Chronic Diarrhea Flashcards
Recipe for homemade ORS
half a teaspoon of salt
• six level teaspoons of sugar
• 1 litre of water
Formula for Estimated
Ideal Weight for Age
1-6 yo
Age 1-6
Wt in kg = age in yrs x 8 +2
Wt in kg= age in yrs x 7–5
` 2
Sample: 7 yo
• Wt= (7 x 7) – 5 = 22kg
2
Definition of Chronic Diarrhea
Diarrheal episode that lasts for >14 days
As stool leaves the colon, fecal osmolality
is equal to the serum osmolality
(290
mosm/kg)
how to estimate stool osmolality?
The stool osmolality may be estimated by
using the formula: (stool Na + stool K) × 2
(multiplied by 2 to account for the anions)
Osmotic vs. Secretory
• OSMOTIC
- • 290 mosm/kg
- -2(actual stool Na +
- stool K) >100
- • An “Osmotic” gap
- • Stool with low
- electrolytes
- • Cause of diarrhea:
- indigestible solutes (lactose, sucrose or fructose)
SECRETORY
- 290 Osm/kg - 2(actual
- stool Na + stool K) <100
- • A stool rich in electrolytes
- • Cause of diarrhea:
- actively secreted
- electrolytes by crypt
- cells
Sudan red stain: neutral fat - a sign of
maldigestion (pancreatic insufficiency,
including cystic fibrosis)
visualized fat after acid hydrolysis of the
stool (split fat) :
malabsorption (celiac
disease)
What indicates the presence of reducing CHOH ( CHOH malabsorption)
A pH <5 or the presence of moderate
reducing substances indicates the
presence of reducing carbohydrates
Hemoccult testing: evaluate for occult
blood
• A positive test indicates
indicates intestinal mucosal
damage, which may be caused by
gastrointestinal infection, protein
intolerance or inflammatory bowel disease.
Fat globules in the stool may be
**normal or abnormal **in the first few months of life.
Normal
• In an older child, the presence of fat
globules suggests
steatorrhea
Other Laboratory Evaluation
hydrogen breath test for
carbohydrate
malabsorption,
72-hour fecal fat test for
fat
malabsorption
sweat chloride test for
cystic fibrosis
upper gastrointestinal series with smallbowel
follow-through for _____________
anatomic
abnormalities and Crohn’s disease
Causes of Chronic Diarrhea
Neonatal Age of Onset
0-30 days
- Microvillus inclusion disease
- Short bowel syndrome
- Food allergy
- Hirschsprung’s disease
- Neonatal Lymphagectasia
- Primary bile salt malabsorption
autosomal recessive disorder
\at birth: profuse watery secretory
diarrhea, dehydration and failure to
thrive
Microvillus inclusion
disease
What is the characteristic of Microvillus inclusion disease in light microscopy?
Light microscopy of small bowel
mucosa:
diffuse thinning of the
mucosa, with hypoplastic villus
atrophy and no inflammatory
infiltrate
What is the prognosis of Microvillus inclusion
disease?
fatal without long-term parenteral
nutrition support- Refer to
GASTROENTEROLOGIST
What is the treatment of Microvillus inclusion
disease
Tx: somatostatin analog octreotide
may reduce the volume of stool
Definitive Tx: Microvillus inclusion
disease
Intestinal
transplantation
results from congenital malformations
or resection of the small bowel
Short Bowel Syndrome
If greater than 50% of the small bowel is loss, what happens?
decreased transit time à geralized
malabsorption disorder + specific
nutrient deficiency
Short Bowel Syndrome
TREATMENT:
- Hospitalization for FLUID AND ELECTROLYTES management
- May require Parenteral nutrition until bowel’s absorptive function normalizes
- Referral to a Gastroenterologist for NUTRITIONAL SUPPORT
A diagnosis in neonates and young infants age:
- Necrotizing enterocolitis in term newborns
- Allergic colitis of neonate/young infant: bloody
stool without other symptoms
- Eosinophilic enteropathy: Profuse Vomiting,
Chronic diarrhea, FTT, Pallor, Edema
COW’S MILK ALLERGY
(Food Proten Allergy)
What is the TX for COW’S MILK ALLERGY
(Food Proten Allergy)
- Eliminate milk in maternal diet if the baby is
- breast-fed OR
- v Use protein hydrolysate formula OR
- v In refractory cases, amino acid–based formulas are often beneficial
- Migratory failure of neural crest cells
- Ø 90% fail to pass meconium in first 24-48 hrs
- Ø Abdominal distension, bilious emesis, obstructive enterocolitis
- Ø Rectal Biopsy: Absence of Ganglion cells
What is the TX Hirschsprung Disease
Referral to SURGERY
What is the TX Hirschsprung Disease in NEONATEs?
In neonates: primary pull-through–
bringing normal colon down to anorectal
junction
What is the treatment of Hirschsprung Disease in older infants
In older infants: 2 steps:
1. may need diverting colostomy first to
decompress the distended colon
2. Anorectal Pull-through
