109. Chronic Diarrhoea

Question 1

A young child comes in with loose stools for 2 months. What do you want to find out more about?

Answer 1

Previous bowel habit
How often are they passing stool
Formed or runny
Blood or mucus
Diet
Associated symptoms?
Travel history
Friends with similar problems
Contact with animals

Question 2

What would you look for on examination in a patient

with this history?

Answer 2

General- height, weight

Peripehral- pallor, clubbing, muscle bulk, jaundice, eczema, lymphadenopathy

Abdomen- distension, masses, liver and spleen, bowel sounds

anus- look for fissure, fistulae, skin tags, soiling

Question 3

What is Toddler’s diarrhoea?

Answer 3

Also known as chronic non-specific diarrhoea, most common cause of diarrhoea in children under 5

Painless passage of 3 stools per day for at least 4 weeks

Question 4

What is the prognosis for toddler’s diarrhoea?

Answer 4

Typically grow out of it by school age
May be a delay in faecal continence
Diet rich in fibre and fat may help as well as restricting juice

Question 5

What examination signs should you look for in suspected coeliacs?

Answer 5

Pallor
Abdominal distension
Muscle wasting

Question 6

What serological tests are done for ceoliac disease?

Answer 6

IgA tissue transglutaminase (sensitive so used as screening)

IgA endomysial antibodies

Question 7

What further investigations are done if serological tests are positive?

Answer 7

Upper Gi endoscopy and biopsy

Expect to find Subtotal villous atrophy
Increased lymphocytes in the lamina propria
Crypt hypertrophy

Question 8

Where else can you go for paediatric revision?

Answer 8

All the case studies in the repro and child health block