Diarrhoea Flashcards
What are causes of acute diarrhoea?
Gastroenteritis
May be an early sign of any septic illness
What are causes of chronic diarrhoea
Cow’s milk intolerace
Toddler’s diarrhoea
Coeliac disease
Post-gastroenteritis lactose intolerance
Breastfed babies normally have liquid stools
What is the most common cause of gastroenteritis in children?
Rotavirus
(Norovirus is most common in adults)
Most common bacterial cause - campylobacter jejuni
Shigella nad salmonella are associated with dysentry (blood and pus in stool)
Protozoa/parasite - Giardia lambia, cryptosporidium
What is the presentation of gastroenteritis?
Diarrhoea may last up to a week
Loos watery stools
Often accompanied by vomiting
Recent travel
Recent contact with person diarrhoea/vomiting
Risk of severe dehydration leading to schock
How can dehydration be assessed?
Weight loss:
<5% body weight
Clinical dehydration 5-10% body weight lost
Shock >10% body weight lost
Sunken fontanelle Dry mucous membranes Eyes sunken and tearless Prolonged capillary refill Pale mottled skin Tachycardia Weak peripheral pulses Reduced tissue turgor Sudden weight loss Reduced urine output Cold extremities
What is hyponatraemic dehydration?
When children with diarrhoea drink large quantities of water or other hypotonic solutions, there is greater net loss of sodium than water, leading to fall in plasma sodium.
Water therefore shifts from the ECF to the ICF
Increase in intracellular volume leads to increased in brain volume
This may result in seizures, where as extracellular depletion leads to greater degree of shock per unit of water loss
What is hypernatraemic dehydration?
Water loss exceed the relative sodium loss and plasma sodium concentration increases.
This usually results from high insensible water losses (high fever) or from profuse low-sodium diarrhoea.
ECF becomes hypertonic
Water shifts from ICF to ECF so signs of ECF depletion and less per unit of fluid loss
Water is drawn out of the prain and cerebral shrinkage with a rigid skull may lead to increased muscle tone with hyperreflexia, altered consciousness, seizures
What is management of gastroenteritis?
Start oral rehydration therapy e.g. dioralyte
Continue breastfeeding
Offer other fluids - bottle milk or water
Consider ORT via NG
IV therapy if shocked
Advise: diligent hand washing, towels not to be shared, do not return to school until 48 hours after last episode
What is management of hypernatraemic dehydration?
ORal rehydration solution
If IV fluids required, rapid correction of hypernatremia may lead to cerebral oedema dn seizures.
Reduction should therefore be slow
Fluid deficit replaced over at least 48 hours and plasma sodium reduced at less than 0.5mmol/L per hour
What is postgastroenteritis syndrome?
Following episode of gastroenteritis, introduction of normal diet results in watery diarrhoea
Oral rehydration therapy restarted
What is toddler’s diarrhoea?
6-30 month
Multiple loos bowel movements per days sometimes with undigested food - carrots and peas
No evidence of malnutrition
Treat with dietary fibre and fat
decrease fruit juice intake
