Diarrhea in children
Introduction
Introduction to pediatric diarrhea Before the cause is unclear, the change of stool characteristics and the number of stools are more common than usual. It is collectively called diarrheal disease. Diarrhea is a group of diseases caused by multiple causes and multiple factors. It is one of the diseases with the highest incidence in childhood. Worldwide public health problems, diarrhea occurs at least 1 billion people worldwide each year. According to the World Health Organization, about 10,000 people die every day from diarrhoea. In China, diarrhoeal diseases are also common diseases in children. According to relevant data, the annual incidence rate of diarrhea in children under 5 years old in China is 201%, with an average annual incidence of 3.5 times per child per year, and the mortality rate is 0.51%. Therefore, the prevention and treatment of diarrhea in children is very important. basic knowledge The proportion of illness: 28.3% Susceptible people: infants and young children Mode of infection: non-infectious Complications: malnutrition bronchopneumonia
Cause
Causes of diarrhea in children
(1) Causes of the disease
There are many causes, multiple factors, internal factors, infectious and non-infectious.
Intrinsic factor
(1) Immature digestive system development: Insomnia, insufficient secretion of gastric acid and digestive enzymes, low activity of digestive enzymes, poor regulation of the gastrointestinal tract by the nervous system, difficulty in adapting to the quality and quantity of food, and rapid growth The need for nutrients is relatively high, the burden on the gastrointestinal tract is large, and the digestive function is often in a state of tension, which is prone to digestive disorders.
(2) The body's defense function is poor: the immune function in infants and young children is relatively immature, the blood immunoglobulin and gastrointestinal tract SIgA are lower, the gastrointestinal barrier function is weaker, the gastric acid secretion is less, and the gastrointestinal emptying is less. Fast, the defense function of infectious factors is poor. In addition, the normal intestinal flora has not been established after the birth of the newborn, and the antagonizing ability of the pathogenic microorganisms invading the intestinal tract is weak. The artificial feeding food lacks a large amount of immune substances contained in the breast milk, and Food and utensils have more chances of contamination, and the incidence of intestinal infections is significantly higher than that of breastfed infants.
(3) Characteristics of body fluid distribution: There are many interstitial fluids in infant cells, and water metabolism is strong, renal function is poorly regulated, and body fluid disorder is prone to occur.
2. Infectious factors
(1) Intestinal infection: mainly caused by bacteria and viruses, including:
1 Bacteria: In addition to legal infectious diseases, there are:
A. Escherichia Coli (E. Coli): classified as Enteropathogenic E. Coli (EPEC) according to its pathogenic mechanism, Enterotoxinogenic E. Coli (ETEC) ), Enteroinvasive E. Coli (EIEC), Enterohenor-rhagic E. Coli (EHEC), Adhesive Escherichia coli (EAEC).
B. Campylobacter jejuni.
C. Yersinia enterocolitica.
D. Others: Salmonella typhimurium, Proteus, Pseudomonas aeruginosa, Klebsiella, Staphylococcus aureus, Clostridium difficile (Clostridium difficile) and so on.
2 virus:
A. Human Rotavirus is the main cause of diarrhea in infants and young children.
B. Norwalk virus.
C. Adenovirus (Adenovirus).
D. Others: Astrovirus, Calicivirus, Corona virus, and the like.
3 fungi and protozoa: fungal infections are mainly Candida albicans, some protozoal infections such as Giardia lamblia, Balantidium coli, cryptosporidium, amoeba Protozoa (Entamocba hiltolytica) and the like.
(2) Intestinal infection: Children with upper respiratory tract infection, pneumonia, pyelonephritis, otitis media, skin infections and other acute infectious diseases may be accompanied by diarrhea, which is caused by fever and pathogen toxins, causing digestive disorders, enzymes Reduced secretion, increased intestinal peristalsis.
3. Non-infectious factors
Mainly for dietary factors, climatic factors and allergic factors, improper feeding is one of the main causes of diarrhea. Too much premature feeding of large amounts of starch, fatty foods, sudden changes in food varieties and weaning can lead to diarrhea, climate Sudden changes, increased bowel movements, decreased digestive enzymes and gastric acid secretion, can induce diarrhea, some malabsorption syndromes such as lactose intolerance, glycogenic diarrhea, congenital chloride diarrhea, hereditary fructose intolerance Pancreatic cystic fibrosis, primary intestinal malabsorption, etc. can cause diarrhea, milk protein allergies, watery diarrhea 48 hours after eating milk.
(two) pathogenesis
Different mechanisms of diarrhea caused by different causes can cause disease through the following mechanisms.
1. Non-infectious factors: mainly the inappropriate amount and quality of the diet, which makes the baby's digestive tract function disorder, the food can not be fully digested and absorbed, accumulated in the upper part of the intestine, and the acidity decreases, which is beneficial to the bacteria in the lower part of the intestine. Breeding, digestive dysfunction, a large amount of organic acids such as lactic acid and acetic acid in the intestine, which enhances the osmotic pressure of the intestinal lumen and causes diarrhea.
2. Infectious factors: Whether the pathogenic microorganism can cause intestinal infection depends on the strength of the host defense function, the amount of infection and the microbial virulence (adhesion, toxicity, invasiveness), cytotoxicity, and the adhesion ability of microorganisms. It is essential for intestinal infections.
(1) Bacterial enteritis: The main pathogenesis is mainly caused by the action of bacteria to produce toxins and bacterial invasiveness.
1 Enterotoxin enteritis: pathogens do not invade the intestinal mucosa, do not cause pathological changes, only adhere to the intact intestinal villi, causing disease by producing enterotoxin, the typical bacteria are ETEC and Vibrio cholera, other bacteria also Can produce enterotoxin, such as Yersinia, Salmonella typhimurium, Staphylococcus aureus, Proteus, Campylobacter jejuni, etc., taking ETEC as an example, through its pili sticks on the small intestine microvilli, grow and multiply, produce a large number There are two kinds of enterotoxin and enterotoxin, namely heat-liable toxin (LT) and heat-resistant toxin (ST). The physicochemical properties of LT, immune state and mechanism of action are the same as cholera toxin. LT binds to receptor gangliosides on intestinal epithelial cells, activates adenylate cyclase, converts adenosine triphosphate (ATP) into intestinal adenosine monophosphate (cAMP) in intestinal epithelial cells, and ST activates guanylate cyclization The enzyme converts guanosine triphosphate (GTP) to cyclic guanosine monophosphate (cGMP), both of which inhibit the absorption of sodium (and chlorine and water) by the intestinal mucosa and promote the secretion of chlorine (and both sodium and water). Water penetrates into the intestinal lumen, and the fluid accumulates In the intestines, causing diarrhea.
2 Invasive enteritis: the pathogen invades the lamina propria of the intestinal mucosa, causing congestion, edema, inflammatory cell infiltration, exudative inflammatory lesions, erosion, ulcers, etc., causing diarrhea caused by various invasive bacteria, such as Shigella, Shamen Bacteria, EIEC, Campylobacter jejuni, Yersinia and Staphylococcus aureus, Shigella, EIEC and Staphylococcus aureus mainly invade the colon; Campylobacter jejuni mainly affects the jejunum and ileum, and may also involve the colon; Sensobacteria involve the ileum; Salmonella typhimurium mainly affects the ileum and colon. These pathogens can cause dysentery-like symptoms, and there is not much fecal water. There is pus and mucus, which can cause abdominal pain. It also has enterotoxin and invasive effects. The strain can cause toxin-like watery diarrhea and dysentery-like symptoms.
(2) Viral enteritis: At present, rotavirus is more studied. Rotavirus invades the upper part of the small intestine. In severe cases, the entire small intestine is involved, and it replicates in the columnar epithelial cells at the tip of the small intestine villi. The microvilli are swollen and irregular, so that the affected small intestinal mucosal epithelial cells will soon fall off, and the cubic epithelial cells (secretory cells) in the small intestine crypt are not damaged, and the proliferation is uplifted to repair the damaged mucosal epithelium, but the neonatal epithelial cells are not enough. Mature, its enzymatic activity and transport function are poor, due to the loss of intestinal mucosal epithelial cells, resulting in reduced absorption area, reduced water and electrolyte absorption, and villi exposed, causing water, electrolytes to ooze, leading to diarrhea; microvilli on disaccharidase In particular, the lactase activity is reduced, causing the absorption of disaccharide such as (lactose), the nutrients that cannot be decomposed are retained in the intestinal lumen, decomposed by the intestinal bacteria, increasing the osmotic pressure in the intestine, causing water to enter the intestinal lumen, resulting in increased diarrhea. , the glucose-sodium coupling transport mechanism has obstacles, further causing water, electrolyte absorption reduction, water-like stool, late foreign research It was found that the non-structural protein NSP4 on rotavirus caused a similar effect to bacterial toxins, leading to secretory diarrhea.
3. Disorders of fat, protein and glucose metabolism: Due to the digestive and absorption function of the intestines, the peristalsis is hyperthyroidism, which causes obstacles to the digestion and absorption of nutrients. The loss of nutrients is mainly caused by the assimilation dysfunction caused by enzyme dysfunction, protein assimilation. The function is weakened, but the protein can still be digested and absorbed. The assimilation and absorption of fat are affected. In the recovery period, the assimilation of fat is still low, the absorption of carbohydrate is also affected, and the glucose tolerance test curve is low, but in acute diarrhea, children Gastrointestinal digestion and absorption function is not completely lost, and the absorption of nutrients can reach 60% to 90% of normal.
Prevention
Pediatric diarrhea prevention
On the basis of scientific research, and in conjunction with the specific conditions of each country, WHO recommends the following seven measures to prevent diarrhea in children, namely breastfeeding and rational addition of complementary food. China's Ministry of Health draws on the research results of WHO, combined with the experience of prevention and treatment of diarrheal diseases in China for many years, and in the current prevention and treatment situation, in the national diarrheal disease control plan, the following measures are clearly defined as the focus of future diarrheal disease prevention work, namely, 4 The exclusive breastfeeding rate of infants within a month; improving personal hygiene habits; washing hands before and after meals; properly handling children's feces; using sufficient clean water; harmless treatment of feces; applying safe and hygienic methods to prepare household foods, especially reasonable Add food supplements hygienically; strengthen hygiene management and supervision during food production, transportation and marketing. Seriously doing all of the above points will definitely reduce the incidence and mortality of diarrhoeal diseases.
Complication
Pediatric diarrhea complications Complications malnutrition
Due to diarrhea, poor absorption of nutrients, coupled with poor appetite, and reduced intake of nutrients, can cause a lack of various nutrients. Chronic diarrhea is particularly serious, with malnutrition, nutritional anemia, and various vitamin deficiencies. Long-term diarrhea after systemic resistance is low, can be secondary to various infections, common otitis media, bronchitis, bronchial pneumonia, urinary tract infections, skin infections and sepsis.
Symptom
Symptoms of diarrhea in children Common symptoms Abdominal diarrhea, abdominal pain, irritability, viral diarrhea, lips, blackness, hypokalemia, refusal to eat baby brown or dark green... ileocecal insufficiency
Gastrointestinal symptoms
When the diarrhea increases the number of stools, the amount increases, the nature changes, the stool is more than 3 times / d, or even 10 to 20 days, can be loose stool, paste-like stool, watery stool, or mucus pus and blood, to determine the traits of feces during diarrhea More than the number of times is more important, if the stool increases and the stool is formed, not diarrhea, human milk feeding children convulsions 2 to 4 times a day is a paste, not diarrhea, nausea, vomiting is a common accompanying symptoms, severe vomiting coffee samples Others may have abdominal pain, bloating, loss of appetite and other symptoms.
2. Systemic symptoms
Severe cases of severe systemic symptoms, most have fever, body temperature 38 ~ 40 ° C, a few up to 40 ° C or more, can appear pale, irritability, apathy, lethargy, convulsions, and even coma, with systemic symptoms aggravated, Can cause nervous system, heart, liver, kidney dysfunction.
3. Water, electrolyte and acid-base balance disorders
Mainly for dehydration and metabolic acidosis, and sometimes hypokalemia, hypocalcemia.
Dehydration
Loss of water and electrolytes due to diarrhea and vomiting reduces the body's ability to retain water; severe vomiting, fasting, loss of appetite or refusal to eat, reducing food and fluid intake; fever, rapid breathing, acidosis Deeper breathing, so that non-dominant water loss increases, according to the amount of water, electrolyte loss and nature are divided into three types: isotonic dehydration (serum sodium concentration 130 ~ 150mmol / L), hypotonic dehydration (serum sodium concentration <130mmol/L), hypertonic dehydration (serum sodium concentration>150mmol/L), most children with acute diarrhea are isotonic dehydration, generally manifested as weight loss, thirst, skin pale or gray, poor elasticity The sputum and eyelid depression, dry mucosa, reduced tears, decreased urine output, severe cases can lead to circulatory disorders, according to the degree of dehydration is divided into light, medium, severe, dehydration assessment.
5. Metabolic acidosis
Most of the dehydration has different degrees of metabolic acidosis. The causes are: a large amount of alkaline substances are lost with the feces; when the dehydration, the renal blood flow is insufficient, the urine volume is reduced, the acidic metabolites in the body cannot be discharged in time; the intestinal digestion and absorption function is poor. Insufficient calorie intake, increased fat oxidation, incomplete metabolism, ketone body accumulation and can not be discharged by the kidney in time; severe dehydration, insufficient tissue filling, tissue hypoxia, lactic acid accumulation, mainly manifested as listlessness, lethargy, deep breathing Sighs, lips and sakura, serious people are unconscious, newborns and small babies have poor respiratory compensatory function, respiratory rhythm changes are not obvious, mainly manifested as lethargy, pale, antifeeding, weak, etc., should pay attention to early detection.
6. Hypokalemia
In the case of diarrhea, the concentration of potassium in the watery stool is about 20-50 mmol/L. Too much vomiting and diarrhea is lost and the intake is insufficient. Potassium can not be compensated, which can lead to hypokalemia. The symptoms are mostly corrected by dehydration and acidosis. appear.
(1) Dehydration, acidosis correction often occurs when low potassium occurs:
1 In the case of acidosis, the extracellular fluid H enters the cell and exchanges with K, so the K in the cell decreases, while the serum potassium does not decrease, the renal function is dehydrated during dehydration, and the potassium is reduced by the urine. After the rehydration, especially the input is not Potassium-containing solution, serum potassium is diluted and increased with urine. After acidosis is corrected, potassium is transferred from the outside to the inside of the cell. At this time, hypokalemia is prone to occur.
2 hypokalemia gradually appeared in the course of disease for more than 1 week.
3 malnourished people appear earlier and heavier, before the dehydration is not corrected, due to blood concentration, acidosis, oliguria and other reasons, the blood potassium concentration can still maintain normal, at this time rarely hypokalemia, and with Dehydration and acidosis are gradually corrected and the amount of urine is increased, and the supplemental potassium content is insufficient to gradually appear.
(2) hypokalemia: serum potassium is less than 3.5mmol / L, manifested as listlessness, decreased muscle tone, abdominal distension, weakened or disappeared intestinal peristalsis, low heart sounds, sputum reflexes weakened or disappeared, severe coma, Intestinal paralysis, respiratory muscle paralysis, slow heart rate, arrhythmia, apical systolic murmur, can be life-threatening, ECG performance ST segment down, T wave low, flat, biphasic, inverted, U wave, PR interval And the QT interval is extended.
7. Hypocalcemia and hypomagnesemia
Generally do not appear, diarrhea lasting, the original rickets or malnutrition children, when acidosis corrected, serum combined calcium increased.
8. Clinical manifestations of several common infectious diarrhea
(1) Rotavirus enteritis: occurs in autumn and winter, is a sporadic or small epidemic, the virus spreads through the fecal-oral route and the respiratory tract, more common in infants and young children aged 6 to 24 months, incubation period 1-3 Days, often accompanied by fever and upper respiratory tract infection symptoms, acute onset, vomiting at the beginning of the disease, then diarrhea, stool water or egg soup, with a small amount of mucus, no odor, several times a day to more than 10 times, Often accompanied by dehydration and acidosis, the disease is a self-limiting disease, the course of disease is 3 to 8 days, a small number of long, stool microscopic examination occasionally a small amount of white blood cells, a large number of viruses from the stool within 1 to 3 days of disease, up to 6 days, Serum antibodies generally rise after 3 weeks, and the virus is difficult to separate. Immunoelectron microscopy, ELISA or nucleic acid electrophoresis are helpful for diagnosis.
(2) Norwalk virus enteritis: more common in older children and adults, clinical manifestations similar to rotavirus enteritis.
(3) Escherichia coli enteritis: often occurs in May to August, the severity of the disease is different, pathogenic E. coli enteritis stool is egg-flower soup, stinking, more mucus, occasionally Bloodshot or sticky stool, often accompanied by vomiting, no fever and systemic symptoms, mainly manifested in water, electrolyte disorders, 1 to 2 weeks of disease, toxin-producing Escherichia coli enteritis, onset is more urgent, the main symptoms are vomiting, Diarrhea, stool is watery, no white blood cells, often obvious water, electrolyte and acid-base balance disorder, disease course 5 to 10 days, invasive E. coli enteritis, acute onset, high fever, frequent diarrhea, stool is sticky, With pus and blood, often accompanied by nausea, abdominal pain, urgency and other symptoms, sometimes severe poisoning symptoms, and even shock, clinical symptoms and bacterial dysentery are difficult to distinguish, need to be identified for stool culture, hemorrhagic Escherichia coli enteritis, stool frequency Increase, start with a yellow watery stool, then turn into blood and water, have a special odor, stool with a large number of red blood cells, often no white blood cells, with abdominal pain, may be associated with hemolytic uremic syndrome and Small purpura.
(4) Campylobacter jejuni enteritis: It can occur all year round, more common in summer, can be sporadic or outbreak, with the highest incidence of infants and young children from 6 months to 2 years old. Livestock and poultry are the main sources of infection. Through the fecal-oral route, animals human or human human transmission, incubation period of 2 to 11 days, acute onset, symptoms similar to bacterial dysentery, fever, vomiting, abdominal pain, diarrhea, stool is mucus or pus and blood, evil Odor, toxin-producing strains can cause watery stools, stools have a large number of white blood cells and a large number of red blood cells, which can be complicated by severe enterocolitis, sepsis, pneumonia, meningitis, endocarditis, pericarditis and so on.
(5) Yersinia enterocolitis: occurs mostly in winter and spring, is more common in infants and young children, the incubation period is about 10 days, no obvious prodromal symptoms, clinical symptoms are related to age, diarrhea is the main symptom in children under 5 years old The stool is watery, mucus-like, pus-like or bloody. There are a lot of white blood cells in the stool. Most of them have abdominal pain, fever, nausea and vomiting. 5 years old and above, adolescents, abdominal pain, increased white blood cells, and accelerated erythrocyte sedimentation rate. Like acute appendicitis, this disease can be complicated by mesenteric lymphadenitis, nodular erythema, reactive arthritis, sepsis, myocarditis, acute hepatitis, liver abscess, conjunctivitis, meningitis, urethritis or acute nephritis, etc., course 1 to 3 week.
(6) Salmonella typhimurium enteritis: the incidence of the whole year, the highest incidence from April to September, most of the infants under 2 years old, easy to occur in the pediatric ward, oral transmission, incubation period of 8 ~ 24h, the main clinical manifestations Fever, nausea, vomiting, abdominal pain, bloating, "spray"-like diarrhea, the number of stools can reach more than 30 times, yellow or dark green loose stools, watery stools, mucus or pus and blood stools, stools can be seen a large number of white blood cells and different The number of red blood cells, severe cases may occur dehydration, acidosis and systemic poisoning symptoms, and even shock, can also cause sepsis, meningitis, general course of 2 to 4 weeks, high rate of infection, some children after the disease 2 bacteria More than a month.
(7) Staphylococcus aureus enteritis: rarely primary, more secondary to the application of a large number of broad-spectrum antibiotics or secondary to chronic diseases, acute onset, severe symptoms of poisoning, manifested as fever, vomiting, frequency Diarrhea, different degrees of dehydration, electrolyte imbalance, severe shock, the first stool is yellow-green, after 3 to 4 days, more turned into odor, seawater-like stool, mucus, stool a large number of pus cells and Gram-positive bacteria, Staphylococcal growth in stool culture is positive for coagulase.
(8) pseudomembranous colitis: more common after long-term use of antibiotics, due to long-term use of antibiotics caused by intestinal flora disorder, so that Clostridium difficile mass reproduction, resulting in necrotic toxins, the main symptoms are diarrhea, stool yellow Lean water or mucus, a small amount of blood, a pseudomembrane discharge (intestinal tube), accompanied by fever, abdominal distension, abdominal pain, abdominal pain often precedes diarrhea or with diarrhea, often accompanied by significant hypoproteinemia, water, Electrolyte disorder, systemic weakness is chronic consumption, light children usually stop diarrhea 5 to 8 days after stopping the drug, severe dehydration, shock to death, if the child diarrhea occurs after stopping the drug, or continue to use after diarrhea Antibiotics, the course of the disease is often delayed.
(9) Candida alicans enteritis: mostly occurs in frail, malnourished children, long-term abuse of broad-spectrum antibiotics or adrenocortical hormones, often accompanied by thrush in the mouth, increased stool frequency, yellow or yellow Green, more foam, with mucus sometimes visible tofu slag-like fine pieces (colony), stool can be seen under the microscope fungal spores and pseudohyphae, for fecal fungus culture to help identify.
9. Pediatric prolonged and chronic diarrhea
The etiology is complex and is currently considered to include infection, allergies, congenital digestive enzyme deficiency, immunodeficiency, drug factors, congenital malformations, etc. Among them, diarrhea after infection is the most common, and intestinal mucosal biopsy results in children with chronic diarrhea indicate small intestinal mucosal structure. Sustained damage to the function or damage to the normal repair mechanism is an important reason for the unhealed diarrhea in children.
(1) History of acute diarrhea: acute infectious diarrhea is mostly transient, but if the host can not produce normal immune response, repeated exposure to infectious agents, or serious damage to intestinal mucus due to infection, acute diarrhea can be converted to chronic diarrhea. Most of the diarrhea caused by persistent mucosal damage is delayed, a small number of persistent infections, duodenum, jejunal mucosa thinning, intestinal villi atrophy, intestinal cell overflow, increased shedding, microvilli degeneration, which accelerates the renewal of epithelial cells. May be related to the adhesion of microbes on the surface of the intestinal mucosa. Due to insufficient regeneration time of the mucosa, these neoplastic epithelial cells are similar to crypt cells, so their function is low, disaccharidase, especially lactase activity and brush edge peptidase activity are reduced, plus The reduction of the effective absorption area causes digestion and absorption of various nutrients. In addition, intestinal mucosal damage increases the permeability to pathogenic substances and macromolecular substances, and mucous mucosa to foreign antigens.
(2) Children with malnutrition: all the bacteria in the upper part of the small intestine increased significantly during diarrhea. The anaerobic bacteria and yeast in the duodenum were over-reproduced. Due to the debinding of chonic acid by a large number of bacteria, the concentration of free bile acid was greatly increased. Increased, high concentration of free bile acid can damage the small intestine cells, but also hinder the formation of fat particles, severe immune malnutrition in children with severe malnutrition, secretory antibodies, phagocytic function and complement levels are reduced, thus increasing the pathogens and food The susceptibility of protein antigens, in short, continuous diarrhea is prone to malnutrition, and malnutrition is easy to delay the diarrhea, the two cause each other, forming a vicious circle.
Examine
Examination of diarrhea in children
1. Routine examination of feces: stool microscopy, pay attention to the presence or absence of pus cells, white blood cells, red blood cells and phagocytic cells, should also pay attention to the presence of eggs, parasites, fungal spores and hyphae, sometimes it takes several times to make sense, there are Helps the etiology and pathogen diagnosis of diarrheal diseases.
2. Stool culture: It is of great significance to determine the original diarrhea disease. The positive rate of faecal culture is low, and it needs to be done several times. The fresh specimen can be cultured immediately to increase the positive detection rate.
3. Stool latex agglutination test: Diagnostic value for certain viral enteritis, such as rotavirus, intestinal adenovirus, etc., has good sensitivity and specificity, and is helpful for the diagnosis of Campylobacter jejuni.
4. Enzyme-linked immunosorbent assay: highly sensitive and specific to rotavirus, contributing to the diagnosis of rotavirus enteritis and other viral enteritis.
5. Polyacrylamide gel (PAGE) electrophoresis test: This method can detect rotavirus subgroups and different electrophoresis types, which is helpful for the classification and research of rotavirus.
6. Fecal reducing sugar test: When the disaccharide digestion is malabsorption, the fecal reducing sugar is positive, the pH value is <6.0, and the reducing sugar test can be improved by the modified plaque reagent or the Clinitest test paper colorimetric color. The secondary disaccharidase deficiency is far more than the primary one. Sexually common, primary sucrose-isomaltase deficiency is most common.
7. Fecal electron microscopy: Diagnostic value for certain viral enteritis, such as rotavirus enteritis, Norwalk viral enteritis.
8. White blood cell count and classification: the total number of white blood cells in viral enteritis is generally not increased, the total number of white blood cells in bacterial enteritis can be increased or not increased, more than half of the children have a rod-shaped nucleus, the rod-shaped nucleus is greater than 10%, contributing to bacteria Diagnosis of infection.
9. Blood culture: It has diagnostic value for bacterial enteritis such as bacterial dysentery, Escherichia coli and Salmonella, and positive blood culture is helpful for diagnosis.
10. Blood biochemical examination: For children with severe diarrhea, blood pH, carbon dioxide binding capacity, bicarbonate, blood sodium, blood potassium, blood chlorine and blood osmotic pressure should be checked in time for diagnosis and treatment.
11. Others: For patients with persistent and chronic diarrhea, if necessary, lactose, sucrose or glucose tolerance test, expiratory hydrogen test (a method for quantitative non-invasive determination of carbohydrate malabsorption, conditional can be applied), For fiber colonoscopy.
Diagnosis
Diagnosis and diagnosis of diarrhea in children
diagnosis
According to the season of onset, age, stool characteristics, the number of bowel movements to make a preliminary diagnosis, for the degree and nature of dehydration, whether there is acidosis and lack of electrolytes such as potassium and sodium, judge, if necessary, carry out pathogens such as bacteria, viruses and parasites As a cause of diagnosis.
Differential diagnosis
1. Physiological diarrhea (physical diarrhea): The appearance of psychiatric pediatrics, the number of stools soon after birth is more, thin, golden yellow, but not accompanied by vomiting, normal weight gain.
2. Acute necrotizing enterocolitis: infection and allergic reaction are important factors in the pathogenesis. The disease has five major symptoms: diarrhea, bloating, blood in the stool, high fever and vomiting. The stool is initially watery, then dark red, jam-like or bloody. Abdominal swelling is more serious, early shock, even coma, convulsions.
3. Acute bacterial dysentery: The incidence rate is high in summer, and the children have a history of unclean food. The incubation period is 24-72 hours. Most patients have acute onset, high fever, abdominal pain, vomiting, diarrhea, and urgency. The stool is mostly mucus and pus. The number of bowel movements is several times a day to more than 10 times. Patients with toxic bacillary dysentery can experience febrile seizures, lethargy or coma, and even shock and other symptoms. The length of the disease varies, and stool culture can be diagnosed.
