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Questions and Answers
Osmotic diarrhoea occurs due to an increased osmotic load from poorly absorbed substances.
True
Secretory diarrhoea resolves with fasting due to reduced secretion of water into the lumen.
False
Faecal impaction is classified as a type of diarrhoea.
False
Infectious agents such as bacteria and viruses can lead to inflammation of the intestinal lining.
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Cholera is an example of a condition that leads to osmotic diarrhoea.
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Chronic diarrhoea can be caused by irritable bowel syndrome (IBS) and other significant conditions.
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Antidepressants and caffeine can contribute to secretory diarrhoea.
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Lactose intolerance may present as diarrhoea due to malabsorption of solute.
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Lactulose is a stimulant laxative that provides relief within 5-15 minutes.
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Glycerol suppositories are categorized as stimulant laxatives.
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Bulk-forming laxatives are preferred over stimulant laxatives for treating constipation.
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MICROLAX® provides relief from constipation within 1-2 hours.
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Referral is required for anyone under 40 years with a persistent change in bowel habit.
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Children should wash their hands thoroughly only before eating.
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Sharing towels and cutlery with a child who had gastroenteritis is advisable to prevent transmission.
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A child can return to school 24 hours after their last episode of diarrhoea and vomiting if they feel better.
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Food hygiene practices include cooking food thoroughly and never storing raw and cooked foods together.
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The rotavirus oral vaccine is effective if given to infants older than 8 months.
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The usual duration for diarrhoea in children is 5 to 7 days, and it rarely lasts longer than 2 weeks.
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Dehydration in children can be recognized by signs such as appearing unwell or being irritable.
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Breast-feeding should be discontinued immediately after a child has gastroenteritis.
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Diarrhoea generally lasts for an average of 3 days in most children.
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It is safe for a child recovering from diarrhoea to enter a swimming pool after 48 hours from their last episode.
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Functional constipation is chronic constipation with a known cause.
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The peak incidence of constipation in children typically occurs around the age of 5–6 years.
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Secondary constipation can be caused by medications such as opioids and antacids.
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A symptom of constipation can include the presence of dark blood in stools.
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Children suffering from constipation should be observed for a maximum period of 10 days before seeking medical advice.
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Laxatives should never be used if a bowel obstruction is suspected.
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The normal prevalence of childhood constipation is estimated to be between 1% and 20%.
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Dietary measures alone can effectively manage all cases of constipation.
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Once stools are soft and easily passed, laxatives should be continued indefinitely.
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Mucus in the stool is a common indicator that a referral is required.
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Scheduled toileting is recommended to be performed at random intervals for children with constipation.
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Using a bowel habit diary can help track the frequency and consistency of stool in children.
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Foods with high fiber content, such as chocolate and pastries, are recommended for treating constipation in children.
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Unprocessed bran is a recommended dietary option to alleviate constipation in children.
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Bulk-forming laxatives work by reducing bowel mass and consequently decreasing peristalsis.
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Osmotic laxatives function by drawing fluid from the body into the bowel to relieve constipation.
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It is safe to take bulk-forming laxatives immediately before going to sleep without any considerations.
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A balanced diet for children experiencing constipation should include high amounts of processed foods.
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Daily physical activity recommendations for children with constipation are based on their developmental stage and ability.
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Consultation with a doctor is necessary if there is no bowel movement after taking bulk-forming laxatives for 3 days.
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Study Notes
Diarrhoea
- Frequent passage of soft or watery stools
- Acute (<14 days) vs Chronic (>1 month)
- Causes include infection (gastroenteritis), medication side effects, IBS, Coeliac disease, lactose intolerance, faecal impaction, ulcerative colitis, Crohn's disease, and colorectal cancer.
- Acute diarrhoea caused by viruses, bacteria, parasites, drugs, anxiety, food allergies, and alcohol misuse.
- Chronic diarrhoea caused by IBS, IBD, microscopic colitis, coeliac, diverticular disease, and colorectal cancer.
Diarrhoea Pathophysiology
- Increased osmotic load (osmotic diarrhoea):
- Ingestion of poorly absorbed substances like mannitol, sorbitol, or magnesium-containing antacids.
- Malabsorption of solutes like lactose or gluten.
- Resolves with fasting.
- Increased secretion (secretory diarrhoea):
- Water normally secreted into the lumen is reabsorbed.
- Diarrhoea occurs when secretion exceeds reabsorption.
- Causes include cholera, E.coli, some laxatives, antidepressants, caffeine, and toxins.
- Does not resolve with fasting.
- Inflammation of the Intestinal Lining:
- Disruption or destruction of the epithelium due to infection by:
- Bacteria: Salmonella, E.coli, Campylobacter
- Viruses: Rotaviruses, coronaviruses, parvoviruses, norovirus
- Protozoa: Coccidia species, Cryptosporium, Giardia
- Inflammatory processes activate white blood cells, cytokines, and inflammatory mediators, leading to increased secretion and destruction of epithelial cells.
- Disruption or destruction of the epithelium due to infection by:
Gastroenteritis Infection Control
- Thorough handwashing after using the toilet and before eating.
- Disinfect potties and toilets after each use.
- Separate towels, utensils, and flannels for infected individuals.
- Do not send children to school or nursery for 48 hours after the last episode of diarrhoea or vomiting.
- Avoid swimming pools for two weeks after the last episode of diarrhoea.
Preventing Gastroenteritis
- Practise good food hygiene.
- Wash hands, surfaces, and utensils with hot, soapy water.
- Store raw and cooked foods separately.
- Refrigerate foods properly.
- Cook food thoroughly.
- Avoid expired food.
Rotavirus Vaccine
- Rotavirus disease is preventable by vaccination.
- All children born on or after October 1, 2016, are given the rotavirus oral vaccine at 2 and 4 months of age.
- The vaccine is ineffective for infants older than 8 months.
Follow-Up for Diarrhoea in Children
- Seek healthcare professional advice if symptoms persist beyond the usual duration.
- Diarrhoea typically lasts 5-7 days and resolves within 2 weeks.
- Vomiting typically lasts 1-2 days and resolves within 3 days.
- Monitor for dehydration and shock symptoms (unwell appearance, lethargy, irritability, decreased responsiveness).
Constipation
- Unsatisfactory defecation, reduction in normal bowel habit.
- Characterized by infrequent stools, straining, difficult stool passage, and incomplete defecation.
- Stools are often dry, hard, and abnormally sized.
- Functional constipation is chronic constipation without an identifiable cause.
- Secondary constipation is constipation caused by medication or medical conditions.
Specific Questions to Ask (Constipation)
- Changes in diet or routine.
- Pain during defecation.
- Presence of blood in stool.
- Duration of symptoms.
- Lifestyle changes.
- Psychological factors.
- Medications (iron, opioids, antacids).
- Appearance of stool.
Constipation Referral
- Painful defecation causing suppression of the defecation reflex.
- Individuals over 40 years old with sudden changes in bowel habits with no obvious cause.
- Constipation lasting more than 14 days without identifiable cause.
- Recurrent abdominal pain, mucus in stool, tiredness, dark blood in stools, unexplained weight loss, fever, nocturnal symptoms.
- Children with constipation lasting over 7 days.
- Suspected misuse or abuse of laxatives.
- Treatment failure.
Constipation in Children
- Prevalence of 1-20%, with ~5% experiencing constipation lasting over 6 months.
- Peak incidence at the time of toilet training (around 2-3 years old).
- Also common during weaning and school age.
- Under-reported, with signs and symptoms often overlooked.
Constipation Treatment Algorithm
- Aim to restore normal bowel function.
- Adjust constipating medications if possible.
- Avoid laxatives if obstruction is suspected.
- Increase dietary fiber, fluid intake, and exercise.
- Offer oral laxatives if dietary measures are ineffective.
- Start with bulk-forming laxatives, then add osmotic laxatives if necessary.
- If stools are soft but passing is difficult, add a stimulant laxative.
- If constipation is due to opioids, stop laxatives when stools become soft and easily passed.
- Avoid excessive laxative doses to prevent diarrhoea and electrolyte disturbances.
Treating Constipation in Children
- Offer age-appropriate behavioural interventions:
- Scheduled toileting.
- Bowel habit diaries.
- Encouragement and reward systems.
- Provide diet and lifestyle advice, including fluid intake and high-fibre foods.
- Recommend a balanced diet with sufficient fibre.
- Do not recommend unprocessed bran or fibre supplements.
- Do not switch formula or change milk intake without specialist advice.
- Encourage physical activity appropriate for the child's age and ability.
- Consult HSE guides on constipation in children and babies.
Constipation Types of Laxatives
- Bulk-forming laxatives:
- Examples: ispaghula husk (Fybogel), sterculia (Normacol).
- Retain fluid within the stool, increasing faecal mass and stimulating peristalsis.
- Have stool-softening properties.
- Increase fluid intake to prevent obstruction.
- Osmotic laxatives:
- Examples: lactulose.
- Increase fluid in the large bowel, drawing fluid from the body.
- Produce bowel distension, stimulating peristalsis.
- Have stool-softening properties.
- Requires adequate fluid intake.
- Stimulant laxatives:
- Examples: bisacodyl (Dulcolax), senna (Senokot), glycerol suppositories.
- Stimulate peristalsis by activating colonic nerves.
Enema
- MicroLAX® is a fast-acting micro-enema
- Provides rapid relief from constipation within 5-15 minutes.
- Works locally in the rectum without intestinal irritation.
- Softens hard faeces and acts as a lubricant.
Haemorrhoids
- Referral Required:
- Individuals over 40 years old with persistent changes in bowel habits.
- Unexplained bleeding.
- Severe pain associated with defecation.
- Blood mixed in stool.
- Fever.
- Treatment failure lasting more than 7 days.
Haemorrhoid Treatment
- Diet
- Minimize constipation and straining.
- Take a laxative if needed.
- Bulk-forming laxatives preferred.
- Lactulose is an alternative.
- Stimulants should not be used as they do not soften stools and may worsen symptoms.
- Symptomatic Relief
- Analgesics, such as paracetamol.
- Topical products:
- Soothing preparations containing mild astringents, emollients, or lubricants preferred.
- Topical corticosteroids and local anaesthetics can be used for perianal inflammation and pain.
OTC Haemorrhoid Treatment Options
- Anaesthetics: lidocaine, benzocaine – provide short-term relief from itching and pain.
- Astringents: zinc, bismuth – create a protective coating over the haemorrhoid and have antiseptic properties.
- Anti-inflammatory: hydrocortisone – reduces swelling of the haemorrhoid.
- Referral: sclerotherapy, rubber band ligation, or haemorrhoidectomy.
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Description
This quiz covers the various causes and types of diarrhea, including acute and chronic forms. It also delves into the pathophysiology associated with increased osmotic and secretory loads. Test your knowledge on how factors like infections and dietary issues contribute to this common condition.
