CHRONIC DIARRHEA WITHOUT FAILURE TO THRIVE

CHRONIC DIARRHEA Clinical Assessment   > 2 weeks onset, nature of stool  nutritional status (chronic diarrhe...

CHRONIC DIARRHEA

Clinical Assessment 

1. > 2 weeks
2. onset, nature of stool 
3. nutritional status (chronic diarrhea with FTT suggests malabsorption)
4. history of infection 
5. hydration status
   

Investigations for Diarrhea of Unknown Etiology

 

1. serial heights, weights, growth percentiles
2. stools for C&S, Ova and Parasites (O&P), occult blood, C. difficile, pH, reducing substances
3. malabsorption work-up if indicated (see next lecture Chronic Diarrhea with FTT )
4. x-rays
   • upper GI series
   • barium enema 
5. mucosal biopsy

 

CHRONIC DIARRHEA WITHOUT FAILURE TO THRIVE (FTT)

Infectious

 

1. bacterial (e.g. Campylobacter, Salmonella)
2. antibiotic induced: C. difficile colitis - often bloody stool
3. parasitic: Giardia lamblia
4. Post-infectious: secondary lactase deficiency
   

Toddler's Diarrhea 

 

1. most common cause of chronic diarrhea during infancy, but still diagnosis of exclusion in thriving child
2. onset between 0.5-3 years of age, ceases spontaneously between 2-4 years 
3. stool may contain undigested food particles,( so called “Peas and carrots syndrome “)
4. per day excoriated diaper rash
5. diet history: lots of  juice overwhelms small bowel resulting in
   disaccharide malabsorption
6. four F’s: adequate Fiber, normal Fluid intake, 35-40% Fat,
   discourage excess Fruit juice
7. management: reassurance, self-limiting
   

Lactase Deficiency (Lactose Intolerance)

 

Clinical features

1. chronic, watery diarrhea
2. abdominal pain, bloating, borborygmi (=stomach rumbling)

 

2 scenarios

1. primary lactose intolerance: crampy abdominal pain with loose stool in older children, usually in Orientals, Blacks
2. secondary lactose intolerance: old infant, persistent diarrhea
   post viral/bacterial infection, Celiac disease, or inflammatory
   bowel disease 

 

Diagnosis

1. clinical trial off milk
2. watery stool, acid pH, positive reducing sugars
3. positive breath hydrogen test if > 6 years

 

Management

1. lactose tolerance test
2. milk free diet, soy formula
3. Lacteeze, Lactaid tabs/drops