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Paeds: Gastro and Growth > Chronic diarrhoea > Flashcards

Chronic diarrhoea Flashcards

1
Q

What has the term ‘chronic non-specific diarrhoea’ replaced?

A

toddler diarrhoea

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2
Q

What is the commonest cause of persistent loose stools in preschool children?

A

chronic non-specific diarrhoea

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3
Q

What is the consistency of stools like in chronic non-specific diarrhoea?

A

varying consistency, sometimes well-formed, sometimes explosive and loose; presence of undigested vegetables common

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4
Q

What is the general health like of children affected by chronic non-specific diarrhoea?

A

well and thriving

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5
Q

What are 3 possible alternative diagnoses to chronic non-specific diarrhoea?

A
  1. Coelia disease
  2. Excessive ingestion of fruit juice, especially apple juice
  3. Temporary cow’s milk allergy following gastroenteritis
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6
Q

How should temporary cows’ milk allergy following gastroenteritis be managed?

A

trial of cows’ milk protein free diet

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7
Q

What is likely the underlying cause of chronic non-specific diarrhoea?

A

dysmotility of the gut (form of irritable bowel syndrome) and fast-transit diarrhoea

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8
Q

What is the prognosis of chronic non-specific diarrhoea?

A

Almost always improves with age

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9
Q

What diagnosis should you consider in chronic diarrhoea following bowel resection, cholestatic liver disease or exocrine pancreatic dysfunction?

A

Malabsorption

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10
Q

What are 3 causes of chronic diarrhoea due to malabsorption?

A
  1. Cholestatic liver disease
  2. Exocrine pancreatic dysfunction
  3. Bowel resection
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11
Q

What is a food allergy?

A

occurs when a pathological immune response is mounted against a specific food protein - usually IgE mediated, but may be non-IgE mediated

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12
Q

What is a food intolerance?

A

non-immunological hypersensitivity reaction to a specific food

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13
Q

What are 2 features of a mild acute IgE-mediated allergic reaction?

A
  1. Urticaria and itchy skin
  2. Facial swelling
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14
Q

What are 7 features of an acute Ig-E mediated allergic reaction that put it into the severe category?

A
  1. Wheeze
  2. Stridor
  3. Abdominal pain
  4. Vomiting
  5. Diarrhoea
  6. Shock
  7. Collapse
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15
Q

What are 3 features of non-IgE mediated cow’s milk allergy?

A
  1. Loose stools
  2. Faltering growth
  3. Elimination of cow’s milk results in resolution of symptoms
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16
Q

What will the result of a skin prick test be in Ig-E mediated food allergy?

A

strongly positive e.g. 8mm weal

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17
Q

What will the result of a non-IgE mediated cow’s milk allergy be in response to skin prick test?

A

negative - 0mm weal

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18
Q

What is the typical presentation of non-allergic food hypersensitivity (e.g. temporary lactose intolerance)?

A

Previously well, develop diarrhoea and vomiting; vomiting settles but watery stools continue for several weeks

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19
Q

What investigation may be useful in suspected non-allergic food hypersensitivity (e.g. temporary lactose intolerance) and what would it show?

A

Stool sample - no pathogens but positive for reducing substances

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20
Q

What are 3 types of distinguishable food allergy/ intolerance?

A
  1. IgE mediated food allergy
  2. Non-IgE mediated allergy
  3. Non-allergic food hypersensitivity
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21
Q

At what exposure to an allergen will children usually react in food allergy?

A

First exposure

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22
Q

What are the 3 most common causes of food allergy in infants?

A

Milk, egg, peanut

23
Q

What are 4 most common causes of food allergy in older children?

A
  1. Peanut
  2. Tree nut
  3. Fish
  4. Shellfish
24
Q

What is the difference between primary and secondary food allergy?

A

primary is when you recact on first exposure to the food, secondary is due to cross-rectivity between proteins present in fresh fruits/veg/nuts and those present in pollens e.g. child who can eat apples may develop allergy to apples when older if develop allergy to birch tree pollen (because they share a similar protein) - aka the pollen food allergy syndrome

25
Q

What is the pollen food allergy syndrome?

A

e.g. child who can eat apples may develop allergy to apples when older if develop allergy to birch tree pollen, because apple and birch pollen share very similar protein.

generally leads to mild allergic reactions, often causing an itchy mouth but no systemic symptoms.

26
Q

What is the typical presentation of the pollen food allergy syndrome?

A

mild allergic reactions, itchy mouth, no systemic symptoms

27
Q

After what time frame does non-IgE food allergy typically occur? What organ system does it involve?

A

hours after ingestion; GI tract - diarrhoea, vomiting, abdominal pain

28
Q

What is food aversion?

A

person refuses food for psychological or behavioural reasons

29
Q

Over what time frame does IgE-mediated food allergy usually occur?

A

10-15 minutes (up to 2 hours) after ingestion of food

30
Q

What are 7 symptoms of non-IgE mediated food allergy?

A
  1. Diarrhoea
  2. Vomiting
  3. Abdominal pain
  4. Faltering growth
  5. Colic
  6. Eczema
  7. Blood in stool - proctitis
31
Q

How does non-IgE mediated food allergy sometimes present in the first few weeks of life?

A

blood in stools from proctitis or severe repetitive vomiting in infant leading to shock (food protein-induced enterocolitis syndrome)

32
Q

What is food protein-induced enterocolitis syndrome?

A

sometimes non-IgE mediated food allergy can present in first few weeks of life with blood in stools from procitits, or severe repetitive vomiting which can lead to shock

33
Q

What is key to a diagnosis in food allergy?

A

Clinical history: symptos following exposure to particular food

34
Q

What are the 2 most helpful confirmatory tests for IgE mediated food allergy?

A
  1. skin-prick tests
  2. measurement of specific IgE antibodies in blood
35
Q

What is the drawback of skin prick tests and serum IgE antibody testing for IgE-mediated food allergy?

A

both may yield false positive results

36
Q

Despite the risk of false positives, what can specific IgE antibodies in the blood and skin prick tests tell you about IgE-mediated food allergies?

A

the greater the response, the more likely child is to be allergic

negative results make IgE-mediated allergy unlikely

37
Q

What does skin prick testing involve?

A

drop of allergen placed on skin, site is marked, pricked with a needle, and any weals measured

38
Q

What is considered positive in a skin prick test?

A

Weal of 4mm or greater

39
Q

What are 3 things that can help make a diagnosis of non-IgE mediated good allergy?

A
  1. History
  2. Examination
  3. Endoscopy and intestinal biopsy if indicated
40
Q

What will an intestinal biopsy show in non-IgE-mediated food allergy if positive?

A

presence of eosinophilic infiltrates

41
Q

What is the gold standard investigation in cases of doubt for both IgE-mediated and non-IgE mediated food allergies?

A

exclusion of relevant food under dietitian’s supervision, followed by double-blind placebo-controlled food challenge

42
Q

What does the double-blind placebo-controlled food challenge involve?

A

child is given increasing amounts of food or placebo, starting with tiny quantity, until full portion reached

Should be in hospital with full resuscitation facilities available and close monitoring for signs of allergic reaction

43
Q

What does the management of food allergy involve?

A

avoidance of reelvant foods

44
Q

Why can allergen avoidance be difficult?

A

common food allergens are common ingredients in the human diet, may be present in small quantities in many foods

45
Q

What is in help to help individuals with food allergy avoid the foods?

A

food labelling in EU legally requires common food allergens to be clearly discosed, including those sold in catering outlets

46
Q

What are the 3 things that a dietitian helps the family of a food-allergic child with?

A
  1. Help avoid foods patient is allergic to
  2. Find appropriate alternatives
  3. Avoid nutritional deficiencies
47
Q

In addition to advice about allergen avoidance, what must the child and family be informed of?

A

must be able to manage an allergic attack: written self-management plans and adequate training

for mild and severe reactions

48
Q

How can the difference between a mild and severe allergic reaction be described?

A

no cardiorespiratory symptoms in mild, but in severe - cardiovascular, laryngeal or bronchial involvement

49
Q

What is the self-management of mild reactions to food allergens?

A

non-sedating antihistamines e.g. loratidine (chlorphenamine = sedating)

50
Q

What is the self-management of a severe reaction to a food allergen?

A

epinephrine (adrenaline) given intramuscularly by autoinjector (e.g. EpiPen) - should carry with them at all times

51
Q

Allergies to which foods often resolve early in childhood? What can be done due to this?

A

cow’s milk and egg; gradual reintroduction under supervision with paediatric dietician

52
Q

What are 2 foods that allergy to usually persists through to adulthood?

A

nuts and seafood

53
Q

Overall what are 7 of the most common causes of food allergy?

A
  1. Milk
  2. Eggs
  3. Nuts
  4. Seafood
  5. Wheat
  6. Legumes
  7. Seeds
  8. Fruits
54
Q

Which children should carry an adrenaline autoinjector?

A

those with risk of severe reaction e.g. previous anaphylaxis or coexistent asthma

Paeds: Gastro and Growth (14 decks)

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