Questions sur les maladies intestinales

Introduction to Chronic Diarrhea in Children

• Chronic diarrhea (DC) is a frequent reason for children to visit the doctor.
• Diagnosing the cause of chronic diarrhea requires a systematic process.
• The diagnostic approach involves three key steps:
  • Confirming the presence of chronic diarrhea.
  • Assessing the impact of the diarrhea.
  • Identifying the underlying cause.

Confirming Chronic Diarrhea

• Frequency: 4-6 stools per day (breastfeeding), 1-3 stools per day (formula feeding). 1-2 stools per day after age 1.
• Consistency: Stools can be watery, liquid, fatty, or contain mucus and blood.
• Volume: Stool volume exceeding 2% of the child's body weight for three consecutive days is considered unusual.
• Chronic: Lasting 3-4 weeks or more.
• Recurrent: Episodes of diarrhea coming back.
• Eliminating false diarrhea/constipation cases:
  • Liquid stools, low volume
  • Alternating diarrhea and constipation
  • Presence of fecalomas in the rectum (as seen via exam).

Evaluating Impact of Diarrhea

• Nutritional impact: Assess for weight loss or stagnation on growth charts. Evaluate degree of malnutrition using indicators such as body mass index (BMI), weight-for-height ratio, and loss of subcutaneous fat.
• Impact on developmental milestones, play, and behavior: Examine for signs of delays in physical milestones
• Long-term impact on growth: Check growth charts for any signs of deceleration in growth trends. Assess the timing and degree of any slowing.

Identifying the Cause-Etiology

• History:
  • Age of onset (newborn to adulthood).
  • Medical history (medications, surgeries, chronic illnesses).
  • Dietary history (breastfeeding, formula, foods introduced).
  • Timing of food introduction relative to the onset of symptoms.
  • Previous diets and elimination of specific foods to see if symptoms improve.
• Associated symptoms:
  • Fever.
  • Vomiting.
  • Chronic cough.
  • Skin conditions.
  • Allergies.
• Physical exam: Assess for signs of malabsorption, such as weight loss, stunted growth, unusual skin conditions, and changes in the consistency and color of the stool. Assess for overall nutritional state and other related symptoms, and signs like pallor, abdominal distention or tenderness. Full physical examination of other aspects, for example, cardiac murmurs.
  • Examination of the stool: Color, and consistency.

Diagnostic Tests

• Laboratory tests: Complete blood count (CBC), blood tests for iron, albumin, and electrolytes. Liver function tests; calcium, phospholipid, lipid profiles, and other markers of dehydration.
• Stool sample testing: stool analysis for parasites, culture, presence of sugars and blood.
• Further tests: Upper endoscopy/colonoscopy (if necessary), endoscopic biopsies, X-rays, and other diagnostics to investigate the possibility of complications.
• Note: the investigations may depend whether the patient has a history of treatment like antibiotics, surgery or if they have traveled recently.

Specific Causes of Chronic Diarrhea

• Infections: (identifying specific types of pathogens)
• Food intolerance: (Identifying specific intolerances)
• Disorders linked to foreign travel: (consider geographical origin)
• Malabsorption syndromes: Conditions hampering the absorption of nutrients from the small intestine (causing chronic diarrhea).
• Inflammatory bowel disease: Crohn's disease and ulcerative colitis.
• Genetic diseases: (ex. cystic fibrosis).
• Post-surgical complications: If patient has a history.

Chronic Diarrhea and Malnutrition

• Chronic diarrhea can lead to malnutrition in both the short and long term.
• The prevalence and severity of nutritional impact may vary significantly
• Nutritional deficiency should be investigated and managed as appropriate.

Treatment

• Treatment depends on the underlying cause of the chronic diarrhea.
• Interventions may involve eliminating certain foods or introducing special formulas.
• Replacing lost nutrients, including electrolytes and vitamins, through supplements and diets.

Conclusions

• Any child with chronic diarrhea requires a thorough investigation and a detailed diagnostic approach.
• Effective strategies include a systematic questioning of the parent/guardian concerning the child's diet and health history.
• A comprehensive evaluation is necessary to rule out possible underlying causes and to avoid misdiagnosis and incorrect treatment.

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