Chronic Diarrhoea

Question 1

Differences between osmotic / secretory Diarrhoea

Answer 1

Osmotic Diarrhoea stops with NBM

Secretory Diarrhoea continues with NBM eg cholera

Question 2

Definition of chronic Diarrhoea

Answer 2

Increased frequency and or volume of stool > 2 weeks
If infection is excluded commonest cause in children
Is toddler Diarrhoea

Question 3

Toddler Diarrhoea

Answer 3

Commonest form of chronic diarrhea in children
Child is thriving normal examination normal investigations
?related to fast gut transit time
And diet fruit juice cordial

Question 4

Osmotic Diarrhoea

Answer 4

Sugar malabsorption primary / secondary

Primary
Monosaccharides intolerance eg fructose ( fruit juice) sorbitol
Given enough most people will have Diarrhoea
Dissacharide def adults common lactose intolerance
5-10year of age African SE Asians Mediterranean
Congential RARE seen as soon as born

Secondary 
Short gut 
Enteropathy
Bacterial overgrowth 
Immune deficiency

Question 5

Secretory diarrhoea continues despite NBM

Answer 5

1 infection E. coli/ cholera
2 fat malabsorption bile acid
Laxative abuse
Rare tumors phaeochromcytoma

Question 6

Inflammatory diarrhoea

Answer 6

2 types infection salmonella yersinia camphlobactier amoebic dystentry
Or idiopathic UC CD eosinophilia enteriits

Question 7

Inflammatory bowel disease

Answer 7

UC /CD increasing incidence ?? Cause

Genetic/ autoimmune /gut biome / infection can trigger it

Question 8

Skin manifestation of CD

Answer 8

Pyoderma gangrenosim

Erythema nodosum

Question 9

Fat malabsorption

Answer 9

1 pancreatic def ( lipase def CF) caloric insufficiency/ Steathorrhoea, Diarrhoea/ Fat soluble vit def A,D,E,K

2 Bile acid insuff seen in liver disease

3 impaired absorption of fat eg Coeliac disease Fatty acid crystals seen in the stool

4 transfer of fat to the lymphatic system failed eg lymphoma

Question 10

Coeliac disease

Answer 10

1/100
Screen high risk populations eg blood test
First degree relatives with Coeliac
Type 1 dm
Down’s syndrome
IgA test Tg IgA test neg if IgA def / or <2years of age

Bowel biopsy is the gold standard
Or <2years