Chronic diarrhoea Flashcards
What has the term ‘chronic non-specific diarrhoea’ replaced?
toddler diarrhoea
What is the commonest cause of persistent loose stools in preschool children?
chronic non-specific diarrhoea
What is the consistency of stools like in chronic non-specific diarrhoea?
varying consistency, sometimes well-formed, sometimes explosive and loose; presence of undigested vegetables common
What is the general health like of children affected by chronic non-specific diarrhoea?
well and thriving
What are 3 possible alternative diagnoses to chronic non-specific diarrhoea?
- Coelia disease
- Excessive ingestion of fruit juice, especially apple juice
- Temporary cow’s milk allergy following gastroenteritis
How should temporary cows’ milk allergy following gastroenteritis be managed?
trial of cows’ milk protein free diet
What is likely the underlying cause of chronic non-specific diarrhoea?
dysmotility of the gut (form of irritable bowel syndrome) and fast-transit diarrhoea
What is the prognosis of chronic non-specific diarrhoea?
Almost always improves with age
What diagnosis should you consider in chronic diarrhoea following bowel resection, cholestatic liver disease or exocrine pancreatic dysfunction?
Malabsorption
What are 3 causes of chronic diarrhoea due to malabsorption?
- Cholestatic liver disease
- Exocrine pancreatic dysfunction
- Bowel resection
What is a food allergy?
occurs when a pathological immune response is mounted against a specific food protein - usually IgE mediated, but may be non-IgE mediated
What is a food intolerance?
non-immunological hypersensitivity reaction to a specific food
What are 2 features of a mild acute IgE-mediated allergic reaction?
- Urticaria and itchy skin
- Facial swelling
What are 7 features of an acute Ig-E mediated allergic reaction that put it into the severe category?
- Wheeze
- Stridor
- Abdominal pain
- Vomiting
- Diarrhoea
- Shock
- Collapse
What are 3 features of non-IgE mediated cow’s milk allergy?
- Loose stools
- Faltering growth
- Elimination of cow’s milk results in resolution of symptoms
What will the result of a skin prick test be in Ig-E mediated food allergy?
strongly positive e.g. 8mm weal
What will the result of a non-IgE mediated cow’s milk allergy be in response to skin prick test?
negative - 0mm weal
What is the typical presentation of non-allergic food hypersensitivity (e.g. temporary lactose intolerance)?
Previously well, develop diarrhoea and vomiting; vomiting settles but watery stools continue for several weeks
What investigation may be useful in suspected non-allergic food hypersensitivity (e.g. temporary lactose intolerance) and what would it show?
Stool sample - no pathogens but positive for reducing substances
What are 3 types of distinguishable food allergy/ intolerance?
- IgE mediated food allergy
- Non-IgE mediated allergy
- Non-allergic food hypersensitivity
At what exposure to an allergen will children usually react in food allergy?
First exposure