2. Definitions
• Diarrhea with passage of 3 or more loose
stools of presumed infectious etiology starting
acutely and lasting for more than 14 days.
• Chronic diarrhea; noninfectious etiology
• Protracted diarrhea
– Persistent diarrhea with weight loss and malnutrition
3. Disease burden
• 24 lakh child deaths in India each year
• 5 children die every minute
• 25% of the global burden is in India
• More in infancy [31 episodes per 100 child
years]
9. Pathology
• Delay in repair of damaged epithelium of gut
• Damage of mucosal absorptive surface
• Loss of brush border enzymes
• Bacterial overgrowth altered intestinal flora
• Prolonged cell mediated immune form of
damage of small intestinal mucosa
10. Presentation
• Mild form
– Several motions
– No significant weight loss
– No significant dehydration
• Moderate form
– Several motions
– Marginal weight loss
– Without dehydration
– Non tolerance to milk
• Severe form
– Dehydration with several motions
– Weight loss
– Non tolerance to milk & cereals
– Secondary infection
19. Definition
• Diarrhea of more than 2 weeks duration or
3 attacks during last 3 months.
• With specific congenital, biochemical or
metabolic disorders.
• Non infectious
23. Secretory diarrhea
• Activation of cAMP
• Activation of cGMP
• Activation of intracellular calcium
E.Coli
Shigella
Salmonella
cholera
24. CMPA
• Few weeks after introducing cow milk
• Diarrhea, vomiting, colic, GI bleed, FTT.
• Due to IgA deficiency?
25. Celiac disease
• Intolerance to wheat gliadin
• Features
– Chronic diarrhea
– Abd distension
– FTT, anorexia, irritable
– Foul, greasy,bulky stool.
• Diagnosis:
– anti endomysial antibody
– Villous atrophy
• Management
26. Work up
• History of intake of fluids
• Nutrition assessment
• Stool pH / RS / WBC / ova ,cyst / cl.difficile culture
• Stool fat estimate
• Breath H2 estimate
• Stool electrolytes
• Sweat chloride
• Small bowel biopsy / endoscopy
• Barium studies
• Hormones assay
27.
28. Case scene 1.
• 8 month old child presents with 18 days of
loose stools, many episodes per day following
milk feeds. initially treated with antibiotics for
1 week.
• On exam, no dehydration, 3% weight loss+,
perianal excoriation +
• What stool exam you do?
• Diagnosis & management?
29. Scene 2
• 7 month old child 2 weeks after introduction
of cow’s milk, cries irritably frequently, loose
stools many episodes,
• O/E ; irritable, poor weight gain,
• Stool occult blood positive.
• One more stool exam to do?
• Diagnosis?
30. Scene3
• 2year old child,3 weeks diarrhea, stools are
bulky, oily, foul smelling, not responding to 2
weeks of antibiotics.
• O/E poor weight gain, abd distension,
• Stool test to do?
• Diagnosis?
Comp- gf.mn. Gf not due malabs, poor cal intake, poor diet managemt.
Cn in mn.major are well hydrated. Most can be managd at home. Admit <4m, dehyd,system inf, severe mn wt <60%
1 normal 5days
Palatable, acceptable
Less starch glucse.
Live microbial feed supplement, which beneficially affects host by improving the host intestinal microbial balance“ secrete iga, produce lactate
Low purge, recurrrent, abd dist, mn
Loose bulky celiac, pasty yellow pancreas, urinelike chloride, toddlers –freq hetero mucus foul alternate normal stool nn.
3 celaic-post age- 1undiges nutrients break into short chain fatty acids.3=nec. 4=mn-dm
lactose is not absorbed in the small intestine and reaches the colon intact The colonic bacteria ferment the nonabsorbed lactose to short-chain organic acids, generating an osmotic load and causing water to be secreted into the lumen
activation of the intracellular mediators such as cAMP, cGMP, and intracellular calcium, which stimulate active chloride secretion from the crypt cells and inhibit the neutral coupled sodium chloride absorption
Patients with chloride diarrhea have hypochloremic metabolic alkalosis with low serum chloride concentration, high stool chloride content coupled with chloride-free urine, low serum potassium, and high serum bicarbonate. Hydramnios is present in the mothers.
Jeju bx- villous atrophy
1encopresis? Breath hydrogen tests can be used to determine a specific carbohydrate malabsorption. A breath hydrogen test for glucose or lactulose can be used to diagnose bacterial overgrowth. Sorbitol, which is a nonabsorbable sugar, is found in apple, pear, and prune juices, and can cause diarrhea in toddlers. Moreover, apple and pear juices contain higher amounts of fructose in excess of glucose concentration, a feature postulated to cause diarrhea in toddlers
