Acute diarrhea or gastroenteritis more commonly known as gastroenteritis is a common situation and at risk. Worldwide it is responsible for significant mortality, particularly in poor countries and in crowded areas where more sanitary conditions are worse.
It is defined by a increase the daily volume of stool, most often linked to an increase in digestive secretions. It must be distinguished from loose stools isolated, often due to "stress", which is not unusual, situation that gave free rein to verbal expressions such as "c is the m ... "that elude us when we are upset and that decency requires me not to develop here. This is not a linguistics course!
The breastfed child has loose stools and that's normal.
acute intestinal failure is a partial
Signs:
Acute diarrhea results in the stools, usually liquid or paste. Vomiting are fickle sometimes foreground when the upper part of the intestine is diseased. Abdominal pain is common. They may be related to irritation of the intestines or abdominal muscle contractions in case of vomiting. Fever is often inconsistent, rarely in the foreground.
In practice, situations can be classified in several ways which help to assess risks and choose Treatment:
forms with high especially vomiting. Diarrhea is sometimes delayed for several hours. Achieving concerns mainly the small intestine. The origin is most often viral.
readily forms low fever with little vomiting, frequent stools often scarce and sometimes slimy paste, foaming. Achieving concerns mainly the colon. The origin is sometimes bacterial (Salmonella, Yersinia, Clostridium D. ...) and then performs a table called dysentery with numerous mucous stools sometimes bloody, fever, abdominal pain and incidental needs. This recalls the crises of amoebic dysentery "colonial."
Mixed forms most frequently affected by predominant bowel through watery diarrhea are sometimes very abundant. A typical example is the cholera with 8 liters of stool per day, or rotavirus. It is these forms that expose the dehydration so feared.
What does the pediatrician with all this?
1. It assesses the severity situation. There dehydration or threat? Taking into account these signs: diarrhea, vomiting, diet, fever, the child's condition, weight, duration of disease.
Diarrhea: more than the number of bowel movements is the volume that is estimated. Watery diarrhea are more abundant.
Vomiting : Always be suspicious of another cause vomiting; appendicitis is the most rare, acute intussusception is more difficult to detect. I spend on strangulated hernia or torsion of the testis, tonsillitis, meningitis and the rest that are easier to remove from the moment we think.
Food: Food intolerance increases the risk of a poor outcome.
Fever: Fever increases water loss through sweating, dehydration increases the severity of the fever.
Trio infernal diarrhea + vomiting + fever should consider hospitalization.
Time evolution : Acute diarrhea is by definition brief. Its main risk is dehydration even more important that the installation is brutal. Beyond 5 to 7 days is more severe diarrhea and malnutrition is a major risk. It is another matter.
State Child : signs of dehydration: poor mine, sunken eyes, depressed fontanelle, dry mouth, persistent skinfold, fever, weight loss, progressive mode? Some are easy to evaluate other less:
- weight loss : This sounds simple but in practice it is rarely decisive, because we do not always have a weight of more recent and very acute diarrhea in the water may still be in the intestines and despite dehydration actual weight is moment stable.
2. It assesses the risk of spread of infection in supposed bacterial diarrhea:
is fortunately uncommon situation: Diarrhea is most often when bacterial mucous or bloody, painful and febrile but nothing is constant. Analyses of feces and very little information can often result after healing. The child's age and the occurrence outside an epidemic context winter are important factors. The risk of dissemination of intestinal infection is maximum one year.
What may be confused with gastroenteritis?
Vomiting see themselves as in tonsillitis, bronchitis, meningitis, acute intestinal intussusception (the bane of pediatricians), appendicitis, obstruction and even testicular torsion.
Diarrhea is less problematic. The only question sometimes is, "is it an acute or chronic?"
Causes of acute gastroenteritis:
If this epidemic are viruses: Rotavirus mainly in children.
Rotavirus (like a small wheel)
Norovirus (Norwalk Virus) that causes a lot of vomiting, and heaps others (Echovirus, Parvovirus, Astrovirus), all immune to antibiotics. We do not search.
Rotavirus (like a small wheel)
Norovirus (Norwalk Virus) that causes a lot of vomiting, and heaps others (Echovirus, Parvovirus, Astrovirus), all immune to antibiotics. We do not search.
forms most isolated should consider bacterial sometimes during a food poisoning (salmonella, shigella, yersinia, campylobacter, E. coli; staphylococci)
Clostridium Difficile has hit the headlines because it has spread in some hospitals. It essentially gives diarrhea after taking antibiotics. It also has the unfortunate property of being able to develop in the water droplets in the bags of food, even in the freezer.
Parasites are rare. In France, we sometimes Gardia lamblia during relapsing.
Complications:
The main risk is dehydration . Over 5 to 7% weight loss, it threatens life, hence the need for greater vigilance by physicians and parents.
Other complications are rare and most business cases.
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Treatment of gastroenteritis: gastroenteritis is an acute partial failure, use the remaining capacity, and stimulate uptake mechanisms that are mostly intact.
Rehydrate and feed:
Rehydrate: was formerly the good old carrot soup or the rice water a bit salty , now it is rehydration solutions (ORS) libitum in small quantities. Drink these solutions rehydrates and reduces diarrhea. Moisturize is the main objective of a mild form during the 24 or 48 early hours. Children who vomit constantly and sometimes worsen should be rehydrated intravenously.
Nourish: is necessary to allow healing of the intestine and prevent malnutrition. Three tracks:
1. divide food into smaller meals.
2. provide easily digestible food that is to say, very mixed and cooked. Use yogurt, naturally low in lactose. Do not force the child.
For infants who have a non-diversified, it seems prudent to use lactose-free milk commonly called "milk diet" . This point is now discussed but lactose intolerance has not disappeared and it is sometimes important.
For infants who have a non-diversified, it seems prudent to use lactose-free milk commonly called "milk diet" . This point is now discussed but lactose intolerance has not disappeared and it is sometimes important.
3. The breast-fed infants should continue to breastfeed what is best for them.
drugs are discussed and are of secondary importance, are: The
lactic and dressings,
The modifiers transits often more dangerous than useful,
The modifiers intestinal absorption.
The use of these substances seems rather correlated to the marketing of laboratories or habits.
The rehydration solutions (ORS) are not really drugs. They are very helpful.
The Antibiotic s bit recommended except in cases of risk of spreading infection among infants and malnourished. The choice is very difficult and quite risky. It is not helped by the analysis because stool cultures are sometimes 5 days to "push".
All this rests with the doctor. We can not do that by phone. Be cool with your doctor: he makes a very difficult job that requires experience.
The Role of Parents:
is crucial because with gastroenteritis should be particularly vigilant: monitoring, rehydration, feeding, getting up at night, decide to take the child to hospital if the situation deteriorates. But overall it went well. Parents are often very competent.
Conclusion:
Acute diarrhea is a common condition, never commonplace because of the risk of dehydration. Should be consulted easily, especially when the child is younger.
Steel The Sick Child (1660)
This child has a small mine, pale, eyes sunken. He may be dehydrated and deserves, I think he, a detour to the hospital. But in 1660 ... Gastroenteritis, if common, is a risky situation, even if hospitalization is limited. It requires parents to become "caregivers" to the "hospital at home '.
references:
Thielman NM, Guerrant RL: Acute Infectious Diarrhea N Engl J Med 350:38, January 1, 2004
M. R. Amiera : Important Bacterial Gastrointestinal Pathogens in Children : A Pathogenesis perspective Pediatr Clin N Am 52 (2005) 749_777
Dupont HL: Bacterial Diarrhea N Engl J Med 361:1560, October 15, 2009 Glass RI, Parashar UD, Estes MK Norovirus Gastroenteritis N Engl J Med 361:1776, October 29, 2009 Review Article 
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