Paediatric-History taking & Physical examination of acute gastroenteritis

Paediatric-History taking & Physical examination of acute gastroenteritisCreated OnApril 23, 2020Last Updated OnApril 26, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of acute gastroenteritis < All Topics Table of Contents History taking: A careful history examination to rule out other illnesses with similar presentations Ask about respiratory symptoms such as cough, dyspnea or tachypnea = the presence of an underlying pneumonia. Ask about urinary frequency, urgency or pain – pyelonephritis, Ask about earache – acute otitis media Ask about high fever and altered mental status – features of meningitis or sepsis. Ask about extrinsic factors: Travel to underdeveloped countries Exposure to untreated drinking or washing water sources Contact with animals or birds Day care center attendance Allergy to certain food Recent antibiotic treatment A recent change in diet may suggest other specifically treatable causes of vomiting and diarrhea Ask the following to assess the severity of symptoms and risk of dehydration: Presence or absence of fever (increases insensible water loss), The amount and type of oral intake The frequency and estimated volume of emesis or stool (Emesis, stool and urine volume in excess of intake invariably leads to significant dehydration) Stool characteristics (presence of blood to consider inflammatory bacterial disease) Important to ask for significant weight loss to assess dehydration severity. Degree of dehydration No clinically detectable dehydration (usually <5% loss of body weight) Clinical dehydration (usually 5% to 10% loss of body weight) Shock (usually >10% loss of body weight). Physical examination: In patients with acute GE, it is important to assess the hydration status of the child since dehydration could lead to shock. Certain children are at increased risk of dehydration: Infants, particularly those under 6 months of age or those born with low birthweight Infants more likely to have dehydration compared to older children due to Greater surface area-to-weight hence, more water loss Higher basal fluid requirements Immature renal tubular reabsorption If they have passed six or more loose stools in the previous 24 hours If they have vomited three or more times in the previous 24 hours If they have been unable to tolerate (or not been offered) extra fluids If they have malnutrition Signs of shock include: Tachycardia, Weak peripheral pulses, Delayed capillary refill time > 2 seconds, Cold peripheries, Depressed mental state with or without hypotension Physical findings of volume depletion in infants and children Finding Mild (3 to 5%) Moderate (6 to 9%) Severe (≥10%) Pulse Full, normal rate Rapid Rapid and weak or absent Systolic pressure Normal Normal...

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