Paeds: Gastroenteritis Flashcards Preview

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Flashcards in Paeds: Gastroenteritis Deck (21):
1

Definition

Infective diarrhoea and vomiting

2

Causes

Viral: Rotavirus (commonest), adenovirus, calcivirus, corona, astroviruses.

3

Dehydration

- Causes of death in gastroenteritis and its correction is fundamental to treatment
- Total body deficit of NA and water

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Types of Dehydration

1. Isnatraemic
2. Hyponatraemic dehydration
3. Hypernatraemic dehydration

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Isnatraemic

- Loss of NA and water are proportional
- Plasma NA remains within normal range

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Hyponatraemic dehydration

- Na losses exceed those of water
- Plasma NA falls
- Shift in water from extra- to intra-cellular compartments = raised brain volume = sometimes convulsions
- Common in poorly nourished in developing countries

7

Hypernatraemic dehydration

1. Water loss exceeds sodium loss and plasma sodium concentration increased (rare)
2. Results from high insensbile water loss e.g. high fever/hot, dry environment/low-sodium diarrhoea
3. Shift in water form intra-to extra-cellular comaprtments
4. Harder to recognise as less evidence of signs

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Hypernatraemic dehydration treatment

reduce plasma sodium slowly to avoid convulsions

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Causes of diarrhoea

- food intolerance
- Antibiotics

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Causes of bloody diarrhoea:

- Bacterial (less common): campylobacter jejuni. shigella, salmonellae, enterotoxigenic E. coli, cholera
- NEC
- Intussusception
- IBD

11

Post-gastroenteritis Syndrome

- Return of watery diarrhoea - Temporary lactulose intolerance may have developed.

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Post-gastroenteritis Syndrome treatment:

- Oral rehydration solution for 24h, then, introduction of a normal diet.
- Rarely need to exclude cow's milk, disaccharides and gluten

13

Toddlers diarrhoea

'Pea and carrots syndrome' - presence of undigested vegetables
- results from underlying maturation delay in intestinal motility
- Most grow out of it by 5 yoa.

14

Diarrhoea mild
- Clinical features

- Dry mucous membranes

15

Diarrhoea mild
- Treatment

Short-term substitution of normal feeds with glucose-electrolyte solution.

16

Diarrhoea moderate
- Clinical features

1. 5-10% body weight loss
2. Thirst, restless, lethargic
3. Reduced tears
4. Reduced tissue elasticity
5. Dry mucous membranes
6. CRT: normal/prlonged
7. BP: normal/low
8. urine output: reduced
9. Pulse: Rapid
10. Eyes: sunken
11. Anterior fontanelle: sunken

17

Diarrhoea moderate
Treatment

- Oral rehydration, give 100ml/kg over 6 hrs
- If no improvement give i.v. rehydration

18

Diarrhoea severe
clinical features

- >10% body weight loss
- Drowsy, cold, sweating
- Tears: absent
- Tissue elasticity:absent
- V.dry mucous membranes
- CRT: prolonged (>2s)
- BP: low/unrecognizable
- Urine output: oliguria
- Pulse: rapid, weak, possibly impalpable
- Eyes: v. sunken
- Anterior fontanelle: v. sunken

19

Diarrhoea severe
Treatment

- I.V. rehydration
- Add plasma chloride to i.v. infusion once urinating
- Shocked then resuscitate with plasma volume expansion
- Monitor: fluid balance, weight, plasma electrolytes

20

Diarrhoea complications

Acute renal failure
Pulmonary oedema

21

Anti-diarrhoea drugs should they be used?

e.g. Loperamide and anti-emetics
NO because
a. they are ineffective
b. prolonged excretion of bacteria in stools
c. side-effects
d. cost
e. focus attention from oral rehydration

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