Diarrhiea

Question 1

What are the time frames for acute vs chronic diarrhoea?

Answer 1

<1wk acute
2-4wks persistant
>4wks chronic

Question 2

What’s the most common cause of diarrhoea in kids?

Answer 2

Dysmotility e.g. Toddler’s Diarrhoea or IBS

Question 3

What are the other 2 major types of chronic diarrhoea?

Answer 3

Secretory e.g. Acute Infective Diarrhoea or IBD

Osmotic related to malabsorption

Question 4

What could cause osmotic diarrhoea?

Answer 4

Lactose intolerance
Coeliac
Fat Malabsorption (CF, chronic liver disease or cholestasis)

Question 5

How does secretory diarrhoea come about?

Answer 5

Toxins from infective agents –> Cl- secretion out CFTR –> Water follows into bowel

Question 6

What organisms can cause secretory diarrhoea?

Answer 6

Mostly:

• Vibrio Cholerae
• Enterotoxigenic E.Coli

Question 7

How does Osmotic Diarrhoea come about

Answer 7

Malabsorption –> High solute level in the bowel –> H2O moving into the bowel

Question 8

What do you want to know in a diarrhoea kids H & E?

Answer 8

Age
Onset (sudden or gradual)
FH
Nocturnal Defecation (more likely organic cause)

Growth & weight gain

Question 9

What tests can you do to narrow down diarrhoea?

Answer 9

Stool analysis:

• Appearance
• Culture
• Biochemistry

Question 10

How would you difffernetiate osmotic from secretory diarrhoea?

Answer 10

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

Question 11

What other symptoms/signs in osmotic diarrhoea would point towards coeliac disease?

Answer 11

Abdo bloating
FTT 
Short stature
Constipation
Tiredness
Dermatitis Herpetiformis
FH

Question 12

What tests would you run for Coeliac?

Answer 12

• Abs
• Genetic tests (HLA DQ2 & 8)
• Duodenal Biopsy

Question 13

What Abs are tested for in Coeliac?

Answer 13

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)

Question 14

How can you diagnose coeliac without a biopsy?

Answer 14

Only if:

• Symptomatic
• Anti-TTG >10x normal
• +ve Anti-Endomysial Abs
• +ve HLA-DQ2 or 8

Question 15

How do you treat Coeliac?

Answer 15

Gluten free diet for life

If they onset <2yrs you may want to re-challenge and re-biopsy later

Question 16

4 types of diarrhoea?

Answer 16

• Secretory
• Osmotic
• motility
• inflammatory

Question 17

What would cause inflammatory diarrhoea ?

Answer 17

Rotavirus 
Salmonella 
Shingella
Camplylobacter 
Crohns
UC

Question 18

Possible complications of Coeliac?

Answer 18

• Small bowel lymphoma
• Osteoporosis
• GF

Question 19

What would you examine for?

Answer 19

• General: growth, height and plot
• Abdomen: distension, masses, tenderness, bowel sounds
• Peripheral: lymphadenopathy, clubbing, pallor, jaundice, dermatitis herpatiformis, erythema nodosum
• Anal: fissures, skin tags, soiling

DO NOT DO AN PR

Question 20

What is chronic non- specific diarrhoea also known as?

Answer 20

Toddler’s diarrhoea
Painless passage of 3 large stools per days for 4 weeks
Classically will have undigested vegetables in stool

Question 21

Common causes of diarrhoea in a newborn? (0-30 days)

Answer 21

• Congenital metabolic problem
• Congenital enteropathy
• Food allergy

Question 22

Common causes of diarrhoea in a child ( 1 month -24 month)

Answer 22

• TODDLER’S DIARRHOEA!!!
• Coeliac
• CF
• Food allergy
• Lactose intolerance

Question 23

Common causes of diarrhoea in a child ( 2-18 years)

Answer 23

• IBS
• Chronic infection
• Diarrhoea following gastroenteritis
• C.diff associated diarrhoea
• Lactose intolerance

Question 24

What would you see on duodenal biopsy in coeliac?

Answer 24

• Crypt hypertrophy
• Scalloping of the endothelial mucosa
• Flattening of the villi
• Lymphocytes in the lamina propia