El Mouzan, MD
Professor and Consultant
Department of Pediatrics (Gastroenterology)
College of Medicine and KKUH
King Saud University. Riyadh, Saudi Arabia.
Investigations.
History.
Physical.
Etiology .
Definitions.
Pathophysiology .
Clinical approach
Introduction
Arbitrary .
Duration of the acute episode .
frequency .
Increased volume .
- Diarrhea :
Definitions
Motility
Motility
Motility disorders :
Pathophysiology
Prolonged diarrhea .
Follows acute gastroenteritis.
After clearance of the infection .
Etiology
Selective Malabsorption :
Generalized malabsorption :
malabsorption syndromes
V.I.P-secreting tumors .
Colitis (allergic) .
Gastroenteritis (allergic) .
Generalized malabsorption .
Etiology
diarrhea.
Malnutrition
Miscellaneous etiologies
Age at onset .
Family history .
Special signs :
Stool :
Microscopy (cells,fat, parasites) , and culture.
Occult blood ,
pH and reducing substances .
Elimination/challenge tests .
Celiac disease
The Postenteritis syndrome
Chronic enteritis (I.e Giardiasis)
Cows milk protein allergy
Autoimune enteropathy
Congenital microvillous atrophy
Eosinophilic gastroenteropathy
Gluten-sensitive enteropathy
3 - 6 BMs / day .
Contains undigested vegetables .
First BM (morning) may be firm and large .
Clinical profile
Management
Risk factors
Prevalence
Diarrhea >2wks, following acute GE, associated with F.T.T and no evidence
of other causes.
Definition
loperamide, antibiotics) .
Genetic predisposition :
Pathogenesis
Non-gastrointestinal
Chronic diarrhea
abdominal distension ,
muscle wasting .
Anorexia,
irritability, apathy .
Short stature.
Enamel hypoplasia
Osteopenia, osteoporosis .
Unexplained anemia
Delayed puberty
ALT elevation .
Arthritis
Intractable seizures .
- Dermatitis herpetiformis
Non-gastrointestinal manifestations of CD
Williams Syndrome
Turner Syndrome
Down Syndrome
Autoimmune thyroiditis
Laboratory findings
Sensitivity
0.52-1.00
0.52-1.00
0.88-1.00
0.92-1.00
Test
AGA-IgA
- IgG
EMA-IgA
TTG-IgA
0.91-1.00
0.91-1.00
0.50
0.92-0.97
Specificity
Guideline for the diagnosis and treatment of Celiac disease: recommendation of the
NASPGHAN. J PG N 2005; 40: 1-19.
Diagnostic criteria :
Noncompliance
Consider other diagnoses :
Nonresponse to GFD
Management