《儿科学教学课件》16、infantile diarrhea(上).ppt
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1、Infantile Diarrhea,Li zhongyue Dep. Gastroenterology Childrens Hospital , CQMU,Dep. Gastroenterology,Childrens Hospital, CQMU,Content,Definition Epidemiology Etiology and Predisposing factor Pathogenesis Clinical manifestation Diagnosis Management & prevention Fluid therapy,Content,Definition Epidem
2、iology Etiology and Predisposing factor Pathogenesis Clinical manifestation Diagnosis Management & prevention Fluid therapy,Diarrhea-definition,Diarrhea is defined as an increase in the Fluidity, Volume, and Frequency of stools. Volume 10 ml/kg/d in children or 200g/day in adolescents Fluidity Decre
3、ase in consistency (loose or liquid) Frequency Bowel movements3 per 24 hours,Content,Definition Epidemiology Etiology and Predisposing factor Pathogenesis Clinical manifestation Diagnosis Management & prevention Fluid therapy,Epidemiology,High incidence and mortality,European 0.5-1.9 episodes per pe
4、rson per year,Consume large amounts of health care costs USA: 1-2 episodes/child/year 1.5 Million medical consultations 160,000 ER visits 220,000 hospitalizations (mean hospital stay 3.4 days) $ 1.8 Billion per year of medical costs Mortality rates: 32.2 deaths/100,000 live born in Afro-Americans (8
5、.2 in whites),Dehydration Death Malnutrition Growth retardation Impaired mental development,Consequences of diarrhea in children,leading causes of death in children in developing countries,15%,Mortality from diarrhea diseases among children in developing countries,The mortality of diarrhea is declin
6、e: Development of economy Progress of Medicine Improvement of medical conditions ORS use But,Predisposing factor,Infant digestive system is not well developed, and the function is immature: Lack of gastric acid secretion,-Lower enzyme activity,-Rapid gastric emptying (infection & indigestion). Water
7、 metabolism rapidly, the water tolerance is poor, once the water loss prone to humoral disorder. The functions of nerve system, endocrine, circulation, liver, kidney are inmature, prone to gastrointestinal dysfunction. More nutrition demand Because children are growing rapidly, they need more nutrit
8、ion to meet their rapid growth the burden of digestive system is heavier.,Weakness of defense system Lack of gastric acid secretion, -rapid gastric emptying, -lower enzyme activity.The introgastric pathogenes cannot be killed thoroughly. The levels of serum IgA, IgM and the secretory IgA in intestin
9、al tract are lower, so the immune defense is insufficient. Normal intestinal flora have not well established,Bottle-feeding (or artificial feeding) Milk or/and bottle is prone to contaminated with pathogens during handling Milk nutrition damaged Breast milk contains immune components:(sIgA, lactofer
10、rin, lysozyme,etc.),E.coli,Etiology,Infective factors (virus,bacteria,fungi,parasites) Noninfective factors Dietary factor Inappropriate feeding Allergic Diarrhea Disaccharidase Deficiency Climate Symptomatic Diarrhea,Etiology,Infective factors (virus,bacteria,fungi,parasites) Noninfective factors D
11、ietary factor Inappropriate feeding Allergic Diarrhea Disaccharidase Deficiency Climate Symptomatic Diarrhea,Etiology-Infective factors,Route of transmission: feces-mouth way,Pathogens of infective factors,Etiology-Infective factors,Viruses: The most Common pathogen in children with infected diarrhe
12、a. Rotavirus, Astrovirus, Noro virus, Coronavirus, Calicivirus, Enteric adenovirus, echo virus, cosackis virus, and so on. Usually occurs in the cold season(Autumn, winter). Rotavirus is the most severe enteric pathogen of childhood diarrhea.,Etiology-Infective factors,Bacteria: The second most comm
13、on cause in children with infective diarrhea.,Etiology-Infective factors,Fungi: Candida albicans, aspergillus, mucor,Etiology-Infective factors,Parasites:,Etiology-Infective factors,The most important infective causes of acute diarrhea in developing countries in children are: Rotavirus Enterotoxigen
14、ic Escherichia coli Shigella Campylobacter jejuni Salmonella typhimurium,Etiology,Infective factors (virus,bacteria,fungi,parasites) Noninfective factors Dietary factor Inappropriate feeding Allergic Diarrhea Disaccharidase Deficiency Climate Symptomatic Diarrhea,Etiology-Non-Infective factors,Dieta
15、ry factors Inappropriate feeding (Dietary Diarrhea): Overfeeding Indigestible diet Sudden change of formula Inappropriate feeding for a milk-fed baby shifting into solid food (too much, too early, too rapid) Disaccharidase Deficiency: Lactose Intolerance Primary disaccharidase deficiency Secondary d
16、isaccharidase deficiency Allergic Diarrhea,Etiology-Non-Infective factors,Climate Seasonal variation affects the digestive function of young children: incidence of diarrhea is highest furing the early rainy season Cold weather causes increasing of enterokinesia Hot weather causes decreasing of diges
17、tive enzyme and malfunction of digestive tract.,Etiology-Non-Infective factors,Symptomatic Diarrhea: Diarrhea is only one of the symptoms of primary disease. Problem is not originally located in intestinal tract. Respiratory tract infection,-Otitis media,-Some infectious diseases, etc. Fever, toxin,
18、antibiotics,local stimulate,etc. Symptom always mild, and recover with the primary disease getting better. The younger the children, the more chance to get a symptomatic diarrhea accompanied by other diseases.,Content,Definition Epidemiology Etiology and Predisposing factor Pathogenesis Clinical man
19、ifestation Diagnosis Management & prevention Fluid therapy,Pathogenesis of Diarrhea,The basic pathogenesis of diarrhea: Osmotic Diarrhea (Pathogenesis of Viral Diarrhea) Secretory Diarrhea( Pathogenesis of Enterotoxigenic Diarrhea) Invasive diarrhea(Exudative diarrhea, Inflammatory diarrhea) Motilit
20、y abnormalities,Pathogenesis of Diarrhea,The basic pathogenesis of diarrhea: Osmotic Diarrhea (Pathogenesis of Viral Diarrhea) Secretory Diarrhea( Pathogenesis of Enterotoxigenic Diarrhea) Invasive diarrhea(Exudative diarrhea, Inflammatory diarrhea) Motility abnormalities,Osmotic Diarrhea,Pathogens:
21、 Virus Giardia EAEC,Characteristics: Watery stool Stool WBC(-) Stool RBC(-) Diarrhea improved after fasting,Pathogenesis of Diarrhea,The basic pathogenesis of diarrhea: Osmotic Diarrhea (Pathogenesis of Viral Diarrhea) Secretory Diarrhea( Pathogenesis of Enterotoxigenic Diarrhea) Invasive diarrhea(E
22、xudative diarrhea, Inflammatory diarrhea) Motility abnormalities,Secretory Diarrhea,Pathogens: Vibrio cholerae (cholera) Enterotoxigenic Escherichia Coli (ETEC) Staphylococcus aureus Clostridium difficile,Characteristics: Watery stool Stool WBC(-) Stool RBC(-) Diarrhea without improvement after fast
23、ing,Pathogenesis of Diarrhea,The basic pathogenesis of diarrhea: Osmotic Diarrhea (Pathogenesis of Viral Diarrhea) Secretory Diarrhea( Pathogenesis of Enterotoxigenic Diarrhea) Invasive diarrhea(Exudative diarrhea, Inflammatory diarrhea) Motility abnormalities,Invasive Diarrhea,Invasive organisms: S
24、higella species EIEC (enteroinvasive E. coli) Campylobacter jejuni Salmonella typhimurium Yersinia enterocolitica,Characteristics: Mucopurulent bloody stool Stool WBC (+) Stool RBC (+) Abdominal pain Tenesmus Fever Toxic appearance,Pathogenesis of Diarrhea,Pathogenesis of Dietary Diarrhea Inappropri
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