chronic diarrhea SOEPLE – 3

AHMAD MHD AL-DHLAWIY

Contents…SOEPEL

Definetion

Epideiology

Physiology

patohphysiology

Classification

Causes

Clinical features

Diagnosis

Treatment

SOEPEL Subject:

A 3 years old child came with abdominal pain, and diarrhea since 3 weeks.

Analysis of pain:

1. Site: diffuse

2. Onset: gradually

3. Character: --

4. Associated factors: --

5. Time/duration: 2 week.

6. Exaggerated and relieving factors: --

7. Severity: moderate

SOEPEL Object: General examination & Abdominal examination

Evaluation (DD): Celiac disease, Crohn’s disease.

Plan: CBC, stool examination, and Antibody test.

Elaboration: Diet management.

Learning goals: chronic diarrhea.

Epidemiology …

- According to ( WHO ) there are more than 700 million episodes of diarrhea annuallyin children > 5 years of age in developing countries.

- more than two to four weeks occurs in up to 3 to 5 percent of the population worldwide.

- more frequent in men.

Physiology …

Physiology

Pathophysiology … Osmotic diarrhea.

Secretory diarrhea.

Mutations in apical membrane transport proteins.

Reduction in anatomic surface area.

And alteration in intestinal motility.

Osmotic diarrhea It’s caused by the presence of nonabsorbable solutes in the gastrointestinal tract.

e.g. lactose intolerance

Secretory diarrhea … Activation of intracellular mediators (cAMP, cGMP and intracellular calcium)

This stimulates active chloride secretions from the crypt and prevent the neutral coupled sodium chloride absorption.

Thus the intraluminal electrolyte content will be high and this leads to diarrhea.

e.g. cholrea, E.coli.

Mutations in apical membrane transport proteins …

Congenital defects in:

1. Sodium-hydrogen exchange.

2. Chloride-bicarbonate exchange.

3. And sodium-bile acid transport protein

CON’T …

Reduction in anatomic surface area: This is called short bowel syndrome and can occur after surgical indications.

And alteration in intestinal motility: This can result duo to malnutrition, scleroderma, and diabetes mellitus.

Causes … 1- Noninfectious Causes of Chronic Diarrhea :A. Antibiotic Therapy

B. Extraintestinal Infections

C. Malnutrition

D. Diet and Medications

E. Allergic Diarrhea

F. Chronic Nonspecific Diarrhea

G. Secretory Diarrhea

H.Inflammatory bowel disease

CON’T …2- Infectious Causes of Chronic Diarrhea: e.g. salmonella, Giardia lamblia

common in immune deficiency

states, especially IgA deficiency and T-cell abnormalities.

Clinical features … Cramping

Abdominal pain

Nausea

Fever

Bloody stools

Dehydration

Incontinence

Investigation … History

Physical examination

General examination:

CON’T …

CON’T …

Treatment …

References …

- Nelson textbook of pediatrics.

- CURRENT diagnosis and treatment pediatrics.

- Some figures from websites.