HD PBL 4

Question 1

What is the main sign of acute gastroenteritis in infants (6months - 2 years)? How long does this last?

Answer 1

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

Question 2

What is the most common cause of gastroenteritis (in children)?

Answer 2

Rotavirus

Question 3

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?

Answer 3

dose 1 = 2 months old

dose 2 = 3 months old

Question 4

What are the different viral causes of gastroenteritis?

Answer 4

1. rotavirus
2. norovirus
3. adenovirus

Question 5

What are the different bacterial causes of gastroenteritis?

Answer 5

1. camplyobacter
2. E coli
3. salmonella
4. shigella

Question 6

What are the different parasitic causes of gastroenteritis?

Answer 6

1. Giardia

2. Cryptosporidium

Question 7

Explain the pathophys of acute gastroenteritis?

Answer 7

• damage to villous brush border of enterocytes
• malabsorption of intestinal contents
• results in osmotic diarrhoea

Question 8

What are the main complications of acute gastroenteritis?

Answer 8

1. extreme dehydration:
   - can lead to HYPOVOLAEMIC shock
   - as there is an increased SA:Vol, children have higher basal fluid requirements
2. Lactose intolerance:
   - damage and loss of mature enterocytes
   - can result in damage/loss of lactase
   - unable to digest lactose

Question 9

What ion channels are found on the apical and basolateral membrane of enterocytes?

Answer 9

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

Question 10

How is acute gastroenteritis without dehydration managed?

Answer 10

• continue breast feeding/other milk feeds
• encourage fluid intake (but not of fruits juices/carbonated drinks)
• oral rehydration solution as a supplement

Question 11

How is acute gastroenteritis with dehydration managed?

Answer 11

• 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

Question 12

What are the signs of dehydration in an infant?

Answer 12

• Sleepiness
• Crying without tears
• Sunken fontanelles
• Sunken eyes
• Irritability
• No/reduced urination
• Increased thirst
• Skin is less elastic

Question 13

What are the roles of a health visitor?

Answer 13

1. Promote good parenting and childcare
2. Offer advice about healthy eating
3. Detect faltering growth
4. Immunisation schedule

Question 14

What are the S+S of lactose intolerance?

Answer 14

• nausea + vomiting
• failure to thrive
• diarrhoea
• symptomatic improvement after avoiding lactose

Question 15

How can lactose intolerance lead to diarrhoea? What other symptoms might accompany this?

Answer 15

• 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

Question 16

How can lactose intolerance lead to flatulence and skin irritation?

Answer 16

• 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

Question 17

When would a lactose hydrogen breath test be performed? Describe the process of this test and a +ve result.

Answer 17

• 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

Question 18

What stool investigations are carried out if lactose intolerance is suspected?

Answer 18

1. Stool pH:
   - initial test done in infants
   - reduced pH is indicative of lactose intolerance
2. Faecal reducing substances:
   - measure reducing sugars (lactose) in the stool
   * reduces cupric ions –> cuprous ions
   - not specific in infants

Question 19

What is faltering growth? When is it considered mild and when is it considered severe?

Answer 19

Suboptimal weight gain + growth of infants/toddlers

• Mild = fall across 2 centiles
• Severe = fall across 3 centiles

Question 20

What are the potential causes of suboptimal growth?

Answer 20

1. inadequate nutrient intake (organic/non-organic)
2. inadequate nutrient absorption
3. increased metabolic requirement
4. increased intestinal/urinary losses
5. ineffective metabolism /utilisation

Question 21

What are the organic causes of inadequate nutrient intake?

Answer 21

1. chronic illness:
   - Crohn’s
   - CF
   - Liver disease
2. impaired feeding:
   - Cleft palate
   - Cerebral palsy
   - GORD

Question 22

What are the non-organic causes of inadequate nutrient intake?

Answer 22

1. Unavailability of food:
   - feeding problems
   - money
   - inefficient/inadequate food
2. Psychosocial:
   - poor interaction
   - maternal depression
   - poor maternal education
3. Neglect/child abuse

Question 23

What foods should be included to provide calcium in a diet that excludes dairy products?

Answer 23

Any from:

• Green leafy vegetables
• soya bean and tofu
• bread and fortified cereals
• fish