Diarrhea

Question 1

Normal Number BMs

Answer 1

0-3mo BF: 1-5 per day
formula: 1-4 per day
6mo - 3yr: 1-3 per day
3+: 1-2 per day

<1 may have 5/wk
3+ may have 3/wk

Question 2

Diarrhea + Chronic Diarrhea Definition

Answer 2

3+ loose /watery per day, OR any deviation from normal

chronic = 14+d

Question 3

gastroenteritis ix + management

Answer 3

Ix: non in young kids usually. Possible:

• C diff if antibiotics or hospitalized
• fecal leuks / blood
• stool pH (<6) - ?virus
• stool culture, O + P

tx: ORS, feed small amounts
- odansetron if severe vomiting (15-30min prior to ORS)
- if severe, IV fluid rescus
- avoid sugary foods

Question 4

Chronic Diarrhea, without FTT - ddx

Answer 4

infection - parasite, bacteria, post enteritis syndrome

carbohydrate malabsorption - toddler’s diarrhea, lactose intol

IBS

meds

Question 5

Chronic Diarrhea, with FTT - ddx

Answer 5

• intractable diarrhea of infancy
• celiac
• allergy / CMPA
• eosinophilic gastroenteritist
• autommune enteropathy
• IBD
• HIV
• maldigestion: CF, pancreative insuff
• protein losing enteropathy
• hirschprungs
• neuroendocrine tumor
• congenital secretory or osmotic

Question 6

Diarrhea red flags

Answer 6

fever
anorexia
N/V
blood
nocturnal
abdo distention
poor weight gain or growth

Question 7

Stool osmotic gap

Answer 7

= 290 - 2 (na + K)

osmotic diarrhea is >100

Question 8

Chronic Diarrhea Investigations

Answer 8

if no red flags, no testing

Hx + Px: growth, clubbing, nasal polys, rash, perianal

stool: C + S, O + P, c diff toxin, microscopy - WBH + pH, 3 day fecal fat (malbsorption)

+/- CBC, Hg and albumin TSH, VMA + HVA, HIV

IgA + anti-TTG

sweat chloride, CXR,

no routine imaging, can consider AXR, upper GI, endoscopy

Question 9

toddler’s diarrhea characteristics + tx

Answer 9

ages 1-4, otherwise healthy
6+ BM/day, food particles
excessive juice
tx: reassure, decrease fructose/sucrose

Question 10

celiac disease presentation

Answer 10

6-24mo, chronic diarrhea, distension, anorexia, FTT

others: vomiting, constipation, pain, ascites, metabolic derangement, Fe def anemia, dermititis herpetiformis

Question 11

Associated with celiac disease

Answer 11

TIDM
autoimmune thyroiditis
downs
turners
williams syndrome
selective IgA deficiency
1st degree relatives with celiac

Question 12

Testing for Celiac Disease

Answer 12

anti EMA, anti TTG
IgA level
intestinal biopsy = gold standard

Question 13

Top 3 non-infectious causes of chronic diarrhea in infants

Answer 13

formula intolerance (CMPA)
cystic fibrosis
immunodeficiency states

Question 14

Top 3 non-infectious causes of chronic diarrhea in toddlers

Answer 14

post-infectious enteritis
toddler’s diarrhea
celiac disease

Question 15

Top 3 non-infectious causes of chronic diarrhea in older kids

Answer 15

celiac disease
lactose intolerance
IBD