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Paediatrics > Diarrhoea > Flashcards

Diarrhoea Flashcards

1
Q

What is the differential for acute diarrhoea?

A

Infective gastroenteritis

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2
Q

What are the possible causative viruses of IE?

A
  1. Rotavirus
  2. Adenovirus
  3. Norovirus
  4. Calcivirus
  5. Coronavirus
  6. Astrovirus
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3
Q

What are the possible causative bacteria of IE?

A
  1. Campylobacter jejuni
  2. Shigella
  3. Cholera
  4. E.coli
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4
Q

What is the most common responsible agent for IE in developed countries?

A

60% of cases in <2y/o = rotavirus

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5
Q

What children are at increased risk of dehydration?

A
  1. Infants <6/12 or of LBW
  2. Passed >/= 6 diarrhoeal stools in 24hrs
  3. Vomited >/= 3x in 24hrs
  4. Unable to tolerate extra fluids
  5. Those that are malnourished
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6
Q

When is a stool culture required in IE?

A
  1. If the child look septic
  2. Blood in stool
  3. The child is immunocompromised
    Consider if:
    1) The child has been abroad recently
    2) Diarrhoea has not improved by day 7
    3) Doubt about the Dx
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7
Q

When should a blood culture be taken in IE?

A

Only if Abx’s are started (Abx’s being v. rarely indicated)

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8
Q

When should blood work be taken in IE?

A

U&Es and glucose should be taken if IV fluids are necessary

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9
Q

What are the red flags for a child at risk of developing shock?

A
  1. Appears unwell/deteriorating
  2. Altered responsiveness - e.g. irritable/lethargic
  3. Sunken eyes
  4. Tachycardia
  5. Tachypnoea
  6. Reduced skin turgor
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10
Q

What should be included in the assessment of dehydration of a child?

A
  1. Conscious level
  2. Fontanelles - ?sunken
  3. Mucous membranes - ?dry
  4. Eyes - ?sunken
  5. Cap refill - ?prolonged
  6. Skin - ?pale/mottled
  7. Nappies - ?reduced urine output
  8. Skin turgor - ?reduced
  9. Extremities - ?cool
  10. Vitals - ?tachycardia, ?tachypnoea, ?hypotensive
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11
Q

If a child were dehydrated without shock, what % of dehydration would they have as a % of their normal body weight?

A

5%

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12
Q

If a child were shocked/shock was imminent, what % of dehydration would they have as a % of their normal body weight?

A

10-15%

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13
Q

What is the management if the child is not clinically dehydrated?

A
  1. Continue usual feeds, including breast milk. Solid food okay
  2. Encourage other fluids, but not fruit juice/carbonated
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14
Q

What is the management if the child is clinically dehydrated?

A
  1. Continue breast feeds, NOT solid food
  2. Give 50mg/kg ORS for fluid replacement + maintenance fluid over 4 hour period. ORS little and freq. Give via NG if not tolerated orally
  3. Do not give additional oral fluids
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15
Q

What is the management if the child is shocked?

A

Replacement and maintenance fluid via IV

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16
Q

What is the replacement fluid requirement for a child that is clinically dehydrated?

A

50ml/kg

17
Q

What is the replacement fluid requirement for a child that is shocked?

A

100ml/kg

18
Q

What are the maintenance fluid requirements for a child

A

100ml/kg for the first 10kg + 50ml/kg for the next 10kg + 25ml/kg after that

19
Q

What should parents be advised re: how long to expect the D&V?

A

Diarrhoea usually lasts 5-7 days, most stop within 2 weeks

Vomiting usually lasts 1-2 days, most stop within 3 days

20
Q

How long before children can return to nursery/school?

A

48 hours after the last diarrhoea episode

21
Q

How long before children can go swimming?

A

2 weeks after the last diarrhoea episode

22
Q

What are the differentials for chronic diarrhoea in children?

A
  1. Toddler diarrhoea
  2. Cows milk protein intolerance
  3. Coeliac disease
  4. Inflammatory bowel disease
23
Q

What is the commenest cause of persistent loose stools in pre-school children?

A

Toddler diarrhoea

24
Q

How does toddler diarrhoea effect growth?

A

It doesn’t - children continue to thrive

25
Q

By what age does toddler diarrhoea tend to resolve?

A

5y/o

26
Q

What is toddler diarrhoea likely caused by?

A

Maturation delay in intestinal motility

27
Q

What dietary advice should be given to parents with children with toddlers diarrhoea?

A

Ensure they have adequate fat intake (slowing gut transit) + avoid excessive quantities of fruit juice/sorbitol

28
Q

How would an IgE-mediated cow’s milk reaction present?

A
  1. Immediate reaction after child’s first formula feed

2. Allergic Sx - mild = urticaria, pruritis, facial swelling; severe = wheeze, stridor etc.

29
Q

How would a non-IgE-mediated cow’s milk reaction present?

A
  1. D&V - (+ ?blood in stools due to proctitis)
  2. Abdominal pain
  3. Failure to thrive
30
Q

What is the gold-standard investigations for both IgE and non-IgE mediated food allergy?

A

Exclusion of food under dietician supervision, followed by double-blind controlled food challenge (in hospital with full resuscitation facilities)

31
Q

How should IgE-mediated food allergies be managed?

A
  1. Written management plan (in the event of an/another attack)
  2. Oral antihistamines
  3. Epi-Pen - for life-threatening reactions
32
Q

What are the Sx of coeliac disease?

A
  1. Failure to thrive
  2. Abdominal distension
  3. Buttock wasting
  4. Abnormal stools
  5. General irritability
  6. Anaemia
33
Q

How should coeliac disease be investigated?

A

IgA tissue transglutaminase + endomysial Ab
endoscopic small intestine biopsy is required for confirmation of Dx, along with Sx resolution + catch-up growth following gluten withdrawal

34
Q

Where in the bowel does Crohn’s most commonly effect?

A

Terminal ileum + proximal colon

35
Q

What is the histological hallmark of Crohn’s?

A

Non-caseating epithelioid cell granulomata

36
Q

What are the extra-intestinal manifestations of Crohn’s?

A
  1. Oral lesions
  2. Perianal skin tags
  3. Uveitis
  4. Arthralgia
  5. Erythema nodosum
37
Q

What endoscopic features are seen in UC?

A
  1. Cryptitis
  2. Architectural distortion
  3. Abscesses
  4. Crypt loss

Paediatrics (27 decks)

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