Diarrhea Flashcards
What are the time frames for acute vs chronic diarrhoea? [3]
<1wk acute
2-4wks persistant
>4wks chronic
What are the 4 major types of chronic diarrhoea?
Secretory e.g. Acute Infective Diarrhoea or IBD
Osmotic related to malabsorption
*Motility - Toddler’s Diarrhea
* Inflammatory
What could cause osmotic diarrhoea?
Lactose intolerance Coeliac Fat Malabsorption (CF, chronic liver disease or cholestasis)
How does secretory diarrhoea come about? [3]
Give 2 eg of causes
Toxins from infective agents –> Cl- secretion via CFTR –> Water follows into bowel
Causative agents: vibrio cholera, E. coli
How does Osmotic Diarrhoea come about [3]
Malabsorption –> High solute level in the bowel –> H2O moving into the bowel
What do you want to know in a diarrhoea kids history and examination [5]
Age
Onset (sudden or gradual)
FH
Nocturnal Defecation (more likely organic cause)
Growth & weight gain
What tests can you do to narrow down diarrhoea? [3]
Stool analysis:
- Appearance
- Culture
- Biochemistry
How would you differentiate osmotic from secretory diarrhoea? [3]
1) Fasting would stop osmotic
2) Stool analysis: Osmotic gap high in osmotic (lower Na/K)
- Volume smaller in osmotic
What other symptoms/signs in osmotic diarrhoea would point towards coeliac disease? [5]
Abdo bloating, constipation FTT, short stature Tiredness Dermatitis Herpetiformis FH
What tests would you run for Coeliac? [4]
What Abs are tested for in Coeliac? [4]
- FBC and haematinics - reduced ferritin, folate
- Ab
- Genetic tests (HLA DQ2 & 8)
- Duodenal Biopsy
Anti-Tissue Transglutaminase (TTG)
Anti-Gliadin
Anti-Endomysial
Serum IgA as 2% have IgA deficiency which would make specific Abs show up as false positive
How can you diagnose coeliac without a biopsy? [4]
Complications
Only if:
- Symptomatic
- Anti-TTG >10x normal
- +ve Anti-Endomysial Abs
- +ve HLA-DQ2 or 8
Complications: small bowel lymphoma (rare)
How do you treat Coeliac? [2]
Gluten free diet for life
If onset <2yrs you may want to re-challenge and re-biopsy later
Acute diarrhea
What advice would you give re: public health?
Management [3]
o Advise not to return to school or nursery until 48h post last vomiting or diarrhoea episode (diarrhoea tends to last 5-7d and stops within 2w, vomiting tends to last 1-2d and stops within 3 days)
Mx:
Oral rehydration solution fluid challenge: 5mL every 5 mins or 50mL/kg over 4h (can use apple juice if no fluid), continue as maintenance and supplement w/ breast milk or usual fluids
Paracetamol NOT ibuprofen
IV fluids
Mx of acute diarrhea - describe the 3 principles of fluid balance
- Resuscitation: 0.9% saline 20mL/kg bolus over <10 mins
- Rehydration: replace losses
- Maintenance: 1st 10kg 4mL/kg , 2nd 10kg 2mL/kg, then 1mL/kg per hour 0.9% normal saline + 5% dextrose or glucose
Toddler’s diarrhea definition
Ax, Ep, Presentation, Rx
Toddler’s diarrhea is also known as chronic nonspecific diarrhea of childhood. Ax: infection
Ep: affects children from 6 months to 5 years of age.
Children with toddler’s diarrhea will have 3-10 loose stools per day. These stools typically occur during the day when the child is awake and sometimes immediately after eating.
Mx: self limiting, supportive only
