Diarrhoea

Question 1

Define

Answer 1

Diarrhoea means loose or watery stools (faeces), usually at least three times in 24 hours. 

Question 2

Outline causes of acute diarrhoea

Answer 2

Infection
* Bacterial
* Viral gastroenteritis
* Protozoal

Question 3

Causes of chronic diarrhoea

Answer 3

Infection
* Bacterial (salmonella, campylobacter)
* Protozoal (giardia)
* Post-gastroenteritis diarrhoea

Malabsorption
* Lactose intolerance
* Cow’s milk protein intolerance
* CF
* Coeliac Disease
* Crohn’s disease
* UC

Miscellaneous
* Toddler’s diarrhoea/ IBS
* Drugs (e.g., laxatives, AB, chemo)
* Immunodeficiency

Dehydration in children with sudden-onset (acute) diarrhoea is more likely to occur in:

• Babies under the age of 1 year (and particularly those under 6 months old). This is because babies don’t need to lose much fluid to lose a significant proportion of their total body fluid.
• Babies under the age of 1 year who were a low birth weight and who have not caught up with their weight.
• A breast-fed baby who has stopped breastfeeding during their illness.
• Any baby or child who does not drink much when they have infection of the gut (gastroenteritis).
• Any baby or child with severe diarrhoea and being sick (vomiting). (In particular, if they have passed six or more diarrhoeal stools and/or vomited three or more times in the previous 24 hours.)

Question 4

Investigations

Answer 4

Stool culture

Bloods

Imaging - AXR, USS

Question 5

Defien Toddler’s diarhoea

Answer 5

Toddler diarrhoea = chronic and non-specific diarrhoea

Commonest cause of loose stools in preschool kids

May be an imbalance of fluid, fibre and undigested sugars

Occasionally caused by temporary cow’s milk allergy after gastroenteritis

Underlying maturational delay in intestinal mobility -> increased intestinal hurry (not malabsorption)

Question 6

Presentation of toddler’s diarhoea

Answer 6

Varying consistency stools (well-formed to explosive and loose ± presence of undigested vegetables in stool)

Child is well and thriving (no precipitating dietary factors and normal examination)

Question 7

Management of toddler’s diarhoea

Answer 7

Increased fibre and fat in diet (whole milk, yoghurts, cheeses) -> relieve symptoms

Avoid fruit juice and squash

Question 8

Complications and prognosis of toddler’s diarhoea

Answer 8

Complications
* Constipation
* Dehydration

Prognosis
* Not a serious problem
* Child is usually well and growth is good
* Should grow out of this by 4-5 years