Diarrhoea Flashcards
What is the differential for acute diarrhoea?
Infective gastroenteritis
What are the possible causative viruses of IE?
- Rotavirus
- Adenovirus
- Norovirus
- Calcivirus
- Coronavirus
- Astrovirus
What are the possible causative bacteria of IE?
- Campylobacter jejuni
- Shigella
- Cholera
- E.coli
What is the most common responsible agent for IE in developed countries?
60% of cases in <2y/o = rotavirus
What children are at increased risk of dehydration?
- Infants <6/12 or of LBW
- Passed >/= 6 diarrhoeal stools in 24hrs
- Vomited >/= 3x in 24hrs
- Unable to tolerate extra fluids
- Those that are malnourished
When is a stool culture required in IE?
- If the child look septic
- Blood in stool
- 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
When should a blood culture be taken in IE?
Only if Abx’s are started (Abx’s being v. rarely indicated)
When should blood work be taken in IE?
U&Es and glucose should be taken if IV fluids are necessary
What are the red flags for a child at risk of developing shock?
- Appears unwell/deteriorating
- Altered responsiveness - e.g. irritable/lethargic
- Sunken eyes
- Tachycardia
- Tachypnoea
- Reduced skin turgor
What should be included in the assessment of dehydration of a child?
- Conscious level
- Fontanelles - ?sunken
- Mucous membranes - ?dry
- Eyes - ?sunken
- Cap refill - ?prolonged
- Skin - ?pale/mottled
- Nappies - ?reduced urine output
- Skin turgor - ?reduced
- Extremities - ?cool
- Vitals - ?tachycardia, ?tachypnoea, ?hypotensive
If a child were dehydrated without shock, what % of dehydration would they have as a % of their normal body weight?
5%
If a child were shocked/shock was imminent, what % of dehydration would they have as a % of their normal body weight?
10-15%
What is the management if the child is not clinically dehydrated?
- Continue usual feeds, including breast milk. Solid food okay
- Encourage other fluids, but not fruit juice/carbonated
What is the management if the child is clinically dehydrated?
- Continue breast feeds, NOT solid food
- Give 50mg/kg ORS for fluid replacement + maintenance fluid over 4 hour period. ORS little and freq. Give via NG if not tolerated orally
- Do not give additional oral fluids
What is the management if the child is shocked?
Replacement and maintenance fluid via IV
What is the replacement fluid requirement for a child that is clinically dehydrated?
50ml/kg
What is the replacement fluid requirement for a child that is shocked?
100ml/kg
What are the maintenance fluid requirements for a child
100ml/kg for the first 10kg + 50ml/kg for the next 10kg + 25ml/kg after that
What should parents be advised re: how long to expect the D&V?
Diarrhoea usually lasts 5-7 days, most stop within 2 weeks
Vomiting usually lasts 1-2 days, most stop within 3 days
How long before children can return to nursery/school?
48 hours after the last diarrhoea episode
How long before children can go swimming?
2 weeks after the last diarrhoea episode
What are the differentials for chronic diarrhoea in children?
- Toddler diarrhoea
- Cows milk protein intolerance
- Coeliac disease
- Inflammatory bowel disease
What is the commenest cause of persistent loose stools in pre-school children?
Toddler diarrhoea
How does toddler diarrhoea effect growth?
It doesn’t - children continue to thrive
By what age does toddler diarrhoea tend to resolve?
5y/o
What is toddler diarrhoea likely caused by?
Maturation delay in intestinal motility
What dietary advice should be given to parents with children with toddlers diarrhoea?
Ensure they have adequate fat intake (slowing gut transit) + avoid excessive quantities of fruit juice/sorbitol
How would an IgE-mediated cow’s milk reaction present?
- Immediate reaction after child’s first formula feed
2. Allergic Sx - mild = urticaria, pruritis, facial swelling; severe = wheeze, stridor etc.
How would a non-IgE-mediated cow’s milk reaction present?
- D&V - (+ ?blood in stools due to proctitis)
- Abdominal pain
- Failure to thrive
What is the gold-standard investigations for both IgE and non-IgE mediated food allergy?
Exclusion of food under dietician supervision, followed by double-blind controlled food challenge (in hospital with full resuscitation facilities)
How should IgE-mediated food allergies be managed?
- Written management plan (in the event of an/another attack)
- Oral antihistamines
- Epi-Pen - for life-threatening reactions
What are the Sx of coeliac disease?
- Failure to thrive
- Abdominal distension
- Buttock wasting
- Abnormal stools
- General irritability
- Anaemia
How should coeliac disease be investigated?
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
Where in the bowel does Crohn’s most commonly effect?
Terminal ileum + proximal colon
What is the histological hallmark of Crohn’s?
Non-caseating epithelioid cell granulomata
What are the extra-intestinal manifestations of Crohn’s?
- Oral lesions
- Perianal skin tags
- Uveitis
- Arthralgia
- Erythema nodosum
What endoscopic features are seen in UC?
- Cryptitis
- Architectural distortion
- Abscesses
- Crypt loss
