Diarrhoea Flashcards
Define diarrhoea
Increase in the frequency, fluidity, and volume of faeces
What is the difference between acute and prolonged diarrhoea
Acute: 3 or more episodes of liquid/semi-liquid stools in a 24h period, lasting for <14 days
Prolonged: acute-onset diarrhoea that has persisted >14 days
What is the difference between food poisoning, dysentery and traveller’s diarrhoea
Food poisoning = illness caused by the consumption of food or water contaminated with bacteria and/or their toxins, or viruses, parasites, or chemicals
Dysentery = acute infectious gastroenteritis characterised by diarrhoea with blood and mucus
Traveller’s diarrhoea = developing diarrhoea at a destination abroad with at least one additional symptom (abdominal cramps, tenesmus, nausea, vomiting, fever, faecal urgency), involves travel from LMICs
Define outbreak
Two or more cases associated in time and place
What are the normal stool patterns for children 0-4 months
Breastfed: 2-4 per day (once per week normal), yellow to golden colour, porridge consistency, pH 5
Bottlefed: 2-3 per day, pale yellow-light brown, firm consistency, pH 7
What are the normal stool patterns of children 4 months - 1 year
1-3 per day
Darker yellow
Firmer
What are the stool patterns of children > 1 yo
Formed
Like adult stool in odour and colour
What are the causes of acute diarrhoea
Gastroenteritis
- Viral e.g. rotavirus, norovirus, adenovirus
- Bacterial e.g. shigella, E. coli, salmonella. campylobacter, yersinia
- Food poisoning: clostridium perfringens, bacilus cereus, staph aureus
- Parasitic e.g. cryptosporiodiosis, entamoeba, giardia
- Traveller’s
URTI, chest infections
Otitis media
UTI’s
Antibiotic induced
Non-infection e.g. intussusception
What investigations should be done for acute diarrhoea
Bedside: stool microscopy and culture, stool immunoassay (rotavirus), urine culture
Bloods: FBC, U&Es, blood culture
Other: CXR (Exclude pneumonia)
What is the management for acute diarrhoea
Assess hydration status
Not dehydrated → re-assure, discharge + advice (maintain fluids, eat as normal)
Dehydrated → ORS (young) or diluted apple juice (older chidlren)
What are the causes of chronic diarrhoea
Non-specific diarrhoea
Toddler diarrhoea
Functional constipation → overflow diarrhoea
Malabsorption: Lactose intolerance | cystic fibrosis | coeliac disease | CMPA | cholestatic liver disease | short-bowel syndrome
Inflammation: IBD
Infection: Giardiasis
What investigations should be done for chronic diarrhoea
Bedside: stool culture, stool sample for occult blood/ova and parasites/reducing substances and pH/chymotrypsin/microscopy, urine MC&S, breath hydrogen test
Bloods: FBC, U&Es, plasma viscosity/ESR, tTG, EMA
Other: sweat test, barium meal and enema, endoscopy, jejunal biopsy
What is toddler diarrhoea
chronic and non-specific diarrhoea
Commonest cause of loose stools in preschool kids
Underlying maturational delay in intestinal mobility → increased intestinal hurry (not malabsorption)
What are the signs and symptoms of toddler’s diarrhoea
Varying consistency stools (well-formed to explosive and loose ± presence of undigested vegetables in stool)
Child is well and thriving (no precipitating dietary factors and normal examination)
What is the management for toddler’s diarrhoea
Increased fibre and fat in diet (whole milk, yoghurts, cheeses) → relieve symptoms
Avoid fruit juice and squash
