Diarrhea is an increased number of watery stools over a defined period of time. An infant may have a formed or semiformed stool after each feeding and this could be normal. Several mechanisms can cause diarrhea in the child, including osmotic, secretory, and transit disorders. Viral and bacterial pathogens cause the majority of episodes of diarrhea. Some tumors, such as neuroblastomas, secrete hormones that can increase stool water content.
When the presenting symptom is diarrhea, one must quantitate the number and volume of stools, consistency, and the presence of blood. Ascertain the norm for the child, since there is great individual variability in frequency and type of stools. Associated symptoms or the presence of diarrheal illness in other members of the family helps in establishing the diagnosis. Dehydration and electrolyte imbalance should be assessed and treated. Diarrhea may represent fluid expelled around an anatomic obstructive mass, such as an impaction, or functional obstruction, as in Hirschsprung disease (absence of parasympathetic ganglia cells in the muscle layers of the colon). Bloody diarrhea may be infectious or a manifestation of a systemic disease (e.g., hemolytic-uremic syndrome; I§bJeJ23-4).
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