Chronic Diarrhea

Question 1

Recipe for homemade ORS

Answer 1

half a teaspoon of salt
• six level teaspoons of sugar
• 1 litre of water

Question 2

Formula for Estimated
Ideal Weight for Age

1-6 yo

Answer 2

Age 1-6
Wt in kg = age in yrs x 8 +2

Question 3

Wt in kg= age in yrs x 7–5
` 2

Sample: 7 yo
• Wt= (7 x 7) – 5 = 22kg
2

Question 4

Definition of Chronic Diarrhea

Answer 4

Diarrheal episode that lasts for >14 days

Question 5

As stool leaves the colon, fecal osmolality
is equal to the serum osmolality

Answer 5

(290
mosm/kg)

Question 6

how to estimate stool osmolality?

Answer 6

The stool osmolality may be estimated by
using the formula: (stool Na + stool K) × 2

(multiplied by 2 to account for the anions)

Question 7

Osmotic vs. Secretory

Answer 7

• 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

Question 8

Sudan red stain: neutral fat - a sign of

Answer 8

maldigestion (pancreatic insufficiency,
including cystic fibrosis)

Question 10

visualized fat after acid hydrolysis of the
stool (split fat) :

Answer 10

malabsorption (celiac
disease)

Question 11

What indicates the presence of reducing CHOH ( CHOH malabsorption)

Answer 11

A pH <5 or the presence of moderate
reducing substances indicates the
presence of reducing carbohydrates

Question 12

Hemoccult testing: evaluate for occult
blood
• A positive test indicates

Answer 12

indicates intestinal mucosal
damage, which may be caused by
gastrointestinal infection, protein
intolerance or inflammatory bowel disease.

Question 13

Fat globules in the stool may be
**normal or abnormal **in the first few months of life.

Answer 13

Normal

Question 14

• In an older child, the presence of fat
globules suggests

Answer 14

steatorrhea

Question 15

Other Laboratory Evaluation

hydrogen breath test for

Answer 15

carbohydrate
malabsorption,

Question 16

72-hour fecal fat test for

Answer 16

fat
malabsorption

Question 17

sweat chloride test for

Answer 17

cystic fibrosis

Question 18

upper gastrointestinal series with smallbowel
follow-through for _____________

Answer 18

anatomic
abnormalities and Crohn’s disease

Question 19

Causes of Chronic Diarrhea

Neonatal Age of Onset

Answer 19

0-30 days

• Microvillus inclusion disease
• Short bowel syndrome
• Food allergy
• Hirschsprung’s disease
• Neonatal Lymphagectasia
• Primary bile salt malabsorption

Question 20

autosomal recessive disorder

\at birth: profuse watery secretory
diarrhea, dehydration and failure to
thrive

Answer 20

Microvillus inclusion
disease

Question 21

What is the characteristic of Microvillus inclusion disease in light microscopy?

Answer 21

Light microscopy of small bowel
mucosa:

diffuse thinning of the
mucosa, with hypoplastic villus
atrophy and no inflammatory
infiltrate

Question 22

What is the prognosis of Microvillus inclusion
disease?

Answer 22

fatal without long-term parenteral
nutrition support- Refer to
GASTROENTEROLOGIST

Question 23

What is the treatment of Microvillus inclusion
disease

Answer 23

Tx: somatostatin analog octreotide
may reduce the volume of stool

Question 24

Definitive Tx: Microvillus inclusion
disease

Answer 24

Intestinal
transplantation

Question 25

results from congenital malformations
or resection of the small bowel

Answer 25

Short Bowel Syndrome

Question 26

If greater than 50% of the small bowel is loss, what happens?

Answer 26

decreased transit time à geralized
malabsorption disorder + specific
nutrient deficiency

Question 27

Short Bowel Syndrome
TREATMENT:

Answer 27

• Hospitalization for FLUID AND ELECTROLYTES management
• May require Parenteral nutrition until bowel’s absorptive function normalizes
• Referral to a Gastroenterologist for NUTRITIONAL SUPPORT

Question 28

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

Answer 28

COW’S MILK ALLERGY

(Food Proten Allergy)

Question 29

What is the TX for COW’S MILK ALLERGY

(Food Proten Allergy)

Answer 29

• 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

Question 30

• 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

Question 31

What is the TX Hirschsprung Disease

Answer 31

Referral to SURGERY

Question 32

What is the TX Hirschsprung Disease in NEONATEs?

Answer 32

In neonates: primary pull-through–
bringing normal colon down to anorectal
junction

Question 33

What is the treatment of Hirschsprung Disease in older infants

Answer 33

In older infants: 2 steps:
1. may need diverting colostomy first to
decompress the distended colon
2. Anorectal Pull-through