Malabsorption in Childhood

Question 1

What defines chronic diarrhoea?

Answer 1

• 4 or more stools a day for more than 4 weeks
• <1 week: acute diarrhoea
• 2-4 weeks persistent diarrhoea
• > 4 weeks: chronic diarrhoea

Question 2

What are gross categories of causes of diarrhoea?

Answer 2

• motility disturbance
• active secretion (secretory)
• malabsorption of nutrients (osmotic)
• inflammatory

Question 3

What are motility disturbance causes of diarrhoea in children?

Answer 3

• Toddler diarrhoea (increased transit - child pass stool after every meal and will see full bits of food e.g. peas in stool)
• Irritable bowel syndrome

Question 4

What are causes of secretory diarrhoea?

Answer 4

• acute infective diarrhoea e.g. cholera caused

- IBD

Question 5

What are causes of osmotic diarrhoea?

Answer 5

-food allergy
-coeliac disease
-cystic fibrosis
-enzymatic defect e.g. acquired lactose intolerance
(something is in lumen of bowel that is drawing water out)

Question 6

How would you approach managing diarrhoea in children?

Answer 6

• age at onset
• abrupt/gradual onset
• family history
• nocturnal defecation suggests organic pathology
• consider growth and weight gain of the child
• faces analysis e.g. appearance, stool culture, determination of secretory vs osmotic

Question 7

How can you distinguish between secretory and osmotic diarrhoea by fasting the child?

Answer 7

if it is an osmotic diarrhoea, the diarrhoea will stop. But if it is a secretory diarrhoea, the diarrhoea will continue

Question 8

What can cause fat malabsorption?

Answer 8

-pancreatic disease :
diarrhoea due to lack of lipase and resultant steatorrhoea
classically cystic fibrosis
-hepatobiliary disease e.g. chronic liver disease or cholestasis

Question 9

What is coeliac disease?

Answer 9

autoimmune condition resulting in having an intolerance to the gliadin fraction of gluten

Question 10

What is gluten found in?

Answer 10

• wheat
• rye
• barley

Question 11

What are symptoms/ signs of coeliac disease in children?

Answer 11

• abdominal bloatedness
• diarrhoea
• FTT
• short stature
• constipation
• tiredness
• dermatitis herpatiformis

Question 12

What groups of children are susceptible asymptomatic groups for coeliac disease?

Answer 12

• type 1 diabetes
• autoimmune thyroid disease
• Downs syndrome

Question 13

What serological screening tests are there for coeliac disease?

Answer 13

• anti-tissue transglutaminase and serum IgA
• positive anti-endomysial antibodies
• anti-gliadin antibodies

Question 14

What is the gold standard of diagnosis of coeliac disease?

Answer 14

duodenal biopsy

Question 15

What would you see on histology of the small intestine that would be indicative of coeliac disease?

Answer 15

• blunting of villi and crypt hyperplasia

- infiltration of lymphocytes

Question 16

What are the guidelines for diagnosing coeliac disease without a biopsy in children?

Answer 16

• symptomatic children
• anti TTG >10 times the upper limit of normal
• positive anti-endomysial antibodies
• normal serum IgA
• HLA DQ2, DQ8 positive

Question 17

How would coeliac disease be treated?

Answer 17

• gluten free diet for life
• in very young (<2 years), re-challenge and re-biopsy may be warranted as other diseases may mimic coeliac
• increased risk of rare small bowel lymphoma if untreated

Question 18

What is an example of a type of common carbohydrate malabsorption?

Answer 18

• secondary lactose malabsorption (commonly preceded by rotavirus infection)
• signs of this may include excoriation of perineal region