CHILD WITH ACUTE DIARRHEA AND

GASTROENTERITIS (GE)
Presented by: Aghadir Al-ahmari, Raghad Almansour
 OBJECTIVES
• 1. Define acute diarrhea.

• 2. List Possible causes of acute diarrhea as well as the Causative organisms of pediatric GE

• (Viral, Bacterial, Parasitic)

• 3. Know the Epidemiology of GE

• 4. Be familiar with clinical manifestation and possible complications

• 5. Discuss the relevant investigation.

• 6. Know Options for management (hospital vs home setting)

• 7. Discuss the role of different pharmacological agents

 DIARRHEA
• Passage of abnormally liquid stool at
an increased frequency

• above the normal value of

approximately 10 mL/kg/d in the
infant and young child, or 200 g/d in
the teenager and adult)

• Classification:

• Acute < 2 weeks

• Persistence 2-4 weeks

• Chronic > 4 weeks

 Osmotic Diarrhea
occurs after malabsorption of an ingested
substance, which “pulls” water into the
bowel lumen
Ex:
lactose intolerance.
generalized maldigestion,
Toddler’s Diarrhea.
toddler’s diarrhea. This condition is
defined by frequent watery stools in the
setting of normal growth and weight gain
and is caused by excessive intake of
sweetened liquids, overwhelming the
disaccharide absorptive capacity of the
intestine.
DIFFERENTIAL DIAGNOSIS
Causative organisms of pediatric GE
 Epidemiology

Worldwide, 3-5 billion cases of acute

gastroenteritis and nearly 2 million deaths occur
each year in children under 5 years. In the
2

United States, gastroenteritis accounts for about

∼10% (220 000) of admissions to hospital, more
than 1.5 million outpatient visits, and around 300
deaths in children under 5 annually
 Important notes
• Norovirus has become the leading cause of GE , while Rotavirus is more common in other
countries and vaccination will have a major impact on disease rates, morbidity, and mortality

• Most children are not dehydrated and can be managed at home

 CLINICAL MANIFESTATION
• Watery stool

• Mixed with blood (sometimes)

• Vomiting

• Fever

• Abdominal pain/cramps

• Nausea

• Dehydration: Sunken eyes, decreased skin turgor

 COMPLICATIONS
• Dehydration

• Metabolic Acidosis

• Impaired consciousness

• Convulstions

• Circulatory shook

• Prerenal azotemia
 INVESTIGATION

• Check the degree of dehydration

• Good history taking

• Physical examination

• Blood & stool tests

HISTORY
 MANAGEMENT
Home setting:

• Tea breaks

• Withholding of food for 4-6 hrs.

• Low fat “build up” diet for several days

Hospital setting:

• Fluid and electrocyte replacement

• Rehydrate with “oral rehydration solution “

PHYSICAL EXAMINATION
ORS
 MANAGEMENT
Pharmacotherapy

• All antidiarrheal are not recommended

• Probiotic agents:

• Reduces duration of diarrhea by live bacteria

• Antiemetic agents:
• Antiemetic drugs are not recommended for GE except for (ondansetron as a single dose)

• Lowers the frequency of vomiting

 Important Notes

• Complications are serious so it’s important to investigate and treat

right away.
 QUESTIONS

Which of the following most commonly cause acute gastroenteritis in childhood?

A. Adenoviruses
B. Campylobacter jejuni
C. Noroviruses
D. Rotaviruses
E. Salmonella

Which of the following manifestations definitely indicates dehydration in acute gastroenteritis?

A. Moist mucous membranes
B. Deeply sunken eyes
C. Nuchal rigidity
D. Increased production of tears
E. Skin wrinkles that disappear immediately
 References
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764079/

• Nelson essential of pediatrics

• https://www.niddk.nih.gov

• https://www.who.int

• https://www.childhealthbc.ca