Diarrhoea Flashcards
when is acute, persistent and chronic diarrhoea?
acute < 1 week
persistent 1-4 weeks
chronic > 4 weeks
what are the causes of diarrhoea?
motility disturbance;
- IBS
- toddlers diarrhoea
inflammation;
- IBD
- acute infection i.e. cholera
malabsorption;
- coeliac
- food allergy
- cystic fibrosis
how would you approach a patient with diarrhoea?
history;
- age at onset
- abrupt or gradual onset
- FHx
- nocturnal defecation
growth and weight
faeces analysis;
- appearance
- stool culture
- trial of by mouth (if still diarrhoea = secretory but if stops = osmotic)
what are the histology features of coeliac disease?
partial or total villous atrophy
lymphocyte infiltrate of surface epithelium
crypt hyperplasia
what is the cause of coeliac disease?
autoimmune
sensitivity to gliadin/gluten
how would you diagnose coeliac disease?
anti-endomysial IgA anti-tissue transglutaminase IgA anti-gliadin duodenal biopsy genetic analysis - HLADQ2, HLADQ8
what is the presentation of coeliac disease?
diarrhoea constipation failure to thrive abdominal bloating fatigue tiredness short stature dermatitis herpetiformis
what are the different types of diarrhoea?
osmotic
secretory
inflammation
motility
describe osmotic diarrhoea?
movement of water into the colon to equilibrate osmotic gradient
feature of malabsorption
accompanied with microscopic and microscopic intestinal injury
remission with removal of causative agent
what information would you ask in the presenting complaint of the history of someone who presented with constipation?
how often how hard is it painful has there been blood has there been a change
what are the symptoms associated with constipation in a child?
poor appetite irritable lack of energy abdominal pain abdominal distention withholding or straining diarrhoea / soiling
what are the causes of constipation in children?
poor diet
- insufficient fluids
- excessive milk
potty training / school toilet (leads to withholding)
physical
- intercurrent illness
- medication
family history
psychological
organic causes i.e. strictures, IBS
describe the vicious cycle that occurs in children with constipation?
large hard stool causes pain or anal fissure
child withholds from going to the toilet
results in constipation as the stool gets larger therefore harder to pass
harder to pass = pain and fissure –> withholding –> constipation…..
what is the management for constipation in children?
1st thing: remove impaction with high dose stimulant laxative i.e. senna, movicol, lactulose
social;
- explain treatment to the parents
- dietary; increase fruit, veg, fibre, decrease milk
psychological;
- make sure going to the toilet is a pleasant experience; position, correct height, not cold
- reward good behaviour
medical;
- soften stool and stimulate defection (laxative)
what are the 3 types of laxatives and give examples?
osmotics i.e. lactulose, movicol
stimulants i.e. senna
