1、 Infantile Diarrhea Infantile Diarrhea outlinenPrevalencenDefinitionnPredisposing factorsnEtiologynPathogenesisnManifestations nDiagnosisnDifferential diagnosisnTreatmentnPrognosisnPreventionnrotavirus diarrheanenterotoxigenic E.coli(ETEC)ninvasive bacterial enteritis nfungusQuestion:Whats kind of s
2、tool is normal?stoolDefinitionis a syndrome with increased stool frequency and changes of character of stool which caused by pathogens infection or other reasons.nWatery stool with/without mucous,bloody stoolnFrequency 3times a day,Stool volume10g/kg.d nThe main reason cause malnutrition and growth
3、retardation Predisposing factorsnImmature digestive functionGastric acidity Digestive enzymesRapid growthnPoor immune function(host defenses)ImmunoglobulinsDisturbed enteric bacterial floranFormula feeding Etiology infection diarrhea non-infection Intestinalextraintestinaldietallergyweather Infectio
4、us factorsVirus(70%)nRotavirusnAdenovirusnAstrovirus,nNorwalk virus nCalicivirusnNorovirusnEnterovirusBacterianEnteropathogenic E.colinCampylobacter jejuninShigella nSalmonellanStaphylococcus aureusnClostridium difficileFungi Candida albicansParasiteDeveloped country Developing country Noninfectious
5、 factorsDiet WeatherColdHotImproper dietAllergyLactase deficiencyPathogenesisnOsmotic diarrheanSecretory diarrheanExudative diarrheanAbormal motility not one,but togetherIntestinal villi cryptepitheliumvirus enteritis virus duplicate mucosal injury，villi damage disaccharidase activity carrier glucos
6、e,fat absorption osmotic pressure watery diarrhea InfectionBacterial enteritis ETEC enterotoxin heat labile toxin heat stable toxin AC GC ATP cAMP GTP cGMP inhibit Na+,Cl-and water absorbtion，promote secrete Cl-Na+,Cl-and water inceased more than colonic absorption limit watery diarrhea Noninfection
7、 overeating food gather in UGI PH bacteria move and reproduce endogenous infection fermentorganic acid(lactose,acetic-acid)amine liver detoxification function insufficiency osmotic toxin enter into blood bowel movement toxicity symptom diarrhea,dehydration,electrolyte disturbances,acidosisManifestat
8、ionsClinical typesnActue diarrhea:2mAcute diarrheaCommon clinical manifestations Mild：nMainly caused by dietary factors or extraintestinal infections.nWatery stool with sour,foam,milk valve,no pus or blood.nWithout dehydration and toxicity symptom.nMost of them recover in a few days.severe：nCaused b
9、y intestinal infectionsn10/d with mucus,pus,bloodnStool test:WBC+,RBC+nGI symptoms:vomit,anorexia,abdominal pain,distention nSystemic symptoms:toxicity,shock,comanModerate,severe dehydrationnMetabolism acidosisnElectrolyte disturbances：hypokalemia,hypocalcemia,hypomagenesemiaWhen to see a doctor?nAg
10、e3mnWeight 8 kgnHistory of premature birth,chronic medical conditions,or concurrent illnessnFever of 38C or higher in infants younger than 3 months or 39C or higher in children aged 3-36 monthsnVisible blood in the stoolnHigh-output diarrheanPersistent emesisnSigns of dehydration,including sunken ey
11、es,decreased tears,dry mucous membranes,and decreased urine outputnMental status changesnInadequate responses to oral rehydration therapy(ORT)Manifestations of some enteritis Rotavirus diarrhea Main cause 3ysnAbruptnVomit,no fever,no systemic symptomsnYellow-green watery stoolnDehydration,electrolyt
12、e disturbances,acidosis nSelf-limittingInvasive bacterial enteritisnAbrupt onset,high fevernDiarrhea frequently,mucous and blood,nNause,vomiting,abdominal pain,cramps,tenesmusnSystemic toxemia:chills,malaise,hyperpyrexia,convulsion,shocknWBC+，RBC+nStool culture:+FungusnWeakness,use antibiotics/corti
13、steriod for a long-term nCandida albicansn2ys,sometimes accompanied with thrushnWatery stool with foam and mucosa,soy-bean residue-like thingsnFungal spore and mycelium Persisting or chronic diarrhea Major Contributor to MalnutritionDiagnosis “soap”nSubject:historynObject:physical examination labora
14、tory examination stool microscopic examination stool cultrure/ELISA electrolyte/acid-base disturbances?nAssessment:dehydration?malnutriton?nPlanDifferential diagnosisFew WBC in stoolPhysiological diarrhea Lactase deficiencyAllergyMany WBC in stoolShigellosisNecrotizing enterocolitisAmebic dysenteryI
15、ntussusception TreatmentnRegulate dietnIntensive nursing carenSymptomatic treatmentnMedication Control infection:antibiotic?Microecology therapyIntestinal mucosal protective agentFluid therapy,correct water and electrolyte disturbances(next class)Zinc supplementWHO and UNICEF recommended take zinc f
16、or 10-14days during diarrhea especial in high-prevalence area6mo:20mg/dSummarynDiarrhea is a common disease in infant,its the main cause of mortality nRotavirus is the major pathogen to cause acute diarrheanMild diarrhea is self-limitingnModerate and severe diarrhea may lead to dehydration,acid-base,electrolyte disturbancesnProper fluid therapy is the keyPreventionnRecommend breast milk feedingnForm good health habitsnHand hygienenAvoid long-term abuse of broad spectrum antibioticsnRotavirus vaccination.Protective rate 80%
