Diarrhiea Flashcards
What are the time frames for acute vs chronic diarrhoea?
<1wk acute
2-4wks persistant
>4wks chronic
What’s the most common cause of diarrhoea in kids?
Dysmotility e.g. Toddler’s Diarrhoea or IBS
What are the other 2 major types of chronic diarrhoea?
Secretory e.g. Acute Infective Diarrhoea or IBD
Osmotic related to malabsorption
What could cause osmotic diarrhoea?
Lactose intolerance Coeliac Fat Malabsorption (CF, chronic liver disease or cholestasis)
How does secretory diarrhoea come about?
Toxins from infective agents –> Cl- secretion out CFTR –> Water follows into bowel
What organisms can cause secretory diarrhoea?
Mostly:
- Vibrio Cholerae
- Enterotoxigenic E.Coli
How does Osmotic Diarrhoea come about
Malabsorption –> High solute level in the bowel –> H2O moving into the bowel
What do you want to know in a diarrhoea kids H & E?
Age
Onset (sudden or gradual)
FH
Nocturnal Defecation (more likely organic cause)
Growth & weight gain
What tests can you do to narrow down diarrhoea?
Stool analysis:
- Appearance
- Culture
- Biochemistry
How would you difffernetiate osmotic from secretory diarrhoea?
1) Fasting would stop osmotic
2) Stool analysis
- Osmotic gap high in osmotic (lower Na/K)
- Na/K/Cl low in osmotic (dilution)
- Volume smaller in osmotic
- opps of the aboves are true in secretory
What other symptoms/signs in osmotic diarrhoea would point towards coeliac disease?
Abdo bloating FTT Short stature Constipation Tiredness Dermatitis Herpetiformis FH
What tests would you run for Coeliac?
- Abs
- Genetic tests (HLA DQ2 & 8)
- Duodenal Biopsy
What Abs are tested for in Coeliac?
Anti-Tissue Transglutaminase (TTG)
Anti-Gliadin
Anti-Endomysial
also Serum IgA (As 2% of people have IgA deficiency which would make the specific Abs show up as a false -ve)
How can you diagnose coeliac without a biopsy?
Only if:
- Symptomatic
- Anti-TTG >10x normal
- +ve Anti-Endomysial Abs
- +ve HLA-DQ2 or 8
How do you treat Coeliac?
Gluten free diet for life
If they onset <2yrs you may want to re-challenge and re-biopsy later