Pediatric emergency medicine trisk 0534 0534
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TABLE 23.2
LIFE-THREATENING CAUSES OF DIARRHEA
Intussusception
Hemolytic uremic syndrome
Pseudomembranous colitis
Appendicitis
Salmonella gastroenteritis (with bacteremia in the neonate or
immunocompromised host)
Hirschsprung disease (with toxic megacolon)
Inflammatory bowel disease (with toxic megacolon)
Appendicitis manifests primarily with abdominal pain. Common presentation
is periumbilical abdominal pain that migrates to the right lower quadrant,
followed by anorexia, vomiting, and/or fever. Less commonly, appendicitis may
cause diarrhea. The presumed mechanism for the diarrhea is irritation of the colon
by the inflamed appendix. Particularly in very young children or among patients
of any age who have a perforated appendix and a long duration of illness, the
diagnosis of appendicitis as the cause of diarrhea may be delayed because the
classic constellation of signs and symptoms is often absent. However, the
examiner will usually be able to elicit abdominal tenderness greater than would
be expected with gastroenteritis.
Toxic megacolon is a life-threatening condition that can occur as a
complication of a number of conditions including inflammatory bowel disease
(IBD), Shigella infection, pseudomembranous colitis, and Hirschsprung disease.
It is characterized by a dilated colon and abdominal distention with abdominal
pain and fever that may progress to shock.
EVALUATION AND DECISION
The history and physical examination are paramount in determining if the child
with diarrhea has a mild self-limiting illness or a condition that is potentially life
threatening. For patients with diarrhea, a comprehensive history, including
exposure history should be obtained. Further, the physician must also identify if
the diarrheal illness is acute or chronic as the etiologies can be different.
In evaluating a child with diarrhea, a rapid assessment is necessary to
determine the need for urgent or emergent fluid resuscitation. Historical
information that should be elicited include detailed questions about the onset of
