GI - Diarrhoea

Question 1

Definition

Answer 1

Diarrhoea = change in consistency and frequency of stools, with enough loss of fluid and electrolytes to cause illness

Question 2

Epidemiology

Answer 2

Normal stool frequency and consistency vary e.g. breastfed infants can pass up to 10-12 stools per day, while primary school children can pass stool anything from 3 times per dat to once every 3 days.
Diarrhoea kills 3 million children per year worldwide.

Question 3

Aetiology (acute diarrhoea)

Answer 3

Infective gastroenteritis (MC)
Non enteric infections e.g. resp tract
Food hypersensitivity reactions
Drugs e.g. Abx
Henoch-Schoenlein purpura
Intussusception (<4yrs)
HUS
Pseudomembranous enterocolitis

Question 4

Aetiology (chronic diarrhoea)

Answer 4

Age 0-24 months
- Malabsorption e.g. lactose intolerance, CF, Coeliac disease
- Food hypersensitivity e.g. cow’s milk protein allergy
- Hirschsprung’s disease
- Excessive fruit juice intake
- Toddlers diarrhoea

Older children
- IBD
- Constipation, overflow diarrhoea
- IBS
- Laxative abuse

Question 5

Symptoms

Answer 5

Fever +/- vomiting
Diarrhoea +/- bloody stools
Dehydration
Reduced consciousness

Question 6

Diagnosis

Answer 6

FIRST LINE =
- Stool inspection
- FBC
- U+E’s
- CRP
- ESR

Question 7

Management (Chronic)

Answer 7

Treat underlying cause
Nutritional intervention if deficiencies are present
Abx only if systemic illness or prolonged infection present e.g. Salmonella, Campylobacter, Giardiasis, Amoebiasis
Rarely other drugs useful e.g. loperamide or cholestyramine

Question 8

Management (Acute)

Answer 8

Assess hydration and vital signs

Mild/moderate dehydration
- No tests necessary
- Replace fluid and electrolyte losses with oral-glucose electrolyte based rehydration fluids

Severe/shock dehydration
- U + E, creatinine, FBC, ABG, Stool MC+S/virology, tests for specific disease
- USS if suspected intussusception
- IV fluids and electrolyte replacement therapy