Symptoms of acute gastrointestinal diseases

The clinic for acute gastrointestinal diseases consists of the following main syndromes: toxicosis, exsicosis, dyspeptic syndrome.

Toxicosis is a nonspecific syndrome, which consists of an increase in body temperature, the appearance of pallor with a grayish color, and with severe acidosis, the marbling of the skin. The child is disturbed by sleep, appetite decreases, behavior changes up to the comorbidity and coma.

Exxicosis (dehydration, dehydration) is most specific for gastrointestinal diseases and is prognostically significant, manifested by a change in the child's attitude to drinking, dryness of the mucous membranes, a decrease in body weight and tissue turgor, the westernization of the fontanel, a decrease in diuresis, and symptoms of hemodynamic disorders due to hypovolemia.

It is important to assess the severity of dehydration by clinical signs.

• I degree (easy) - deficiency of body weight 4-5%;
• II degree (moderate severity) - body weight deficit of 6-9%;
• III degree (severe) - a body mass deficit of 10% or more.

Deficiency of body weight due to water 20% or more is incompatible with life.

Assessment of the severity of dehydration by clinical signs

Symptom or symptom	Degree of dehydration (% of weight loss)
	Easy (4-5%)	The average severity (9%)	Heavy with or without shock (10% or more)
Appearance	Excitement or anxiety	Anxiety or inhibition, state of tension, anxiety, reaction to touch is retained	Drowsiness, cold, wet and often cyanotic limbs, the child can be in a coma
Thirst	Moderate	Expressive	Weak desire to drink
Elasticity of the skin	Normal	Decreased	Sharply reduced
Elasticity of the skin	Normal	Sunken	Highly sunken
Tear fluid	There is	Absent	Absent
Large fontanel	Normal	Wants	Sharply sinks
Mucous membranes of the mouth, tongue	Wet or dry	Dry	Very dry
Pulse on the radial artery	Normal or slightly tapered, good filling	Fast, weak	Frequent, threadlike, sometimes not palpable
Diuresis	Normal	Absence for several hours; or a small amount of dark urine is released	Absence for 6 hours or more
Breath	Normal	Increased	Rapid, deep
Cardiovascular system condition	Without violations	Tachycardia	Tachycardia, deafness of cardiac tones

The state of hemodynamics is a mild degree of excision is compensated, medium-heavy - subcompensated, heavy - decompensated.

There are also types of exsicosis, depending on the ratio of losses through the gastrointestinal tract of water and electrolytes:

1. Water-deficient (hypertonic) type of exsicosis develops with the prevalence of water losses with liquid stools at enteritis. The child is excited, thirst is expressed, motor anxiety is noted, diuresis is reduced slightly, hemodynamics is stable, all signs of dehydration are externally sharply expressed.
2. A solodalemic (hypotonic) type of exsicosis occurs when vomiting is severe, when a significant loss of electrolytes occurs. The child becomes sluggish, adynamic, refuses drinking, attempts to give a drink provoke vomiting, hypothermia is noted, all hemodynamic parameters are violated, diuresis is reduced or absent, and external signs of exsicosis are expressed moderately.
3. Isotonic type of exsicosis. Develops with proportional loss of water and electrolytes in gastroenteritis. The child is sluggish, sleepy, periodically excited, drinks reluctantly, the turgor of tissues is lowered, the mild dryness of the mucous membranes, diuresis is insufficient.

[1], [2], [3], [4], [5], [6], [7],

Dyspeptic syndrome (syndrome of local changes)

The characteristic of a dyspeptic syndrome allows to allocate the primary localization of the pathological process in the digestive tract.

Gastritis - begins acutely. The patient has cramping abdominal pain localized in the epigastrium or around the navel, nausea. At the height of pain, vomiting occurs with remnants of food and fluids, in infants - regurgitation or regurgitation with a "fountain".

Enteritis is clinically manifested by frequent watery, plentiful stools, up to the stool with "one water". In infants in the stool there are white lumps (soaps) resembling a chopped egg. In infectious processes, the stool can be frothy and fetid. There is bloating, rumbling along the loops of the small intestine.

Colitis is characterized by a moderately frequent meager, stooly stool with an admixture of mucus or pus in the form of lumps, strings, sometimes with veins of blood. The child is troubled by the urge to defecate: often tenses, cries, presses the legs to the stomach.

In young children, signs of lesions of various parts of the gastrointestinal tract are rarely isolated, more often they are combined. For functional and viral diseases, enteritis or gastroenteritis is characteristic. With bacterial infections, any combination of levels of damage is possible, but in the presence of a colitis syndrome, one always has to think about the bacterial process (dysentery, salmonellosis, staphylococcal disease, disease caused by opportunistic flora).

Differentiation of functional and infectious diseases of the digestive tract in children is helped by the sequence of appearance and severity of the main clinical syndromes. With functional disorders of the gastrointestinal tract, the first appears dyspeptic syndrome, then the dehydration syndrome can join and the last appears moderate toxemia.

Infectious diseases of the gastrointestinal tract begin, as a rule, sharply with the appearance of a syndrome of toxicosis, which sometimes goes ahead of the dyspeptic syndrome, later dehydration develops, but the severity of the patient's condition will largely determine the severity of toxicosis.

Each nosological form of acute gastrointestinal disease has clinical features.

Simple dyspepsia begins with the appearance of vomiting and rapid fluid stool with a relatively satisfactory state of health of the child. The stool becomes liquid with an admixture of greenery, lumps of white and yellow color, vomiting of food eaten 1-2 times (gastroenteritis syndrome). Body temperature, as a rule, remains normal, can be subfebrile. The child is capricious and worried, legs with legs. The dream is broken. The abdomen is moderately inflated, the rumbling of the intestinal loops is determined.

In untimely and inadequate treatment of simple dyspepsia, activation of endogenous intestinal flora and the development of toxic dyspepsia are possible, especially in children with an unfavorable premorbid background. The symptoms of toxicosis begin to prevail in the clinical picture of toxic dyspepsia.

With parenteral dyspepsia, a stool becomes more frequent, vomiting may appear on the background of the symptoms of the underlying disease outside the gastrointestinal tract. Dyspeptic phenomena appear 3-4 days after the onset of the disease. The clinic more often corresponds to the clinic of simple dyspepsia. As the main disease subsides and with adequate treatment, dyspeptic symptoms are eliminated.

Rotavirus diarrhea begins acutely, symptoms of mild enteritis or gastroenteritis predominate. The autumn-winter-spring seasonality is characteristic. There are signs of lactose insufficiency (the causative agent disrupts the absorption of water and disaccharides). Toxicosis is expressed first 2-3 days. There is hyperemia of the soft palate, earrings, tongue.

Salmonellosis is characterized by an acute onset with the appearance of toxicosis syndrome (steadily increasing) and enteritis or gastroenterocolitis. Typical is a chair in the form of "marsh mud". The severity of the pathological process in salmonella infection is determined by both toxicosis and exsicosis (often II-III degree), the latter in its development lagging behind the toxicosis. Children may have metastatic foci (meningitis, pneumonia, osteomyelitis).

Dysentery manifests itself as a syndrome of colitis or gastroenterocolitis. Both clinical variants are characterized by acute onset, symptoms of toxicosis and exciticosis of I-II degree (in the early days of vomiting) and distal colitis in the form of "rectal spitting" (stool without feces with a lot of turbid mucus and blood veins). For dysentery, there is a parallel development of the symptoms of toxicosis and dyspeptic phenomena caused by the defeat of the large intestine.

Coley infection. Enteropathogenic Escherichia causes intestinal lesions in the form of enteritis or gastroenteritis mainly in children of the first two years of life. The onset of the disease can be acute or gradual. The child has a regurgitation, vomiting, refusal to eat. A chair becomes more frequent, which becomes abundant, watery, splashing with a small amount of transparent, glassy, mixed with mucus masses of mucus. The stomach is evenly swollen, often paresis of the intestine. Symptoms of II-III degree exacerbosis, toxicosis develop.

Intestinal infection of the prosthetic etiology is characterized by lesion of the gastrointestinal tract more often as an enterocolitis. It begins acutely with a short-term rise in body temperature, the rapid development of intoxication. At the same time, the chair becomes more frequent, it becomes liquid, watery, fetid, yellow-green with an admixture of transparent mucus. It can be vomiting up to 5-6 times a day. The abdomen is swollen, painful on palpation.

In the clinical picture of campylobacteriosis, enteritis and gastroenteritis prevail, toxicosis is not expressed, usually an I-II degree of exci- cosis.

[8], [9], [10], [11], [12], [13], [14], [15]