Vinnytsya National Pirogov Memorial Medical University
The Department of Children Infectious Diseases
“Approved”
at sub-faculty meeting
“__”_____2012,
protocol №_____
Head of the Department
prof. _______I.I. Nezgoda
Study Guide for Practical Work for Students
Topic: “The urgent conditions of acute intestinal diseases in children.
Diagnostics and treatment.”
Course VI
English-speaking Students
Medical Faculty
Duration of the class-6,6 hours
Composed by assoc. prof., phD O.S. Onofriychuk
Vinnitsa
I. The theme urgency
The intestinal toxicosis with exicosis is the pathological process, which develops,
as a rule, during the acute intestinal disease. All the doctors must be able to
diagnose the different clinical symptoms of the dehydration and provide the
adequate help.
ІІ.
Primary aims of the study
Students must know:
1. Etiology and properties of causing factors of illness
2. Epidemiology (source of infection, ways of transmission, age-old receptivity
and morbidity).
3. Pathogenesis of disease, pathomorphologic changes in the staggered organs.
4. Classification of the illness, clinical symptoms depending of the AID types
and the patient’s age .
5. Clinical manifestations of typical form of AID.
6. The basic clinical symptoms of toxicosis during AID in the children.
7. The basic clinical symptoms of exicosis during AID in the children.
8. The basic clinical symptoms of neurotoxicosis during AID in the children.
9. Methods of laboratory research.
10.Principles of therapy of AID.
11.Measures of the urgent therapy.
A student must be able:
1. To follow the basic rules of work near a bed sick with AID.
2. To take anamnesis with the estimation of epidemiology information.
3. To examine a patient and reveal the basic clinical signs of illness.
4. To represent information of anamnesis and objective inspection in a hospital
chart and formulate the preliminary diagnosis.
5. To give an urgent aid for patients with syndromes of toxicosis, exicosis,
neurotoxicosis during AID in the children.
6. To organize the plating of feces and vomit mass and gastric and intestinal
lavage waters plating.
7. To organize the determination of specific antibody titer in the blood (RHA,
RA, CFR, HIR, RPHA).
8. Estimate the date of the laboratory findings.
9. To prescribe treatment accordingly the age, severity of illness.
10.To write out prescription on basic drugs.
III. Educational aims of the study
- forming the deontology presentations, skills of conduct with the patients
- to develop deontology presentations, be able to carry out deontology approach
to the patient
- to develop the presentations of influence of ecological and socio-economic
factors on the state of health
- to lay hands on ability to set psychological contact with a patient and his
family
IV. Control materials for the preliminary and final stage for the lesson
Tests and tasks
1. The isotonic type of dehydration isn’t characterized by:
A. Decreasing of arterial pressure
B. Moderate increasing the specific weight of urine
C. Wet and cold limbs
D. Dieresis is normal
2. What symptom does not belong to toxicosis?
A. Fever
B. Disorder of microcirculation
C. Loss of appetite
D. Decreasing of skin’s turgor
3. For centralization of blood circulation isn’t typical decreasing blood
circulation in such organs, except for:
A. Skin
B. Muscles
C. Hepar
D. Brain
4. What symptom does not belong to neurotoxicosis?
A. Excitation
B. Convulsion
C. Disorders of microcirculation
D. Pleocytosis
5. Call the main indications for paranteral rehydration:
A. I-II degree of exicosis
B. Good appetite
C. II-III degree of exicosis
D. Moderate diarrhea
6. What solutions are used for oral rehydration:
A. 10% glucose solution
B. Reopolyglucin
C. Rehydron
D. Potassium chloride
7. Name the medicine, which is used for correction DIC-syndrome:
A. Calcium chloride
B. Vikasol
C. Heparin
D. Aminocaproic acid
8. The main pathogenic mechanism of diarrhea syndrome during
rotavirus gastroenteritis is:
A. Activation the cyclic adenosinemonophosphate
B. Disaccharides insufficiency
C. Inflammation of the mucosa membranes of intestinal canal
9. Point out the main clinical syndromes of shigellosis:
A. Dyspeptic one, intoxication one
B. Dyspeptic one, allergic one
C. Dyspeptic one, astheno-vegetative one
10.Name the type of diarrhea of enterotoxigenic E.Coli:
A. Invasive one
B. Secretory one
C. Osmotic one
TASK 1
A girl patient, aged a year and 2 months was admitted to the in-patient
department on the 4th day of the disease with a diagnosis “Acute salmonellosis”.
Epidemic anamnesis: 3 days before the child’s disease her mother had signs
of acute intestinal infection (pains in the abdomen, vomiting twice, watery stool
twice a day that was associated with intake of curds prepared at home). There is
one more child in the family, aged 5 who attending the kindergarten and is
healthy.
The disease anamnesis: the girl fell ill acutely – temperature up to 38°C,
profuse watery stool up to 4 times a day. On the 2 nd day the temperature elevated
to 39.1°C, the baby refused the food but drank willingly, there was vomiting
once, stool became more frequent, up to 10 times per 24 hours, watery, of
“swampy slime” colour, foamy, profuse, fetid with admixtures of mucus. On the
3rd day of the disease the temperature was 38.3°C; there was no vomiting, stool
was of the same character 8 times a day, some of its portions were with a great
amount of mucus and blood streaks; the baby refused the food and drank less
willingly.
On examination: the condition of moderate severity – the baby is flaccid,
adynamic; the temperature is 37.9°C, she refuses food and drink. The skin is pale,
dryish, and bluish under the eyes, perioral cyanosis. Turgor of the soft tissues is
decreased. Deficiency of body weight is 8%. The tongue is thickly coated and
dryish. There are no rales in the lungs; the respiration is puerile. The heart sounds
are muffled. The respiration rate is 148 per min. The abdomen is moderately
distended, painful on palpation, borborygmus in all parts. The sigmoid is slightly
spasmic. There is irritation around the anus and on the buttocks. The liver is
palpated 4 cm below the costal edge; the spleen is at the edge of the costal arch,
elastic, painless. Stool is profuse, with admixture of a great amount of turbid
mucus, brown-green, with blood streaks, fetid, up to 10 times per 24 hours.
Urination is rare.
The laboratory data on admission: Blood count: Hb –120g/l, Eryth- 3·812
T/l, L – 12·109 T/l, bands –9%, S –52%, Lymph –26%, M – 9%, Eos – 4%, ESR
–16 mm/hr.
Coprogram: a great amount of unchanged muscular fibers, fat acids, starch
(extracellular), erythrocytes –15, leukocytes –32 in the field of vision
Biochemical blood analysis: plasma potassium 3.5 mmol/l, sodium –130
mmol/l, KOC indices- ph= 7.32; BE =10.
Coagglutination reaction – positive for salmonella group B antigen
Bacteriological urine analysis – negative result, feces for intestinal group is
negative.
Questions:
1. Administer etiotropic therapy.
2. Administer rehydration therapy.
3. Name the criteria of efficacy of the 1st stage of oral rehydration.
The answer to the task 4.
1. Cephtriaxon the daily dose of 100 mg/kg twice a day intramuscularly for
7 days.
Salmonellas bacteriophage 5 doses a day for 15 days.
2. The “Rehydron” solution, water, tea in two stages
The 1st stage – 100 ml/kg of body mass – 1200 ml during the first 4-6
hours
The 2nd stage – 50 ml/kg of body mass – 600 ml after the 1st stage
3. The criteria of efficacy of the 1st stage of oral rehydration:
1) Decreased fluid loss with stool and vomit
2) Absence of thirst
3) Restoration of tissue turgor
4) Restoration of mucous membrane moisture
5) Elevation of diuresis
6) Disappearance of microcirculatory disorders.
TASK 2
A 5-month baby has been in the infant in-patient department for 8 days for
bilateral small focal pneumonia. On the 2nd hospital day the temperature elevated
to 38.0°C, the baby was flaccid, adynamic, very thirsty, the skin was pale with
marble pattern; the tongue was dry with white coating. The large fontanelle was
1.5x 1.5 and moderately sunken. The turgor of the soft tissues was decreased. The
lung respiration was with rough breathing sounds and there were isolated dry
rales. The heart sounds were muffled; there was a systolic murmur on the top.
The respiration rate was 144 per min. The abdomen was soft, could be deeply
palpated, borborygmus. Stool was watery of yellow-green colour, with white
small lumps and insignificant amount of mucus up to 12 times a day. There was
decreased diuresis. Feces culture for intestinal group was negative.
Questions:
1. Make a preliminary diagnosis.
2. What variant of toxicosis does this baby have? Recall the symptoms
characteristic of this toxicosis.
3. Enumerate the criteria of severity evaluation of the disease in this case.
The answer to the task 5.
1. Acute gastroenteritis of moderate severity, toxicosis with exicosis of II
degree.
2. Toxicosis with exicosis of II degree:
a) flaccidity
b) adynamia
c) paleness of the skin
d) marble pattern
e) dry tongue
f) decreased tissue turgor
g) muffled heart sounds, systolic murmur, tachycardia
h) reduced diuresis
3. a) elevated temperature to 38.0°C
b) moderately marked symptoms of intoxication
c) clinical manifestations of toxicosis with exicosis of II degree
d) frequent stool up to 12 times corresponds to moderately severe form
of the disease.
V. Literature
1. Mikhailova A.M., Minkov I.P., Savchuk A.I. Infection diseases in children.Odessa, 2003.- 236 p.
2. Kuznetcov S.V., Olchovskaya O.N., Tatarkina A.N. Selected lectures in
children’s infectious diseases for English medical students. – Kharkov:
KSMU, 2006. – 164 p.
3. Nelson textbooks of pediatrics. / Edited by Richard E. Behrman, Robert M.
Kliegman, Ann M. Arvin.; senior editor, Waldo E. Nelson. – 1996.
