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Paediatrics > Chronic diarrhoea (and malabsorption) > Flashcards

Chronic diarrhoea (and malabsorption) Flashcards

1
Q

How much fluid enters the duodenum ever day?

A

9 litres

  1. 5 litres to the colon
    - 200 mls lost in the faeces
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2
Q

What are some of the secretory components of the small intestine? (3)

A
  • Water for fluidity/enzyme transport/absorption
  • Ions e.g. duodenal HCO3-
  • Defence mechanism against pathogens/harmful substances/antigens
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3
Q

what is chronic diarrhoea?

A

4 or more stools per day for more than 4 weeks

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4
Q

motility disturbance causes?

A

Toddler Diarrhoea - increased transit in the SI - food not digested

Irritable Bowel Syndrome - abdo pain after eating, urge to go to toilet

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5
Q

Active secretion causes?

A

Acute Infective Diarrhoea
Inflammatory Bowel Disease

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6
Q

Malabsorption of nutrients (osmotic) causes?

A

Food Allergy
Coeliac Disease
Cystic Fibrosis

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7
Q

What is osmotic diarrhoea caused by?

A

Movement of water into the bowel to equilibrate osmotic gradient

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8
Q

Enzymatic defect diarrhoea - example (osmotic)

A

lactose intolerance

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9
Q

Transport defect diarrhoea - example (osmotic)

A

glucose-galactose malabsorption or congenital chloride diarrhoea.

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10
Q

Secretory types of diarrhoea?

A

toxin production
- from Vibrio cholerae and enterotoxigenic Escherichia coli
In cholera, can lose 24L per day!

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11
Q

In secretory diarrhoea, what is inertial fluid secret driven by

A

Cl- secretion via CFTR

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12
Q

Nocturnal defecation suggests?

A

organic pathology

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13
Q

coeliac symptoms often begin with?

A

the introduction of food

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14
Q

CMPI symptoms introduced with?

A

cow’s milk

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15
Q

Sucrase-isomaltase with introduction of?

A

fruits and juices.

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16
Q

features of osmotic diarrhoea

A

low stool volume - responds to fasting

- osmolality high

17
Q

Secretory diarrhoea and electrolytes

A

electrolytes are high , sodium potassium , chloride

18
Q

Fat malabsorption is seen in pancreatic disorders - why? give examples
?

A

Diarrhoea due to lack of lipase and resultant steatorrhoea

- Classically cystic fibrosis

19
Q

Hepatobiliary Disease causing fat malabsorption examples?

A

Chronic liver disease

Cholestasis

20
Q

What is Shwachman-Diamond syndrome

A

Pancreatic insufficiency and bone marrow dysfunction. 98% have neutropenia.

21
Q

Most common cause of malabsorption in children?

A

coeliac disease
(exposed to solids)
- Gluten-sensitive enteropathy

22
Q

Coeliac disease features and symptoms

A 
Abdominal bloatedness
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpatiformis
IDDM and first relatives
23
Q

Screening tests for coeliac disease? (4)

A
  • Anti-tissue transglutaminase (high sensitivity)
  • Anti-endomysial ( high specificity)
  • Check Serum IgA
  • Concurrent IgA deficiency in 2% may result in false negatives
24
Q

Gold standard test for coeliac disease?

A

duodenal biopsy

25
Q

Genetic testing - genes to look for?

A

HLA DQ2, DQ8

26
Q

Features of coeliac histology?

A

Lymphocytic infiltration of surface epithelium, partial /total villous atrophy,
crypt hyperplasia

27
Q

what guidelines can you use?

A

ESPGHAN /BSPGHAN

28
Q

ESPGHAN /BSPGHAN guidelines are? (making a diagnosis without a biopsy) - what 4 features do you need

A
  • Symptomatic children
  • Anti TTG >10 times upper limit of normal
  • Positive anti endomysial antibodies
  • HLA DQ2, DQ8 positive
29
Q

Treatment of Coeliac disease.. what is there a small risk of?

A
  • Gluten-free diet for life
  • Gluten must not be removed prior to diagnosis as serological and histological features will resolve
  • In very young <2yrs, re-challenge and re-biopsy may be warranted (auto immune enteritis)

Increased risk of rare small bowel lymphoma in untreated

Paediatrics (49 decks)

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