《儿科学》课程教学课件（PPT讲稿）22 Infantale Diarrhea and Fluid Therapy

INFANTILEDIARRHEA

1 INFANTILE DIARRHEA

Infantile diarrheaWhat is the diarrhea?Why diarrhea is highly susceptible tochildren?Why diarrhea is more dangerous for children?百 What isthe causes ofdiarrhea?What is the diarrhea manifestation? How to diagnose diarrhea?What is the most important points in treatment ofTdiarrhea?What should we pay more attentionto, when fluidtherapy is erfomed a data taueChildren's Hospital

Infantile diarrhea Children's Hospital 2 □ What is the diarrhea? □ Why diarrhea is highly susceptible tochildren? □ Why diarrhea is more dangerous for children ? □ What is the causes of diarrhea? □ What is the diarrhea manifestation? □ How to diagnose diarrhea? □ What is the most important points in treatment of diarrhea? □ What should we pay more attention to, when fluid therapy is performi enfd an ?tile diarrhea Dr.zhanxue

InfantileDiarrheaBackground口Disease burdenDefinitionEtiology ofdiarrhea-Infectivefactors-Non-infective factorsPathogenesis ofviral,Enterotoxigenic,enteroinvasivediarrheaClinical manifestations-dehydration, metabolic acidosis..Clews of diagnosis fordiarrheaTreatment of diarrheaFluidtherapyAssessment of dehydration..infantile diarrhea Dr.zhanxueChildren's Hospital

□ Background □ Disease burden □ Definition □ Etiology of diarrhea - Infective factors - Non-infective factors □ Pathogenesis of viral, Enterotoxigenic, enteroinvasive diarrhea □ Clinical manifestations -dehydration, metabolic acidosis. □ Clews of diagnosis for diarrhea □ Treatment of diarrhea □ Fluid therapy □ Assessment of dehydration. infantile diarrhea Dr.zhanxue Children's Hospital 3 Infantile Diarrhea

BackgroundDiarrhea is a clinical syndrome caused by diverseetiology.It is the second most frequent childhood disease justnexttotherespiratoryinfectionIt is the major cause of death among world's childrenespecially in children under five years old in manydeveloping countries.infantile diarrhea Dr.zhanxueChildren's Hospital4

Background □Diarrhea is a clinical syndrome caused by diverse etiology. □It is the second most frequent childhood disease just next to the respiratory infection. □It is the major cause of death among world’s children especially in children under five years old in many developing countries. infantile diarrhea Dr.zhanxue Children's Hospital 4

BackgroundDisease burdenDefinitionEtiology ofdiarrheaInfective factors-Non-infective factorsPathogenesis of viral diarrheaDiseaseBurdenPathogenesis ofentrotoxinicdiarrheaPathogenesis of entroinvasivedarrheaClinical manifestationsWorldwide-dehydration,metabolicacidosisClews ofdiagnosis fordiarrhea 3-5billion episodes ofdiarrhea/yearTreatment ofdiarrheaFluid therapy 4-5 million deaths/year (serious diarrhea/dehydration)Assessment of dehydrationChildren are the predominant populationsReplacement of fluid3.2billion episodes1.3milliondeaths/year(<5yearsold)口In China836million episodesinpediatrics,1/4-1/3ofalloutpatientsMortality ofdiarrhea 51/10000During 1993~2006, ChildrensHospital,C QM U1/3of clinicvisitpatients口22910 inpatients with diarrhea?(among ofall hospitalizations,8.86%inpatients due to diarrhea)5

5 Disease Burden Worldwide □ 3-5 billion episodes of diarrhea/year, Childrenarethepredominant populations □ 3.2 billion episodes □ 1.3 million deaths/ year (< 5years old) In China 836 million episodes in pediatrics, 1/4~1/3 of all outpatients Mortality of diarrhea 51/10 000. During 1993~2006, Children’sHospital, CQMU □ 1/3 of clinic visit patients □ 22 910 inpatients with diarrhea (among of all hospitalizations, 8.86% inpatients due to diarrhea). □ 4-5 million deaths/year (serious diarrhea/dehydr ation) □ Background □ Disease burden □ Definition □ Etiology of diarrhea - Infective factors - Non-infective factors □ Pathogenesis of viral diarrhea □ Pathogenesis of entrotoxinic diarrhea Pathogenesis of entroinvasive diarrhea □ Clinical manifestations -dehydration, metabolic acidosis. □ Clews of diagnosis for diarrhea □ Treatment of diarrhea Fluid therapy □ Assessment of dehydration □ Replacement of fluid

DefinitionSalivary glandsEsophogusIn pediatrics,diarrhea isdefined as an increasein theFluidityLiverStomachGalbladderTransversecolon(cut)Volumeof stoolsDescending.colonDuodenumFrequencySmallJejunumPancreasintestine-lleumAstending colonCecumIt isrelativeto the usualhabitsSigmoid colonAppendixofeachindividualesUroMayoFoundationforMedical Educalion and ResearchAll nights reservod.infantile diarrhea Dr.zhanxueChildren's Hospital

infantile diarrhea Dr.zhanxue Children's Hospital 6 In pediatrics, diarrhea is defined as an increasein the Fluidity Volume of stools Frequency It is relative to the usualhabits of each individual. Definition

Normall Stool of ChildrenBreastfed babies:pass stools 3-4 times a dayyellowloose (soft to runny)buttexturedsour-smellingBottlefed babies: once a daypale yellow or yellowish-brownbulkier and more formedpretty pungentBabies on solids:thicken and darken slightlyhavea strongerodor7

7 Normal Stool of Children Breastfed babies: pass stools 3-4 times a day yellow loose (soft to runny) but textured sour -smelling Bottlefed babies: once a day pale yellow or yellowish-brown bulkier and more formed pretty pungent Babies on solids: thicken and darken slightly have a stronger odor

Immature digestive systemWhy childrenare highlyMore nutrition demandsusceptible to diarrhea?*Weakness of defense system*Thenormal intestinal florahave not built up well*Bottlefeeding*Immature digestive system-Lack of gastric acid secretion,-Rapid gastric emptying-Lower enzyme activityBacteria*ADAMinfantile diarrhea Dr.zhanxue8Children's Hospital

Why children are highly susceptible to diarrhea? *Immature digestive system -Lack of gastric acid secretion, - Rapid gastric emptying, -Lower enzyme activity. *Immature digestive system * More nutrition demand *Weakness of defense system *The normal intestinalflora have not built up well infantile diarrhea Dr.zhanxue Children's Hospital 8 *Bottle feeding

Why children arehighlysusceptible to diarrhea?Immature-digestnve system* More nutrition demandgrowing rapidlymore nutritionthe burden ofdigestive systemheavierinfantile diarrhea Dr.zhanxueChildren's Hospital

* More nutrition demand growing rapidly more nutrition the burden of digestive system heavier infantile diarrhea Dr.zhanxue Children's Hospital 9 Why children are highly susceptible to diarrhea? *Immature digestive system

Why children are highly*Immature digestive systemsusceptibletoidiarrhea?*More nutrition demand*Weakness of defense systemlack ofgastric acid secretion,rapidgastricemptying,and lower enzyme activityas well as the level of serum IgA, IgM and the secretory IgAinintestinaltractarelowersothe immune defenseisinsufficientinfantile diarrhea Dr.zhanxue10Children's Hospital

*Weakness of defense system lack of gastric acid secretion, rapid gastric emptying, and lower enzyme activity as well as the level of serum IgA, IgM and the secretory IgAin intestinal tract are lower so the immune defense isinsufficient. infantile diarrhea Dr.zhanxue Children's Hospital 10 Why children are highly susceptible to diarrhea? *Immature digestive system *More nutrition demand