Constipation and Malabsorption

Question 1

A two and a half year old boy is brought to see you. His mother is concerned about loose stools over the past 6 months. He passes 3 to 4 stools a day which are sloppy, occasionally watery and contain undigested corn and pea husks. There is no blood or mucus and there has been no associated vomiting. He has otherwise been well, happy and active and appears to be growing well. He has started toilet training.

With these presenting symptoms, what is the appropriate next step in assessing this child?

Question 1Select one:

a.
Blood levels of antigliadin antibodies

b.
Careful history of food and fluid intake

c.
One month trial of a dairy-free diet

d.
Stool analysis for ova, cysts and parasites

Answer 1

Careful history of food and fluid intake (might just need more fibre!)

‘toddler diarrhoea’, growing well so coeliacs _ parasites unlikely.

Question 2

A 2-year-old boy, Daniel is seen because of faecal soiling and the passage of hard, infrequent stools over 3 months. Defaecation is painful at times. Prior to this, and as a neonate, his bowel motions were normal. Daniel is otherwise healthy and developing normally except for slow speech.

What is the most likely diagnosis?

Question 2Select one:

a.
Constipation from developmental delay

b.
Neurointestinal epithelial dysplasia

c.
Short segment Hirschprung’s disease

d.
Constipation associated with anal fissure

Answer 2

Constipation associated with anal fissure

cycle

Question 3

A 12-month old boy is treated for gastroenteritis with oral rehydration and only clear fluids for 5 days. In the subsequent week, as he returns towards his normal diet, he develops irritability, bloating, and foul smelling watery motions. What is the likely diagnosis?

Question 3Select one:

a.
Lactose intolerance

b.
Cows milk enterocolitis

c.
Bacterial superinfection

d.
Cows milk allergy

Answer 3

Lactose intolerance

Acute gastro can cause villi destruction. need early refeed when sick