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Paediatrics Brian > Vomiting and Malabsorption in Children 2 > Flashcards

Vomiting and Malabsorption in Children 2 Flashcards

1
Q

How much fluid:

  • enters duodenum
  • colon
  • lost in faeces
A
  • 9L fluid enters duodenum
  • 1.5L gets to colon
  • <200ml lost in faeces
  • (rest gets reabsorbed in small intestine)
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2
Q

What are essential secretory compoents?

A
  • Water for fluiditiy/enzyme transport/absorption
  • Ions such as duodenal bicarbonate
  • Defect mechanism against pathogens/harmful substances/antigens
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3
Q

Chronic diarrhoea - definition

A
  • 4 or more stools per day for more than 4 weeks
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4
Q

Chronic diarrhoea - classification

A
  • <1 week
    • Acute diarrhoea
  • 2 to 4 weeks
    • Persistent diarrhoea
  • >4 weeks
    • Chronic diarrhoea
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5
Q

Chronic diarrhoea - aetiology

A
  • Motility disturbance
    • Toddler diarrhoea
    • Irritable bowel syndrome
  • Active secretion (secretory)
    • Acute infective diarrhoea
    • Inflammatory bowel disease
  • Malabsorption of nutrients (osmotic)
    • Food allergy
    • Coeliac disease
    • Cystic fibrosis
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6
Q

Osmotic diarrhoea - pathology

A

Occurs when movement of water into the bowel to equilibrate osmotic gradient

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7
Q

What is osmotic diarrhoea usuallt a feature of?

A

Usually a feature of malabsorption:

  • Enzymatic defect (such as secondary lactose deficiency)
  • Transport defect (such as glucose galactose transporter defect)
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8
Q

What are examples of the following which can cause osmotic diarrhoea:

  • enzymatic defect
  • transport defect
A
  • Enzymatic defect (such as secondary lactose deficiency)
  • Transport defect (such as glucose galactose transporter defect)
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9
Q

Osmotic diarrhoea is the mechanism of action of what drugs?

A

This is the mechanism of action ofluctulose/movicol

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10
Q

Osmotic diarrhoea - treatment

A
  • Remission with removal of causative agent
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11
Q

Secretory diarrhoea - aetiology

A

Classifically associated with toxin production from Vibrio Cholerae and enterotoxigenic E-coli

Intestinal fluid secretion predominantly driven by active chloride secretion via CFTR

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12
Q

What are the different kinds of diarrhoea?

A

Osmotic diarrhoea

Secretory diarrhoea

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13
Q

Describe the clinical approach for chronic diarrhoea?

A
  • History
    • Age of onset
    • Abrupt/gradual onset
    • Family history
    • Travel history/local outbreaks
    • Nocturnal defecation is always pathological
  • Consider growth and weight of child
  • Faeces analysis
    • Appearance
    • Stool culture
    • Determination of secretory vs osmotic
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14
Q

Compare and contrast osmotic and secretory diarrhoea in terms of:

  • stool volume
  • response to fasting
  • stool osmolarity
  • osmotic gap
  • stool sodium
  • stool potassium
  • stool chloride
  • stool pH
  • stool reducing substance
A
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15
Q

Fat malabsorption - causes

A
  • Pancreatic disease
    • Due to lack of lipase and resultant steatorrhea
    • Classically cystic fibrosis
  • Hepatobiliary disease
    • Chronic liver disease
    • Cholestasis
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16
Q

What of the following can cause fat malabsorption:

  • pancreatic disease
  • hepatobiliary disease
A
  • Pancreatic disease
    • Due to lack of lipase and resultant steatorrhea
    • Classically cystic fibrosis
  • Hepatobiliary disease
    • Chronic liver disease
    • Cholestasis
17
Q

Coeliac disease - epidemiology

(prevalence)

A
  • 1% western population
18
Q

Coeliac disease - risk factors

A
  • Genetics
    • HLA-DQ2, DQ8
19
Q

What genes have been linked to coeliac disease?

A
  • HLA-DQ2, DQ8
20
Q

Coeliac disease - presentation

A
  • Abdominal bloatedness
  • Diarrhoea
  • Failure to thrive
  • Short stature
  • Constipation
  • Tiredness
  • Dermatitis herpatiformis
  • More common in children with other autoimmune conditions like diabetes
21
Q

Coeliac disease - investigations

A
  • Serological screens
    • Anti-tissue transglutaminase (high sensitivity)
    • Anti-endomysial (high sensitivity)
    • Check serum IgA
  • Duodenal biopsy for histology
    • Gold standard
  • Genetic testing
    • HLA DQ2, DQ8
22
Q

What serological screens should be done for coeliac disease?

A
  • Anti-tissue transglutaminase (high sensitivity)
  • Anti-endomysial (high sensitivity)
  • Check serum IgA
23
Q

What are the guidelines for when coeliac disease diagnosis can be made without biopsy?

A
  • Espghan/Bspghan guidelines
  • If ALL of these features are present do not need
    • Symptomatic children
    • Anti TTG>10x upper limit of normal
    • Positive anti-endomysial antibodies
    • HLA DQ2, DQ8 positive
24
Q

Coeliac disease - treatment

A
  • Gluten free diet for life
    • Do not remove gluten prior to diagnosis
25
Q

Coeliac disease - complications

A
  • Increased risk of rare small bowel lymphoma in untreated

Paediatrics Brian (37 decks)

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