PBL 4 Flashcards

1
Q

what is gastroenteritis

A

infection of the intestines

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2
Q

what is the presentation of gastroenteritis

A

• 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).

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3
Q

what is the main risk of gastroenteritis

A

Main Risk: dehydration.

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4
Q

How do you treat gastroenteritis

A

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

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5
Q

How can the severity of gastroenteritis vary

A

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.

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6
Q

what are the causes of gastroenteritis

A

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

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7
Q

what is the most common cause of gastroenteritis

A

rotavirus

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8
Q

what other viruses can cause gastroenteritis

A

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

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9
Q

when you tend to get the rotavirus

A

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

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10
Q

how do you prevent gastroenteritis

A
  • vaccine
  • good hygiene
  • wash hands regular
  • teach child to wash hands
  • proper storage, preparation and cooking of food
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11
Q

describe the vaccine of rotavirus

A

• 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.

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12
Q

Is lactose a disaccharide or a monosaccaride

A

• Disaccharide

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13
Q

where do you find lactose

A

mammalian milk and dairy products.

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14
Q

what is lactose broken down into

A

o Hydrolysed by lactase into the monosaccharides = glucose and galactose

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15
Q

what happens to the sugars glucose and galactose

A

These sugars can be transported across the brush border.

• Intracellular glucose goes into the portal capillary blood.

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16
Q

what is the most common cause of secondary lactose intolerance

A

• Most common cause of secondary lactose intolerance is gastroenteritis

17
Q

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

A

• 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.

18
Q

How do you diagnose a lactose intolerance

A

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

19
Q

describe how an gastrointestinal infection leads to lactose intolerance

A
  • 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
20
Q

what are the symptoms of gastroenteritis and explain what causes them

A

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

21
Q

how do you treat secondary lactose intolerance caused by gastroenteritis

A

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.

22
Q

what are the risk factors that cause gastroenteritis causing lactose intolerance

A
  • High sensitivity of the gut to infectious agents
  • Low reserve because of the SI surface area.
  • High reliance on milk-based products for nutrition.
23
Q

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

A

investigate for coeliac disease

24
Q

what is faltering growth

A

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

25
when is general faltering growth assessment required (remember this card)
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.
26
what's the problem with diagnosing faltering growth
• Differentiation an infant who is failing to thrive from a normal but small thin baby is a problem
27
describe what normal but short infants would be like
• Alert, responsive and happy, and their development is satisfactory. o Infant may have been extremely preterm/growth-restricted at birth
28
How do you calculate the low mid parental centile
 Boy = (Father's Height + Mother's Height + 13) / 2 (cm) |  Girl = (Father's Height - 13 + Mother's Height) / 2 (cm).
29
how would a child with recent onset faltering growth look like
• Usually maintain their height which is compromised by prolonged severe illness. o May impact child’s developmental progress.
30
what are the organic causes of inadequate intake and poor growth
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
31
what are the non organic causes of inadequate intake and poor growth
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
32
what can cause inadequate retention of food
- vomiting - severe - GORD
33
what can cause malabsorption of food
- coeliacs disease - cystic fibrosis - cows milk protein intolerance
34
what can cause failure to utilise nutrients
- chromosomal disorder such as down syndrome, IGUR, congenital infection, metabolic disorders
35
what can cause increased requirements
- Thyrotoxicosis - cystic fibrosis - malignancy - chronic infection such as HIV - congenital heart disease