Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (103.26 KB, 1 trang )
cause colitis, particularly after the use of antibiotics. Parasitic infestations rarely lead to diarrhea in developed
countries. Giardia lamblia and Cryptosporidium should be considered, particularly in outbreaks in daycare centers,
and Entamoeba histolytica, among immigrants or travelers from tropical areas; cryptosporidiosis also commonly
affects patients with HIV. These topics are covered later in this chapter, in the sections on travel medicine and HIV,
respectively. Current diagnostic techniques are unable to identify an etiologic agent in most of the remaining
episodes.
Viral hepatitis is covered in Chapter 91 Gastrointestinal Emergencies . Bacterial infections of the liver and
bacterial cholangitis, almost exclusively abscesses, are rare in otherwise healthy children; more commonly, they
complicate either an anatomic malformation (e.g., biliary atresia) or affect neonates or immunocompromised hosts.
Because calculi in the bile ducts rarely occur before adolescence, cholecystitis occurs much less often in
children than in adults. Occasionally, episodes are seen in teenagers or children predisposed to stone formation, as
in the chronic hemolytic anemias. Less commonly, salmonellosis, leptospirosis, or KD produces acalculous
cholecystitis. These diseases are discussed elsewhere in this chapter.
In childhood, peritonitis almost invariably reflects an intra-abdominal catastrophe that requires surgical
intervention. However, the accumulation of ascitic fluid in children with diseases such as nephrosis and cirrhosis
allows the development of a primary infection of the peritoneum.
Gastroenteritis—Viral
The most common etiologies of acute gastroenteritis (AGE) in the United States are viral, most commonly
noroviruses and rotavirus, which comprise almost 40% of viral AGE in the United States. Rotavirus has been on a
major decline since the introduction of routine vaccination. Please also see Chapter 23 Diarrhea . Adenovirus,
sapovirus, astrovirus, parechovirus, and bocavirus comprise an additional 30% of cases in preschool-aged children.
Most causes of viral gastroenteritis are self-limited in healthy children; however, young children can shed viruses
in feces for weeks to months after acute infection, contributing to secondary spread in the community. The most
common symptoms are diarrhea and/or vomiting, crampy abdominal pain, and fever. Signs on examination may
include pyrexia, tachycardia, and hyperactive bowel sounds. Hematochezia and high fever in the older child may
suggest a bacterial etiology, as would a history of international travel to a developing nation. No laboratory studies
are indicated in uncomplicated gastroenteritis in the previously healthy child with mild dehydration. Fecal
leukocytes or stool lactoferrin is more indicative of a bacterial pathogen.
Gastroenteritis—Bacterial