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Pediatrics > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What are the types of diarrhea

A

Osmotic
Secretary
motility
surface area

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2
Q

Differentiate between osmotic and secretary diarrhea breifly

A

Osmotic is nutrient stay in the lumen and water follows

Secretory is enterocyte secretes electrolyte instead of absorbing it and water follows

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3
Q

Name the reasons for osmotic diarrhea

A
  • Nutrients that cannot be absorbed
  • damage to the mucosa
  • malabsorption of salutes
  • motility disorders
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4
Q

Examples of Malabsorption of specific solutes that causes osmotic diarrhea

A

Abnormality at the cellular level

Disaccharide deficiency, glucose-galactose mal-absorption

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5
Q

Examples of Damage to the absorptive area of the mucosa that causes osmotic diarrhea

A

Celiac disease
Crohn’s disease
Acute gastroenteritis
cows milk allergy

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6
Q

Examples of Ingestion of solutes that cannot be absorbed that causes osmotic diarrhea

A

Osmotic laxative
Candies
Fruits

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7
Q

Examples of motility disorders that causes osmotic diarrhea

A

Hyperthyroidism

IBs

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8
Q

Name the causes for secretory diarrhea

A
  • activation of pathway by toxin

- inherent abnormality of enterocyte

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9
Q

How does cholerra toxin cause diarrhea

A

toxin attached to the receptor, then changes the intracellular chemistry ( produce cyclicGMP and this enhances kinases. Kinases enhance the secretion, and inhibit Na, Cl absorption)

= inhibition of electrolytes absorption + ENHANCING RECEPTORS TO SECRETE ABNORMALLY.

“Secretory diarrhea”

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10
Q

Name inherent abnormalities in the enterocytes that causes secretory diarrhea

A

congenital microvillus atrophy)

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11
Q

Diff Between Osmotic diarrhea and secretary diarrhea

In volume of stool

A

Osmotic: <200ml
Secretory: >200ml

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12
Q

Diff Between Osmotic diarrhea and secretary diarrhea

In Response to fasting

A

Osmotic: stops
Secretory: continues

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13
Q

Diff Between Osmotic diarrhea and secretary diarrhea

In Stool sodium

A

Osmotic: <70
Secretory: >70

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14
Q

Diff Between Osmotic diarrhea and secretary diarrhea

In Reducing substances

A

Osmotic: positive
Secretory: negative

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15
Q

Diff Between Osmotic diarrhea and secretary diarrhea

In Stool PH

A

Osmotic: <5
Secretory: >5

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16
Q

Diff Between Osmotic diarrhea and secretary diarrhea

In anion gap

A

Osmotic: >100
Secretory: <100

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17
Q

Name a mixed pathology of osmotic and secretory diarrhea

A

Bacterial gastritis

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18
Q

What is the most common cause of acute diarrhea in all age groups?

A

Gastroentritis

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19
Q

What is the 2nd most common cause of acute diarrhea in all age groups?

A

Infant: systemic infection > ab > overfeeding

Child and adolescent: food poisoning

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20
Q

What is the most common cause of chronic diarrhea in all age groups?

A
  • infant and child: Post-infectious secondary lactase deficiency
  • adolescent: IBS
21
Q

First cause of diarrhea is:

A

Viral > bacteria

22
Q

How does rotavirus cause diarrhea?

A

By damaging the mucosa

23
Q

Name common viruses to cause diarrhea:

A
  • Rotavirus
  • Norwalk virus
  • Norovirus
  • CMV
  • Calicivirus
24
Q

Acute vs chronic diarrhea duration is

A

14d

25
Q

In patient with bloody diarrhea, it can be either viral or bacterial, how to differentiate from the clinical scenario?

A

In bacterial, he’ll have high grade fever, lethargy, extraintestinal mainfestaitons
Wheras viral more beingin and started with vomitting > diarrrhea

26
Q

Name an extraintestinal mainfestation of sheigella?

A

Seizures

27
Q

Name common bacteria to diarrhears

A

Campylobacter jujeni, salmonella, sheigella, ecoli, yersenia, clostredium.

28
Q

If it’s a prolonged diarrhea, the causative organism is most likely:

A

Parsitice

29
Q

What is the pathophysiology of autoimmune enteropathy?

A

Anti-enterocyte antibodies (IgG) damage mucosa

30
Q

What is the pathophysiology of micovillus inclusion

A

Reduction of surface area and massive excretion of electrolyte

31
Q

In electrolyte transport defect, what indicates the severity of diarrhea

A

The strenght of the salute and wither it’s eaten or not (fructose tranport defect, if child is eating fructose or not)

32
Q

In cystic fibrosis, what is the associated diarrhea?

A

Osmotic (due to pancreatic insuffecency > protein and fat malabsorption)

33
Q

What liver disease may cause osmotic diarrhea?

A

Cholestasis: reduced bile salt > insufficicent fat malabsorption

34
Q

How are disorders of motility like (hyperthyroidism) and (psudointestinal obstruction) cause dirrhae

A
  • increased motility: no time to absorp electrolyte

- decreased motility: increased time causing fermentation & changing osmolality

35
Q

Define toddler diarrhea

A

High sugar content diarrhea

36
Q

General history for diarrhea what will you ask?

A
  • stool description
  • course of complain (infancy\affected by fasting)
  • type of diarrhea
  • organic\functional
37
Q

Risk factors in history of dirrhea:

A
  • contact\travel: infectious
  • nutritional\water: toddler\poisoining
  • prev surgery
  • pancreatic disease
  • systemic disease
  • drugs: laxatice, AB
  • family hx of IBD or Celiac
38
Q

What will you do in the physical examination of dirrhea?

A
  • hydration status
  • growth parameters\nourishment
  • intestinal\extraintestinal
    Complete systemic examination
39
Q

What will you do in stool examination:

A 
1- analysis 
2- culture 
3- virology 
4- ova\parasite
5- PH 
6- osmotic\secretory 
7- occult blood 
8- calprotectin
40
Q

What investigations would be suitable in pancreatic insufficiency leading to fat and protein malabsorption?

A
  • fecal elastase
  • A1AT
  • 72 hours stool collection (fat\reducing substance)
41
Q

What investigations would be suitable in celiac?

A
  • trans-tissue glutaminase
  • endomysel antibodies (IgA, IgG)
  • biopsy: “positive serology”
42
Q

What other investigations will you order for diarrhea

A

CBC, LFT, RFT, Immunoglobulin, food allergies, abdominal US

43
Q

What is step 2 in diarrhea disease?

A
  • Endoscopy
  • barium meal\enema
  • CT\mri enterography
  • electron microscopy
44
Q

What is step 3 in diarrhea investigations

A

Immunohistochemistry - antienterocyte AB

45
Q

How to manage diarrhea?

A

Rehydration and nutirition rehabilitation

46
Q

What is the role of anti-diarrhea medications

A

No role

47
Q

Specific treatment for diarrrhea

For bacterial, celiac, allergic, CF, IBD, Cl & Na losing,

A
  • antibiotic: bacterial
  • avoid gluten: celiac
  • avoid trigger: allergies
  • pancreatic enzyme replacement: CF
  • steroid\azathioprine: IBD
  • salt replacement: Na losing
48
Q

How to treat conginital intractable diarrhea

A

Insure optimum nutrition TPN + small bowel transplantation

Pediatrics (41 decks)

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