Gastroenteritis

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

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

Resource summary

Gastroenteritis
1 differential diagnoses
1.1 infection
1.1.1 systemic
1.1.1.1 septicaemia
1.1.1.2 meningitis
1.1.2 local
1.1.2.1 resp tract infection
1.1.2.2 otitis media
1.1.2.3 hepatitis A
1.1.2.4 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
2.2.2.1 10% of 5 yr olds annually
3 causes
3.1 viral
3.1.1 rotavirus
3.1.1.1 commonest cause in developed countries
3.1.1.2 accounts for 60% of cases in <2 yr olds
3.1.1.3 effective vaccine available
3.1.1.3.1 not part of national immunisation programme
3.1.2 cause outbreaks
3.1.2.1 adenovirus
3.1.2.2 norovirus
3.1.2.3 calicivirus
3.1.2.4 coronavirus
3.1.2.5 astrovirus
3.2 bacterial
3.2.1 less common in developed countries
3.2.1.1 Campylobacter jejuni
3.2.1.1.1 commonest bacterial infection in developed countries
3.2.1.1.2 assoc w/ severe abdo pain
3.2.1.2 Shigella, some Salmonella spp.
3.2.1.2.1 dysentry
3.2.1.2.2 blood and pus in stool
3.2.1.2.3 pain
3.2.1.2.4 tenesmus
3.2.1.2.5 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
3.2.4.1 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
5.1.1.1 infants
5.1.1.1.1 esp < 6months old or born w/ low birth weight
5.1.1.1.2 at greater risk than older kids
5.1.1.1.2.1 infants have higher surface area:weight
5.1.1.1.2.1.1 -> greater insensible losses
5.1.1.1.2.2 infants have higher basal fluid requirements
5.1.1.1.2.2.1 10-12% of body weight
5.1.1.1.2.3 infants have immature renal tubular absorption
5.1.1.1.2.4 infants can't get fluid for themselves when thirsty
5.1.1.2 children passed 6 or more diarrhoeal stools in prev 24 hours
5.1.1.3 children vomited 3 or more times in prev 24h
5.1.1.4 children unable to tolerate (or not been offered extra fluids)
5.1.1.5 children w/ malnutrition
5.1.2 Rx aims to prevent or correct this
5.1.3 -> shock
5.1.4 types
5.1.4.1 isonatraemic
5.1.4.1.1 loss of water and Na+ are proportional
5.1.4.1.1.1 so plasma Na+ within normal range
5.1.4.2 hyponatraemic
5.1.4.2.1 when kids w/ diarrhoea drink large amounts of water or other hypotonic sols
5.1.4.2.1.1 -> greater net loss of Na+ than water
5.1.4.2.1.1.1 -> fall in plasma Na+
5.1.4.2.1.1.1.1 -> water shifting from extracellular to intracellular comp
5.1.4.2.1.1.1.1.1 -> increase in brain vol
5.1.4.2.1.1.1.1.1.1 ->convulsions
5.1.4.2.1.1.1.1.2 greater degree of shock per unit of water loss
5.1.4.2.1.1.1.1.2.1 due to marked extracellular depletion
5.1.4.2.2 more common in poorly nourished infants in developing countries
5.1.4.3 hypernatraemic
5.1.4.3.1 infrequent
5.1.4.3.2 water loss exceeds relative Na+ loss
5.1.4.3.2.1 plasma [Na+] increases
5.1.4.3.2.1.1 usually results from high insensible water losses
5.1.4.3.2.1.1.1 high fever or hot dry env
5.1.4.3.2.1.2 can result from profuse low Na+ diarrhoea
5.1.4.3.2.1.3 extracellular fluid becomes hypertonic vs intracellular fluid
5.1.4.3.2.1.3.1 -> shift of water into extracellular space from intracellular
5.1.4.3.3 signs of fluid depletion less obvious
5.1.4.3.3.1 so hard to recognise this type of dehydration clinically
5.1.4.3.3.1.1 esp in obese infants
5.1.4.3.4 dangerous form of dehydration
5.1.4.3.4.1 water is drawn out of brain
5.1.4.3.4.1.1 cerebral shrinkage within a rigid skull ->
5.1.4.3.4.1.1.1 jittery movements
5.1.4.3.4.1.1.2 increased muscle tone
5.1.4.3.4.1.1.2.1 with hyperreflexia
5.1.4.3.4.1.1.3 altered consciousness
5.1.4.3.4.1.1.4 seizures
5.1.4.3.4.1.1.5 multiple, small cerebral haemorrhages
5.1.4.3.4.1.1.6 transient hyperglycaemia
5.1.4.3.4.1.1.6.1 self-correcting
5.1.4.3.4.1.1.6.2 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
6.1.1.1 most accurate measure of dehydration
6.1.2 use hx and examination
6.1.2.1 degree of dehydration
6.1.2.1.1 no clinically detectable dehydration
6.1.2.1.1.1 usually 5% loss of body weight
6.1.2.1.2 clinical dehydration (usually 5-10%)
6.1.2.1.3 shock
6.1.2.1.3.1 > 10% loss of body weight
6.1.2.1.3.2 clinical features
6.1.2.1.3.2.1 decreased levels of consciousness
6.1.2.1.3.2.2 sunken fontanelle
6.1.2.1.3.2.3 dry mucous mbs
6.1.2.1.3.2.4 eyes sunken and tearless
6.1.2.1.3.2.5 pale mottled skin
6.1.2.1.3.2.6 increased resp rate
6.1.2.1.3.2.7 prolonged capillary refill time (> 2 secs)
6.1.2.1.3.2.8 increased heart rate
6.1.2.1.3.2.9 weak peripheral pulses
6.1.2.1.3.2.10 hypotension
6.1.2.1.3.2.11 reduced skin turgor
6.1.2.1.3.2.12 sudden weight loss
6.1.2.1.3.2.13 cold extremities
6.1.2.1.3.2.14 reduced urine output
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