0071643192.pdf

PEDIATRICS

SYMPTOMS/EXAM

The term “diarrhea” describes an increased frequency of loose bowel move-

ments. Important history includes the presence of blood or mucus in the

stool, as well as ill contacts. Typically, viral enteritis is associated with non-

bloody diarrhea, without mucus (<5 PMN/hpf on microscopic examination

of the stool). Diarrheal diseases caused by viruses usually last around 5 days,

and occur most frequently in the late winter or spring. Bacterial enteritis may

present with severe abdominal pain, tenesmus, bloody/mucoid stool, fever,

and possibly altered mental status.

DIFFERENTIAL

See Table 5.3.

Perform a careful physical examination to evaluate for the presence of intra-

abdominal emergencies, such as intussusception, as well as extra-abdominal

infections (such as otitis media or pneumonia).

DIAGNOSIS

■ Based on history and physical examination

■ Stool guaiac and fecal leukocytes may support a class of infection.

■ Lab studies are not routinely needed unless a child is moderately to

severely ill or the diagnosis is unclear.

TABLE 5.3. Differential Diagnosis of Diarrhea

Infection—viral Rotavirus

Enterovirus

Norwalk virus

Infection—bacterial Salmonella

Shigella

Escherichia coli

Other:Campylobacter, Yersinia, Vibrio cholera,

Staphylococcus aureus, Bacillus cereus

Infectious colitis Clostridium difficile colitis; typically associated with

antecedent antibiotics

Inflammatory bowel disease Crohn disease or ulcerative colitis

Intussusception Classically associated with bloody diarrhea, intermit-

tent crying, and lethargy

Hemolytic uremic syndrome Preceding infection with E. coli

Other infections UTI, otitis media, pneumonia

Malabsorption Cystic fibrosis, celiac disease

Other Overflow with chronic constipation, endocrine, drugs