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Final Pediatre > Chronic Diahria In Infants > Flashcards

Chronic Diahria In Infants Flashcards

1
Q

State 3 definitions of diahria

A

-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)

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2
Q

We should eliminate the “false diarrhoea”of chronic constipation
T or f

A

T

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3
Q

What is the definition of chronic diahria

A

> 15 d

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4
Q

In the absence of any consequence for diarrhia we should think of 2 DD:

A

-toddlers diarrhoea / irritable bowel/ functional colopathy
-prandial diarrhea of infants

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5
Q

What is the cause of prandial diarrhoea

A

Physiological cause
These children when ingesting milk go to stool directly (still absorb nutrients but consistency of stool changes)

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6
Q

In functional colopathy there is a dysfunction in colon leading to chronic diahria

A

F, the colon is fully functional

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7
Q

Toddlers diahria is the most frequent cause of chronic diahria in infants aged between 1 to 4y and having bad W and L curve

A

F
They have good W L curve

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8
Q

Why does toddlers diahria develop

A

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

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9
Q

Harmful effects of fruit juice

A

-dental carries
-obesity
-malnutrition
-abd pain
-diahria

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10
Q

How can we avoid the harmful effects of fruit juice

A

-not from bottle
-not before 6m
-whole fruit is better
-pastured

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11
Q

State the cases where we have N weight to height curve associated with chronic diahria

A

1) toddlers diahria/ irritable bowel
2) pancreatic insufficiency
3) sugar malabsorption

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12
Q

State the cases where we have abnormal weight to height curve associated with chronic diahria

A

-malabsorption (celiac and APLV and giardia)
-maldigestion
-inflammation

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13
Q

In case of clinical impact of diahria, what organic cause may be present

A

1) Celiac dz and gluten intolerence
2) CF and pancreatic insuff
3) sugar intolerence
4) cows milk allergy
5) inflammation
6) amebiasis

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14
Q

What are the 3 examinations that we should do when a pt arrives with chronic diahria

A

1) evaluate the impact of chronic diahria
2) study the fts of digestion and absorption
3) precise etiological orientation

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15
Q

How can we evaluate the impact of the chronic diahria on pts body

A

-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

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16
Q

What are specific tests that are done to study digestion and absorption of sugars

A

•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

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17
Q

What are specific tests that are done to study digestion and absorption of proteins

A

-creatorrhea
-clearance of alfa 1 antitrypsin
(Anti trypsin is not digested by trypsin, it appears only in case of exudation)

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18
Q

What are specific tests that are done to study digestion and absorption of fats

A

-carotene level
-fat soluble vitamins level, PT (vit k)
-steatirhea

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19
Q

In practice, 95% of chronic diahria in infants are relevent to 5-6 etiologies

A

T

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20
Q

What are the tests that quickly confirms the cause of chronic diahria

A

-stopping cows milk
-sweat test
-biopsy of SI

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21
Q

Diahria by malabsorption includes

A

-ALVP
-celiac dz
-giardiasis

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22
Q

Villous atrophy exists in

A

-APLV
-celiac dz

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23
Q

APLV is the most SEVERE food intolerance of child

A

T

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24
Q

The milk allergy is more severe in young due to

A

-immature digestive phenomena
-infectious attacks of intestinal mucosa
-familial atopy

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25
Q

Clinical picture

A

-vomiting
-diahria
-cutaneous signs
-malaise

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26
Q

Allergy to what protein in milk

A

Betta globulin

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27
Q

Tx of AVLP includes only BF

A

F
1) BF
2) hypoallergic formula: polypeptide containing formula
3) elementary formula: aa containing formula (neocate)

28
Q

Tx pf AVLP extends for 12 to 15 months with gradual re introduction in hospital

A

T

29
Q

It is recommended to use soybeans since there is no cross reactivity with PLV

A

F

It is not recommended to use soybeans since there is cross reactivity with PLV

30
Q

Celiac disease

A
31
Q

What is celiac dz

A

Immune mediated enteropathy caused by permanent sensitivity to gluten in genetically susceptible individuals

32
Q

Always individuals having celiac are symptomatic
T or f

A

F
They may be:
Symptomatic (GI or extra GI)
Asymptomatic

33
Q

In Asymptomatic individuals, celiac dz may be associated with

A

-IgA deficiency
-Diabetes type 1
-turner
-down syndrome
-1st degree relative
-williams disorder

34
Q

Gluten intolerance is defined based on 3 criteria

A

-malabsorption synd after total/subtotal villous atrophy
-healing of CLINICAL and HX after stopping gluten
-Reappearance of clinical signs &/ only histological lesions after the reintroduction of gluten in diet

35
Q

If typical, 1&2 criteria are accepted with +ve Ab

A

T

36
Q

The typical table of celiac dz consists of

A

-decrease in weight curve after introduction of gluten (6m to 12m)
-fatty diahria
-abd bloating

37
Q

State the GI (classic manifestations appear at 6 to 24m) of celiac dz

A

-vomit
-chronic or recurrent diahria
-constipation
-bloating (abd distention)
-abd pain
-anorexia
-FTT/ wt loss
-irritability

38
Q

Non GI manifestation of celiac

A

-short stature
-osteoporosis
-epilepsy with occ bone calcification
-arthritis
-dental enamel hyoplasia
-delayed puberty
-dermarititis herpatiformis
-hepatitis
-iron deff anemia
-stomatitis
-gluten ataxia and other neurological disorders

39
Q

Dermatitis herpatiformis is unilateral and pruritic

A

F
Bilateral
With severe pruritis

40
Q

Dermatitis herpatiformis is 90% not associated with GI symptoms
And indicates 75% villous atrophy

A

T

41
Q

Malabsorption tests done in case of celiac

A

-sugar: D xylose and folate
-fat: steatorreha, deficiencies in fat soluble vitamins
-late bone maturation

42
Q

Screening for celiac is done by doing different types of Ab
What are these

A

-anti endomysial Ab
-anti gliadin
-anti reticulin
-anti transglutaminase

43
Q

HLA studies are not imp in celiac dz

A

F
Both HLA DQ (2 and 8)
HLA DQ2: found in 95% of celiac pts
HLA DQ8: found in others

44
Q

HLA testing has a high negative predictive value for celiac dz
T or f

A

T

45
Q

How can we confirm celiac dz

A

-by SI biopsy
Total or subtotal atrophy of villi with decrease in villous /crypt ratio
OR lyphoplasmocytic infiltration

46
Q

What are the changes that occur under gluten exlusion

A

-Rapid restart of growth
-villous regrowth in 6 to 12 m
-regression of all clinical signs with sometimes clinical sensitivity to diet disorder

47
Q

Long term symps specially if No gluten free diet

A

-digestive cancer (lymphoma of SI and adenocarcinoma)
-autoimmune dz (diabetes, thyroditis)

with a probable preventive effect of a diet for life

48
Q

Tx for celiac

A

Gluten free diet
Avoid Barley, wheat, rye, oat

49
Q

Giardasis (lambliasis) can give chronic disruption by malabsorption with true pseudoceliac

A

T

50
Q

Dg of giardiasis

A

-parasitological exam of stool
-Ag in stool is more sensitive
-duodenal brushing / search for lamblia in the lining of the loops in biopsy

51
Q

Infection of gardia is severe and can be severe in IGA deficiency

A

T

52
Q

Maldigestion disorders

A

-pancreatic origin
-biliary origin —> no N bile: imp for lipid digestion
-disachharide intolerence
-intolerence to sugar of active transport (glucose)

53
Q

Disorders of pancreatic origin

A

-CF
-schwachman synd
-Janson blizzard synd
-dficit pancreatic lipase
-deficiency in enterokinase

54
Q

CF is an auto d dz

A

F
Auto R affecting CFTR gene

55
Q

Clinical presentation of CF

A

-chronic diahria
-not able to compensate completely
-recurrent infection
-thick secretions :
thick bile
Thick nasal discharge
Thick stool ( obstruct SI (ilius))
Thick sweat (hyponatremia)
Thick sperm secretion

56
Q

Confirm CF by which test

A

Sweat test
Genetic mutation search

57
Q

N to high fat diet is good in CF to decrease lung infection

A

T

58
Q

Schawchman synd has pancreatic exocrine insufficiency

A

T

59
Q

What are other characteristics of schwachman

A

-recurrent infections
-neutropenia other hematological abnormalities (pancytopenia)
-Metaphyseal dysostosis (ribs or femoral head)
-Dwarfism :
Liver - Myocardial fibrosis - Mental
retardation - Myelo or lymphoblastic leukemia

60
Q

Janson synd is characterized by replacement of pancreatic cells by fat tissue

A

T

61
Q

Clinical manifestations of janson

A

-digestive abn (anal imperforation )
-absence of nasal cartilage
-deafness
-pancreatic insuff
-diabetes

62
Q

Also in pancreatic maldigestion we have
Deficiency in pancreatic lipase
Deficiency in enterokinase

A

T

63
Q

In deficiency in pancreatic lipase we can eat lipids

A

F; we cant eat lipids since stool will appear very fatty mtl shame3

64
Q

What is enterokinase

A

A digestive enzyme from duo that insure the activation of trypsin (protein problem)

65
Q

Sugar intolerance

A
66
Q

What are 2 mech of sugar intolerence

A
  • absence of disacharidase that causes lack of hydrolysis of disach—> the most common mechanism
    Rarely

Final Pediatre (5 decks)

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