Diarrhoeal Disease In Children

Question 1

Diarrhea

Answer 1

Increase in the fluidity, volume, and frequency of stools relative to the usual habits of each individual.

Question 2

Diarrhea types

Answer 2

1. Acute watery = hrs – days. 80%
2. Acute bloody = dysentery (bloody, small, mucus, tensmus, urgency)→ colitis.
3. Chronic ≥ 2wks.

Question 3

Diarrhea pathophysiology

Answer 3

Due to disturbance of water absorption and important solutes.

Question 4

Osmotic diarrhea

Answer 4

♠ Presence of non absorbable solutes in GIT

♠ Colonic bacteria ferment lactose→ SCFA → osmotic load→ water secretion

Question 5

Secretary diarrhea

Answer 5

Active secretion of water into gut lumen due to interruption of cellular pumps transporting sodium, glucose, amino acids.
Caused by infectious (cholera toxin) and non infectious (laxatives & VIP & Gastrin).

Question 6

Inflammatory diarrhea

Answer 6

Exudation of mucus, protein, and blood into the gut lumen leads to water and electrolyte loss and subsequent diarrhea.
Infection or chronic diseases (Celiac).

Question 7

Decrease in anatomic surface area

Answer 7

Short bowel syndrome due to surgical resection of the bowel (volvolus) or non surgical (celiac disease). Loss of fluids, electrolytes & macro – micro nutrients.

Question 8

Alteration in intestinal motility

Answer 8

a-Decrease intestinal motility e.g. diabetes & malnutrition hypo motility→ bacterial over growth → deconjucation of bile salts →↑cAMP → secretary diarrhea. bIncrease motility e.g. thyrotoxicosis (↓ transit time)

Question 9

Differential diagnosis of acute diarrhea

Answer 9

Infant: gastroenteritis, systemic infection, antibiotic associated.
Child: gastroenteritis, food poisoning, systemic infection, antibiotic associated.

Question 10

Differential diagnosis of chronic diarrhea

Infant: 

Answer 10

post infectious secondary lactase deficiency, cow’s milk intolerance, chromic non specific diarrhea of infancy, celiac diseases, Aids enteropathy.  Rare=primary immune defect & secretary tumor.

Question 11

Differential diagnosis of chronic diarrhea

Child

Answer 11

post infectious secondary lactase deficiency, irritable BS, celiac D, lactose intolerance, chronic Giardiasis, inflammatory bowel disease & Aids entropathy.  Rare= acquired immune defect, secretary tumor.

Question 12

The most important causes of infectious diarrhea in developing countries are (5)

Answer 12

oRota virus 
oEnterotoxigenic Escherichia coli 
oShigella 
oCampylobacter jejuni 
oCryptosporidium

Question 13

Assessment of the degree of dehydration

Answer 13

�Sensorium : lethargic or restless or normal. �Sunken Eyes : ask care taker as well.
�Drinking: poorly or eagerly or normally.
�Skin Pinch: very slowly or slowly or immediately.

Question 14

Diarrhea investigation (3)

Answer 14

1-Stool examination: mucus, blood & leukocytes (colitis).
2-Stool culture (bloody, out break and immunosuppressed).
3-Blood urea and electrolyltes.

Question 15

Aim of diarrhea management

Answer 15

Assessment of the degree of dehydration.
 Determine of electrolytes imbalance – hypo or hyper nitremia, hypokalemia & metabolic acidosis.
 Correction 4 – 6 hrs.

Question 16

Diarrhea prevention

Answer 16

Save drinking water. Hand washing. Prevention of fecal contamination of food & milk. Exclusive breast feeding(1st 6 mon). Vitamin A supplementation(6-59 mon).  Vaccination= Rota virus (infant) and salmonella typhus. Isolation= cholera endemic.