Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Nutrition, constipation and dehydration > Flashcards

Nutrition, constipation and dehydration Flashcards

1
Q

Daily fluid requirements (>6months)

A

1,500ml/m2/day by surface area

Or by weight - 1st 10kg - 100ml/kg/day –> 2nd 10kg 50ml/kg/day –> each further kg 20ml/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Daily fluid requirements (<6months)

A

Term (1-3months) - 150ml/kg/day

Preterm (<32weeks) - 200ml/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Benefits of breast feeding (6)

A

Ideal nutritions, immunoglobulins & leukocytes, low risk of infection or incorrect mixing. Emotional bonding, oxytocin release, lower risk of obesity/atopic disorders, better neurodevelopmental performance and emotional stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Breast milk vs Cows milk

A

Slightly less energy except in colostrum
More protein, IgG, Casein, less lactose and fat,
Much more ions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diarrhoeal dehydration (2,5,1)

A

The biggest killer of babies globablly. Viral - Rotavirus, Norovirus and others. Bacterial - campylobacter, shigella/salmonella/Enteropathogenic E coli or cholera
Protozoal - Cryptosporidium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mild Dehydration

A

Up to 5% weight loss
Hx of diarrhoea and vomiting, – no/minimal physical signs
Skin turgor and fontanelle tension is normal
Extremities are warm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Moderate Dehydration

A

5-10% weight loss - Signs of contraction of interstitial fluid
Reduced skin turgor, depressed fonanelle, sunken eyes but circulation is maintained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Severe Dehydration

A

10-15% weight loss - Signs of contraction of interstitial fluid and circulatory compromise. Reduced skin turgor, depressed fonanelle, sunken eyes and tachycardia, weak peripheral pulses, delayed cap refill, cold extremities (central/peripheral temp gap >2C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Types of dehydration

A

Defined by ECF tonicity:
Isotonic - plasma Na 130-150mmol/L
Hypertonic - plasma Na >150mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment of deydration

A

Restore the ECF volume with isotonic fluid
Replace K+ and alkali – give K+ and bicarbonate
Maintain nutrition – give local starch staple (polymer base)
Do not interrupt breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

WHO oral rehydration solution

A

3.5g salt 2.5g baking soda
1.5g KCl 20g sugar
In 1L of water - if using polymer base replace sugar with 30g of ground rice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

IV rehydration

A

Used when oral rehydration has failed in moderate to severe dehydration — use isotonic solution and be careful about replacing hypernatreamia too quickly
Re-establish feeding as soon as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of acid/base imbalance in children

A

Respiratory acidosis - CO2 retention in bronchiolitis
Respiratory alkalosis - hyperventilating
Metabolic acidosis - ketoacidosis in diabetes
Metabolic alkalosis - loss of HCl due to pyloric stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Infantile hypertrophic pyloric stenosis

A

Due to fibromuscular hypertrophy of the pylorus - palpable as an olive mass below the right costal margin. Causes projectile vomiting from the 1st wk upto 2months. More in boys and first borns – can lead to FTT. Vomit is never bile stained and HCl is lost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diagnosis of pyloric stenosis

A

USS is diagnostic but can also feel an ‘olive tumor’ during test feed - may be a family history. Persistent jaundice
May be visible peristalsis from left–>right across abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of pyloric stenosis

A

Replace fluid with saline + 20mmol K+
Definitive treatment is longitudinal division
(Ramstedt’s pyloromyotomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diabetic ketoacidosis

A

Metabolic acidosis due to production of ketones from fats to replace sugars which cannot enter cells due to lack of insulin - smell of acetone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why are children dehydrated during ketoacidosis?

A

Hyperglycaemia increases ECF osmolality which causes some water loss from cells (idiogenic osmols defend cell volume) –> hyperglycaemia causes osmotic diuresis causing dehydration and hyponatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Signs of ketoacidosis

A

Impaired consciousness. Ketotic (acetone) breath. Kussmaul’s breathing (deep sighing). Will be acidotic, Low HCO3, hyperglycaemic, hyponatraemic, hypokalemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment of ketoacidosis

A

Treat shock and restore fluid volume with saline (with K+)
Gently lower glucose with small doses of insulin
Do not give alkali and beware rapid changes in osmolality as this can cause cerebral oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Other causes of acid/base imbalance

A

Burns
Acute or chronic renal failure
Diabetes insipidus or psychogenic polydipsia
Congenital adrenal hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Epidemiology of Constipation

A

3% of general paediatric and 25% of paediatric gastro clinics
prevalence 0.3-28% in vulnerable periods

23
Q

Vulnerable periods for constipation

A

Infants: after the introduction of solid foods and weaning onto solid foods. Toddlers: at the time of potty training
Older children: avoiding the bathroom at school

24
Q

Definition of functional constipation in Infants (<4yrs)

A

1/12 with 2 of: 1wk of incontinence after potty training, Hx of retention with painful and large poos with feeling of fecal mass in rectum, accompanying symptoms (irritability, decreased appetite, early satiety)

25
Q

Definition of functional constipation in Infants (>4yrs)

A

2/12 with 2 of: 1wk of incontinence after potty training, Hx of retention with painful and large poos with feeling of fecal mass in rectum, accompanying symptoms (irritability, decreased appetite, early satiety)

26
Q

Disorders of defecation

A

Infant dischezia
Constipation
Retentive incontinence
Non-retentive incontinece soiling

27
Q

Physiology of defecation

A

rectal distention -> the external anal sphincter (EAS) and puborecalis (PR) contract and the internal AS (IAS) relaxes –> Defecation Urge-> If appropriate EAS and PR relax and you poo-> if not EAS and PR remain contracted and IAS recovers tone and defecation urge passes

28
Q

Stool withholding cycle

A

previous painful experience prevents children passing stools which leads to rectal distension > eventually this forms a faecal mass around which liquid stool seeps causing overflow incontinence > distension reduces rectal sensitivity leading to the loss of normal defecation urge

29
Q

Causes of constipation in infants

A

Intestinal obstruction, Hirschsprungs disease, Ano-rectal anomalies (agensis, myelocele), Cystic fibrosis, Functional fecal retention

30
Q

Causes of functional non-retentive fecal incontience

A

IBS Coeliac disease
Myopathies
Other metabolic or endocrine disorders, lead poisoning
Drugs – opiates or antacids

31
Q

How to assess constipation in a child - History

A

Did they pass meconium? Age of onset, consistency and size of stools
Associated symptoms –> pain, blood, Holding posture. Functional constipation risk period/possible causes. Is there incontinence or overflow diarrhoea? Diet and toilet training

32
Q

How to assess constipation in a child - Exam

A

Gen. growth and abdomen (size and masses)
Anal – position, fissures?, redness, signs of abuse, soiling
PR – tone, sensation, presence and quality of stool
Lumbo-sacral dimple with tuff of hair (spina bifida occulta)

33
Q

Red flags for constipation

A

Onset <12months – delayed passage of meconium
No soiling, FTT, Empty rectum, tight anal sphincter
Abnormal neurology and lumbo sacral anatomy
Extra-intestinal symptoms, bladder symptoms, blood in stool

34
Q

Infant dischezia

A

When healthy infants strains and cries to pass soft stools —> abdomino-pelvic dyssynergia
Treat with reassurance

35
Q

Hirschsprung’s disease

A

Lack of nervous innervation of the large bowel

can present from birth into childhood

36
Q

Diagnostics for constipation

A

History and exam are most important
AXR, Barium enema or CT
Can use colonic or anorectal manometry
Sweat test if CF is suspected

37
Q

Treatment of constipation

A

Improve dietary fluid and fiber –> if not able to pass stools evacuate with senna or manually. Give parallel psychological help
Can also use osmotic and stimulant laxatives, also lubricants and bulking agents. Movicol is 1st line in kids

38
Q

Causes of dehydration (3)

A

Gastroenteritis and diarrhoea (biggest for children)
Diabetes
Intestinal obstruction leading to vomiting

39
Q

Homeostatic regulation of body fluid

A

Osmolarity and fluid volume are closely related
At first osmolarity is prioritised —> when volume drops significantly this reverses
Controlled by ADH, distal renal tubules, aldosterone

40
Q

Acute diarrhoea & vomiting - causes

A

Usually in children under 2yrs in the winter
Aetiology: 60% viral, 15% bacterial, 1% protozoan, idiopathic 24%
Differential –> meningitis, DKA, appendicitis, Intussusception

41
Q

Acute diarrhoea & vomiting - presentation

A

D&V , abdo distension and pain, watery stools, mild fever

may have URTI prodrome

42
Q

if invasive bacterial gastroenteritis

A

bloody mucoid stools –> show be treated with abx

May also have high fever, iritability, convulsions, erythema nodosum and arthritis

43
Q

In most cases of gastroenteritis antibiotics are…

A

CONTRAINDICATED because there is a risk of toxicity

and the slow gut transit time which encourages abnormal bowel flora

44
Q

Fluid deficit in dehydration

A

If shock treat with 20ml/kg boluses
Deficit is kg x % dehydration x 10
Aim to replace deficit over 24-48hrs

45
Q

Morbidity of dehydration

A

Early - Oliguria and renal failure, convulsions, pulmonary odema
Late - protracted diarrhoea due to persistent reinfection
Mortality: 6/100,000 in under 5s with gastroenteritis
8% of surviving infants have neurological deficits

46
Q

Causes of chronic diarrhoea in children

A

Well children - toddler’s or non-specific
Malabsorption – cystic fibrosis, Coeliac, lactose intolerance
Infection - giardia lamblia
Inflammatory - crohn’s, cow milk protein intolerance, UC

47
Q

Toddler’s diarrhoea

A

Non-specific diarrhoea in a healthy toddler, especially if there is loose stools with undiagested food. May be linked to a large fluid intake or just rapid transit.

48
Q

Coeliac disease

A

Gluten intolerance which will present before 2yrs with FTT, anorexia, abdo pain/distension, vomiting & diarrhoea and buttock wasting. stools will be pale and foul smelling. gluten free diet and rechallange after 2yrs. 95% are HLA DQ2

49
Q

Secondary lactose intolerance

A

Occurs secondary to Gastroenteritis where the surface mucosal cells with lactose have been stripped away. congential intolerance is rare. switching to soy or breast milk for a period is often enough

50
Q

Cow milk protein intolerance

A

Rare, diarrhoea may be bloody with urticaria/eczema, stridor and wheeze. presents in first 3months. Less common in breast fed babies. switched to hydrolysed formula and rechallanged over a period of time. Usually resolves within 1-2yrs

51
Q

Giardia lamblia

A

Causes outbreaks of watery diarrhoea with weight loss and abdo pain in playcentres. may follow foreign travel. treat with metronidazole.

52
Q

kwashiorkor

A

A form of severe protein-energy malnutrition characterised by oedema, abdominal distension, irritability, anorexia & fatty liver enlargement. this occurs in cases of sufficient calories but insufficient protein. May also have thinning or discoloured hair, loss of teeth and skin depigmentation.

53
Q

Marasmus

A

A severe form of calorie deficiency characterised by emacited appearance (<60% of expected body weight). May be fretful, irritable and extremely hungry

Paediatrics (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions