Infant diarrhea
Introduction
Introduction to infantile diarrhea Infant diarrhea, also known as infantile dyspepsia, is an acute gastrointestinal dysfunction in infants and young children, with diarrhea and vomiting as the main syndrome, with the highest incidence in summer and autumn. The pathogenic factors of this disease are divided into three aspects: physical fitness, infection and digestive dysfunction. The main clinical manifestations are increased stool frequency, loose stools and water and electrolyte disorders. The disease is treated properly and the effect is good, but it can be endangered when the serious water-electrolyte disorder occurs without timely treatment. In the season of diarrhea, try to take the children to the hospital or public places as much as possible to avoid infection and start the disease; and pay attention to the child's food hygiene, such as washing hands before feeding, etc., all of which are beneficial to prevent "sickness from entering the mouth." At the same time, we must pay attention to breastfeeding and strengthen the self-immunity and disease resistance of infants and young children. basic knowledge The proportion of illness: 80% Susceptible people: children Mode of infection: non-infectious Complications: malnutrition, hyponatremia, acute heart failure
Cause
Causes of infantile diarrhea
Physical factors (30%):
The disease mainly occurs in infants and young children, and its internal characteristics:
1, the baby's gastrointestinal tract development is not mature enough, the enzyme activity is low, but the nutritional needs are relatively large, the gastrointestinal burden is heavy.
2, infantile nerve, endocrine, circulatory system and liver, kidney function development are immature, poor regulation function.
3, the immune function of the baby is not perfect, the serum E. coli antibody titer is the lowest from the first birth to 2 years old, and then gradually increase, so infants and young children are prone to E. coli enteritis, breast cancer E. coli antibody titer is high, especially in colostrum Pathogenic E. coli secreted IgA is high, so breast-fed infants are less ill, and the disease is also milder. Similarly, small infant rotavirus antibodies are low. When the same group is popular, small infants have more rickets.
4, baby body fluid distribution and adult, the proportion of extracellular fluid is high, and the water metabolism is strong, the regulation function is poor, more likely to occur body fluids, electrolyte disorders, babies are susceptible to rickets and malnutrition, easy to cause digestive disorders, this When the intestinal secretion type IgA is insufficient, it is prone to prolonged after diarrhea.
Infection factor (35%):
Divided into the digestive tract and the infection of the digestive tract, the former is the main.
1. Infection in the digestive tract: pathogenic microorganisms can enter the digestive tract of children with contaminated food or water, which is easy to occur in artificial feeding. If the utensils or food itself used for feeding are not disinfected or disinfected enough, there may be infection. The virus can also be infected through the respiratory tract or water source, followed by infection by adult carriers (poisons), such as bacterial infection (or viral) enteritis in the ward, some medical personnel are infected, become asymptomatic intestinal bacteria (poison) Can cause the spread of pathogens.
2, digestive tract infections: organs outside the digestive tract, tissue infection can also cause diarrhea, common in otitis media, pharyngitis, pneumonia, urinary tract infections and skin infections, diarrhea is not serious, the younger the more common, causing diarrhea Part of the reason is due to digestive disorders caused by extraintestinal infections, and the other part may be caused by the same pathogen (mainly virus) infection inside and outside the intestine.
3, the abuse of antibiotics caused by intestinal flora disorder: long-term application of broad-spectrum antibiotics such as chloramphenicol, kanamycin, gentamicin, ampicillin, various cephalosporins, especially two or When used in combination, it can directly stimulate the intestinal tract or stimulate the autonomic nerve to cause intestinal peristalsis, decrease glucose absorption, decrease disaccharidase activity and cause diarrhea, and more serious can cause intestinal flora disorder. Intestinal E. coli disappears or is significantly reduced, and drug-resistant Staphylococcus aureus, Proteus, Pseudomonas aeruginosa, Clostridium difficile or Candida albicans can be multiplied, causing enteritis that is difficult to control.
Digestive disorders (35%):
Due to dietary factors, intolerance to carbohydrates, food allergies, drug effects, other factors: such as unclean environment, too little outdoor activities, sudden changes in the law of life, sudden changes in the external climate (Chinese medicine called "wind, cold, heat" , wet diarrhea"), etc., causing digestive disorders can also cause infantile diarrhea.
Prevention
Infant diarrhea prevention
1. Encourage breastfeeding, especially in the 4 to 6 months after birth and the first summer, and should avoid summer weaning.
2, artificial feeding should pay attention to food hygiene and clean water, wash the utensils with boiling water before each feeding, boil once a day disinfection.
3, breast milk and artificial feeding should be added food supplements on time, avoiding several complementary foods at the same time.
4, loss of appetite or in the early stage of fever, should reduce the amount of milk and other foods, replaced by water, it is best to use oral rehydration salts into a drink orally.
5, in the summer heat to avoid overeating or eating fat-rich foods, baby's temperature regulation is poor, wear less clothes in the summer, pay attention to room ventilation.
6, suffering from malnutrition, rickets or extraintestinal infections, should be treated in time to prevent concurrent diarrhea.
7, infectious diarrhea, especially caused by Escherichia coli, typhoid fever or other Salmonella and rotavirus, is highly contagious, easy to spread widely in the ward, must be severely disinfected and isolated, otherwise it is easy to cross infection in the pediatric ward, disinfection The method has the best effect of peracetic acid smoking, followed by disinfection with new disinfection surface and ultraviolet radiation. The ward of diarrhea cases is best disinfected with peroxyacetic acid smoke every month.
8. Children who play in the ground should wash their hands before and after meals.
9, medical staff should work hard to promote prevention measures for diarrhea in children, so as not to commit diarrhea.
Rotavirus enteritis is widespread, vaccine is an ideal preventive method, and the vaccine has been reported to have a protective rate of more than 80%, but the persistence remains to be studied.
Complication
Infantile diarrhea complications Complications, malnutrition, hyponatremia, acute heart failure
Diarrhea often leads to malnutrition, multiple vitamin deficiency and multiple infections.
1, digestive tract infection
Digestive tract infection may be the cause of diarrhea, but it is often infected by low body resistance after diarrhea. Common skin purulent infections, urinary tract infections, otitis media, upper respiratory tract infections, bronchitis, pneumonia, phlebitis and sepsis Viral enteritis occasionally complicated with myocarditis.
2, thrush
Children with prolonged disease or malnutrition are prone to thrush, especially after long-term use of broad-spectrum antibiotics. If not stopped in time, fungi can invade the intestines and even cause systemic fungal diseases.
3. Toxic hepatitis
In the course of diarrhea, jaundice may occur, which is more common in children with malnutrition, may be caused by E. coli, and cause Escherichia coli sepsis, leading to toxic hepatitis. The condition will soon increase after diarrhea, and soon after jaundice, but if Early detection of timely injection of polymyxin, ampicillin or carbenicillin, most can be cured.
4. Malnutrition and vitamin deficiency
Diarrhea is prolonged for a long time, or repeated fasting, long-term calorie deficiency, easy to lead to malnutrition, anemia and vitamin A deficiency, chronic liver damage caused by chronic diarrhea, reduced vitamin K absorption and decreased prothrombin, resulting in bleeding.
5, other
Acute dehydration can be complicated by acute renal failure, in addition to: toxic intestinal paralysis, intestinal bleeding, intestinal perforation, intussusception and gastric dilatation, acute heart failure due to improper infusion, high sodium or hyponatremia, or Hyperkalemia, vomiting can occur when the baby is vomiting poorly.
Symptom
Infants and young children with diarrhea symptoms Common symptoms Fecal diarrhea, abdominal pain, explosive watery diarrhea, bloating, infant brown or dark green... Intestinal dehydration, loss of appetite, antifeeding
1, general symptoms
It varies with diarrhea.
(1) Light diarrhea: mainly the number of ambassadors increased, several times a day to 10 times, the ambassador is thin, sometimes there is a small amount of water, yellow or yellow-green, mixed with a small amount of mucus, each time is not much, common white or light yellow Small pieces, calcium, magnesium and fatty acid combination soap, occasionally a small amount of vomiting or galactorrhea, loss of appetite, normal body temperature or occasionally low fever, pale face, good spirits, no other symptoms, weight loss or slightly lower The body fluid loss is below 50ml/kg, the clinical dehydration symptoms are obvious from time to time, and the prognosis is good. The course of disease is about 3 to 7 days. In children with rickets or malnutrition, although the diarrhea is light, it is often 3 to 7 times a day, and the color is yellow. There are often mucus, stench, and a small amount of white blood cells can be seen in the stool. The traits and frequency of the ambassador are unstable. The prolonged period of time, the worse the nutritional status, often secondary to the urinary tract, middle ear or other parts of the infection.
(2) Heavy-duty diarrhea: It can be made by light weighting. The stool is changed from a few times to 40 times a day. When it starts to be heavy, the water will increase. Occasionally, it will be mucus, yellow or yellow-green, with odor and acidic reaction. If the diaper is not timely, the skin of the buttocks is often corroded, and the epidermis is exfoliated and reddened. As the condition is aggravated and the food intake is reduced, the stool smell is reduced, and the fecal mass disappears and is watery or egg-like, and the color becomes light, mainly Ingredients are intestinal fluid and small amount of mucus, alkaline reaction, the amount of stool increased to 10 ~ 30ml each time, more than 50ml, see fat drops under the microscope, swimming bacteria, mucus, severe occasional red blood cells, white blood cells reach Each high part of the field of vision is about 10, the child's appetite is low, often accompanied by vomiting, more irregular low fever, severe hyperthermia, rapid weight loss, significant weight loss, such as not timely rehydration, dehydration, acidosis gradually worsened, a few critically ill High fever of 39 ~ 40 ° C, frequent vomiting, diarrhea-like stools, rapid symptoms of water and electrolyte disorders, in the past ten years, due to early treatment, severe severe diarrhea has been significantly reduced.
2, water and electrolyte disorders symptoms
Dehydration, acidosis, sometimes low potassium, low calcium symptoms.
(1) Dehydration: The child loses weight quickly, loses weight, is wilting, has pale or even gray skin, poor elasticity, anterior and dilated eye sockets, dry mucous membranes, depressed abdomen, fine pulse, lower blood pressure and reduced urine output. Dehydration is divided into light, medium and heavy three degrees: 1 mild dehydration: body fluid loss accounts for less than 5% of body weight, the child's mentality is slightly poor, the complexion is slightly pale, the skin is slightly dry but the elasticity is still good, the eye socket is slightly poor, and the complexion is slightly pale. The skin is slightly dry but the elasticity is still good, the eye socket is slightly trapped, and the urine is slightly less than usual; 2 moderate dehydration: the body fluid loss accounts for about 5-10% of the body weight, the child is wilting, the irritability, the skin is pale and gray, dry and slack, The elasticity is poor, it can not be flattened immediately after pinching, the mouth is blue, the front and eye sockets are obviously sunken, the lips and mucous membranes are dry, the heart sound is blunt, the abdomen is concave, the limbs are cold, and the urine is obviously reduced; 3 severe dehydration: body fluid loss accounts for 10 of body weight ~15%, the child is wilting, indifferent, no response to the surrounding environment, the skin is gray, the elasticity is very poor, it is not easy to calm after pinching, the front and the eye socket are deep, the eye is not closed, the conjunctiva is dry, crying without tears, the cornea is not Light, lips , Dry mucous membranes, clear, heart rate, blood pressure is not easy to measure, the abdomen deep, cold limbs, little or no urine the urine.
When estimating the degree of dehydration, attention should be paid to the eye socket, the degree of anterior sulcus depression, hypotonic dehydration is easy to reduce skin elasticity, and the malnutrition children usually have poor elasticity at ordinary times, which should be noted.
The clinical symptoms of different dehydration types are also different. Due to the loss of extracellular fluid during hypotonic dehydration, the symptoms of dehydration appear early and heavier, but the thirst is lighter and the wilting is heavier. In hypertonic dehydration, the intracellular fluid Exogenously, the extracellular fluid is relatively less lost, the child has thirst, fever, irritability, increased muscle tone, occasional convulsions, eye sockets, anterior sac depression, warmer hands and feet, and pulse.
(2) Acidosis: mainly mental wilting, deep breathing, showing a stagnation, severe breathing, and even coma, newborns or small babies have no or late breathing, mainly characterized by lethargy, pale, antifeedant, Debilitation, etc., when estimating acidosis, pay attention to the age of the child.
(3) hypokalemia: more than 1 week of watery diarrhea, there is obvious hypokalemia, the original malnutrition appears earlier, heavier, generally children have less hypokalemia before infusion, input potassium-free liquid After the correction of dehydration acidosis, symptoms of hypokalemia gradually appear: apathetic, low muscle tone, first heart sounds blunt, and then heavy abdominal distension, bowel sounds weakened or disappeared, tendon reflexes weakened, if not timely potassium When the hypokalemia is severe, muscle paralysis or respiratory muscle paralysis may occur, intestinal paralysis, bladder paralysis, paralysis reflexes disappear, heart rate slows down, arrhythmia, systolic murmur in the apex, heart enlargement, life-threatening, blood potassium Below 0.5mmol/L, there are many symptoms of hypokalemia.
(4) hypocalcemia: the original malnutrition, rickets or diarrhea for a long time, often after the round of fluid irritability, hand, foot and even convulsions and other low calcium symptoms, check the Foster and sputum reflex positive .
(5) hypomagnesemia: a small number of children corrected dehydration, acidosis, calcium deficiency after the occurrence of low-magnesium hand and foot sputum, manifested as hand and foot tremor, sputum, crying, susceptible to stimulation, can not fall asleep, individual children in the amount A blush appears at the department or skin wrinkles.
Examine
Examination of infantile diarrhea
1, stool examination: bleeding, pus cells, protozoa, eggs, fat drops and so on.
2, small intestine absorption function measurement: showing intestinal malabsorption.
3, X-ray and endoscopy detected lesion location, motor function status, gallstones and so on.
4. Ultrasound.
5, small intestinal mucosal biopsy, conditional should be used for stool culture, electron microscopy or virus isolation.
6, other: for severe or difficult to judge, serum sodium, potassium, chloride and blood gas should be measured, or carbon dioxide binding force, serum can be measured when convulsions, pay attention to the history and clinical manifestations of water, electrolyte disorders Analysis, ECG examination helps to understand the blood potassium situation. When the potassium is low, the T wave is flat, then the inversion is reversed, the ST segment is lowered, U waves are often present, and sometimes the T wave is fused. In the case of severe hypokalemia, ventricular premature beats and ventricular tachycardia may occur, and individual severe cases have ventricular fibrillation.
Diagnosis
Diagnosis and diagnosis of infantile diarrhea
diagnosis
Diagnosis can be performed based on clinical manifestations and examinations.
Differential diagnosis
1, bacillary dysentery
Infants with dysentery are mostly atypical, often without pus and blood, clinical manifestations of general diarrhea, difficult to identify, should pay attention to the prevalence, often can contact the history of contact, often crying before defecation, showing urgency and heavy, carefully observed the visible stool Frequent, but not much amount each time, sometimes see watery stool mixed with pus and blood, there are more pus cells, red blood cells and phagocytic cells under the microscope, while E. coli enteritis is more than one time, some of them can reach each time. More than 20ml, mucus in the stool is common, but very little pus, occasionally a small number of white blood cells and red blood cells, should be cultured and identified.
2, infant hemorrhagic enteritis
The onset is no different from E. coli enteritis, but after treatment, the diarrhea is not only worse, the condition is worse, the abdominal distension is heavier, the fever is high, the vomiting is frequent, the coffee is spit, the stool is watery in the early stage, the occult blood test is negative, and the typical dark red color appears later. Jam-like stool, dehydration, early shock, severe symptoms of poisoning can be coma, convulsions.
3. "Physiological diarrhea"
Exudative physique children can start to yellow and green loose stools soon after birth, but the number of stools is many, but no vomiting, good appetite, normal weight gain, and the stool will naturally return to normal after adding complementary food.
