Persistent and chronic diarrhoea — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar in a general paediatric clinic. A nine-year-old is referred with a six-month history of three to five loose, pale, bulky stools a day, a distended abdomen, tiredness and irritability, and a fall from the 50th to below the 9th centile for weight over the past year. The general practitioner has found a microcytic anaemia. The team asks you to establish the differential and the workup, to explain a serology pitfall, and then to proceed to the management and family counselling. You have 12 minutes with the team and 5 minutes for examiner discussion. ^[1]