Symptoms of acute gastrointestinal disease

The clinical picture of acute gastrointestinal diseases consists of the following main syndromes: toxicosis, exicosis, dyspeptic syndrome.

Toxicosis is a non-specific syndrome that consists of an increase in body temperature, the appearance of pallor with a grayish color, and, in the case of severe acidosis, marbling of the skin. The child's sleep is disturbed, appetite decreases, behavior changes up to a soporous and comatose state.

Exicosis (dehydration) is most specific for gastrointestinal diseases and is prognostically significant, manifested by a change in the child's attitude to drinking, dry mucous membranes, decreased body weight and tissue turgor, sunken fontanelle, decreased diuresis, and symptoms of hemodynamic disturbances due to hypovolemia.

Assessing the severity of dehydration based on clinical signs is important.

• I degree (mild) - body weight deficit of 4-5%;
• II degree (moderate severity) - body weight deficit of 6-9%;
• Grade III (severe) – body weight deficit of 10% or more.

A body mass deficit due to water of 20% or more is incompatible with life.

Assessment of the severity of dehydration based on clinical signs

Symptom or sign	Degree of dehydration (% body weight loss)
	Light (4-5%)	Moderate (9%)	Severe with or without shock (10% or more)
Appearance	Excitement or anxiety	Restlessness or inhibition, state of tension, anxiety, reaction to touch is preserved	Drowsiness, cold, clammy and often cyanotic extremities, the child may be comatose
Thirst	Moderate	Expressed	Weak desire to drink
Skin elasticity	Normal	Reduced	Sharply reduced
Skin elasticity	Normal	Sunken	Very sunken
Lacrimal fluid	Eat	Absent	Absent
Large fontanelle	Normal	It sinks in	It falls sharply
Mucous membranes of the mouth, tongue	Wet or dryish	Dry	Very dry
Radial artery pulse	Normal or slightly increased, good filling	Fast, weak	Frequent, threadlike, sometimes not palpable
Diuresis	Normal	Absence for several hours; or small amounts of dark urine	Absence for 6 hours or more
Breath	Normal	Accelerated	Frequent, deep
Cardiovascular health	No violations	Tachycardia	Tachycardia, muffled heart sounds

According to the hemodynamic state, a mild degree of exsicosis is compensated, moderate-severe - subcompensated, severe - decompensated.

There are also different types of exsicosis depending on the ratio of water and electrolyte losses through the gastrointestinal tract:

1. The water-deficient (hypertonic) type of exsicosis develops with the predominance of water loss with liquid stool during enteritis. The child is agitated, thirst is expressed, motor restlessness is noted, diuresis is slightly reduced, hemodynamics are stable, all signs of dehydration are clearly expressed externally.
2. The salt-deficient (hypotonic) type of exsicosis occurs with severe vomiting, when there is a significant loss of electrolytes. The child becomes lethargic, adynamic, refuses to drink, attempts to give water provoke vomiting, hypothermia is observed, all hemodynamic parameters are sharply impaired, diuresis is reduced or absent, and the external signs of exsicosis are moderate.
3. Isotonic type of exicosis. Develops with proportional losses of water and electrolytes in gastroenteritis. The child is lethargic, sleepy, periodically excited, drinks reluctantly, tissue turgor is reduced, mucous membranes are moderately dry, diuresis is insufficient.

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Dyspeptic syndrome (syndrome of local changes)

The characteristics of dyspeptic syndrome allow us to identify the predominant localization of the pathological process in the gastrointestinal tract.

Gastritis - begins acutely. The patient experiences cramping pains in the abdomen, localized in the epigastrium or around the navel, nausea. At the height of the pain, vomiting of food and liquid remains occurs, in infants - regurgitation or regurgitation "fountain".

Enteritis is clinically manifested by frequent, watery, abundant stools, up to stools "only water". In infants, white lumps (soaps) appear in the feces, resembling chopped eggs. In infectious processes, the stool may be foamy and foul-smelling. Abdominal distension and rumbling along the loops of the small intestine are noted.

Colitis is characterized by moderately frequent, scanty, fecal stool with an admixture of mucus or pus in the form of lumps, cords, sometimes with streaks of blood. The child is bothered by the urge to defecate: often strains, cries, pulls his legs to his stomach.

In young children, signs of damage to various parts of the gastrointestinal tract are rarely isolated, they are often combined. Enteritis or gastroenteritis are typical for functional and viral diseases. Any combination of damage levels is possible with bacterial infections, but in the presence of colitis syndrome, one should always think about a bacterial process (dysentery, salmonellosis, staphylococcal infection, disease caused by opportunistic flora).

The sequence of appearance and severity of the main clinical syndromes helps differentiate functional and infectious diseases of the gastrointestinal tract in children. In functional disorders of the gastrointestinal tract, the dyspeptic syndrome appears first, then dehydration syndrome may join in, and moderate toxicosis appears last.

Infectious diseases of the gastrointestinal tract usually begin acutely with the appearance of toxicosis syndrome, which sometimes precedes dyspeptic syndrome; dehydration develops later, but the severity of the patient's condition will largely determine the severity of toxicosis.

Each nosological form of acute gastrointestinal disease has clinical features.

Simple dyspepsia begins with vomiting and frequent loose stools with a relatively satisfactory state of health of the child. The stool becomes loose with an admixture of green, lumps of white and yellow color, vomiting of eaten food 1-2 times (gastroenteritis syndrome). Body temperature, as a rule, remains normal, can be subfebrile. The child is capricious and restless, kicks his legs. Sleep is disturbed. The abdomen is moderately swollen, rumbling of intestinal loops is determined.

If simple dyspepsia is not treated in a timely and adequate manner, activation of endogenous intestinal flora and development of toxic dyspepsia are possible, especially in children with an unfavorable premorbid background. In the clinical picture of toxic dyspepsia, symptoms of toxicosis begin to predominate.

With parenteral dyspepsia, stool frequency increases, vomiting may occur against the background of symptoms of the underlying disease outside the gastrointestinal tract. Dyspeptic symptoms appear 3-4 days after the onset of the disease. The clinical picture often corresponds to the clinical picture of simple dyspepsia. As the underlying disease subsides and with adequate treatment, dyspeptic symptoms are eliminated.

Rotavirus diarrhea begins acutely, with symptoms of moderate enteritis or gastroenteritis predominating. Autumn-winter-spring seasonality is typical. Manifestations of lactose deficiency are noted (the pathogen disrupts the absorption of water and disaccharides). Toxicosis is expressed during the first 2-3 days. Hyperemia of the soft palate, arches, and uvula is noted.

Salmonellosis is characterized by an acute onset with the appearance of toxicosis syndrome (steadily increasing) and enteritis or gastroenterocolitis. Typical is a stool in the form of "swamp mud". The severity of the pathological process in salmonella infection is determined by both toxicosis and exicosis (often II-III degree), and the latter lags behind toxicosis in its development. In children, metastatic foci may develop (meningitis, pneumonia, osteomyelitis).

Dysentery manifests itself as a syndrome of colitis or gastroenterocolitis. Both clinical variants are characterized by an acute onset, symptoms of toxicosis and exicosis of I-II degree (vomiting in the first days of the disease) and distal colitis in the form of "rectal spit" (stool without feces with a large amount of cloudy mucus and streaks of blood). Dysentery is characterized by the parallel development of symptoms of toxicosis and dyspeptic phenomena caused by damage to the colon.

Coli infection. Enteropathogenic Escherichia coli causes intestinal damage in the form of enteritis or gastroenteritis mainly in children of the first two years of life. The onset of the disease can be acute or gradual. The child begins to regurgitate, vomit, and refuse to eat. Stool becomes more frequent, becomes abundant, watery, splashing with a small amount of transparent, glassy mucus mixed with feces. The abdomen is uniformly swollen, intestinal paresis often occurs. Symptoms of exsicosis of the II-III degree, toxicosis develop.

Intestinal infection of proteus etiology is characterized by damage to the gastrointestinal tract, most often by the enterocolitis type. It begins acutely with a short-term rise in body temperature, rapid development of intoxication. At the same time, stool becomes more frequent, becomes liquid, watery, foul-smelling, yellow-green in color with an admixture of transparent mucus. There may be vomiting up to 5-6 times a day. The abdomen is swollen, painful on palpation.

In the clinical picture of campylobacteriosis, symptoms of enteritis and gastroenteritis predominate, toxicosis is not pronounced, exicosis is usually of I-II degree.

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