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Primary Care Liaison

Diarrhoea - chronic non bloody

  • Initial work-up

    • History (travel, diet - including softdrink and lolly intake)
    • Stool MC&S x 1 - Ova and parasites (ie.giardia)
    • Stool for clostridium difficile toxin
    • Stool occult blood
    • Stool for fat and fatty acid crystals
    • FBE with diff, ESR or CRP
    • LFTs 
    • Coeliac serology and total IgA
    • Weight and height evaluation
    If growth failure or excess fat droplets in stool, consider -

    Recommended pre-referral treatment

    • Increase fibre in diet.
    • Consider osmotic diarrhoea (eg.high fruit juice or soft drink or lolly intake). Provide advice as needed to modify diet.
    • Consider lactose intolerance, especially in children aged ~7-10 years old and/or of non-European background.

    When to refer

    • Blood = refer
    • Positive coeliac serology = refer. See  Coeliac pre-referral guideline.  Coeliac pre-referral guideline. NB: It is vital the child does NOT change their diet while waiting for the appointment.
    • If conventional therapy such as diet medication has failed, refer for further evaluation.
    • Consider contacting the  RCH Dept of Gastroenterology for advice before referring.

    Resources

    References and more reading

    • Paediatric Handbook (2009). Gastrointestinal Conditions, Chapter 27 George Alex and Lionel Lubitz. Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

     

    Guideline developed by the RCH Department of Gastroenterology in consultation with a GP Review Group and RCH Primary Care Liaison. First published Nov 2007. Reviewed Oct 2011. Please read  Copyright and Disclaimer