Practice 10-Minute Consultation

Chronic diarrhoea in a teenager

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.39490.625197.BE (Published 14 July 2008) Cite this as: BMJ 2008;337:a430
  1. Sonia Saxena, senior lecturer and honorary consultant in primary care1,
  2. Sally G Mitton, consultant and honorary senior lecturer in paediatric gastroenterology2,
  3. Richard Pollok, consultant and honorary senior lecturer in gastroenterology3
  1. 1Department of Primary Care and Social Medicine, Imperial College London W6 8RP
  2. 2Department of Child Health, St George’s University London, London SW17 0RE
  3. 3Department of Gastroenterology, St George’s Hospital Trust, London SW17 0QT
  1. Correspondence to: S Saxena s.saxena{at}imperial.ac.uk
  • Accepted 10 September 2007

A 14 year old boy has a three year history of loose stools with intermittent abdominal pain. He is the smallest boy in his class.

What issues you should cover

What is the risk of underlying disease?

Chronic diarrhoea is defined as >3 loose or liquid stools a day, lasting more than three weeks. This may indicate an underlying non-infectious diagnosis, such as coeliac or inflammatory bowel disease, particularly if accompanied by delayed development or growth retardation. A key consideration is whether the boy’s gastrointestinal symptoms and growth are pathological, and if so, whether they are related. Since issues around puberty and diarrhoea may be embarrassing for him, it may be better to conduct the consultation without his mother present.

History

Ask about consistency and frequency of diarrhoea. Paleness and foul smell with residual fat droplets in the toilet water suggests fat malabsorption. Blood in the stool may occur with infection or inflammatory bowel disease. Mucus and pus are more likely with inflammatory bowel disease. A history of foreign travel in developing countries may indicate bacterial or …

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