood allergy• past illness(antibiotic related diarrhea, etpast illness(antibiotic related diarrhea, et

c.)c.)• medication take(corticosteroids, laxativesmedication take(corticosteroids, laxatives

, etc.), etc.)• predisposing conditions (surgical resectiopredisposing conditions (surgical resectio

n, parasitic infection, etc.)n, parasitic infection, etc.)

Lab findings•Blood•Urine•Stool•Microscopy•Tolerance tests•Breath tests •Culture of Jejunal aspirates•5 HIAA (urinary excretion)

•Vit B12 absorption test

•X-ray Barium•Endoscopy•Suction biopsy technique (Jejunal mucosa histology

bloodblood RBCRBC WBCWBC CultureCulture Specific Antigen/Antibody (widal test, etc.Specific Antigen/Antibody (widal test, etc.

)) Serum testings Serum testings (carotin/iron, Ferritin/albumin/folic acid)(carotin/iron, Ferritin/albumin/folic acid) (vitB12/glucose/gut hormone/Ca2+,K+,Cl-(vitB12/glucose/gut hormone/Ca2+,K+,Cl-

, Na+), Na+)

Lab findings

Lab findingsLab findings

UrineUrine ProteinProtein castcast

StoolStool appearanceappearance

(watery, bloody, bulky, stick(watery, bloody, bulky, sticky, malodorous, steaterrhea, y, malodorous, steaterrhea,

foul-smelling)foul-smelling)

Lab findingsLab findings

MicroscopyMicroscopyRBC, WBCRBC, WBC

polymorphonuclear (PMN):Shigella, solmonella, polymorphonuclear (PMN):Shigella, solmonella, E coliE colimononuclear (M)mononuclear (M)motile amebic trophozoitesmotile amebic trophozoites

Gram’s stain (+) staphylococcal enteritiGram’s stain (+) staphylococcal enteritiss

Culture: salmonolla, shigella, v. choleraCulture: salmonolla, shigella, v. cholera Fat determinationFat determination

Lab findingsLab findings Tolerance tests Tolerance tests

(d-xylose; Glucose/lactose/sucrose(d-xylose; Glucose/lactose/sucrose))

Breath tests Breath tests 14C Glycine-cholate, xylose14C Glycine-cholate, xylose

Culture of Jejunal aspirates Culture of Jejunal aspirates (Bacterial overgrowth)(Bacterial overgrowth) (increased Bile and deconjugation)(increased Bile and deconjugation)

5 HIAA (urinary excretion)5 HIAA (urinary excretion) Vit BVit B1212 absorption test absorption test

Lab findingsLab findings X-ray BariumX-ray Barium

mealmeal enemaenema

• EndoscopyEndoscopy Duodenoscopy (ERCP)Duodenoscopy (ERCP) ColonoscopyColonoscopy SigmoidoscopySigmoidoscopy

Suction biopsy technique (Jejunal Suction biopsy technique (Jejunal mucosa histology)mucosa histology)