Clinical manifestations of diarrhea in children

1. Diarrhea is often accompanied by symptoms (1) Mild? The onset can be slow or urgent, mainly gastrointestinal symptoms, loss of appetite, occasional galactorrhea or vomiting, increased stool frequency (3 ~ 1 times/day) and changes in characteristics; No symptoms of systemic acidosis occurred in the dehydrator, and most of them recovered within a few days, which was often caused by dietary factors and extraintestinal infection. In children with rickets or malnutrition, diarrhea is mild, but it is often prolonged, which can lead to other diseases. Children may show weakness, pallor and poor appetite. Microscopic examination of stool showed a small amount of white blood cells. (2) heavy? Often acute onset, but also from mild gradually aggravated, transformed, in addition to severe gastrointestinal symptoms, there are more obvious symptoms of dehydration, electrolyte disorder and systemic poisoning (fever, irritability, listlessness, lethargy and even coma, shock). Mostly caused by intestinal infection. 1) Gastrointestinal symptoms? Often vomiting, severe cases can vomit brown liquid, poor appetite, frequent diarrhea, stool ten to dozens times a day, mostly yellow water sample or egg-shaped stool, containing a small amount of mucus, and a few children can also have a small amount of bloody stool. 2) dehydration? Due to vomiting and diarrhea, the total amount of fluid, especially extracellular fluid, is reduced, which leads to dehydration in different degrees (see Table 1). Because of the different ratio of water and electrolyte lost by diarrhea children, it can cause isotonic, hypotonic or hypertonic dehydration (see Table 2), and the former two are more common. 3) Metabolic acidosis? Generally parallel to the degree of dehydration. Mild people have no obvious manifestations, and severe people may have pale face, cherry red lips, deep breathing, listlessness, irritability and even coma. According to the blood C2CP, it can be divided into mild (18 ~ 13 mmol/L), moderate (13 ~ 9 mmol/L) and severe (< 9 mmol/L). 4) Hypokalemia? It is more common in acute diarrhea after dehydration is partially corrected, or chronic diarrhea and malnutrition with diarrhea. The clinical manifestations are listlessness, decreased muscle tone, weakened tendon reflex, abdominal distension, weakened bowel sounds, increased heart rate and dull heart sounds; Serum potassium < 3.5 MMO 1/L; Electrocardiogram showed that T wave was widened, flat and inverted, and U wave and arrhythmia appeared. 5) Hypocalcemia and hypomagnesemia? The possibility of low calcium should be considered when children with active rickets have convulsions after dehydration acidosis is corrected, and the possibility of low magnesium should be considered when calcium is ineffective. The normal value of blood magnesium is .74 ~ .99 mmol/L (1.8 ~ 2.4 mg/DL), and convulsion or tetany may occur when it is less than .58 mmol/L (1.4 mg/DL). ? Table 1? Judging the degree of dehydration, the clinical manifestations show that the degree of dehydration is mild, moderate and severe. The amount of fluid lost (%) is 55 ~ 11 (ml/kg) 3 ~ 55 ~ 11 ~ 12. The urine volume is slightly reduced, and the pulse is very strong, fast and weak, and you can hardly feel your mind. The skin elasticity is slightly agitated, blurred, sleepy and even comatose. The anterior fontanelle is slightly sunken, and the eye socket is normal or slightly sunken. Judging the nature of dehydration, the incidence of serum sodium mmol/L is%. The main symptoms are isotonic 13 ~ 154 ~ 8, and those who are severe have circulatory disorders. Hypoosmotic < 132 ~ 5, thirst is not obvious, circulatory disorders are more obvious. Hyperthermia and nervous system symptoms are less prominent. 2. Clinical characteristics of several common types of enteritis (1) Rotavirus enteritis? It is more common in infants aged from June to 2 years old, who have onset in autumn and winter, often vomiting at the beginning of the disease, and then diarrhea. The stool is watery or egg drop soup-like, which is prone to water and electrolyte disorders, often accompanied by fever and upper respiratory symptoms. It is a self-limited disease with a course of 3 to 8 days, and occasionally a small amount of white blood cells are detected by stool microscopy. The stool rotavirus detection (ELISA method) can be quickly diagnosed. (2) Pathogenic Escherichia coli enteritis? It is more common in infants under 2 years old, mostly in the high temperature season, with the most in May-August. The onset is slow, the stool is yellow and egg drop soup-like, with foul smell and more mucus, frequent vomiting, no fever and systemic symptoms, and a small amount of white blood cells in the stool under microscope. Bacterial culture can make a definite diagnosis. (3) Invasive Escherichia coli enteritis? It mainly infects school-age children, with acute onset, frequent diarrhea, sticky stool with purulent blood, often accompanied by vomiting, abdominal pain, acute diarrhea, high fever, severe symptoms of systemic poisoning and even shock. It is difficult to distinguish clinical manifestations from bacillary dysentery, and stool culture is needed. (4) Toxic Escherichia coli enteritis? Incidence occurs all year round, with September to November as the high incidence season. It can cause an explosive epidemic in the neonatal room and is also the main pathogen of tourists' diarrhea. The disease is transmitted through fecal-oral route, and the incubation period is 12 ~ 24 hours. Sudden onset; Stool 1 ~ 2 times a day, watery stool, diarrhea accompanied by abdominal pain or colic, nausea, vomiting, listlessness and fever, severe cases accompanied by water, electrolyte and acid-base balance disorder. The course of the disease lasts for several days and is self-limited. (5) Hemorrhagic Escherichia coli enteritis? It occurs in summer and autumn and can occur at all ages, with an incubation period of 2-7 days. The onset is urgent and the condition is serious. Fever, nausea, vomiting, abdominal pain, frequent stools, watery stools at first, followed by bloody stools, with a special odor. Microscopic examination of stools shows a large number of red blood cells, often without white blood cells. (6) Salmonella typhimurium enteritis? Most of them are children under 2 years old, and the disease occurs all year round, especially in summer, so we should pay attention to the epidemiological history; The main symptoms are diarrhea, diverse stool characteristics, indigestion, watery stool, mucus-like stool and even purulent stool; The severity of the disease varies, and shock and DIC； may occur in severe cases; Some children showed septicemia and had a long heat course. Half of the children have stool bacteria for about 2 weeks or even longer after illness. (7) Staphylococcus aureus enteritis? Have a history of long-term use of broad-spectrum antibiotics, yellow-green water-like stool, like sea water color, mucus, foul smell; Accompanied by different degrees of systemic poisoning symptoms; Microscopically, there are a large number of pus cells and clusters of G+ cocci in stool, and then Staphylococcus aureus grows and coagulase is positive. (8) fungal enteritis? It is more common in malnourished children or has a long history of using broad-spectrum antibiotics, and children are often accompanied by thrush; The main symptoms are diarrhea, yellow and thin stool, frothy, fermented, and sometimes bean curd residue; Microscopic examination of stool showed fungal sporophytes and hyphae, which were confirmed by fungal culture in sabouraud medium. (9) Pseudomembranous enteritis? Caused by Clostridium difficile. Except aminoglycoside antibiotics and vancomycin for gastrointestinal use, almost all kinds of antibiotics can induce this disease. It can occur within one week or several hours early or as late as 4-6 weeks after drug withdrawal. It can also be seen in patients who are weak after surgery, intestinal obstruction, intussusception and megacolon. This bacterium proliferates in large numbers, producing toxin A (enterotoxin) and toxin B (cytotoxin) to cause disease. The main symptoms are fever, diarrhea, mild stool several times a day, and soon recovered after stopping antibiotics; Severe frequent diarrhea, yellow-green watery stool, pseudomembranous discharge, a few bloody stools, dehydration, electrolyte disorder, acidosis, toxic megacolon and intestinal perforation. The peripheral blood picture is increased. Accompanied by abdominal pain, abdominal distension and systemic poisoning symptoms, and even shock. Fiberoptic and electronic colonoscopy are feasible for suspicious cases. Detection of cytotoxin by fecal anaerobic culture and tissue culture can help to diagnose the disease.