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Paediatrics > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What is diarrhea?

A

It is the increased frequency and volume of stools caused by decreased water and electrolyte absorption in the intestine

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2
Q

How much water do infants usually lose in their stool?

A

5-10g/kg per day

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3
Q

How much water does the small intestine usually reabsorb?

A

80-90%

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4
Q

How long does acute diarrhea last for?

A

14 days

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5
Q

How long does chronic diarrhea last for?

A

> 14 days

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6
Q

What are the two types of acute diarrhea?

A
  1. Osmotic diarrhea

2. Secretory diarrhea

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7
Q

What is osmotic diarrhea?

A

This is due to the increased intraluminal osmolality due to sugar malabsorption or ingestion of sorbitol which decreases the absorption of water

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8
Q

What is secretory diarrhea?

A

It is diarrhea that leads to increased secretion of water and electrolytes induced by a variety of stimuli caused by bacterial toxins etc.

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9
Q

How are carbohydrate malabsorption stools?

A

They are water stools that are forceful and have tons of gas
The younger child cries a lot and is irritable prior to stooling
The older child has abdominal pain

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10
Q

How do we diagnose carbohydrate malabsorption?

A

The stool is usually acidic and has a pH<4 and an abnormal hydrogen breath test

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11
Q

How can we resolve carbohydrate malabsorption diarrhea?

A

A lot of the time removing lactose from the diet helps

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12
Q

What is intraluminal digestion largely dependent on?

A

Rly dependent on the delivery of adequate exocrine pancreatic enzymes and bile salts

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13
Q

What typically causes fat malabsorption?

A
  1. Cystic fibrosis in white kids
  2. Colic disease
  3. Giardia lamblia and abdominal TB in disadvantaged communities
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14
Q

What investigations do we usually do for persistent and chronic diarrhea?

A
  1. Stool cultures
  2. Microscopy
  3. Viral studies
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15
Q

How do we determine whether there is secretory or osmotic diarrhea?

A

The facael osmolar gap can help
280-(2x(NA+K))
If it less than 50 it is secretory diarrhea
If it 100-125 it is osmotic diarrhea

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16
Q

What other special investigations can we use to determine the type of acute diarrhea?

A
  1. Hydrogen breath test
  2. Pancreatic elastase-!
  3. Stool alpha 1 anti-trypsin
  4. Determination of stool fat
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17
Q

In poor communities hope many diarrheal can we expect in children?

A

5 times a year

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18
Q

What are the most common causes of death in acute viral diarrhea?

A
  1. Dehydration
  2. Shock
  3. Electrolyte abnormalities (hypokalaemia and hypernatraemia)
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19
Q

What are the common comorbidities that lead to death in diarrhea?

A
  1. Immunocompromise
  2. Malnutrition
  3. Pneumonia
  4. Bacteriemia
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20
Q

What are the common organism groups that cause acute diarhea?

A
  1. Viruses
    - rotavirus, norvirus
  2. Bacteria
    - E.coli, Shigella, Salmonella, Campylobacter
  3. Parasites
    - cryptosporidium, giardia lamblia
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21
Q

What are the signs of moderate dehydration in children?

A
  1. Irritability, restless
  2. More thirsty, drinks eagerly
  3. Sunken eyes
  4. Skin pinch goes back slowly
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22
Q

What are the signs of severe dehydration?

A
  1. Sunken eyes
  2. Lethargic or unconscious
  3. Not able to drink and eat properly
  4. Skin turbo very slow
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23
Q

What are the signs of hypovolaemic shock?

A
  1. Hypotension
  2. Tachycardia
  3. Cold extremities
  4. Low and threads pulse
  5. Lerthargic or unconscious
  6. Delayed capillary
24
Q

What is dysentery?

A

The presence of blood and mucus in the stool

25
Q

What are the causes of dysentery?

A
  1. Infective-salmonella, shigella, compylobacter
  2. Non-infective
    - allergic proctolitis
26
Q

What should we think of if mucus and blood passes without stool?

A

Intussusception

27
Q

What is the differential diagnosis for dysentery?

A
  1. Meckels diverticulum
  2. Inflammatory bowel disease
  3. Polyps
28
Q

What should we think of if there’s blood on the stool?

A

Ano-rectal pathology like fissure in ano

29
Q

What are the complications of acute diarrhea?

A
  1. Hypoglycaemia
  2. CNS-convulsions
  3. Dehydration
  4. Electrolyte abnormalities
  5. Renal failure
30
Q

What are the electrolyte abnormalities we can expect?

A
  1. Hyponatraemia
  2. Hypokalaemia
  3. Hypernatramia
  4. Hypocalcaemia
  5. Hypomagnesaemia
31
Q

How does hypokalaemia present?

A
  • hypotonia
  • paralytic ileus
  • bradycardia
  • respiratory failure
32
Q

What complication does hyperkalemia cause?

A

Cardiac arrhythmia and death

33
Q

How can we supplement the potassium?

A

We supplement it intravenously or orally

34
Q

What are the complications of hypernatraemia and hyponatraemia?

A
  1. CNS-irritability, and seizures, Cerebral vein thrombosis, Cerebral oedema
35
Q

What type of diarrhea usually causes hyponatraemia?

A

Secretatory (shigella, cholera)

36
Q

What do we do to manage metabolic acidosis?

A
  1. Correct the shock and dehydration with fluid replacement

2. If the the metabolic acidosis is very severe then we use bicarbonate

37
Q

What type of renal failure is usually a complication of diarrhea?

A

Pre-renal failure

38
Q

What is the management for hypovolaemic shock in these children?

A
  1. Start with IV access then Ringers Lactate or normal saline
  2. Diff cannot get access, use intra-osseaous line
39
Q

What is the management for children that are moderately dehydrated and above 3 months?

A
  1. Start oral rehydration over 4-6 hours

- if they continue to vomit or refuse oral rehydration then use nasogastric tube

40
Q

In which patients do we not use oral rehydration in?

A
  1. Cardiac or respiratory disease

2. Severely malnourished children

41
Q

How much rehydration do we give at first?

A

20ml/kg/hour and re-evaluate after 2 hours

-if the hydration and weight improves then we can reduce it 10ml/kg/hour and start feeds

42
Q

Why must we still continue breastfeeding even in a shocked or severely dehydrated child while re-hydrating?

A

This causes an increase the nutrients that the baby gets

43
Q

Which children typically receive antibiotics?

A

Children with pneumonia, bacteriremia, but specifically dysentery and cholera

44
Q

What other treatment modalities do we have that we can give to the infants?

A
  1. Probiotics
  2. Anti-diarrheal drugs-but more in chronic diarrhea
  3. Vitamin A
  4. Zinc
45
Q

When must infants who had an acute diarrheal attack return for their check-up?

A

2 days later for a weight and wellbeing check

46
Q

What vaccine can we give to children that can dramatically reduces the incidence of acute diarrhea?

A
  1. Rotavirus vaccine given in the first 6 months
47
Q

What is the organism that causes cholera?

A

Vibrio cholera

48
Q

How is cholera passed?

A

Via the faceal oral route

49
Q

What are he clinical features of cholera?

A

Watery Diarrhea and vomiting with no nausea

  • the stools are colourless with mucus(rice water)
  • dehydration
  • shock
  • Electrolyte abnormalities ensue
50
Q

What is the incubation period for cholera?

A

1-5 days

51
Q

What is the management of cholera?

A
  1. Fluid replacement and rehydration
  2. Antibiotic use in only severe forms of dehydration
    - we use ciprofloxacin children under 8 years and tetracycline over 8 years
52
Q

Which organism causes the most common cause of dysentery in South Africa?

A
  1. Shigella flexneri
53
Q

How does dysentery present in children?

A

After an incubation period of one to four days the child presents with fever, abdominal pain, watery stools which can include blood and mucus

54
Q

What antibiotics do we treat shigella with?

A

Ciprofloxacin and ceftriaxone and Nalidixic acid

55
Q

What are the causes of chronic diarrhea?

A
  1. Congenital diarrhea
  2. Pancreatic insufficiency
  3. Infection
  4. Celiac disease
  5. HIV
  6. Short bowel syndrome
56
Q

What is persistent diarrhea?

A

Acute episodes of Diarrhea that last more than 14 days

57
Q

Which patients are at a higher risk of developing persistent diarrhea?

A
  1. Malnourished
  2. Early breast feeding weaning
  3. Immune-compromised
  4. Those with E.coli, shigella, and salmonella

Paediatrics (40 decks)

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