Diarrhoea (Management of acute diarrhoea: (Assess hydration status and…
Management of acute diarrhoea:
Assess hydration status and vital signs = how severe is it?
If mild/moderate but able to take oral fluids >> oral glucose/electrolyte rehydration fluid
Severe shock/dehydration >> admit and do IV fluid and electrolyte replacement.
they will need bloods, FBC, stool MCS, U&Es etc
Hydration status exam:
Basic obs - HR, BP in particular
Check orthostatic BP in older children.
Temperature - fever?
Mucous membranes - look inside their mouth. Sunken eyes?
Anterior fontanelle in children (closes around 18-24mo?)
Pulses - radial, brachial, femoral. If thready - worrying.
Capillary refill - hand nails peripheral (but nb vasoconstriction) and central on the sternum. HOLD FOR 5s, then see if <2s.
Skin turgor - assess on belly skin, pinch gently. If slow to retract = dehydrated, if 'tenting' - v v worrying
Like to look at their weight and compare to previous if possible - sudden weight loss suggests water loss?
to check renal function (volume depletion), consider HUS if really bad and further tests - LDH, blood smear, haptoglobin.
Look for infection, dehydration (haemoconcentration), anaemia/thrombocytopaenia in HUS
Stool cultures if they have diarrhoea + fever.
check for parasite and virus in poo - special tests
dip - UTIs commonly cause diarrhoea
Blood cultures if SEPTIC
RED FLAGS for clinical dehydration:
Altered responsiveness, decreased urine output, sunken eyes, dry mucous membranes, fast HR, fast RR, reduced skin turgor
RED FLAGS for SHOCK:
Decreased level of consciousness, pallor, cold extremities, grossly sunken eyes, dry mucous membranes, fast HR, fast RR, weak peripheral pulses, prolonged cap refill, reduced skin turgor, hypotension (decompensation)
: i.e. diarrhoea that persists for >14 days. Can also be caused by ongoing acute diarrhoea
Age: neonate - 2 years old
6mo-5years (usually resolves by 5 years)
. 'peas and sweetcorn' poo, varied consistency, may be explosive as well as loose, often smelly.
Children are WELL and THRIVING.
(maturational delay in gut motility development >> gut hurry)
Often presents with colicky intestinal pain, flatus, abdo distension.
Investigation and examination are normal.
Increase fat intake to slow gut transit, more fibre, decrease fruit juice/sugary intake
Conservative mx - reassure parents. Increased fibre and fat to slow gut transit time. Reduce sugary drink/food intake to prevent osmotic diarrhoea exasperation.
Stool sample MCS, check for parasites, viral
TTG - coeliac?
Cow's milk protein allergy
. Would by a wasted child, FAILURE TO THRIVE, pale
- multiple aetiologies:
Classical triad of malabsorption is:
abnormal poo (true - hard to flush down the loo and really pongy)
FTT or poor growth (usually)
specific nutrient deficiencies
Post-infective gastroenteritis syndrome
- they've had gastroenteritis and when the normal diet is reintroduced, they get a watery stool. Usually resolves with 24h more of oral rehydration sachets then normal diet.
- begins after child has been weaned onto wheat containing foods (8-24mo)
Reaction to gliadin component of wheat, inflammatory destruction to gut villi >> blunting.
Presents with FTT, BUTTOCK WASTING, ADBO DISTENSION (acute)
Now picked up earlier - may just be non-specific GI symptoms, anaemia, nutrient deficiencies, growth failure.
- gut doesn't absorb lactose so it is kept in the colon and draws water out with it (osmotic diarrhoea)
Excessive fluid intake?
IBD - inflammatory
IBS - functional gut hypersensitivity and dysmotility
Constipation (spurious diarrhoea)
In examination - as well as assessing fluid status also look for extraintestinal signs of GI disease.
Abdo exam if there is a mass suggests surgical cause - if so , consider intussception, toxic megacolon, appendicitis. Consider imaging to help.
: change in consistency and frequency of stools - enough loss of fluid and electrolytes to cause illness
Inflammatory causes: Allergy, cows milk protein, lactose etc., IBD, (older children), NEC (infants)
Most commonly infective gastroenteritis
Haemolytic uraemic syndrome - can get diarrhoea
Whipple's disease (rare bacterial infection) that presents with abdo pain, diarrhoea, malabsoprtion syndrome and weight loss - most common in men >40yo???
Other infections in the bod - otitis media, UTI, sepsis can also cause diarrhoea
Fever +/- vomiting (gastroenteritis)
Diarrhoea +/- blood stools (colitis)
Dehydration and decreased consciousness