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DIARRHOEA

Increased frequency of defecation, with a loosening consistency. In general:

  • Organic aetiology: copious watery diarrhoea/nocturnal diarrhoea – see Lower GI Red Flags
  • Functional bowel disease (i.e. irritable bowel syndrome, anxiety): frequent small amounts of diarrhoea
  • Colonic disease: bloody diarrhoea
  • Infective aetiology: acute diarrhoea.

Diarrhoea in children Infectious diarrhoea is common and in most cases viral (usually rotavirus). Be alert for signs of a serious cause, e.g. blood in stool. Often environmental, reasons being poverty, poor personal hygiene, malnutrition, poor sterilisation if bottle feeding

NICE CG84 Diarrhoea and vomiting caused by gastoenteritis in children under 5: diagnosis and management; 2009 https://www.nice.org.uk/guidance/CG84

Gastroenteritis

Common infection of the stomach and intestines, transmitted mainly by the faecal–oral route and usually highly infectious. Presents with diarrhoea, vomiting and abdominal pain following consumption of infected food or drink (food poisoning) or contact with an infected individual. The rotavirus is the leading cause of gastroenteritis in children. Always ask about recent travel. Usually mild and self-limiting. Individuals with severe symptoms or vulnerable because of age or other illness may need hospital treatment to manage dehydration. Patients should stay away from work or school until 48 hours after last episode of diarrhoea or vomiting.

NICE Clinical Knowledge Summaries (CKS) Gastroenteritis. Management scenarios - child, remote presentation; child, face-to-face; adult; 2020 https://cks.nice.org.uk/gastroenteritis

Lower GI Red Flags 
  • Rectal bleeding, fresh/mixed with stool
  • Dramatic changes in bowel habit: constipation/loose, particularly chronically loose
  • Loss of appetite/unintentional weight loss
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