Clinical features atypical for acute viral gastroenteritis in children

Clinical feature	Potential significance
Historical features
Fever: ≥38°C (100.4°F) in infants <3 months ≥39°C (102.2°F) in infants and children ≥3 months	Extraintestinal infection (eg, UTI, otitis media, pneumonia, etc) or bacterial gastroenteritis (particularly if >40°C [104°F])
Gross blood or mucus in stool	Bacterial gastroenteritis, IBD
Bilious vomiting	Intestinal obstruction
Projectile vomiting	Pyloric stenosis, intestinal obstruction
Persistent diarrhea (>7 days)	Underlying gastrointestinal, metabolic, or CNS disease
Persistent, recurrent, or isolated vomiting	CNS disease, metabolic disease
Increased urine output	Diabetic ketoacidosis
Altered consciousness, seizures, focal neurologic abnormalities	Increased ICP (CNS mass, hydrocephalus, idiopathic intracranial hypertension)
History of trauma	Intracranial or intra-abdominal injury (eg, duodenal hematoma)
Weight loss and multisystem involvement	Parasitic gastroenteritis; underlying gastrointestinal or metabolic disorder
Recent antibiotic exposure	Antibiotic-associated diarrhea, including Clostridioides difficile colitis
International travel	Bacterial or parasitic gastroenteritis, measles
Exposures: unsafe foods (eg, raw/undercooked meats, eggs, shellfish, unpasteurized milk or juice), farm animals, petting zoo, reptiles, pets with diarrhea, untreated surface water	Bacterial or parasitic gastroenteritis
Examination
Moderate to severe dehydration in a child >2 years	May indicate underlying condition predisposing to dehydration
Bulging fontanelle	Hydrocephalus, meningitis
Bulging tympanic membrane	Acute otitis media
Hypotension disproportionate to apparent illness and/or hyponatremia with hyperkalemia	Adrenal crisis
Tachypnea, retractions, crackles, decreased breath sounds	Pneumonia or other respiratory tract infection
Marked abdominal distention, peritoneal signs, absent bowel sounds or increased high-pitched bowel sounds ("borborygmi")	Acute abdomen (eg, appendicitis, intestinal obstruction)
Focal abdominal tenderness	RLQ: appendicitis, Crohn disease RUQ: gallbladder disease, pancreatitis Suprapubic or flank: UTI Epigastric: pancreatitis, peptic ulcer disease/gastritis
Abdominal mass	"Olive" at lateral edge of rectus abdominus in RUQ: pyloric stenosis "Sausage-shaped" right-sided mass: intussusception
Petechiae, purpura, bruising	Hemolytic uremic syndrome, trauma, extraintestinal infection (eg, RMSF, meningococcemia)
Jaundice	Viral hepatitis, HUS
Signs of trauma	Intracranial or intra-abdominal injury (eg, duodenal hematoma)
Increased muscle tone, hyperreflexia	Hyperkalemia
Laboratory findings (if performed)
Abnormal CBC	Anemia, thrombocytopenia, hemolysis: HUS Elevated band count: bacterial gastroenteritis Elevated eosinophil count: parasitic gastroenteritis
Elevated serum C-reactive protein, procalcitonin	Bacterial gastroenteritis, IBD
Fecal leukocytes, fecal lactoferrin, fecal calprotectin	Bacterial gastroenteritis, IBD
Eosinophils on fecal smear	Amoeba or other intestinal parasite
Persistent watery diarrhea	Microsporidia, Cyclospora, and other intestinal parasites

UTI: urinary tract infection; IBD: inflammatory bowel disease; CNS: central nervous system; ICP: intracranial pressure; RLQ: right lower quadrant; RUQ: right upper quadrant; RMSF: Rocky Mountain spotted fever; HUS: hemolytic uremic syndrome; CBC: complete blood count.

Graphic 103390 Version 4.0

خرید پکیج

Clinical features atypical for acute viral gastroenteritis in children