Gastroenterology Book

http://www.fpnotebook.com/

Diarrhea in ChildrenAka: Pediatric Diarrhea

Advertisement

  1. See Also
    1. Pediatric Vomiting
      1. Vomiting takes priority over pediatric Diarrhea
    2. Triage of Children with Diarrhea
  2. Definitions: Diarrhea
    1. See also Stools in Breast Fed Infants
    2. General
      1. Sudden increased stool frequency and looseness
    3. Mild Diarrhea
      1. Mushy stools
    4. Severe Diarrhea
      1. Any Age
        1. Stools hourly for >5 hours
      2. Age under 1 year
        1. Stools >9 in 24 hours
      3. Age 1-2 years
        1. Stools >14 in 24 hours
      4. Age >2 years
        1. Stool >19 in 24 hours
    5. Green Stools
      1. Suggests very rapid transit
      2. Seen in moderate to severe Diarrhea
  3. Causes: Common infections
    1. Febrile Diarrhea
      1. Rotavirus (fever in 50% of cases)
        1. Seen in under age 5 years during winter
        2. Fecal Leukocytes present in 12% of cases
      2. Escherichia coli (fever in 20% of cases)
        1. Seen in Summer
      3. Campylobacter (fever in 80% of cases)
        1. Occurs all year but peaks in July
        2. Bloody Diarrhea with Fecal Leukocytes
    2. Non-febrile Diarrhea
      1. Norwalk virus
      2. Giardia lamblia
  4. History
    1. Onset and Duration of Diarrhea
    2. Fever and associated symptoms
    3. Emesis Frequency
    4. Stool Frequency and Character
      1. Watery stools
      2. Foamy stools
      3. Bloody stools
    5. Urinary output
    6. Feeding history
    7. Behavior and activity
    8. Recent Medications
      1. Antibiotics in the last 3 months
    9. Possible ingestions
    10. Contagious contacts
    11. Recent travel
    12. Pet exposure
  5. Signs: Red Flags
    1. Fever over 103 degrees Fahrenheit
    2. Systemic illness
    3. Tenesmus
    4. Bloody Diarrhea
    5. Prolonged course longer than 2 weeks
    6. Pediatric Dehydration
  6. Labs: Fecal specimen (Indicated for red flags above)
    1. Stool Ova and Parasites
    2. Direct fecal smear for Stool Leukocytes
      1. Stool Leukocytes absent: Stool Culture
        1. Salmonella
        2. Yersinia
        3. Aeromonas
        4. Escherichia coli
          1. Enterotoxigenic E. coli (ETEC)
          2. Enteroadherent E. coli (EAEC)
        5. Clostridium Dificile
      2. Stool Leukocytes present: Stool Culture
        1. Most commonly cause Fecal Leukocytes
          1. Shigella
          2. Campylobacter
          3. Escherichia coli
            1. Enteroinvasive E. coli (EIEC)
            2. Enterohemorrhagic E. coli (EHEC)
        2. Less commonly cause Fecal Leukocytes
          1. Yersinia
          2. Salmonella
          3. Clostridium difficile
          4. Aeromonas
          5. Plsiomonas
  7. Management
    1. See Diarrhea Management in Children
    2. See Management of Moderate Diarrhea under age 2 years
    3. See Management of Mild Diarrhea under age 2 years
    4. See Pediatric Diarrhea Fluid Replacement
    5. See Oral Rehydration Solution

Navigation Tree