Mind Map by v.djabatey, updated more than 1 year ago
Created by v.djabatey about 6 years ago


Paediatrics (Gastroenterology & nutrition) Mind Map on Gastroenteritis, created by v.djabatey on 01/07/2014.

Resource summary

1 differential diagnoses
1.1 infection
1.1.1 systemic septicaemia meningitis
1.1.2 local resp tract infection otitis media hepatitis A UTI
1.2 surgical disorders
1.2.1 pyloric stenosis
1.2.2 intussusception
1.2.3 acute appendicitis
1.2.4 necrotising enterocolitis
1.2.5 Hirschsprung disease
1.3 metabolic disorder
1.3.1 diabetic ketoacidosis
1.4 renal disorder
1.4.1 haemolytic uraemic syn
1.5 other
1.5.1 coeliac disease
1.5.2 cow's milk protein intolerance
1.5.3 adrenal insufficiency
2 epidemiology
2.1 developing countries
2.1.1 major cause of child mortality
2.2 developing countries
2.2.1 major cause of child morbidity
2.2.2 UK 10% of 5 yr olds annually
3 causes
3.1 viral
3.1.1 rotavirus commonest cause in developed countries accounts for 60% of cases in <2 yr olds effective vaccine available not part of national immunisation programme
3.1.2 cause outbreaks adenovirus norovirus calicivirus coronavirus astrovirus
3.2 bacterial
3.2.1 less common in developed countries Campylobacter jejuni commonest bacterial infection in developed countries assoc w/ severe abdo pain Shigella, some Salmonella spp. dysentry blood and pus in stool pain tenesmus Shigella may be acc by high fever
3.2.2 blood in stool
3.2.3 clinical features are poor guide to the pathogen
3.2.4 cholera and enterotoxic E. coli profuse, rapidly dehydrating diarrhoea
4 clinical features
4.1 sudden change to loose or watery stools
4.1.1 often + vomiting
4.2 contact w/ a person w/ diarrhoea
4.3 recent travel abroad
5 complication
5.1 dehydration
5.1.1 increased risk of dehydration in infants esp < 6months old or born w/ low birth weight at greater risk than older kids infants have higher surface area:weight -> greater insensible losses infants have higher basal fluid requirements 10-12% of body weight infants have immature renal tubular absorption infants can't get fluid for themselves when thirsty children passed 6 or more diarrhoeal stools in prev 24 hours children vomited 3 or more times in prev 24h children unable to tolerate (or not been offered extra fluids) children w/ malnutrition
5.1.2 Rx aims to prevent or correct this
5.1.3 -> shock
5.1.4 types isonatraemic loss of water and Na+ are proportional so plasma Na+ within normal range hyponatraemic when kids w/ diarrhoea drink large amounts of water or other hypotonic sols -> greater net loss of Na+ than water -> fall in plasma Na+ -> water shifting from extracellular to intracellular comp -> increase in brain vol ->convulsions greater degree of shock per unit of water loss due to marked extracellular depletion more common in poorly nourished infants in developing countries hypernatraemic infrequent water loss exceeds relative Na+ loss plasma [Na+] increases usually results from high insensible water losses high fever or hot dry env can result from profuse low Na+ diarrhoea extracellular fluid becomes hypertonic vs intracellular fluid -> shift of water into extracellular space from intracellular signs of fluid depletion less obvious so hard to recognise this type of dehydration clinically esp in obese infants dangerous form of dehydration water is drawn out of brain cerebral shrinkage within a rigid skull -> jittery movements increased muscle tone with hyperreflexia altered consciousness seizures multiple, small cerebral haemorrhages transient hyperglycaemia self-correcting no need for insulin
5.1.5 total body deficit of Na+ & water
6 Mx
6.1 assessment of dehydration
6.1.1 degree of weight loss during diarrhoeal illness most accurate measure of dehydration
6.1.2 use hx and examination degree of dehydration no clinically detectable dehydration usually 5% loss of body weight clinical dehydration (usually 5-10%) shock > 10% loss of body weight clinical features decreased levels of consciousness sunken fontanelle dry mucous mbs eyes sunken and tearless pale mottled skin increased resp rate prolonged capillary refill time (> 2 secs) increased heart rate weak peripheral pulses hypotension reduced skin turgor sudden weight loss cold extremities reduced urine output
Show full summary Hide full summary


Coeliac disease
Recurrent abdominal pain- abdo migraine, peptic ulceration, IBS
Recurrent abdominal pain
Post-gastroenteritis syndrome
Causes of acute abdominal pain
Infant 'colic'
Pyloric stenosis
Non-specific abdominal pain
Meckel diverticulum
Mesenteric adenitis