Diarrhea: History & Physical Exam – Pediatric Gastroenterology | Lecturio
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Diarrhea: History & Physical Exam – Pediatric Gastroenterology | Lecturio

October 1, 2019

So if you see a child with
vomiting and/or diarrhea, what are key things you want to ask? First is obviously fever. Children with infectious diarrhea
typically may have a fever. Ask about blood or mucus in the stool. This may tip you off if this is bacterial
as opposed to a viral pathogen. Most bacterial gastroenteritis
requiring treatment is bloody. Ask about exposure to
farm animals or reptiles. 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. Petting zoos are a big
problem in the United States if children don’t wash their hands with
alcohol after they pet the animals. Suspicious foods are
always a potential cause and we hear about
outbreaks all the time. 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. Ask about recent travel. 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. And of course, as about
recent antibiotic use because C. diff is a possibility as well
as the antibiotic-associated diarrhea. So on exam, critically important
to look for signs of dehydration. Tenting is rare and is only at
extreme ends of dehydration. Mostly, you’re going to look at mucus
membranes and see if they’re moist. See if the child is making
tears when they cry. Look for sings of systemic infection. Is there something else going on. 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. In babies, this can be tricky. The baby, if you’re careful, will seem to
resist you if you squeeze on their belly. But in a crying baby who doesn’t want
to be examined in the first place, this can be a challenge. A perianal inspection is
important on children especially if you’re concerned
about inflammatory bowel disease. Sometimes, a rectal tag or fissure is the best clue you have that
the child has Crohn’s disease.

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  1. This one time I had diarrhea so bad I could not rest at all I could not eat anything solid for a week I had a high fever Very lethargic I had to call in to work which I never do. Went to the doctor's. I had lost 10 lbs just in 5 days. So they started me on a potent antibiotic. Finally after 2 weeks I was better

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