Gastroenteritis in children ,Dr.youssef quda

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Acute Gastroenteritis in children

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Gastroenteritis in children ,Dr.youssef quda

  1. 1. Gastroenteritis in Children ByBy Dr. Youssef QudaDr. Youssef Quda MSc. PediatricsMSc. Pediatrics www.facebook.com/dryousefqudawww.facebook.com/dryousefquda
  2. 2. Definition:  Passage of 3 or more watery loose motions per day. Increased volume, fluidity, or frequency of motions relative to the usual pattern of individual (WHO).
  3. 3. Classification of Diarrhea  Acute diarrhea: Short in duration (less than 2 weeks) Watery without visible blood.  Chronic diarrhea: 6 weeks or more Persistent diarrhea: > 14 days
  4. 4. Causes of Gastroenteritis Viral: (60% of cases) Rota virus, Norwalk virus Adenovirus , Enteroviruses Bacterial: Salmonella, shigella, enteroinvasive E coli Enterhemorrhgic E coli Parasitic: Giardia , Entameoba histolytica,cryptosprodium parvum.
  5. 5. Causes of Gastroenteritis Viral: (60% of cases) Rota virus, Norwalk virus Adenovirus , Enteroviruses  Criteria: -Age less than 2 years. - common in winter. - associated with URTI. - pyrexia < 38.5C
  6. 6. Causes of Gastroenteritis Viral: (60% of cases) Rota virus, Norwalk virus Adenovirus , Enteroviruses  Criteria: - Diarrhea is: 1. mild to moderate. 2. transient (5-7days). 3. watery 4. odorless
  7. 7. Causes of Gastroenteritis Bacterial: Salmonella, shigella, enteroinvasive E coli Enterhemorrhgic E coli  Criteria: - Common in summer - With high fever - Cramping abdominal pain
  8. 8. Causes of Gastroenteritis Parasitic: 1. Giardia Lambelia -watery - offensive - no fever nor vomiting 2. Entameaba histolytica - Bloody ± tenesmus - no fever nor vomiting 3. Cryptospordium parvum - watery with fever and vomiting
  9. 9. Mechanisms of Diarrhea  Osmotic  Secretory  Exudative  Motility disorders
  10. 10. Mechanisms of Diarrhea  Osmotic Defect present: Digestive enzyme deficiencies Ingestion of unabsorbable solute Examples: Viral infection Lactase deficiency Sorbitol/magnesium sulfate Infections Comments: Stop with fasting No stool WBCs
  11. 11. Mechanisms of Diarrhea  Increased motility: Defect: Decreased transit time Example: Irritable bowel syndrome
  12. 12. Mechanisms of Diarrhea  Exudative Diarrhea: Defects: Inflammation Decreased colonic reabsorption Increased motility Examples: Bacterial enteritis Comments: Blood, mucus and WBCs in stool
  13. 13. Mechanisms of Diarrhea  Secretory: Defect: Increased secretion Decreased absorption Examples: Cholera Toxinogenic E.coli Comments: Persists during fasting No stool leukocytes
  14. 14. Mechanisms of Diarrhea E. Coli bacteria •Contaminated food or water •Usually affect small kids
  15. 15. Mechanisms of Diarrhea Salmonella enteritidis bact •In contaminated raw or undercooked chicken and eggs
  16. 16. Bacterial enterocolitis  Sign of inflammation – blood or pus in stool, fever Shigella bacteria Campylobacter bacteria
  17. 17. Cryptosporidium • in contaminated water – can survive chlorination Parasites Giardia lamblia • in contaminated water •Usually not associated with inflammation
  18. 18. • Food Poisoning Staphylococcus aureus • Produces toxins in food before it is eaten •Usually food contaminated left unrefrigerated overnight
  19. 19. • Food Poisoning Clostridium perfringens • Multiplies in food •Produces toxins in SI after contaminated food is eaten
  20. 20. Acute non infectious diarrhea 1.Dietetic: overfeeding, hyperactive gastrocolic reflex, bad feeding, starvation diarrhea. 2.Drugs: Oral antibiotics, laxatives. 3.Parentral diarrhea (2ry GE) - infection outside GIT (AOM)
  21. 21. Complications of Diarrhea  Dehydration  Metabolic Acidosis  Acute Renal Failure.  Shock  Electrolyte disturbance.  Convulsions.  CNS infections: meningitis & encephalitis.  Malnutrition (PCM).
  22. 22. Complications of Diarrhea 1.Dehydration -Due to vomiting & diarrhea -The main cause of death in GE. -Other causes: 1. hyperventilation 2. Excessive sweating 3. burn 4. polyuria
  23. 23. Degree of Dehydration Factors Mild < 5% Moderate 5-10% Severe >10% General Condition Well, alert Restless, thirsty, irritable Drowsy, cold extremities, lethargic Eyes Normal Sunken Very sunken, dry Anterior fontanelle Normal depressed Very depressed Tears Present Absent Absent Mouth + tongue Moist Sticky Dry Skin turgor Slightly decrease Decreased Very decreased Pulse (N=110- 120 beat/min) Slightly increase Rapid, weak Rapid, sometime impalpable BP (N=90/60 mm Hg) Normal Deceased Deceased, may be unrecordable Respiratory rate Slightly increased Increased Deep, rapid Normal Reduced Markedly reduced
  24. 24. Types of dehydration Isotonic (isonatremic) Hypertonic (hypernatremic) Hypotonic (hyponatremic) Loses H2O = Na H2O > Na H2O < Na Plasma osmolality Normal Increase Decrease Serum Na Normal Increase Decrease ECV ICV Decrease maintained Decrease Decrease +++ Decrease +++ Increase Thirst ++ +++ +/- Skin turgor ++ Not lost +++ Mental state Irritable/lethargic Very irritable Lethargy/coma shock In severe cases Uncommon Common
  25. 25. Examination
  26. 26. Complications of dehydration 1.Shock 2. Acute Renal Failure 3. Metabolic acidosis 4. Electrolyte disturbance 5. Convulsions 6. DIC 7. Metabolic alkalosis
  27. 27. Complications of Diarrhea 2. Shock: - types (hypovolemic & septic) - Clinically: 1. hypotension and rapid pulse 2. Decreased vital organ perfusion 3. Decreased peripheral perfusion
  28. 28. Complications of Diarrhea 3. Acute renal failure: - due to: hypovolemia & untreated pre-renal failure - Clinically: 1. oliguria 2. edema 3. acidotic breathing
  29. 29. Complications of Diarrhea 4. Metabolic acidosis: - due to: loss of HCO3 in stool & ARF - Clinically: 1. disturbed consciousness 2. altered blood gases( --ph& --Paco2& --hco3) 3. acidotic breathing
  30. 30. Complications of Diarrhea 5. Convulsions: - due to: 1.Hypoglycemia 2.Febrile convulsions 3.CNS infections 4.Hypocalcaemia 5.Brain edema
  31. 31. Complications of Diarrhea 6. CNS infection: - due to meningitis & Encephalitis 7. Electrolyte Disturbance a. Hypokalemia b. Hypocalcaemia c. Hyponatremia
  32. 32. Complications of Diarrhea 8. Bleedig: - due to DIC & RVT& Intussusception & Hypoprothrombinemia 9. PCM (malnutrition) 10. Persistent diarrhea

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