Diarrhea

Question 1

What is acute diarrhea?

Answer 1

Disruption of the normal intestinal net absorptive versus secretory mechanisms of fluids and electrolytes, resulting in excessive loss of fluid into the intestinal lumen.
Which can lead to dehydration, electrolyte imbalance, and in severe cases, death in those also malnourished.
<2 yo = daily stool volume greater than 10 ML/ KG.
>2 yo = >4/24 hours
Duration can last up to 14 days

Question 2

How do viruses cause acute diarrhea?

Answer 2

They can injure the absorptive surface of mature villus cells, which reduces the amount of fluid absorbed. Some can release viral enterotoxin (i.e. rotavirus). The loss of water and electrolytes ensues and there can be volumes of watery diarrhea, even if the child is not being fed.

Question 3

How do bacteria and parasites cause acute diarrhea?

Answer 3

Can adhere &/or translocate, causing non inflammatory diarrhea. Bacteria can also damage the anatomy and functional ability of the intestinal mucosa by direct invasion. Some bacteria release endotoxins, whereas others release cytotoxins that can result in the excretion of fluid, protein, and cells into the intestinal lumen and an inflammatory response in some cases.

Question 4

What are bacterial causes of acute diarrhea?

Answer 4

Food borne disease diarrheal diseases are most commonly due to salmonella & campylobacter species, followed by shigella, cryptosporidium, & E coli. C diff has been associated with pseudomembranous colitis and diarrhea after the use of antibiotics; it is not a causative agent in most antibiotic associated diarrhea in children.

Question 5

What are viral causes of acute diarrhea?

Answer 5

Noroviruses & rotaviruses are the most common, followed by adenovirus & astroviruses.

Question 6

What symptoms indicate a potentially serious infection of the upper intestine?

Answer 6

• Foodborne illness suspected
• Bloody diarrhea, weight loss, dehydration, severe abdominal pain, and fever
• Diarrhea lasting several days with more than three stools per day
• Neurological involvement on PE

Question 7

What are diagnostic studies for acute diarrhea?

Answer 7

Testing is only ordered if a more serious infection may be present. see table.
Start list
• stool exam (color, consistency, blood, mucus, plus, order, volume)
• Stool: pH (less than 5.5 suggest chors intolerance typically a viral infection), leucocytes (suggest bacterial invasion), reducing substances (viral infections), and occult blood. Normal stool:PH greater than 5.5, carbohydrate negative
• Stool cultures should be considered early in the course of illness for bloodier polong diarrhea; In the presence of leukocytes; If clinical signs of colitis are present; For food for suspected foodborne illness outbreaks; In the immuno compromised; Or after recent travel abroad
• Electrolytes, if indicated, to evaluate degree of dehydration and for more serious signs and symptoms of infectious disease.
• CBC is indicated for serious infectious disease

Question 8

what are differential diagnosis for acute diarrhea?

Answer 8

Diarrhea from viral etiology and antibiotic use to the most common causes and all age groups. Systemic infection is a common cause in infants and children, and food poisoning is a common cause in children and teens. Overfeeding could be considered an infant. Rare causes of acute diarrhea in infants include primary disaccharidase deficiency, hirschsprung toxic colitis, adrenal genital syndrome, a neonatal opiate withdrawal; toxic ingestion and children,; It hyperthyroidism in teens.

Question 9

What is the treatment of acute diarrhea?

Answer 9

• restore maintain hydration and correct/ maintain electrical light electrolyte and acid base balance. Oral rehydration with an oral electrolyte solution when dehydration assessed between 3 to 9%. Administer parenteral hydration if necessary for the following: impaired circulation and possible shock, weight less than four to five kilograms or a child younger than three months old, intractable diarrhea, lethargy, anatomic anomalies, or failure to gain weight for continued weight loss despite oral fluids table
• Maintain nutrition. Resume early refeeding because contents of the bowls law
• Prescribe antibiotics prudently. Antibiotics are recommended for those caused by G. Lamblia, V. Cholera, and shigella.
• Treat any related such as sepsis and cardiovascular collapse.

Question 10

what adjunct medication and treatments are common outside of the US?

Answer 10

• antidiarrheals
• Probiotics: Lactobacillus Cassie strain Gigi or S. Belardi (a yeast)
• Oral enteric peppermint oil capsules
• Sync:

Question 11

what are complications of acute diarrhea?

Answer 11

Table

Question 12

What are preventative measures for acute diarrhea?

Answer 12

• good hand washing
• Good sanitation and appropriate removal of soiled clothing and diapers
• Avoid contaminated sources; Meat should be properly cooked
• Promote exclusive breastfeeding for first six months of life
• Promote appropriate supplementations starting at six months
• Avoid unnecessary antibiotic usage
• Promote well-functioning sewage system
• Promote rotavirus vaccine

Question 13

What is chronic diarrhea?

Answer 13

Loose stools <10ML/ KG/ D in infants & <200 grams/ 24 hours in older children

Question 14

What are common causes of chronic diarrhea in children?

Answer 14

See table.

Question 15

How do you diagnose chronic diarrhea?

Answer 15

• Stool: culture, O& P (best done on three specimens collected on separate days), pH, reducing substances, or cold blood, leucocytes, fat and fecal elastase (to evaluate for pancreatic insufficiency)
• CBC with diff, lights, albumen
• UA and you see in young children

Question 16

What additional testing can be ordered as indicated by history and physical exam for possible differential diagnosis for chronic diarrhea?

Answer 16

• ESR, CRP
• Hormonal studies for secondary to assess for secretary tumors
• Breath hydrogen test for lactose or sucrose intolerance (difficult to assess and infants)
• Viral serologies, such as HIV or CMV
• Sweat chloride test
• Endoscopy, barium studies end listwhat are differential diagnosis for chronic diarrhea?
• See table for common causes of chronic diarrhea in children

Question 17

what is treatment for chronic diarrhea?

Answer 17

• treat the underlying cause
o chronic nonspecific diarrhea (toddlers diarrhea): normalize the diet; Remove offending foods and fluids; Eliminates sorbitol and fructose containing fluids; Reduced fluid intake to no greater than 90ML/ KG/24 hours (give half of fluid as milk) increase fat intake up to 35 to 40% of the diet; Increase fiber to bulk up stools
• Treat carbohydrate malabsorption by decreasing lactose or sucrose; Add lactose or sacro cities as indicated by particular carbohydrate intolerance
• Post gastroenteritis malabsorption syndrome (evidenced in infants with weight loss and fat globules in the stool) can be given a preja jested formula if tolerated, for three to four weeks.

Question 18

Which patients should be referred to GI with chronic diarrhea?

Answer 18

• Newborns with diarrhea in the first hours of life
• growth delay or failure or abnormal physical findings (anorexia, abdominal pain, chronic bloating, vomiting, or weakness)
• severe illness.

Question 19

What are complications of chronic diarrhea?

Answer 19

Malnutrition, growth failure, and cognitive/developmental impairments can occur (found more in developing countries)

Question 20

What are patient and family education points for intestinal parasites?

Answer 20

Most parasitic infestations can be prevented by good hand washing and good sanitation. The following preventative measures are recommended:
• travelers in developing countries need to eat only foods that can be peeled or have been cooked
• G lamblia: encourage good hand hygiene preventing contamination of water sources. Treat questionable water with iodine, boiling for 20 minutes, or use commercial filters to filter contaminated water. Exclude symptomatic children and staff from school and daycare until asymptomatic.
• Eve Verma colaris: avoid scratching. Wash sheets and clothing in hot water and detergent.
• A lumber codes parentheses appropriate food preparation is necessary to prevent infection when human feces are used for fertilizer thoroughly cooked or soaked fruit and vegetables and diluted iodine solution before consuming consuming. Periodic empiric treatment of children may prevent nutritional and cognitive difficulties in endemic areas
• TAENIA: avoid raw or undercooked beef or pork.

Question 21

What are intestinal parasites?

Answer 21

Various protozoa and helminths can invade the GI tract and cause disease. All can multiply within the human body, are associated with diarrhea symptoms, and are spread by fecal contamination due to poor water and sewage disposal practices. Cysts of these parasites are often resistant to chlorine.

Question 22

What are helminths?

Answer 22

• They are worms. Nematodes (roundworms), cestodes (tapeworms), trematodes (flatworms) most commonly reside in the human intestines but don’t multiply there.
• Some helminths (hookworms and whip worms) release larvae into the soil; Humans become infected when they walk barefoot on contaminated soil and the skin is penetrated by larvae. The larvae they travel to the lungs & intestines. Eggs can also be excreted in stool.

Question 23

What are some common intestinal parasites that affect the pediatric population?

Answer 23

Enterobius vermicularis (pinworm), ascaris lumbricoides (roundworm), & taenia (tapeworm).

Question 24

What are patient and family education points for intestinal parasites?

Answer 24

Most parasitic infestations can be prevented by good hand washing and good sanitation. The following preventative measures are recommended:
• travelers in developing countries need to eat only foods that can be peeled or have been cooked
• G. lamblia: encourage good hand hygiene preventing contamination of water sources. Treat questionable water with iodine, boiling for 20 minutes, or use commercial filters to filter contaminated water. Exclude symptomatic children and staff from school and daycare until asymptomatic.
• E. vermicularis: avoid scratching. Wash sheets and clothing in hot water and detergent.
• A. lumbricoides: appropriate food preparation is necessary to prevent infection when human feces are used for fertilizer thoroughly cooked or soaked fruit and vegetables and diluted iodine solution before consuming. Periodic empiric treatment of children may prevent nutritional and cognitive difficulties in endemic areas
• TAENIA: avoid raw or undercooked beef or pork.