Which type of diarrhea is common for a child with Crohn's disease?

NVS Staff Nurse - 2022

Child Health Nursing (Pediatrics)

Medium

Appeared in: NVS Staff Nurse - 2022

Explanation

Crohn's disease is a form of inflammatory bowel disease (IBD) characterized by chronic inflammation and ulceration of the gastrointestinal tract.
This inflammation damages the intestinal mucosa, compromising its integrity.
The damaged mucosa leaks (exudes) fluid, blood, mucus, and proteins into the intestinal lumen.
This process defines exudative diarrhea, which is a hallmark symptom of active Crohn's disease.

Option A: Secretory diarrhea is caused by active ion secretion into the gut, often triggered by bacterial toxins (like cholera) or hormones. It results in large-volume watery stools but is not primarily driven by mucosal destruction and leakage of blood and pus.
Option C: Osmotic diarrhea occurs when poorly absorbed substances (like lactose or sorbitol) remain in the gut and draw water into the lumen. This type of diarrhea typically stops when the patient fasts.
Option D: Motility-related diarrhea is caused by abnormally fast intestinal transit, which reduces the time available for water and electrolyte absorption. While motility can be altered in Crohn's disease, the primary mechanism is inflammation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of diarrhea in Crohn's disease to guide bedside assessment, documentation, and the next nursing action.
Nurses must accurately assess and document stool characteristics (frequency, consistency, presence of blood or mucus) in children with IBD, as this is a key indicator of disease activity and treatment effectiveness.
Monitoring for signs of dehydration, electrolyte imbalance, and malnutrition is a critical nursing responsibility, as chronic diarrhea can lead to severe complications.
Patient education is vital. Nurses teach families how to manage symptoms, adhere to treatment plans, and recognize signs of a flare-up that require medical attention.

How to Approach the Question

First, identify the key condition in the question stem: Crohn's disease.
Recall the core pathophysiology of Crohn's disease. It is an 'inflammatory' bowel disease that causes 'ulceration' and 'damage' to the intestinal lining.
Next, analyze the options, which are four distinct mechanisms of diarrhea.
Match the pathophysiology of Crohn's (inflammation, damage, leakage) to the definition of each type of diarrhea.
Exudative diarrhea is defined by the leakage of fluid, blood, and pus from a damaged mucosal surface. This directly matches the pathology of Crohn's disease.
Eliminate the other options by contrasting their mechanisms: Secretory (toxins/hormones), Osmotic (solutes), and Motility (transit time).

Concept Tested & Keywords

Concept Tested: Pathophysiology of diarrhea in Crohn's disease
Stem keywords: Crohn's disease, child, diarrhea
Lead-in keywords: Which type
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 158-160, 9-11

E6 Medicine Harrison 22e Part 1 p. 348-350