Parasitic Diseases and Gastroenteritis Overview

Parasitic Diseases and Gastroenteritis

• Common parasitic infections in travelers from endemic areas include Giardia and Cryptosporidium as well as cholera.
• Gastroenteritis in daycare settings is often caused by Rotavirus, Norovirus, Campylobacter, Salmonella, Shigella, and enterohemorrhagic E. coli (EHEC).
• Increasing incidence of gastroenteritis observed, with 1.3 cases per 1,000 adults, affecting ages disproportionately: 10% under 6 months, 21% aged 0.5 to 10 years, and 69% aged 11 to 21 years.

Cholecystitis

• Divided into acute and chronic types; acalculous cholecystitis (without stones) can occur.
• Symptoms include intermittent abdominal pain and possible scapular radiation. In infants, signs include irritability, jaundice, and acholic stools.
• Types of gallstones:
  • Cholesterol stones: Radiolucent, >50% cholesterol.
  • Pigment stones: Radiopaque, black, associated with hemolytic disease.
  • Brown stones: Orange, soft, fatty, form in ductal systems.
• Most common complication: pancreatitis.
• Abdominal ultrasonography is the diagnostic tool of choice, while cholecystectomy is the standard treatment.

Pancreatitis

• Types include Acute, Acute Recurrent, Acute Hemorrhagic, Chronic, and Pseudocysts.
• Acute pancreatitis affects 1 in 10,000 children, Chronic affects 2 in 100,000.
• Main risk factors: genetic variants and obstructed ducts, with Cystic Fibrosis being the most common inherited cause.
• Characterized by inflammation of the pancreas leading to epigastric pain, vomiting, and elevated serum digestive enzymes.
• Diagnostic imaging includes ultrasound, CT, and MR cholangiopancreatography; laboratory tests involve CMP, Amylase, Lipase, etc.
• Treatment focuses on pain management, pancreatic enzymes, bowel rest, insulin, and IV fluids.

Toddler's Diarrhea

• Known as chronic nonspecific diarrhea affecting children 6 months to 5 years.
• Characterized by 3-10 loose stools per day, often occurring during daytime and immediately after eating.
• Stools are typically loose and may contain food particles but are not bloody. Children continue to grow and gain weight.
• Associated with a high carbohydrate diet and sweetened drinks. Treatment includes avoiding sorbitol or fructose.

Inflammatory Bowel Disease (IBD): Ulcerative Colitis vs. Crohn's Disease

Crohn's Disease

• A chronic inflammatory process affecting any part of the GI tract and may extend through multiple layers.
• Involves "patchy" inflammation in the GI tract.

Ulcerative Colitis

• Characterized by continuous inflammation in the colon and rectum, affecting only the innermost layer of the intestinal wall.

Treatments for Inflammatory Bowel Disease (IBD)

• Objectives include symptom relief, preventing flares, and achieving mucosal healing.
• Medications include Adalimumab (Humira), Infliximab (Remicade), Steroids, and Nutritional therapy.
• Surgery may be an option; these conditions are treatable but not curable.

Pediatric Gastrointestinal Motility Disorders

• Common in children, ranging from benign conditions like constipation to severe disorders such as esophageal achalasia and Hirschsprung disease.
• Diagnostic tools include plain films, barium enema, and upper GI series with small-bowel follow-through.

Constipation

• Common childhood issue with both somatic and psychological effects.
• Encopresis categorized into primary (continuous soiling) and secondary (post-toilet training soiling).
• Management includes education, behavioral modifications, stool softeners, and dietary changes. Polyethylene glycol 3350 is often used.

Gastrointestinal Bleeding in Infants and Children

• Hematochezia (GI bleeding) commonly originates from anal fissures in neonates, typically resulting in bright red blood in stool or diapers.
• Hematemesis in neonates is often due to swallowed maternal blood, milk protein allergies, or bacterial enteritis.
• In older children, causes vary by age, including peptic ulcer disease and esophageal varices due to portal hypertension.

Common Causes of Hematochezia

• In children over age 2: juvenile polyps, inflammatory bowel diseases, and infectious diarrhea caused by E. coli and Shigella species.

This quiz explores the history of travel-related parasitic diseases, including Giardia and Cryptosporidium, and examines gastroenteritis caused by pathogens like Rotavirus and EHEC. Test your knowledge on the symptoms, treatments, and epidemiology of these diseases.