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Diarrhea
- Mechanisms
- – Osmotic:
- ingestion of poorly absorbable solutes.
- – Dx:
- diarrhea ceases when osmolytes are removed from intestine.
- – Increased stool osmolality (>280 mosm)
- – eg. intestinal disaccharidase deficiency, monosaccharide malabsorption, cathartics (phos and magnesium salts)
- Secretory:
- pathological stimulation of normal Na, K, Cl, HCO3 secretion.
- – Dx:
- diarrhea continues with fasting.
- – Stool is isosmotic to plasma (280 mosm)
- – eg. toxin producing bacteria (E.coli, V. choerae, staph), hormones (gastrin, histamine, prostaglandins, VIP), drugs (phenophthalein, ricinoleic acid)
- Malabsorptive:
- – Inflammatory conditions (Crohn’s, Sprue), drugs (Digitalis, colchicine, Abx), digestive enzyme deficiency (pancreatic insufficiency), obstruction
- Exudative:
- damage to intestinal mucosa resulting in discharge of mucus, serum proteins, and blood into bowel lumen
- – egs: infection (amebiasis, shigellosis, staph), inflammation (UC, pseudomembranous colitis), ischemia, drugs(Abx, heavy metal poisoning)
- Increased intestinal motility
- Bacterial diarrhea
- Sxs: Bloody stool
- Causes:
- Yersinia (pseudo-appendicitis, erythema nodosum)
- Campylobacter
- Salmonella (cystitis)
- Shigella (generalized seizures due to toxin, hi temp, hyponatremia)
- E. coli
- Dx:
- Wright stain of stool for poly’s; if <3 months, consider bacteremia
- Treatment:
- Give Pedialyte; feed through diarrhea;
- DO NOT give Anti-diarrheals (may cause toxic megacolon and retention of toxins)
Chronic Childhood Diarrhea Causes
Neonates
- Infections: previous infections decrease enterocytes
- Protein intolerance: causes damage to enterocytes
- Short bowel syndrome
- NEC
- Congenital absorptive defect
- Congenital disaccharidase defect
- CF
Children <2 yrs
- Infections
- Protein intolerance
- Giardiasis
- Celiac disease
- Sucrase/isomaltase deficiency
- Irritable bowel syndrome
- CF
Children >2 yrs
- Infections
- IBD
- Giardia
- Celiac disease
- Irritable bowel syndrome
- CF
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