Diarrhea may be accompanied by loss of appetite, vomiting, acute weight loss, abdominal pain, fever, or admixture of blood. If the diarrhea is very severe or persistent, there is a risk of dehydration. Even if none exists dehydration, chronic diarrhea usually leads to weight loss or delayed weight gain.
Diarrhea (diarrhea) is more common, soft or watery bowel movements, which differs from the usual chairs of the child. Diarrhea may be accompanied by loss of appetite, vomiting, acute weight loss, abdominal pain, fever, or admixture of blood. If the diarrhea is very severe or persistent, there is a risk of dehydration. Even if none exists dehydration, chronic diarrhea usually leads to weight loss or delayed weight gain. Diarrhea is a very common disease in children and causes about 1.5 million deaths worldwide each year. Diarrhea is in the United States, the reason for about 9% of all hospitalizations in children aged <5 years. Diarrhea in adults is treated elsewhere. Pathophysiology The mechanisms of diarrhea include the following: Osmotic secretory flammable malabsorptive Osmotic diarrhea resulting from the presence of nonabsorbable solute in the gastrointestinal tract such. As in lactose intolerance. 2 to 3-day fast stops osmotic diarrhea. Secretory diarrhea is a result of certain substances such. B. bacterial toxins that increase the secretion of Cl-ions and water into the intestinal lumen. Secretory diarrhea does not stop fasting. Inflammatory diarrhea is associated with conditions that cause inflammation or ulceration of the intestinal mucosa such. As Crohn's disease and ulcerative colitis. The resulting leakage of plasma, serum proteins, blood and mucus increases the stool volume and the liquid content. To malabsorption osmotic or secretory mechanisms or conditions can cause that reduce the surface in the gut. Conditions such as pancreatic insufficiency and short bowel syndrome as well as conditions that increase the intestine run lead due to decreased absorption diarrhea. Etiology The importance of diarrhea (see Table: Some causes of diarrhea) differs at any age after that if there is an acute (<2 weeks) or chronic (> 2 weeks) diarrhea. Most cases of diarrhea are acute. Acute diarrhea is usually caused by gastroenteritis the use of antibiotics food allergies food poisoning Most gastroenteritis is caused by a virus, but each enteric pathogen can cause acute diarrhea. Chronic diarrhea is usually caused by dietary factors infection Celiac Disease Inflammatory bowel disease Chronic diarrhea can also be caused by anatomical disorders and diseases that interfere with the absorption or digestion. Some causes of diarrhea due suspects findings Diagnostic approach of acute treatment of antibiotics, especially broad-spectrum antibiotics, multiple antibiotics simultaneously can [Temporal relationship from the onset of diarrhea with the use of antibiotics Clinical investigation bacteria (eg. As Campylobacter sp, Clostridium difficile, Escherichia coli hemolytic -urämisches syndrome cause], Salmonella sp, Shigella sp, Yersinia enterocolitica) * Fever, blood in the stool, abdominal pain may petechiae or paleness (in patients with haemolytic uraemic syndrome) history of contact with animals (E. coli) or reptiles (Salmonella) history of eating raw food (Salmonella) Previous (<2 months in the past) taking antibiotics (C. difficile) epidemic in the daycare stool culture Fecal leukocytes If patients appear ill, complete blood count, kidney function tests and blood culture if the patients were recently given antibiotics: stool test for C. difficile - toxins food allergy or food poisoning) allergy: urticaria, swelling of the lips, stomach pain, vomiting, diarrhea, difficulty breathing within minutes to several hours after eating poisoning: nausea, vomiting, abdominal pain, diarrhea several hours after ingestion of contaminated food Clinical evaluation Parasites (eg. B., Giardia intestinalis [lamblia], Cryptosporidium parvum) * Bloated belly and cramping, foul-smelling stools, anorexia Maybe history of travel or use of a contaminated water source Microscopic examination of the stool on ova and parasite stool antigen test viruses (eg. B. astrovirus, calicivirus, enteric adenovirus, rotavirus) * <5 days diarrhea without blood Common vomiting may fever contact with infected persons Usual season for the infection Clinical evaluation Chronically Hirschsprung enterocolitis Delayed intestinal transit> 48 h after birth may longstanding history of constipation poison green vomit, abdominal distention, poor appearance radiograph of the abdomen Barium enema Rectal biopsy short bowel syndrome history of bowel resection (eg. As for necrotizing enterocolitis, or volvulus Hirschsprung’s disease) Clinical examination lactose intolerance Bloated stomach, flatulence, explosive Diarrhea Diarrhea Clinical after eating dairy products clarification if necessary Hydrogen breath test Sometimes test for reducing substances in the stool (check for carbohydrates) and stool pH (<6.0 has carbohydrates in the chair for her) cow's milk protein intolerance (milk protein allergy), vomiting, diarrhea or constipation Hematochezia anal fissures failure to thrive resolution of symptoms upon removal of cow's milk protein Occasionally endoscopy or colonoscopy Excessive juice intake history of excessive consumption of juice or sugary drinks (118 to 177 ml / day [4-6 oz / day]) Clinical examination Chronic nonspecific fischer childhood diarrhea (infant diarrhea) aged 6 months-5 years 3-10 loose stools / day usually visible normal during the day while awake and sometimes immediately after eating Sometimes undigested food in stool growth, weight gain, activity and appetite Clinical examination immunodeficiency ( z. B. HIV infection, IgA deficiency or ? IgG deficiency ?) history of recurrent skin, respiratory or enteric infections weight loss or poor weight gain HIV test blood immunoglobulin levels Inflammatory bowel disease (z. B. Crohn's disease, ulcerative colitis) blood in chair, crampy abdominal pain, weight loss, loss of appetite may arthritis, oral ulcers, skin lesions, rectal fissures colonoscopy eosinophils gastroenteritis abdominal pain, nausea, vomiting, weight loss blood for peripheral blood eosinophilia Sometimes IgE levels Endoscopy and / or colonoscopy celiac disease (Glutenenteropathie) symptom onset after the introduction of wheat in the diet (usually after the age of 4 to 6 months) failure to thrive Recurrent abdominal pain bloating diarrhea or constipation blood Serological screening for celiac disease (IgA antibodies against tissue transglutaminase ) endoscopy for duodenal biopsy cystic fibrosis failure to thrive Recurrent episodes of pneumonia or wheezing Oily and foul-smelling stools bloating, flatulence Fecal fat excretion over 72 hours sweat test genetic testing Akrodermatitis Sometimes Enteropathica psoriasähnlicher rash, stomatitis angular zinc levels constipation with encopresis history of hard chairs fecal incontinence radiograph of the abdomen * Can also lead to chronic diarrhea clarification history should The course of the current disease, the frequency and duration of bowel movements and accompanying symptoms such as fever, vomiting, abdominal pain or blood in the stool hold. The parents should be asked to present or recently administered (within 2 months) antibiotics. Doctors should implement the elements of the diet (eg. As quantities of juice, foods high in sugar or sorbitol content). Each episode with hard stools or constipation deserves attention. Doctors should the risk factors for infection assess (eg recently made travel;. Exposure to questionable food sources, last contact with animals in a petting zoo, contact with reptiles or a person with similar symptoms). A review of organ systems should the search for symptoms of both complications and causes of diarrhea to combat social exclusion. Symptoms of complications include weight loss, decreased urination and fluid loss (dehydration). Symptoms of causes include urticaria associated with ingestion (food allergy); Nasal polyps, sinusitis and growth retardation (cystic fibrosis) and arthritis, skin lesions and anal fissures (inflammatory bowel disease). For the history of history are known causative diseases (eg. As immune deficiency, cystic fibrosis, celiac disease, inflammatory bowel disease) in patients and Familienmitgliedern.Körperliche Exam Vital signs should be checked for signs of dehydration (eg. As tachycardia, hypotension) and fever. A general assessment includes signs of lethargy or mental distress. The growth parameters should be noted. Because the examination of the abdomen may be painful, it is advisable to start with an examination of the head. The investigation of the mucous membranes determines whether they are wet or dry. On suspicion of nasal polyps should be paid to psoriasähnliche dermatitis around the eyes, nose and mouth, or oral ulcers. The investigation focuses on the extremities skin turgor, capillary refill and the existence of petechalen or purple rashes or other skin lesions (eg. B. erythema nodosum, pyoderma gangrenosum), skin rashes and reddened, swollen joints. In the examination of the abdomen, the distension and hardness of the abdominal wall as well as the type of bowel sounds (eg. As high, normal, absent) is important. The examination of the genitals focuses on rashes and signs of anal fissures or ulcerative Läsionen.Warnhinweise The following findings are of particular importance: tachycardia, hypotension, lethargy and (significant dehydration) Bloody stools bilious vomiting Extreme tenderness of the abdomen and / or bloating petechiae and / or pallor assessment of the findings antibiotic indicated, post-infectious and anatomically related causes of diarrhea Ergebn usually from the history. A determination of the time frame helps determine whether it is acute or chronic diarrhea. An assessment of urgency is also important. Most cases of acute diarrhea have a viral etiology, mild and verusachen fever and bloodless diarrhea. However, bacterial diarrhea can lead to serious consequences; Symptoms include fever, bloody diarrhea and possibly a petechial or purple rash. Symptoms associated with chronic diarrhea can vary and it is possible that symptoms of various diseases overlap. As Crohn's disease and celiac disease Both can cause oral ulcers. A number of causes cause rashes and almost every disease can lead to reduced growth. If the cause is unclear, can be carried out further tests that are based on the clinical findings (see table: Some causes of diarrhea) .Tests In most cases of acute, diarrhea selbstlimitierendem No tests are necessary. However, when assessing the findings suggesting an etiology other than viral gastroenteritis, tests should be in accordance with the presumed etiology (see table: Some causes of diarrhea). Treatment Specific treatment measures diarrhea are sorted by the underlying disease indicated (eg. As gluten-free diet in children with celiac disease). A general treatment consists firstly in hydration, which is oral in general. Intravenous hydration is rarely necessary. Attention: medicines for diarrhea (. Eg loperamide) are not recommended for infants and young children. The rehydration oral rehydration (ORS) should contain complex carbohydrates or 2% glucose and 50 to 90 mEq / L sodium. Sports drinks, soda, juice and similar beverages do not meet these criteria and should therefore not be used. either they contain too little sodium or too many carbohydrates in order to take advantage of the sodium-glucose Kotransports. The osmotic effect of excessive consumption of carbohydrates can lead to further fluid loss. The WHO-recommended oral rehydration solutions are available without prescription in the US. Premixed solutions are also available in most pharmacies and drugstores. If the child also is vomiting, should start with small, frequent doses (every 5 min 5 ml) that are slowly increased as tolerated (oral rehydration). If the child does not vomit, the original amount is not restricted. In each case, 50 ml / kg administered over 4 h and at moderate dehydration 100 ml / kg over 4 h generally in mild dehydration. After each liquid stool further 10 ml / kg (up to 240 ml) are additionally added. After 4 hours, the patient is reassessed. If signs of dehydration persist, the same amount of liquid is given again. Nutrition and children with acute diarrhea should, as soon as they are rehydrated and not vomit, get an age appropriate diet. Infants can be resolved or get baby food again. In chronic nonspecific childhood diarrhea (infant diarrhea) should be reduced, increased fat and fiber in the diet and fluid intake (especially fruit juice). For other causes of chronic diarrhea, it is important to ensure adequate nutrition, eg. As with fat-soluble vitamins. Conclusion Diarrhea is common in pediatrics. The most common cause is gastroenteritis. Tests are rarely necessary in children with acute diarrhea. Dehydration is likely if the diarrhea is strong or lasting. Oral rehydration is effective in most cases. Medicines for diarrhea (z. B. loperamide) are not recommended for infants and young children.