Gastroenterology - Nutrition/GORD/Constipation

Question 1

How much feeding do babies need?

Answer 1

150mls/kg/day 20mins is a good breast feed

Question 2

What are the advantages of breast feeding?

Answer 2

provides ideal nutrition for infants 
reduces risks of infection 
enhances mother-child relationship 
reduces the risk of diabetes, HTN and obesity in later life 
provides close attachment

Question 3

Describe infant formula?

Answer 3

milk has been modified to make their mineral content and renal solute load comparable with human milk no evidence that one brand is superior

Question 4

What are the causes of weight faltering?

Answer 4

Inadequate intake environmental

• inadequate availability of food
• psychosocial deprivation
• neglect or child abuse pathology
• impaired suck and swallow (cerebral palsy or cleft lip)

Inadequate retention
- vomiting, severe gastro-oesophageal reflux

Malabsorption

• coeliac disease, CF, NEC Failure to utilize nutrients
• syndromes, chromosomal disorders (downs, IUGR)

Increased requirements
- CF, thyrotoxicosis, malignancy, chronic infection

Question 5

What are important points of a dietary history?

Answer 5

history of milk feeding age at weaning range and type of foods now taken mealtime routine and eating and feeding behaviours 3 day food diary will helpobserve a meal being taken

Question 6

What is included in a nutrition assessment?

Answer 6

weight 
height 
mid upper arm circumference 
skinfold thickness 
low plasma albumin
low concentration of specific minerals and vitamins
dietary recall
dietary diary low 
lymphocyte count 
impaired cell-mediated immunity

Question 7

What are the presenting features of kwashiorkor) energy/protein deficiency?

Answer 7

oedema may be present
flaky paint skin rash with hyperkeratosis and desquamation
distended abdomen and enlarged liver
angular stomatitis
hair is sparse and depigmented
diarrhoea, hypothermia, bradycardia, hypotension

Question 8

What is the energy intake needed in the first year of life?

Answer 8

0-6 months 
115kcal/kg/24hr - energy 
2.2g/kg/24hr - protein
6-12 months 
95kcal/kg/24hr - energy 
2.0g/kg/24hr - protein

Question 9

What are the signs of overfeeding?

Answer 9

baby gains greater than average weight 
eight of more heavily wet nappies a day 
frequent sloppy bowel movements
extreme flatulence 
large belching milk regurgitation 
irritability 
sleep disturbance

Question 10

What are the red flag symptoms in constipation?

differentiating simple constipation from motility disorders such as Hirschsprung disease

Answer 10

failure to pass meconium in first 24 hrs of life - HS disease
faltering growth - hypothyroidism, coeliac disease abdominal distention - HS/gastrodysmotility
abnormal lower limb neurology or deformity - lumbosacral pathology
sacral dimple above the natal cleft - spina bifida
abnormal anus - anorectal
abnormality perianal bruising - sexual abuse
perianal fistula - perianal crohns

Question 11

What is stool withholding?

Answer 11

rectum becomes dilated in long standing constipation –> loss of feeling the need to defecate –> involuntary soiling occurs
MDT management is needed

Question 12

What is encopresis?

Answer 12

overflow diarrhoea

Question 13

What support can be given to children with soiling?

Answer 13

disimpactation is a long process family and MDT of health professionals must be involved
laxatives should be used

Question 14

How does Hirschsprungs disease present?

Answer 14

failure to pass meconium is first 24 hours of life
abdominal distention
bile stained vomiting in older children - chronic constipation, abdo distention, growth failure

Question 15

What is Hirschsprungs disease?

Answer 15

absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel results in a narrow, contracted segment

Question 16

How is Hirschsprungs managed?

Answer 16

surgical management

initial colostomy followed by anastomoses of normal bowel to anus

Question 17

How does Hirschspruings associated enterocolitis present?

Answer 17

intestinal inflammation 
fever
abdo distention 
diarrhoea 
sepsis 
major cause of mortality and morbidity in children

Question 18

How is gastroenteritis managed?

no clinical dehydration

Answer 18

continue breast feeding and other milk feeds
encourage fluid intake to compensate for increased gastrointestinal losses
discourage fruit juices and carbonated drinks
oral rehydration solution

Question 19

How is gastroenteritis managed?

clinical dehydration

Answer 19

fluid deficit replacement over 4 hours continue breastfeeding ORS

Question 20

How is gastroenteritis managed?

shock

Answer 20

fluid bolus
repeat is necessary
intensive care specialist call

Question 21

What are the signs of dehydration?

Answer 21

appears unwell 
altered responsiveness 
decreased consciousness
pale and mottled skin colour 
reduced skin turgor 
eyes sunken
dry mucous membranes 
tachycardia 
tachypnoea 
extremities cold, 
weak peripheral pulses, 
prolonged cap refill, 
hypotension (if severe)

Question 22

What is gastro-oeseophageal reflux?

Answer 22

involuntary passage of gastric contents into the oesophagus

common in infancy caused by inappropriate relaxation of the lower oesophageal sphincter

Question 23

How is GORD managed?

Answer 23

parental reassurance
adding thickening agents to feeds
hydrogen receptor antagonists/proton pump inhibitors drugs
reduce volume of gastric contents and treat acid-related oesophagitis
surgical management if extremely severe

Question 24

What are the complications of GORD?

Answer 24

faltering growth from severe vomiting 
oesophagitis 
recurrent pulmonary aspiration 
dystonic neck posturing apparent 
life threatening events