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Acute

Gastroenteritis

NORFARAHIDA BT BANI YAMIN


SH.LIANAH BT SH.BASIR
JURURAWAT U29
PEDIATRIK WARD
OF VOMITING..
Vomiting is the forceful ejection of gastric
contents through the mouth. It is a well
defined, complex, coordinated process that is
under central nervous system control and is
usually accompanied by nausea and retching.
CAUSES OF VOMITING
Acute infectious disease
Increased intracranial pressure (ICP)
Food intolerance and allergies
Mechanical obstruction of the gastrointestinal
tract
Psychogenic problems
VOMITING IN PEDIATRICS
Common symptoms that seen in pediatrics.
Should known to distinguish between regurgitate
and vomiting.
PATHOPHYSIOLOGY
INVESTIGATION
MANAGEMENT
Dehydration should be treated with fluid
resuscitation (IV Fluid)
Based on the causes of the vomiting
Antiemetic medication (should not be
prescribed until the cause of vomiting is
known)
INCIDENCE
Worldwide, there are an estimated 1.3 billion
episodes of diarrhea each year.
24% of all deaths in children living in developing
countries are related to diarrhea and dehydration.
Most children living in developed countries have
mild form of gastroenteritis.
In United States, approximately 200,000 children
younger than age 5 are hospitalized and
approximately 200 children younger than 5 years
die of diarrhea and dehydration each year.
OF DIARRHEA.
Diarrhea is a symptom that result from
disorders involving digestive, absorptive,
and secretory functions. Diarrhea is caused
by abnormal intestinal water and electrolyte
transport.

(Malek, Curns, Holman, et al, 2006)


According to World Health Organization
(WHO )= Having 3 or more loose or
liquid stools per day, or as having more
stools than is normal for that person.
Characterized by an increase in the
frequency, volume, or liquid content of
stool.
FACTORS THAT PREDISPOSE TO
DIARRHEA
Age the younger the child, the greater the
susceptibility and the more severe the diarrhea.
Impaired health Malnourished or
immunocompromised children is more
susceptible to have severe diarrhea.
Environment With crowding, substandard
sanitation, poor facilities for preparation and
refrigeration of food and inadequate health
care education.
PATHOPHYSIOLOGY
Invasions of the gastrointestinal tract by pathogens
results in increased intestinal secretions as a result of
enterotoxins, cytotoxic mediators, or decreased
intestinal absorption secondary to intestinal damage or
inflammation. Enteric pathogens attach to the mucosal
cells and form a cuplike pedestal on which the bacteria
rest. The pathogenesis of the diarrhea depends on
whether the organism remains attached to the cell
surface resulting in a secretory toxin or penetrates the
mucosa. Non inflammatory diarrhea is the most
common diarrheal illness, resulting from the action of
enterotoxin that is released after attachment to the
mucosa.
TYPE OF DIARRHEA

Acute Diarrhea

Chronic diarrhea
ACUTE DIARRHEA
ACUTE DIARRHEA
Leading cause of illness in children
younger than 5 years of age.
Defined as a sudden increase in frequency
and a change in consistency of stools, often
caused by an infectious agent in
gastrointestinal tract.
Acute diarrhea is usually self-limited
(<14days duration) and subsides without
specific treatment if dehydration was not
occur.
CAUSE OF ACUTE DIARRHEA
Bacteria- Salmonella, Shigella, Campylobacter, Escherichia
coli, Yersinia, Aeromonas, Clostridium difficile,
Staphylococcus aureus.
Viruses-Rotavirus, Norwalk virus, small and round viruses,
adenovirus, astrovirus, parvovirus.
Parasites- Giardia lamblia, Isospora belli, Microsporidia,
Strongyloides, Entamoeba histolytica.
Associated Conditions- Urinary tract infections, otitis media.
Dietary cause- Over feeding, introductions of new foods,
Reinstituting milk too soon after diarrheal episodes,Osmotic
diarrhea
Medications- Antibiotics, Laxatives
Functional Cause- Irritable bowel cause
Others cause- Hirschsprung disease
CHRONIC DIARRHEA
CHRONIC DIARRHEA
Chronic diarrhea is an increase in stool
frequency and increased water content with a
duration of more than 14 days.
It is often caused by chronic conditions such as
malabsorption syndromes, immunodeficiency,
lactose intolerance or chronic nonspecific
diarrhea.
Chronic nonspecific diarrhea (CNSD), also
known as irritable colon of child hood and
toddlers diarrhea. Its a common cause in
children 6 to 54 months of age.
CHRONIC DIARRHEA
Malabsorptive causes Lactose intolerance,
Celiac disease, Pancreatic insufficiency example
cyctic fibrosis.
Immunodeficiency Acquired hypoglobulinemia,
wiskott-Aldrich syndrome, agammaglobulinemia,
and thymic hypoplasia.
Inflammatory bowel disease Crohn disease
Endocrine cause Addison disease,
hyperthyroidism.
Motility disorders Hirschsprung disease
Others cause Radiation enteritis, Abdominal
tumors.
Well child with no weight loss:
Toddler diarrhea typically occurs in the second
year of life and is associated with undigested food
such as peas and carrots in the stools. The child is
well and growing normally. It is thought to relate to
a rapid intestinal transit time. It resolves by the age
of 4 years.

Breast-fed babies often have liquid and abnormal


stools. This is normal and doesn't need any further
investigation if the baby is otherwise well and
thriving.
SIGN AND SYMPTOMS
1. Malabsorption secondary to pancreatic
insufficiency or intestinal mucosal injury
Children are frequently irritable and have
loss of appetite
Stools are foul smelling and greasy
Poor weight gain and abdominal distention.
The child is often weak and displays
decreased activity.
Anemia, hypoproteinemia, vitamin
deficiencies.
2.Allergies to Food
Vomiting, diarrhea, and blood in stool
+ family history of atopy
Failure to gain and grow
History of eczema, reactive airway disease,
urticaria, and allergic rhinitis
Loss of protein in the gut may lead to
hypoproteinemia and edema
3.Lactose Intolerance
Usually in formula-fed babies less than 6 months old
with infectious diarrhea
Genetic lactase deficiency is rare in young children and
will manifest later on in life
Secondary lactase deficiency following gastroenteritis is
usually transient and is improved within 2 weeks
Clinical features:
Persistent loose/watery diarrhea
Abdominal distention
Increased flatus
Perianal excoriation
4.Giardia Infection
Foul smelling watery stools
Gassy and abdominal distention
Can develop into chronic condition and diagnosed
by inspecting stool or duodenal fluid for cysts.
Usually waterborne but can be from person to
person transmission
5.Cryptosporidium
Watery, foul smelling stools that may be mucousy.
Crampy abdominal pain
+ oocysts in stool specimen
DIAGNOSTIC EVALUATION
History that seeks to discover the possible cause of
diarrhea, symptoms and the risks of complication,
and the elicit information about current symptoms
indicating other treatable illness that could be
causing the diarrhea.
Full blood count
BUSE
ABG/VBG
Liver Function Test
Renal Function Test
CLINICAL ASESSMENT OF
DEHYDRATION
PLAN A :
Treat diarrhea at home
Give extra fluids (as much as the child will take)
Continue feeding
When to return
Not able to drink / breastfeed / drinking poorly
Becomes sicker
Develops fever
Has blood in stool
PLAN B :
Treat some dehydration with ORS
Give recommended amount of ORS over 4 hours period:

After 4 hours,
Reassess the child and classify the child for dehydration
Select the appropriate plan to continue treatment (Plan A, B, C)
Begin feeding the child
Composition of oral rehydration
solutions (mmol/L)
PLAN C :
Treat severe dehydration quickly
Start IV or intraosseous fluid immediately
If fail to set up, arrange the child to the nearest health centre
Try to rehydrate with ORS (20ml/kg/hour for 6 hours) orally or
by orogastric tube
Volume of IV fluid required for maintenance:
<6 months : 150ml / kg / day
6 months 1 years : 120ml / kg / day
>1 years : 1st 10 kg = 100ml / kg / day
10 -20 kg = 1000ml (1st kg) + 50ml / kg (next
subsequent 10kg)
> 20kg = 1500ml (1st kg) + 20ml / kg (any
subsequent kg)
Hypernatremic dehydration

Resuscitation 20 ml/kg of normal saline over 1-2 hours


Deficit corrected over 48 hours
Giving maintenance 3/5 of normal total plus of the
deficit over 24 h
Deficit with normal or half saline and maintenance with
0.18% saline 4.3% dextrose
Fluids not given more than 100 ml/kg/day
DRUG THERAPY
Septicemias = antibiotics
Campylobacter infection = erythromycin
Cholera = tetracycline
Severe shigellosis = ampicilin/
cotrimaxazole
Amoebiasis = metronidazole
Yersinia enterocolityca = cotrimaxazole
COMPLICATION
Dehydration
Metabolic acidosis
Lactose intolerance
Usually in formula fed babies <6m with infectious diarrhea
Clinical features:
Persistent loose/watery diarrhea
Abdominal distention
Increased flatus
Perianal excoriation
Susceptibility to re infection
Haemolytic uraemic syndrome
Death
PREVENTION
1.Hand washing before handling food
2. Food hygiene (storage, handling, cooking).
3. Good housing and sanitary disposal
4.Access to safe drinking-water
5.Vaccination:
rotavirus vaccine
Salmonella Typhi vaccine is recommended for
travellers to countries with a high incidence.
Vibrio species vaccine is available but only protects
50% of immunized persons for 3-6 months and is not
indicated for use
6.Exclusive breastfeeding for the first six months of life
7.Health education about how infections
NURSING INTERVENTION
1.FLUID VOLUME DEFICIT RELATED TO
RAPID FLUID LOSS ASSOCIATED WITH
VOMITING / DIARRHOEA
OBJECTIVE:
Child will receive adequate fluid volume.

NURSING INTERVENTION:
Assess for hydration status.
Monitor intake and output.
Administer ORS accordingly using either Plan A or Plan B.
Administer IV fluids as ordered.
Ensure blood for BUSE is taken and inform result to doctor.
2.IMPAIRED SKIN INTEGRITY RELATED
TO FREQUENT DIARRHEA.
OBJECTIVE:
Child skin will remain intact.

NURSING INTERVENTION:
Assess skin of perianal.
Clean area with water each bowel movement, rinse well
and dry with soft towel.
Change linen and napkin whenever dirty or wet.
Apply barrier cream (zinc oxide) to perianal area.
3. KNOWLEDGE DEFICIT OF PARENTS /
CHILD RELATED HYGIENE.
OBJECTIVE:
Parents / child will acquire adequate knowledge on
hygiene.

NURSING INTERVENTION:
Assess level of knowledge regarding spread of infection.
Educate parents child on spread of infection.
Teach parents/ chlild correct technique of handwashing.
Educate parents on proper disposing of disposible
diaper.
4. POTENTIAL OF INFECTION RELATED
TO SUSCEPTIBLE HOST AND INFECTIOUS
AGENT.
OBJECTIVE:
Child infection will not spread to other children.

NURSING INTERVENTION:
Assess family knowledge of hand washing.
Maintain good hand washing.
Isolate patient as ordered.
Assess family description of living condition and
advice accordingly