Vomitting and diarrhea in children

Question 1

definition of diarrhoea

Answer 1

defined as 3 or more loose stools in a day

Question 2

causes of diarrhea in developed countries ;

Answer 2

1. rotavirus
   2, adenovirus
2. calcivirus
3. astrovirus

Question 3

causes of diarrhea in less developed countries

Answer 3

1. rotavirus
2. Ecoli
3. Adenovirus
4. Parasites
5. Astrovirus/Calcivirus
   Rota virus is responsible or 1/3 of cases of severe diarrhea globally each year

Question 4

Acute diarrhea

Answer 4

1. occurs for less than 10 days
2. caused by ;
   - Acute gastroenteritis
   - Appendicitis
   - other

Question 5

persistent diarrhea

Answer 5

1. Persistent diarrhea < 14 days

2. Consider malabsorbtion problems - manifestation of malnutrition

Question 6

‘red flags’ of vomit

Answer 6

1. bile in vomit - surgical causes
2. blood in vomit - acute bleed if red
3. coffee ground in vomit

Question 7

causes of vomiting coffee grounds

Answer 7

1. old blood has been oxidised
2. gastro - oesophaegeal reflux
3. Mallory weiss tear - tearing of mucous membrane in oesophagus
4. swallowed blood - e.g. nose bleed
5. rarely
   - coagulation disorders
   - peptic ulcers

Question 8

red flags of diarrhea

Answer 8

1. Bloody diarrhoea
   - high risk of bacterial diarrhea such as salmonella/shigella/campylobacter
   - campylobacter or E coli
2. Short/abnormal gut
   - high risk of dehydration as v little fluid able to be absorbed from the gut
   - needs to see a paediatrician

Question 9

3 x Ds in diarrhea

Answer 9

1. Dehydration
2. Diet
3. Drugs

Question 10

Dehydration in diarrhea

Answer 10

3 categories of dehydration

1. normal hydration
2. clinical dehydration
3. shock

Question 11

signs of dehydration in children

Answer 11

1. altered responsiveness
2. sunken eyes
3. tachycardia
4. tachypnoea
5. reduced skin turgor

Question 12

signs of shock in children

Answer 12

1. decreased level of consciousness
2. mottled/cold extremities
3. tachycardia
4. tachypnea
5. reduced capillary refill time

Question 13

management of dehydration

Answer 13

1. normal hydration - continue feeds and encourage fluid intake
2. clinical dehydration
   - give oral rehydration solution
   - alternative is dilute apple juice
3. Shock
   - give IV fluids

Question 14

how does oral rehydration solution work

Answer 14

• Na and Glucose enter the enterocyte via Sodium-Glucose co transport channel from the lumen of the large intestine
• Na + leaves eneterocyte via NA+/K+/ATPASE
• Glucose leaves via GLUT2 channel
• This creates an osmotic gradient by which water is reabsorbed by the interocyte form the gut lumen more effectively

Question 15

Diet

Answer 15

1. after rehydration
   - full strength milk straight away
   - reintroduce usual solid food
   - avoid fizzy drinks

Question 16

Drugs

Answer 16

1. Antibiotics
   - do not give
   - most diarrhea is viral
   - ECOLI diarrhea treated with antibiotics makes more likely for comp - hemolytic uraemic syndrome which damages the kidneys
2. Anti emetics - stops them being sick but children are much more sensitive to the side effects : neurological/dyskinetic side effects
3. Anti diarrheals - not recommended in children

DONT GIVE NO DRUGS

Question 17

Rotavirus

Answer 17

1. causes 1/3 of cases of diarrhea worldwide
2. 92% of immunity in europe
3. only 76% of immunity is South Africa due to
   - poor nutritional status
   - enteric co infections
   - antirotavirus antibodies in breast milk
   - co administration of oral poliovirus vaccine