Diarrhea Disease

              General introduction

Concept    common disease in childhood

 

                  frequency and characters of stool

 

Ages          6m~2y      50% ＜1y

 

Seasons     viral origins—late autumn and spring beginning
           bacterial origins—summer

                   noninfectious diarrhea— every season

 

  Predisposing factor-1

Ø   Gastric acid secretion   , secretion and activity of enzyme  , quality and quantity of diet change quickly.

Ø   Water metabolism  ，tolerance of hydropenia  ，easy to body fluid disorder.

Ø   Nerves, endocrine, circulation, liver and renal function: not mature, easy to digestive tract function disorder.

 

 

Grow and develop   , demand for nutrients    , burden of the stomach and intestines   , easy to indigestion.

 

Artifical feeding: enteritis morbility 10 times higher

                              than breast feeding.

milk: nutritional ingredient destroyed

milk tool: disinfection.

 

 Ø   Rotavirus

Ø   Astrovirus

Ø   Calicivirus: Norwalk virus,  sapovirus

Ø   Enterovirus: Coxsackie virus, echovirus,  enteric adenovirus

Ø   Coronavirus: torovirus

 

o    Bacillus coli 

   enteropathogenic E. coli ………………………EPEC
    enterotoxigenic E. coli …………………………ETEC
    enteroinvasive E. coli …………………………..EIEC
    enterhemorrhagic E. coli ………………………EHEC
    enteroadherent aggregative E. coli ……………EAEC

 

o    Campylobacter jejuni, Yersinia enterocolitica, others

o    Fungi ：blastomyces albicans

o    Protozoa (parasite) ：giardia lamblia, amebic protozoa

 

Ø    Disorder intestinal function

Ø    Infect intestinal tract directly

Ø    Irritation of rectum (eg. bladder infection)

                                                     alteration of intestinal flora

Ø    Much antibiotics used          transport of carbohydrate

                                                     lactase

 

                                                     o   Dietary factors

*  quality and quantity of food (feeding starch and fat too early)

*  Allergic diarrhea: milk or bean

*  Primary and secondary disaccharidase deficiency

 

 

 

Ø    Osmotic diarrhea: much poorly absorbed and hyperosmotic solute

Ø    Secretory diarrhea: electrolytes hypersecretion

Ø    Exudative diarrhea: inflammatory states causing liquor exudation

Ø    Motility disturbance: dynamic abnormality of intestine

Ø    Noninfectious diarrhea: feeding factors

 

 

 o   Dehydration

o   Metabolic acidosis

o   Electrolytes disorder

Mild and severe  diarrhea

 

Ø    Mild: the times of stool and character change

      

    —— stool :frequency ,loose, liquid,

               color: yellow or greenyellow,

               smell: sour flavor, shape: egg soup 

   —— vomiting: seldom

   —— general  poisoning symptom: without

   —— dehydration, electrolytes abnormality

        and general toxicity symptoms': none

Mild and severe  diarrhea

Ø    Severe: accompany dehydration, electrolytes

    abnormality and  general toxicity symptoms

    — digestive tract symptom : diarrhea serious ,mucus blood  sample stool, anorexia, nausea, abdominal                    

      pain  and abdominal distention

 

 

 

    — general  poisoning symptom : lethargy, dysphoria,

                                            unconsciousness and coma

 

    — dehydration, electrolytes abnormality ,

          acid base  imbalance

       

 

      Severity clinical signs of dehydration

 

Ø    Vomiting and diarrhea :Alkalinity intestinal juice lost

Ø    Eat  :calorie  , malabsorption®lipoclasis ®keto-bodies

Ø    Hypovolemia®pachemia®blood flow slowly®

       hypoxia®  anaerobic glycolysis ® lactic acid

Ø    dehydration® blood flow  ®excluding acid   ®

       acid metabolic product

 

Ø    Dispirited, dysphoria, drowsiness, coma

Ø    Hypernea  (Kussmauls  breathing)，exhalation cool

Ø    Expiratory gas smells ketone

Ø    Cherry lips

Ø    Nausea, vomit

 

K⁺  (potassium)<3.5mmol/L (normal: 3.5～5.5 mmol/L)

causes：

Ø    Excessive losses: vomit, diarrhea.

Ø    Inadequate intake.

Ø    Renal function of keeping kalium    ,it continues excluding kalium when with hypokalemia.

 

Ø    depressed

Ø    Tension of skeletal muscle ，tendon reflex，

       even respiratory muscle weakness

Ø    Tension of smooth muscle   , abdominal distention

       intestinal sound  or disappear

Ø    Myocardium excitability   , arrhythmia, ECG: T-wave

       is low or inversion, U-wave occurs, prolonged P-R

       interval and Q-T interval, ST section descending.

Ø    Baseosis

 

Ø     Ca²⁺﹤1.75mmol/L (7mg/dl) ;

       Mg²⁺﹤0.6mmol/L (1.5mg/dl).

 

Ø    Symptoms usually occur after dehydration and

      acidosis resolved, or fluid replacement.

Ø    Clinical manifestation: thrill, tetany, convulsion.

 

Ø    If convulsion hasn’t relieved after supplement

 

 

 

      calcium,  pay attention to hypomagnesemia.

 

 

 

Ø    Season: cool months (autumn and winter)

Ø    Age: 6m~2y

Ø    Symptom: fever, vomit, mild general toxicity symptoms.

Ø    Stool: frequency, amount, water; yellow-water or egg soup-like; a small amount of mucus.

Ø    Dehydration: mild/moderate，isotonic/hypertonic

Ø    Complication: convulsion, myocardium damaged.

Ø    Prognosis: self-limited, course: 3~8d.

Ø    Viral antigen detection: from stool.

 

Ø    Season: summer

Ø    Symptom: vomit and diarrhea, no obvious general toxicity symptoms.

Ø    Stool: water-like or egg soup-like, without mucus, blood or pus, no WBC (test under microscope).

Ø    Dehydration: dehydration, electrolyte and acid-base disorder usually occur.

Ø    Prognosis: self-limited, course: 3~7d.

 

Ø    Similar with bacillary dysentery.

Ø    Symptom: diarrhea with fever, nausea, vomit, abdominal pain, tenesmus. Severe general toxicity symptoms, e.g. ardent fever, consciousness change, even septic shock.

Ø    Stool: with mucus, blood and pus, smell of fish, with WBC (test under microscope).

Ø    Stool culture: pathogenic bacterium.

 

Ø    Pathogen: usually Blastomyces albicans.

Ø    Age: ﹤2y.

Ø    Complication by other infection, or after using antibiotics for long time.

Ø    Persistent course, usually thrush companion.

Ø    Stool: yellow thin stool, more foam with mucus, sometimes tofukasu-like.

Ø    test under microscope: fungal spore and hypha.

 

 

Ø    Gastric mucosa analosis ® bacterium and yeast fungus

Ø    Intestinal mucosa thinner®indigestion and malabsorption

Ø    Bacterium in upper small intestine ®enterocyte damaged

Ø    Dynamic abnormality of intestine.

Ø    Using antibiotics for long time.

Ø    Immune function defect ® liability to agents  

 

vicious cycle

 

 

o   Not difficult

o   According to clinical manifestation, laboratory tests and character of stool.

 

 

 

 

Ø    Usually ﹤6m, bloating, breast-feeding.

Ø    Usually with eczema.

Ø    Normal appetite, growth and developed.

Ø    After cofood addition, stool turns to normal.

Ø    A special type of lactose intolerance

 

Ø    Epidemiology character

Ø    Stool culture: a dysentery bacillus discovered

 

Ø    Symptom: ardent fever, severe toxicity symptoms, abdominal pain and distension, vomit frequently.

Ø    Stool: first, yellow thin or egg soup-like;

                then, red pasty or adsuki bean soup-like.

Ø    X-ray of abdomen: local aerate and expansion in  

                small intestine, intestinal wall pneumatosis.

 

 

*   Adjust and continue feeding,  not abrosia or

      restricting water, prevent malnutrition.

*   Prevent and cure dehydration.

*   Rational administration: proper antibiotics, microecosystem preparation, assist-digestive drugs, mucosa protectant, antivomit drugs. Usually disusing antidiarrheal.

 

*   Strengthen nursing, symptomatic treatment, prevent

      complications.

*   Fluid therapy (next week lesson)