Gastroenterology — MCQs

Q: What is the most common electrolyte disturbance observed in children with severe viral enteritis?

Isotonic dehydration with Acidosis. ***Isotonic dehydration with Acidosis*** - This is the **most common** electrolyte disturbance in severe viral enteritis due to equal loss of water and electrolytes, leading to **isotonic dehydration** (serum sodium 130-150 mEq/L). - **Metabolic acidosis** frequently accompanies severe diarrhea as the intestine loses significant amounts of bicarbonate in stool. - Accounts for approximately **70-80%** of dehydration cases in acute gastroenteritis. *Isotonic dehydration with Alkalosis* - While isotonic dehydration is common, **alkalosis** is rare in severe viral enteritis. - Diarrhea typically causes **bicarbonate loss**, leading to acidosis, not alkalosis. - Alkalosis would only occur with predominant vomiting without diarrhea (uncommon in viral enteritis). *Hypotonic dehydration with Acidosis* - **Hypotonic dehydration** (more water loss than electrolytes) is less common, occurring in only **10-15%** of cases. - Usually results from inappropriate fluid replacement with hypotonic solutions or specific electrolyte-losing conditions. - While acidosis can be present, the primary dehydration type in typical viral enteritis is isotonic, not hypotonic. *Hypotonic dehydration with Alkalosis* - **Hypotonic dehydration** is uncommon, and **alkalosis** is very rare in severe viral enteritis. - Severe diarrhea almost invariably causes metabolic **acidosis** due to bicarbonate loss, making this combination extremely unlikely.

Q: What is the duration that defines persistent diarrhea in infants?

14 days or more. ***14 days or more*** - According to the World Health Organization (WHO) definition, **persistent diarrhea** is any diarrheal episode lasting for **14 days or longer**. - This duration signifies a more severe and prolonged condition, requiring different management strategies than acute diarrhea. *Less than 14 days* - Diarrhea lasting **less than 14 days** is typically classified as **acute diarrhea**. - Acute diarrhea is generally self-limiting and often caused by different pathogens and mechanisms compared to persistent diarrhea. *More than 14 days but less than 21 days* - While this period falls within the definition of **persistent diarrhea**, it is not the complete and most accurate definition. - The definition encompasses **any duration equal to or greater than 14 days**. *More than 21 days* - Diarrhea lasting **more than 21 days** is a severe form of persistent diarrhea and may be termed **chronic diarrhea** by some, but the general definition of persistent diarrhea starts at 14 days. - While concerning, it is not the initial threshold for defining persistent diarrhea.

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Gastroesophageal Reflux

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Acute and Chronic Diarrhea

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Constipation and Encopresis

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Gastrointestinal Bleeding

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Intestinal Obstruction

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Liver Diseases in Children

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Pancreatic Disorders

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Pediatric Nutritional Support

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