HD PBL 4 Flashcards
What is the main sign of acute gastroenteritis in infants (6months - 2 years)? How long does this last?
Increased stool frequency (>3 loose/watery stools in 24 hours) - osmotic diarrhoea
Usually lasts 2+ weeks
Other clinical features:
- vomiting
- fever (>37.8°C)
- abdo cramps
What is the most common cause of gastroenteritis (in children)?
Rotavirus
When should the 1st and 2nd dose of the rotavirus vaccine (i think it’s called RotaRix but I could be making that up lol) be given?
dose 1 = 2 months old
dose 2 = 3 months old
What are the different viral causes of gastroenteritis?
- rotavirus
- norovirus
- adenovirus
What are the different bacterial causes of gastroenteritis?
- camplyobacter
- E coli
- salmonella
- shigella
What are the different parasitic causes of gastroenteritis?
- Giardia
2. Cryptosporidium
Explain the pathophys of acute gastroenteritis?
- damage to villous brush border of enterocytes
- malabsorption of intestinal contents
- results in osmotic diarrhoea
What are the main complications of acute gastroenteritis?
- extreme dehydration:
- can lead to HYPOVOLAEMIC shock
- as there is an increased SA:Vol, children have higher basal fluid requirements - Lactose intolerance:
- damage and loss of mature enterocytes
- can result in damage/loss of lactase
- unable to digest lactose
What ion channels are found on the apical and basolateral membrane of enterocytes?
Apical (from lumen into cell):
- Na+/glucose symporter
Basolateral (cell into blood):
- Na+/K+ antiporter (with Na+ going into the blood)
- K+ channel (into blood)
- Glucose channel (into blood)
*important when thinking about oral rehydration solution
How is acute gastroenteritis without dehydration managed?
- continue breast feeding/other milk feeds
- encourage fluid intake (but not of fruits juices/carbonated drinks)
- oral rehydration solution as a supplement
How is acute gastroenteritis with dehydration managed?
- Oral rehydration solution (give frequently + in small amounts)
- Supplementation with usual food
- Consider NG tube if they can’t drink ORS/vomit persistently
- Monitor regularly
What are the signs of dehydration in an infant?
- Sleepiness
- Crying without tears
- Sunken fontanelles
- Sunken eyes
- Irritability
- No/reduced urination
- Increased thirst
- Skin is less elastic
What are the roles of a health visitor?
- Promote good parenting and childcare
- Offer advice about healthy eating
- Detect faltering growth
- Immunisation schedule
What are the S+S of lactose intolerance?
- nausea + vomiting
- failure to thrive
- diarrhoea
- symptomatic improvement after avoiding lactose
How can lactose intolerance lead to diarrhoea? What other symptoms might accompany this?
- lactose is osmotically active
- as it is not being broken down into glucose + galactose, it pulls water into the lumen
- result is watery diarrhoea
can be accompanied by: abdominal distension + vomiting
How can lactose intolerance lead to flatulence and skin irritation?
- lactose is not absorbed in the small intestine and so is fermented by bacteria
2 things:
1. the byproducts of this fermentation are CO2, lactic acid, methane and hydrogen which causes flatulence
2. the stools become acidic which will lead to skin irritation + breakdown of some skin
When would a lactose hydrogen breath test be performed? Describe the process of this test and a +ve result.
- perform after a -ve stool test in children
- give lactose as 2g/kg after overnight fasting
- take a breath sample and measure baseline hydrogen, and then every 30 minutes for 3 hours after that
- record symptoms
+ve result: >20 ppm of CO2
What stool investigations are carried out if lactose intolerance is suspected?
- Stool pH:
- initial test done in infants
- reduced pH is indicative of lactose intolerance - Faecal reducing substances:
- measure reducing sugars (lactose) in the stool
* reduces cupric ions –> cuprous ions
- not specific in infants
What is faltering growth? When is it considered mild and when is it considered severe?
Suboptimal weight gain + growth of infants/toddlers
- Mild = fall across 2 centiles
- Severe = fall across 3 centiles
What are the potential causes of suboptimal growth?
- inadequate nutrient intake (organic/non-organic)
- inadequate nutrient absorption
- increased metabolic requirement
- increased intestinal/urinary losses
- ineffective metabolism /utilisation
What are the organic causes of inadequate nutrient intake?
- chronic illness:
- Crohn’s
- CF
- Liver disease - impaired feeding:
- Cleft palate
- Cerebral palsy
- GORD
What are the non-organic causes of inadequate nutrient intake?
- Unavailability of food:
- feeding problems
- money
- inefficient/inadequate food - Psychosocial:
- poor interaction
- maternal depression
- poor maternal education - Neglect/child abuse
What foods should be included to provide calcium in a diet that excludes dairy products?
Any from:
- Green leafy vegetables
- soya bean and tofu
- bread and fortified cereals
- fish
