PBL 4

Question 1

what is gastroenteritis

Answer 1

infection of the intestines

Question 2

what is the presentation of gastroenteritis

Answer 2

• Causes diarrhoea and may also cause symptoms such as vomiting and abdominal pain.
o Usually the infection clears within a few days (can sometimes take longer).

Question 3

what is the main risk of gastroenteritis

Answer 3

Main Risk: dehydration.

Question 4

How do you treat gastroenteritis

Answer 4

Treatment: rehydration.
• May include rehydration drinks.
• Most children recover at home within a few days.
o 1/5 needs to see doctor.
o 1/10 ends up in hospital due to complications.
NOTE: many children have more than one episode in a year

Question 5

How can the severity of gastroenteritis vary

Answer 5

Severity: can range from an upset stomach (from a day or two with mild diarrhoea) to severe diarrhoea and vomiting for several days or longer.

Question 6

what are the causes of gastroenteritis

Answer 6

• Various bacteria, viruses and other microbes can cause it.

Question 7

what is the most common cause of gastroenteritis

Answer 7

rotavirus

Question 8

what other viruses can cause gastroenteritis

Answer 8

o Norovirus (may be as common as rotavirus), astrovirus and adenovirus.

Question 9

when you tend to get the rotavirus

Answer 9

• Almost every child in the UK has a rotavirus infection before they are 5 years old

Question 10

how do you prevent gastroenteritis

Answer 10

• vaccine
• good hygiene
• wash hands regular
• teach child to wash hands
• proper storage, preparation and cooking of food

Question 11

describe the vaccine of rotavirus

Answer 11

• A vaccine against rotavirus was introduced in the UK in September 2013 (Brand name: Rotarix).
o Given drops by mouth at around 2 to 3 months old.
o Rotavirus vaccine has prevented more than 70% of cases.

Question 12

Is lactose a disaccharide or a monosaccaride

Answer 12

• Disaccharide

Question 13

where do you find lactose

Answer 13

mammalian milk and dairy products.

Question 14

what is lactose broken down into

Answer 14

o Hydrolysed by lactase into the monosaccharides = glucose and galactose

Question 15

what happens to the sugars glucose and galactose

Answer 15

These sugars can be transported across the brush border.

• Intracellular glucose goes into the portal capillary blood.

Question 16

what is the most common cause of secondary lactose intolerance

Answer 16

• Most common cause of secondary lactose intolerance is gastroenteritis

Question 17

describe the mechanism of action of how lactose can lead to diarrhoea

Answer 17

• The enzyme lactase is found on the brush border membrane of enterocytes lining the villi of the SI.
• When the lining of the small intestine is damaged, there will be a reduction/lack of lactase.
o Lactase cannot hydrolyse lactose.

If lactose is unhydrolysed, it cannot be absorbed and accumulates.
• Leads to an increase in osmolarity, which will cause water to be retained in the lumen of the SI.

Large Intestine
• Unabsorbed lactose will move into the LI/colon
o Metabolised by bacterial enzymes.
o Further increases the osmolarity in the lumen of the intestine and water retention.

Question 18

How do you diagnose a lactose intolerance

Answer 18

• This bacterial fermentation also produces H2, CO2, CH4, lactic acid and acetic acid.
o Can be observed in the stool.

Question 19

describe how an gastrointestinal infection leads to lactose intolerance

Answer 19

• so you have a gastrointestinal infection such as rotavirus
• this causes damage to the brush border enzymes of the small intestine which decreases lactase
• therefore there is an increase in the amount of lactose in the small intestine and thus an increase in the osmolarity and retention of water
• bacterial fermentation of lactose in the large intestine produces hydrogen, carbon dioxide and methane with the formation of lactic acid and acetic acid and reabsorbed water
• acids leads to the sore bottom
• gasses lead to wind and abdominal main
• water leads to frequent watery stools

Question 20

what are the symptoms of gastroenteritis and explain what causes them

Answer 20

o Causes abdominal pain (CO2 and other gases).
o Acids causes sore bottom
o Water causes diarrhoea.

Question 21

how do you treat secondary lactose intolerance caused by gastroenteritis

Answer 21

The condition gets better when the infection is finished.
• Cutting out dairy products from the diet for a few weeks/months will give the gut lining time to heal.
o Ability of the gut to produce lactase will build up again and the child will be able to eat dairy.

Question 22

what are the risk factors that cause gastroenteritis causing lactose intolerance

Answer 22

• High sensitivity of the gut to infectious agents
• Low reserve because of the SI surface area.
• High reliance on milk-based products for nutrition.

Question 23

what should you investigate if anklets diet does not improve on a lactose free diet

Answer 23

investigate for coeliac disease

Question 24

what is faltering growth

Answer 24

Faltering growth (or failure to thrive) is used to describe suboptimal weight gain in infants/toddlers.

Mild faltering growth: fall across two centile lines.

Severe faltering growth: fall across the three centile lines

Question 25

when is general faltering growth assessment required (remember this card)

Answer 25

o Height centile is more than 3 centile spaces below mid-parental centile.
o Drop in Height Centile Position of more than 2 centile spaces.

Question 26

what’s the problem with diagnosing faltering growth

Answer 26

• Differentiation an infant who is failing to thrive from a normal but small thin baby is a problem

Question 27

describe what normal but short infants would be like

Answer 27

• Alert, responsive and happy, and their development is satisfactory.
o Infant may have been extremely preterm/growth-restricted at birth

Question 28

How do you calculate the low mid parental centile

Answer 28

 Boy = (Father’s Height + Mother’s Height + 13) / 2 (cm)

 Girl = (Father’s Height - 13 + Mother’s Height) / 2 (cm).

Question 29

how would a child with recent onset faltering growth look like

Answer 29

• Usually maintain their height which is compromised by prolonged severe illness.
o May impact child’s developmental progress.

Question 30

what are the organic causes of inadequate intake and poor growth

Answer 30

Impaired ability to suck

• this can be an oro-motor dsyfcution, neurological disorder such as cerebral palsy
• can be due to cleft palate

Chronic illness leading to anorexia

• croons disease
• chronic renal failure
• cystic fibrosis
• liver disease

Question 31

what are the non organic causes of inadequate intake and poor growth

Answer 31

Inadequate availability of food

• feeding problems
• insufficient or unsuitable food offered
• lack of regular feeding times
• infant difficult to feed
• problems with money
• low socioeconomic status

Psychosocial deprivation

• poor maternal-infant interaction
• maternal depression
• poor maternal education

Neglect or child abuse
- includes factious illness; deliberate underfeeding to generate failure to thrive

Question 32

what can cause inadequate retention of food

Answer 32

• vomiting
• severe
• GORD

Question 33

what can cause malabsorption of food

Answer 33

• coeliacs disease
• cystic fibrosis
• cows milk protein intolerance

Question 34

what can cause failure to utilise nutrients

Answer 34

• chromosomal disorder such as down syndrome, IGUR, congenital infection, metabolic disorders

Question 35

what can cause increased requirements

Answer 35

• Thyrotoxicosis
• cystic fibrosis
• malignancy
• chronic infection such as HIV
• congenital heart disease