EM nutrition Flashcards
Vitamin ____ is involved in cellular oxidation through reduction reactions; it is required for the normal growth and maturation of cells. It helps form the ground substance among cells of the capillary walls, collagen, and osteoid tissue.
Vitamin C
Seizures, irritability, peripheral neuritis, dermatitis, and microcytic anemia can be seen with a deficiency of vitamin B6, or pyridoxine. It is a vitamin found in yeast, rice polishings, and cereals.
It serves as a coenzyme in the metabolism and transfer of amino acids. Primary deficiencies are rare, but secondary deficiencies due to malabsorption, diarrhea, or certain drugs like isoniazid can occur.
____ food poisoning can be seen with desserts that are filled or topped with cream, salads made with mayonnaise, dairy products, meat salads, and some other foods as well. Contamination occurs during the preparation of the food.
Staphylococcus aureus. When the food is kept at room temperature, the bacteria, Gram-positive cocci, rapidly reproduce and produce a heat stable toxin. Symptoms usually occur within several hours of eating the contaminated food. Food poisoning by Staphylococcus aureus produces nausea, vomiting, and diarrhea.
_____ is useful for assessing the adequacy of dosage of medication in children with GERD.
Esophageal pH monitoring
The triad of colicky abdominal pain, vomiting, and rectal bleeding in 3 moth to 1 yr age group is a reliable hint to the diagnosis of ____. Rare presentations, such as those with neurological symptoms, subacute, or chronic forms, can also occur.
Intussusception is the ‘telescoping’ of bowel into the adjacent segment of the bowel. It is most common in male children of the age group 3 months-1 year. The most commonly involved sites are the terminal ileum and ileocecum.
In intussusception a mechanical lead point can be identified in children above 2 years, such as abdominal trauma, hemangioma, Meckels diverticulum, and foreign body; however, in younger children it is assumed to be a
previous viral infection causing hypertrophy of Peyer’s patches. This leads to intussusception, strangulates venous return, and results in the classic consequences of bowel swelling, ischemia, and perforation.
_____ is both diagnostic and therapeutic for intussusception.
A contrast enema. Reduction can be achieved in most cases. There is a chance of recurrence in 10% of children, which can be treated again by contrast barium enema.
Bilious vomiting is caused by intestinal obstruction distal to the ampulla of Vater. In the newborn period, _____ is a common cause of obstruction.
midgut volvulus. Malrotation, in which the intestine fails to rotate 270 degrees during fetal development, results in malpositioning, obstruction, and volvulus. Ischemia and infarction occurs as the small intestine twists around the superior mesenteric artery. Although it can appear at any age, volvulus from malrotation typically presents during infancy.
The infant who is suspected of having midgut volvulus should be stabilized by
administration of intravenous fluids, antibiotics, and initiation of nasogastric suction. Radiologic evaluation to confirm the diagnosis should be undertaken after the infant is stabilized.
The radiologic findings of intestinal obstruction due to volvulus include
gastric and proximal duodenal dilatation, paucity of intestinal air, and corkscrew-like appearance of the duodenum.
Emergency surgical intervention to relieve the volvulus and reposition the bowel is essential in any infant suspected of having a midgut volvulus, even without radiologic evaluation. Adhesive bands affecting the small or large bowel, if present, are resected, and the bowel should be inspected for other anomalies. Any ischemic segment of bowel is removed during the initial surgery.
However, if the viability of the affected bowel cannot be confirmed during the initial inspection, a second operation is needed approximately 12 to 36 hours later to define the location of nonviable intestine more clearly. A central venous catheter should be placed to provide access for total parenteral hyperalimentation.
Onset of symptoms usually occurs at 3 to 4 weeks of age but may begin as early as the first week of life or as late as 5 months of age. The primary symptom is intermittent non-bilious emesis that is persistent and progresses to frequent episodes of projectile vomiting. The infant remains hungry despite regular feedings. Dehydration and weight loss ensue over time
Pyloric stenosis occurs in 1:300 to 1:1,000 live births. Caucasians are affected more than twice as often as African Americans and males 5 times as often as females. The risk of an infant developing pyloric stenosis is 6% if either parent had pyloric stenosis as a child.
Plain films of the abdomen are often unremarkable. The diagnosis is established by upper gastrointestinal (GI) series or abdominal ultrasound, which show narrowing and elongation of the pyloric canal. Capillary blood gas reveals
a hypochloremic metabolic alkalosis due to loss of gastric hydrochloric acid. Pyloromyotomy is curative in the majority of patients with a 1% to 3% chance of recurrence.
The skin findings described are typical for acanthosis nigricans. It is found in approximately 7% of children and is almost always associated with obesity. Often the term pseudoacanthosis nigricans is used to describe the lesions in obese children.
Acanthosis nigricans is found in all the other disease processes listed, including
Stein-Leventhal syndrome as well as hypo- and hyperthyroidism, Wilson disease, and adults with malignancies. The skin lesions appear to be a manifestation of insulin resistance. It is thought that the compensatory hyperinsulinism associated with insulin resistance leads to insulin binding to and activation of insulin-like growth factor receptors, promoting epidermal growth.
The diagnosis of _____ heavily depends on the detailed history which can explore many predisposing factors (e.g., decreased exposure to sun, food faddish parents, winter season, overcrowded housing). Both calcium and phosphorus levels are low in the serum.
nutritional rickets
