Diarrhea in children: Difference between revisions
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===Physical Examination=== | ===Physical Examination=== | ||
*Patients with | *Patients with severe diarrhea usually appear toxic. | ||
*Physical examination may be remarkable for: | *Physical examination may be remarkable for: | ||
:* | :*tenderness | ||
:* | :*low blood pressure | ||
:* | :*dry skin <ref name="urlDiagnosis of Chronic Diarrhea in Children | NIDDK">{{cite web |url=https://www.niddk.nih.gov/health-information/digestive-diseases/chronic-diarrhea-children/diagnosis#:~:text=During%20a%20physical%20exam%2C%20a%20doctor%20typically.%20checks,find%20the%20cause%20of%20chronic%20diarrhea%20in%20children%3F |title=Diagnosis of Chronic Diarrhea in Children | NIDDK |format= |work= |accessdate=}}</ref> | ||
:* | :*history of constipation which may be leading to overflow diarrhea. | ||
:* | :*right lower abdominal quadrant tenderness caused by pseudoappendicitis can also be caused by causes like Yersinia enterocolitica, intussusception, hemolytic uremic syndrome, etc. <ref name="urlDiagnosing and treating diarrhea in children">{{cite web |url=https://notes.childrenshospital.org/diarrhea-in-children/ |title=Diagnosing and treating diarrhea in children |format= |work= |accessdate=}}</ref> | ||
: | |||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Revision as of 19:47, 19 December 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Debduti Mukhopadhyay, M.B.B.S[2]
Synonyms and keywords: Diarrhea in kids
Overview
Historical Perspective
- Hippocrates first coined the term diarrhea which was derived from the Greek word "diarrhoia", which translates into "flowing through".
- It was described as a symptom of a lot of conditions such as intestinal parasites, cholera, and in relation to improper water and food handling.
Classification
- Chronic diarrhea in children may be classified according to the following subtypes/groups:
- Osmotic: due to unabsorbed nutrients
- Secretory: due to imbalances in ion secretion
- Mixed: stool osmotic gap (50-100 mOsm) [2]
Pathophysiology
- The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
- The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
- On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Causes
- Diarrhea in children can be divided into acute and chronic causes:
- Acute:
- use of antibiotics
- gastroenteritis
- allergies
- food poisoning
- Chronic:
- diet-related
- infectious causes
- autoimmune such as celiac
- inflammatory bowel disease [3]
- Few other causes of chronic diarrhea in children are:
- lactose intolerance
- irritable bowel syndrome
- non-specific: from consumption of artificially sweetened drinks in a large amount, eg: sports drinks, juice, etc. [4]
- Covid-19 [5]
Differentiating [disease name] from other Diseases
For further information about the differential diagnosis, click here.
Epidemiology and Demographics
- In 2017, 8% of all deaths in children all over the world were due to diarrhea. [6]
- 2-3 million deaths per year occur every year due to acute diarrhea especially in developing countries.
- 9% of all hospitalizations in the United States under the age of 5 are due to diarrhea.
- In the age group of less than 3 years the incidence of diarrhea is noted to be 1.3-2.3 episodes per child annually. [7]
Age
- In one study conducted in Hanoi, Vietnam on children <5 years of age with diarrhea; it was found that 40.9% were 1 year and below and 71.0% were 2 years and below.
Gender
- Female gender has a lower risk of diarrheal disease. [9]
Risk Factors
- Travel to countries with poor sanitary conditions, swimming, daycare, sick contacts at home and school, antibiotics usage. Autoimmune conditions such as celiac and inflammatory bowel disease. [4]
Natural History, Complications and Prognosis
- Moderate to severe diarrhea can cause dehydration in children. Severe dehydration can cause seizures, dizziness, lack of energy, dry skin, etc. [10]
- Usually prognosis is good, and most cases resolve in a few days.
Diagnosis
Diagnostic Criteria
- The diagnosis of diarrhea is made when either the frequency of bowel movements increases or the consistency of stools becomes looser than what is normal for that child. [4]
Symptoms
Signs and symptoms that indicate severe disease:
- Altered mental status
- Vomiting with bile or blood in it
- Cyanosis
- Increased irritability and/or crying
- Rash
- Fast breathing
- Temperature of 104 F (40C) or more
- Age less than six months or baby with low body weight [11]
Physical Examination
- Patients with severe diarrhea usually appear toxic.
- Physical examination may be remarkable for:
Laboratory Findings
- Measurement of serum bicarbonate concentration of more than 15mEq per L is the laboratory finding used to evaluate 5% or less dehydration. Hypernatremic dehydration can be confirmed by serum sodium levels.
- If there is evidence of blood or mucus in stool, or if the patient is immunocompromised, then stool microbiological tests can be done. They are however, not required in suspected viral cases. [11]
- Stool culture results can sometimes become available only after 3-5 days, in some infectious causes, the organism is not visible even on stool testing. [4]
Electrocardiogram
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
X-ray
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with [disease name].
OR
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
CT scan
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for [disease name]; the mainstay of therapy is supportive care.
- The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action 1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for [disease name].
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
- [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
References
- ↑ "Ancient Origin of the Word 'Diarrhea' and Other Common Medical Terms".
- ↑ Thiagarajah JR, Kamin DS, Acra S, Goldsmith JD, Roland JT, Lencer WI, Muise AM, Goldenring JR, Avitzur Y, Martín MG (June 2018). "Advances in Evaluation of Chronic Diarrhea in Infants". Gastroenterology. 154 (8): 2045–2059.e6. doi:10.1053/j.gastro.2018.03.067. PMC 6044208. PMID 29654747.
- ↑ "Diarrhea in Children - Pediatrics - MSD Manual Professional Edition".
- ↑ 4.0 4.1 4.2 4.3 "Diarrhea in Children - American College of Gastroenterology".
- ↑ D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L (July 2020). "Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management". Clin Gastroenterol Hepatol. 18 (8): 1663–1672. doi:10.1016/j.cgh.2020.04.001. PMC 7141637 Check
|pmc=value (help). PMID 32278065 Check|pmid=value (help). - ↑ "Diarrhoea - UNICEF DATA".
- ↑ Dennehy PH (September 2005). "Acute diarrheal disease in children: epidemiology, prevention, and treatment". Infect Dis Clin North Am. 19 (3): 585–602. doi:10.1016/j.idc.2005.05.003. PMID 16102650.
- ↑ Vu Nguyen T, Le Van P, Le Huy C, Nguyen Gia K, Weintraub A (July 2006). "Etiology and epidemiology of diarrhea in children in Hanoi, Vietnam". Int J Infect Dis. 10 (4): 298–308. doi:10.1016/j.ijid.2005.05.009. PMID 16458564.
- ↑ Pinzón-Rondón ÁM, Zárate-Ardila C, Hoyos-Martínez A, Ruiz-Sternberg ÁM, Vélez-van-Meerbeke A (August 2015). "Country characteristics and acute diarrhea in children from developing nations: a multilevel study". BMC Public Health. 15: 811. doi:10.1186/s12889-015-2120-8. PMC 4546125. PMID 26293136.
- ↑ "Diarrhea in Children: Why It Happens & How To Stop It".
- ↑ 11.0 11.1 "Gastroenteritis in Children - American Family Physician".
- ↑ "Diagnosis of Chronic Diarrhea in Children | NIDDK".
- ↑ "Diagnosing and treating diarrhea in children".