Chronic Diahria In Infants Flashcards
State 3 definitions of diahria
-increase in number of stool:
N in artificial feeding ( 1 to 3 per day)
N in BF (4 to 6 per day)
-increase in volume or better stool weight collected over 3 days (normally less than 2% of infant weight)
-change in appearance of stools (watery, liquid, greasy, or bloody)
We should eliminate the “false diarrhoea”of chronic constipation
T or f
T
What is the definition of chronic diahria
> 15 d
In the absence of any consequence for diarrhia we should think of 2 DD:
-toddlers diarrhoea / irritable bowel/ functional colopathy
-prandial diarrhea of infants
What is the cause of prandial diarrhoea
Physiological cause
These children when ingesting milk go to stool directly (still absorb nutrients but consistency of stool changes)
In functional colopathy there is a dysfunction in colon leading to chronic diahria
F, the colon is fully functional
Toddlers diahria is the most frequent cause of chronic diahria in infants aged between 1 to 4y and having bad W and L curve
F
They have good W L curve
Why does toddlers diahria develop
It develops due to errors in diet (abusive diet)
-Too early introduction of food
-Hypolipidic food
-Hyperprotid food
-Hypercaloric food
-increase in fruit juice (An example of inadvertent nutrient insufficiency is the excessive feeding of fruit juice to young
children)
-sorbitol containing products
Harmful effects of fruit juice
-dental carries
-obesity
-malnutrition
-abd pain
-diahria
How can we avoid the harmful effects of fruit juice
-not from bottle
-not before 6m
-whole fruit is better
-pastured
State the cases where we have N weight to height curve associated with chronic diahria
1) toddlers diahria/ irritable bowel
2) pancreatic insufficiency
3) sugar malabsorption
State the cases where we have abnormal weight to height curve associated with chronic diahria
-malabsorption (celiac and APLV and giardia)
-maldigestion
-inflammation
In case of clinical impact of diahria, what organic cause may be present
1) Celiac dz and gluten intolerence
2) CF and pancreatic insuff
3) sugar intolerence
4) cows milk allergy
5) inflammation
6) amebiasis
What are the 3 examinations that we should do when a pt arrives with chronic diahria
1) evaluate the impact of chronic diahria
2) study the fts of digestion and absorption
3) precise etiological orientation
How can we evaluate the impact of the chronic diahria on pts body
-CBC (search for anemia)
-iron
-electrophoresis for proteins ( hypo albunemia/ hypo gammaglobulinemia)
-liposoluble vitamines (A,E, PT for vit K)
-folate
-inflammatory profile
-phosphocalcic profile : alkaline phosphatase, calcemia, radio for bone
What are specific tests that are done to study digestion and absorption of sugars
•sugar:
-sugar reductors in stool
-stool ph
-D xylose test for absorption( N: absorbed, indigested, eliminated by urine/ Abn: eliminated by stool)
-resp test
-serum folate
What are specific tests that are done to study digestion and absorption of proteins
-creatorrhea
-clearance of alfa 1 antitrypsin
(Anti trypsin is not digested by trypsin, it appears only in case of exudation)
What are specific tests that are done to study digestion and absorption of fats
-carotene level
-fat soluble vitamins level, PT (vit k)
-steatirhea
In practice, 95% of chronic diahria in infants are relevent to 5-6 etiologies
T
What are the tests that quickly confirms the cause of chronic diahria
-stopping cows milk
-sweat test
-biopsy of SI
Diahria by malabsorption includes
-ALVP
-celiac dz
-giardiasis
Villous atrophy exists in
-APLV
-celiac dz
APLV is the most SEVERE food intolerance of child
T
The milk allergy is more severe in young due to
-immature digestive phenomena
-infectious attacks of intestinal mucosa
-familial atopy
