infantile-diarrhea

InfantileDiarrhea2012.025thfloorofBuildingNo.6Content•Definition•Epidemiology•EtiologyandPredisposingfactor•Pathogenesis•Clinicalmanifestation•Diagnosis•Management&prevention•FluidtherapyDiarrheaContent•Definition•Epidemiology•EtiologyandPredisposingfactor•Pathogenesis•Clinicalmanifestation•Diagnosis•Management&prevention•FluidtherapyDiarrheaDiarrhea-definition•DiarrheaisdefinedasanincreaseintheFluidity,Volume,andFrequencyofstools.–Volume•＞10ml/kg/dinchildrenor＞200g/dayinadolescents–Fluidity•Decreaseinconsistency(looseorliquid)–Frequency•Bowelmovements≥3per24hoursConstipationDiarrheaDiarrhea-definition•DiarrheaisdefinedasanincreaseintheFluidity,Volume,andFrequencyofstools.–Volume•＞10ml/kg/dinchildrenor＞200g/dayinadolescents–Fluidity•Decreaseinconsistency(looseorliquid)–Frequency•Bowelmovements≥3per24hoursThesuddenchangeofstoolcharacteristicsismoreimportant!Content•Definition•Epidemiology•EtiologyandPredisposingfactor•Pathogenesis•Clinicalmanifestation•Diagnosis•Management&prevention•FluidtherapyDiarrheaEpidemiology•HighincidenceandmortalityEuropean0.5-1.9episodesperpersonperyear•Consumelargeamountsofhealthcarecosts•USA:–1-2episodes/child/year–1.5Millionmedicalconsultations–160,000ERvisits–220,000hospitalizations(meanhospitalstay3.4days)–$1.8Billionperyearofmedicalcosts–Mortalityrates:32.2deaths/100,000liveborninAfro-Americans(8.2inwhites)•Dehydration•Death•Malnutrition•Growthretardation•Impairedmentaldevelopment•ConsequencesofdiarrheainchildrenAcutestageChronicstage•leadingcausesofdeathinchildrenindevelopingcountries15%malariameaslesHIVPerinataldiseasesothersARTIdiarrheaMortalityfromdiarrheadiseasesamongchildrenindevelopingcountriesThemortalityofdiarrheaisdecline:•Developmentofeconomy•ProgressofMedicine•Improvementofmedicalconditions•ORSuseBut……Predisposingfactor•Infantdigestivesystemisnotwelldeveloped,andthefunctionisimmature:–Lackofgastricacidsecretion,-Lowerenzymeactivity,-Rapidgastricemptying(infection&indigestion).–Watermetabolismrapidly,thewatertoleranceispoor,oncethewaterlosspronetohumoraldisorder.–Thefunctionsofnervesystem,endocrine,circulation,liver,kidneyareinmature,pronetogastrointestinaldysfunction.•Morenutritiondemand–Becausechildrenaregrowingrapidly,theyneedmorenutritiontomeettheirrapidgrowth.–theburdenofdigestivesystemisheavier.•Weaknessofdefensesystem–Lackofgastricacidsecretion,-rapidgastricemptying,-lowerenzymeactivity.Theintrogastricpathogenescannotbekilledthoroughly.–ThelevelsofserumIgA,IgMandthesecretoryIgAinintestinaltractarelower,sotheimmunedefenseisinsufficient.•Normalintestinalflorahavenotwellestablished•Bottle-feeding(orartificialfeeding)–Milkor/andbottleispronetocontaminatedwithpathogensduringhandling–Milknutritiondamaged–Breastmilkcontainsimmunecomponents:(sIgA,lactoferrin,lysozyme,etc.)E.coliContent•Definition•Epidemiology•EtiologyandPredisposingfactor•Pathogenesis•Clinicalmanifestation•Diagnosis•Management&prevention•FluidtherapyDiarrheaEtiology•Infectivefactors(virus,bacteria,fungi,parasites…)•Noninfectivefactors–Dietaryfactor•Inappropriatefeeding•AllergicDiarrhea•DisaccharidaseDeficiency–Climate–SymptomaticDiarrheaEtiology•Infectivefactors(virus,bacteria,fungi,parasites…)•Noninfectivefactors–Dietaryfactor•Inappropriatefeeding•AllergicDiarrhea•DisaccharidaseDeficiency–Climate–SymptomaticDiarrheaEtiology---InfectivefactorsRouteoftransmission:feces-mouthwayPathogensofinfectivefactorsshigellaEtiology---Infectivefactors•Viruses:–ThemostCommonpathogeninchildrenwithinfecteddiarrhea.–Rotavirus,Astrovirus,Norovirus,Coronavirus,Calicivirus,Entericadenovirus,echovirus,cosackisvirus,andsoon.–Usuallyoccursinthecoldseason(Autumn,winter).–Rotavirusisthemostsevereentericpathogenofchildhooddiarrhea.Etiology---Infectivefactors•Bacteria:–Thesecondmostcommoncauseinchildrenwithinfectivediarrhea.Etiology---Infectivefactors•Fungi:Candidaalbicans,aspergillus,mucorEtiology---Infectivefactors•Parasites:Etiology---Infectivefactors•Themostimportantinfectivecausesofacutediarrheaindevelopingcountriesinchildrenare:–Rotavirus/norovirus–EnterotoxigenicEscherichiacoli–Shigella–Campylobacterjejuni–SalmonellatyphimuriumEtiology•Infectivefactors(virus,bacteria,fungi,parasites…)•Noninfectivefactors–Dietaryfactor•Inappropriatefeeding•AllergicDiarrhea•DisaccharidaseDeficiency–Climate–SymptomaticDiarrheaEtiology---Non-Infectivefactors•Dietaryfactors–Inappropriatefeeding(DietaryDiarrhea):•Overfeeding•Indigestiblediet•Suddenchangeofformula•Inappropriatefeedingforamilk-fedbabyshiftingintosolidfood(toomuch,tooearly,toorapid…)–DisaccharidaseDeficiency:LactoseIntolerance•Primarydisaccharidasedeficiency•Secondarydisaccharidasedeficiency(Lactasedeficiency)–AllergicDiarrheaAllergiccolitisEtiology---Non-Infectivefactors•Climate–Seasonalvariationaffectsthedigestivefunctionofyoungchildren:incidenceofdiarrheaishighestfuringtheearlyrainyseason–Coldweathercausesincreasingofenterokinesia–HotweathercausesdecreasingofdigestiveenzymeandmalfunctionofdigestivetractEtiology---Non-Infectivefactors•SymptomaticDiarrhea:–Diarrheaisonlyoneofth