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Pediatric Diarrhea: History & Physical Exam

by Brian Alverson, MD
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    00:02 So if you see a child with vomiting and/or diarrhea, what are key things you want to ask? First is obviously fever.

    00:10 Children with infectious diarrhea typically may have a fever.

    00:14 Ask about blood or mucus in the stool.

    00:16 This may tip you off if this is bacterial as opposed to a viral pathogen.

    00:22 Most bacterial gastroenteritis requiring treatment is bloody.

    00:28 Ask about exposure to farm animals or reptiles.

    00:31 This is actually a really important question because a common cause of salmonella in children is reptile pets and a common cause of E. coli, especially the variety that causes hemolytic uremic syndrome, is from farm animal exposure.

    00:49 Petting zoos are a big problem in the United States if children don’t wash their hands with alcohol after they pet the animals.

    00:58 Suspicious foods are always a potential cause and we hear about outbreaks all the time.

    01:03 For example, E. coli in spinach, this happens periodically and so when such a thing happened, you might ask about suspicious or also undercooked foods, things like uncooked eggs, which might show up in raw cookie dough.

    01:17 Ask about recent travel.

    01:18 Recent travel’s important because there are some causes of diarrhea that are unusual in the United States that may be more prevalent in developing countries.

    01:27 And of course, as about recent antibiotic use because C. diff is a possibility as well as the antibiotic-associated diarrhea.

    01:37 So on exam, critically important to look for signs of dehydration.

    01:42 Tenting is rare and is only at extreme ends of dehydration.

    01:47 Mostly, you’re going to look at mucus membranes and see if they’re moist.

    01:50 See if the child is making tears when they cry.

    01:53 Look for sings of systemic infection.

    01:55 Is there something else going on.

    01:57 The abdominal exam is critical especially, especially looking for rebound guarding, things like that where the child doesn’t want you pressing on their abdomen.

    02:07 In babies, this can be tricky.

    02:09 The baby, if you’re careful, will seem to resist you if you squeeze on their belly.

    02:15 But in a crying baby who doesn’t want to be examined in the first place, this can be a challenge.

    02:20 A perianal inspection is important on children especially if you’re concerned about inflammatory bowel disease.

    02:27 Sometimes, a rectal tag or fissure is the best clue you have that the child has Crohn’s disease.


    About the Lecture

    The lecture Pediatric Diarrhea: History & Physical Exam by Brian Alverson, MD is from the course Pediatric Gastroenterology.


    Included Quiz Questions

    1. E. coli
    2. Salmonella species
    3. Clostridium difficile
    4. E. histolytica
    5. Shigella species
    1. Inflammatory bowel disease
    2. Viral gastroenteritis
    3. Bacterial enteritis
    4. Celiac disease
    5. Cholera
    1. E.coli infection
    2. Hepatitis A
    3. Salmonella
    4. Shigella
    5. Viral enteropathy
    1. Tearless crying
    2. Confusion
    3. Excessing crying
    4. Vertigo
    5. Cyanosis

    Author of lecture Pediatric Diarrhea: History & Physical Exam

     Brian Alverson, MD

    Brian Alverson, MD


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