Acute Gastroenteritis in children

1. Gastroenteritis in
Children
ByBy
Dr. Youssef QudaDr. Youssef Quda
MSc. PediatricsMSc. Pediatrics
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3. 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).

4. 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

5. 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.

6. 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

7. 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

8. Causes of Gastroenteritis
Bacterial:
Salmonella, shigella, enteroinvasive E coli
Enterhemorrhgic E coli
 Criteria:
- Common in summer
- With high fever
- Cramping abdominal pain

9. 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

11. Mechanisms of Diarrhea
 Osmotic
 Secretory
 Exudative
 Motility disorders

12. 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

13. Mechanisms of Diarrhea
 Increased motility:
Defect:
Decreased transit time
Example:
Irritable bowel syndrome

14. Mechanisms of Diarrhea
 Exudative Diarrhea:
Defects:
Inflammation
Decreased colonic reabsorption
Increased motility
Examples:
Bacterial enteritis
Comments:
Blood, mucus and WBCs in stool

15. Mechanisms of Diarrhea
 Secretory:
Defect:
Increased secretion
Decreased absorption
Examples:
Cholera
Toxinogenic E.coli
Comments:
Persists during fasting
No stool leukocytes

16. Mechanisms of Diarrhea
E. Coli bacteria
•Contaminated food or water
•Usually affect small kids

17. Mechanisms of Diarrhea
Salmonella enteritidis bact
•In contaminated raw or
undercooked chicken and eggs

18. Bacterial enterocolitis
 Sign of inflammation – blood or pus in stool,
fever
Shigella bacteria
Campylobacter
bacteria

19. Cryptosporidium
• in contaminated water –
can survive chlorination
Parasites
Giardia lamblia
• in contaminated water
•Usually not associated
with inflammation

20. • Food Poisoning
Staphylococcus aureus
• Produces toxins in food before it is eaten
•Usually food contaminated left unrefrigerated
overnight

21. • Food Poisoning
Clostridium perfringens
• Multiplies in food
•Produces toxins in SI after contaminated food is eaten

23. 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)

24. Complications of
Diarrhea
 Dehydration
 Metabolic Acidosis
 Acute Renal Failure.
 Shock
 Electrolyte disturbance.
 Convulsions.
 CNS infections: meningitis & encephalitis.
 Malnutrition (PCM).

25. 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

26. 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

27. 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

28. Examination

29. Complications of
dehydration
1.Shock 2. Acute Renal Failure
3. Metabolic acidosis
4. Electrolyte disturbance
5. Convulsions
6. DIC
7. Metabolic alkalosis

30. Complications of Diarrhea
2. Shock:
- types (hypovolemic & septic)
- Clinically:
1. hypotension and rapid pulse
2. Decreased vital organ perfusion
3. Decreased peripheral perfusion

31. Complications of Diarrhea
3. Acute renal failure:
- due to: hypovolemia & untreated pre-renal failure
- Clinically:
1. oliguria
2. edema
3. acidotic breathing

32. 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

33. Complications of Diarrhea
5. Convulsions: - due to:
1.Hypoglycemia
2.Febrile convulsions
3.CNS infections
4.Hypocalcaemia
5.Brain edema

34. Complications of Diarrhea
6. CNS infection: - due to meningitis &
Encephalitis
7. Electrolyte Disturbance
a. Hypokalemia
b. Hypocalcaemia
c. Hyponatremia

35. Complications of Diarrhea
8. Bleedig: - due to DIC & RVT&
Intussusception & Hypoprothrombinemia
9. PCM (malnutrition)
10. Persistent diarrhea