Peds Diarrhea

Table Of Contents
1 Diarrhea
2 Chronic Childhood Diarrhea Causes
2.1 Neonates
2.2 Children <2 yrs
2.3 Children >2 yrs

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:
      1. Yersinia (pseudo-appendicitis, erythema nodosum)
      2. Campylobacter
      3. Salmonella (cystitis)
      4. Shigella (generalized seizures due to toxin, hi temp, hyponatremia)
      5. 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