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Diarrhea |
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Frequent loose bowel movements (4 to 6/day) may occur in normal infants; they are of no concern unless anorexia, vomiting, weight loss, failure to gain weight, or passage of blood also occurs. Breastfed infants tend to have frequent bowel movements, especially if they are not receiving solid food. The significance of diarrhea in a child at any age differs if it is acute (< 2 wk) or chronic (> 2 wk). |
正常嬰兒一天可多次稀松排便（4－6次/天)。這不用擔心，除非有厭食、嘔吐、體征減輕、長不胖、便血等情況。母乳喂養(yǎng)嬰兒排便次數(shù)較多，特別是在未添加固體食物情況下。任何年齡兒童腹瀉意義各不相同，還要看是否是急性< 2 wk)或慢性（> 2 wk)。 | |
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Etiology |
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病因?qū)W |
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Acute diarrhea is most likely infectious, especially if onset is sudden or accompanied by vomiting, bloody stools, fever, anorexia, or listlessness. Diagnosis is clinical, and treatment is supportive until the condition resolves spontaneously. |
急性腹瀉最可能是感染性，特別是起病突然或伴有嘔吐、便血、發(fā)燒、厭食或無精打采等情形。予門診診斷、支持性治療，直到病情自行消退。 | |
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Chronic diarrhea is usually more significant. Causes include gluten-induced enteropathy, cystic fibrosis, sugar malabsorption, and allergic gastroenteropathy. Inflammatory bowel disease and some infections (eg, with Giardia) can also cause chronic diarrhea. |
慢性腹瀉較重要，其原因包括可谷膠所致腸病、囊性纖維病、糖吸收不良及過敏性胃腸病。炎性腸病和一些傳染�。ㄈ缳Z第蟲性)也能引起慢性腹瀉。 | |
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With gluten-induced enteropathy (celiac sprue), the gluten fraction of wheat protein causes intestinal mucosal damage and malabsorption of dietary fats, resulting in malnutrition, anorexia, and bulky, foul-smelling stools. The change in stools starts when wheat and other gluten-containing foods are added.醫(yī)學.全在線www.med126.com |
谷膠所致腸�。�小麥蛋白谷膠引起腸粘膜損壞和飲食脂肪吸收不良，導致營養(yǎng)不良、厭食，大便成團、惡臭。當麥和其他含谷膠食物增加時大便就會發(fā)生變化。 | |
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With cystic fibrosis, pancreatic insufficiency results in trypsin and lipase deficits, causing high fecal losses of protein and fats with consequent malnutrition and growth retardation. The stool is voluminous and often foul-smelling. Children who have cystic fibrosis often have respiratory problems and growth failure. |
囊性纖維病：胰腺功能不足導致胰蛋白酶和脂酶不足，蛋白質(zhì)和脂肪隨糞便大量丟失，造成營養(yǎng)不良，發(fā)育遲滯，大便量多、味臭。有囊性纖維病兒童常常有呼吸道問題和生長不足。 | |
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With sugar malabsorption, intestinal mucosal enzymes, such as lactase, which splits lactose to galactose and glucose, may be congenitally absent or temporarily deficient secondary to GI infection. Improvement after eliminating lactose (or other carbohydrates) from the diet or after substituting a lactose-free formula strongly suggests the diagnosis. |
糖吸收不良：小腸粘膜酶，如乳糖酶能將乳糖分解成半乳糖和葡萄糖，可能是先天缺失或因胃腸感染引起暫時不足。從飲食中除去乳糖（或其他碳水化合物)或用無乳糖配方替代后癥狀改善，都有力支持本診斷。 | |
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With allergic gastroenteropathy, cow's milk protein may cause diarrhea, often with vomiting and blood in the stools, but intolerance to the carbohydrate fraction of the ingested food should be suspected also. Symptoms often abate promptly when soy formula is substituted for cow's milk and return if cow's milk is reintroduced. Some infants intolerant of cow's milk are also intolerant of soy, so a formula that has had the protein pre-digested and does not contain the offending disaccharide may be needed. Spontaneous improvement usually occurs toward the end of the 1st yr. |
過敏性胃腸�。号Ｄ痰鞍卓赡芤鸶篂a，通常伴有嘔吐和便血，但也應懷疑對攝入食物中的碳水化合物不耐受。用大豆配方替代后癥狀迅速減輕，但牛奶可使癥狀再現(xiàn)。有些對牛奶不耐受的嬰兒通常對大豆也不耐受，因此，需要一種蛋白預先消化、不含雙糖的配方。1周歲時癥狀會自行改善。 | |
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Evaluation |
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評估 |
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History: History focuses on the quality and frequency of stools as well as accompanying signs and symptoms. Reports of vomiting or fever suggest GI infection. An accurate dietary history is critical. Reports of diarrhea beginning with the introduction of wheat cereal suggest celiac disease. Reports of variation in the stool pattern with certain elements of the diet suggest dietary intolerance. The persistent presence of blood in the stool mandates a careful search for more serious infection or GI disorder. |
病史：病史重點是大便質(zhì)量和頻率及伴隨癥狀。嘔吐或發(fā)燒提示有胃腸感染。準確的飲食史很關(guān)鍵，始于食用小麥類食品引起的腹瀉提示有乳糜瀉。大便形態(tài)各異伴未消化食物提示為飲食不耐受。持續(xù)便血就必須深查是否有嚴重感染或胃腸疾病。 | |
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Physical examination: Examination focuses on overall appearance and signs of dehydration, growth parameters, and abdominal findings; poor growth suggests more serious disorders. Pulmonary status is also evaluated in children in whom cystic fibrosis is suspected. |
體檢：體檢重點是總外表和脫水、生長發(fā)育、腹部檢查癥狀等。發(fā)育不良提示有更嚴重的疾病。懷疑有囊性纖維化兒童還應作肺部評估。 | |
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Testing: Tests are ordered if history and examination suggest a chronic condition. Tests include electrolyte levels if there is dehydration; sweat Cl and Na levels for cystic fibrosis; cultures for viruses, bacteria, or parasites when infection appears to be present; and stool pH for disaccharide intolerance. Levels of certain antibodies are associated with celiac disease. Dietary manipulations can be diagnostic as well as therapeutic. |
化驗：如病史和體檢提示有慢性疾病則應作化驗檢查。如有脫水，應檢查電解質(zhì)水平；囊性纖維病檢查氯和鈉水平；如有感染則進行病毒、細菌或寄生蟲培養(yǎng)檢查；雙糖耐受情況檢查大便pH值。一定的抗體水平與乳糜瀉有關(guān)。飲食控制既是診斷性也是治療性的。 | |
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Treatment |
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治療 |
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Supportive care for acute diarrhea consists primarily of providing adequate oral (or rarely IV) rehydration. Antimotility agents (eg, loperamide: IMODIUM) are generally not recommended for infants and young children. |
急性腹瀉的支持護理主要包括足夠的口服補水（或IV補液)�？鼓軇宇愃帲ㄈ�洛哌丁胺：易蒙停)通常不建議嬰兒和幼兒服用。 | |
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For chronic diarrhea, adequate nutrition must be maintained, particularly of fat-soluble vitamins. Specific treatments are indicated for certain causes (eg, gluten-free diet for those with celiac disease). |
慢性腹瀉必須保持營養(yǎng)，尤其是脂溶性維生素。有些病因應采取對癥療法（如乳糜瀉病人的無谷膠飲食)。 |
