PBL 4: Faltering Growth

Question 1

Define gastroenteritis

Answer 1

Inflammation of the GI tract, involving the stomach and small intestine, causing infectious diarrhoea. Commonly affects infants between 6 months and 2 years old.

Question 2

Define diarrhoea

Answer 2

Passing 3 or more watery stools per day, or more than what is normal for that individual.

Question 3

Define Rotavirus

Answer 3

Double stranded RNA virus, which is the most common cause of diarrhoea in children.

Question 4

What is faltering growth?

Answer 4

Inadequate weight gain in an infant.

Question 5

What are reasons to assess faltering growth?

Answer 5

• Weight/ height below 0.4 centile.
• Height centile 3 centiles below the mid parental centile.
• A drop in height or weight of more than 2 centile spaces.

Question 6

What is mid faltering growth?

Answer 6

A drop of 2 centile spaces

Question 7

What is severe faltering growth?

Answer 7

A drop of 3 centile spaces

Question 8

What are organic causes of faltering growth?

Answer 8

• Genetic metabolism disorders (Crohn’s, liver disease).
• Gas and acid reflux.
• Coeliac disease.
• Cystic fibrosis.
• Cleft palate.
• Parasites (raise metabolism).
• Lactose intolerance.
• UTIs.

Question 9

What are organic causes of faltering growth?

Answer 9

Due to the child

Accounts for 5% of cases

Question 10

What are non organic causes?

Answer 10

• Physical inability to produce breast milk.
• Child abuse and neglect.
• Maternal depression.
• Lack of money for food.

Question 11

Define non-organic causes?

Answer 11

Due to environment around the child

Question 12

S+S of gastroenteritis?

Answer 12

• Diarrhoea (may also cause dehydration).
• Vomiting.
• Abdominal pain.
• Fever.
• Lethargy.
• Symptoms usually last for 2 weeks, with an incubation time of 48 hours for rotavirus.

Question 13

Causes of gastroenteritis?

Answer 13

bacteria, viruses or parasites.

Transmission occurs from eating contaminated food or water, or through close contact to an infected person.

Question 14

What is the main bacterial cause?

Answer 14

• Campylobacter

Through undercooked meat

Question 15

What is the main parasite?

Answer 15

Giaridia

Through infected water

Question 16

What is most common viral cause of gastroenteritis for children?

Answer 16

Rotavirus

Question 17

What is most common viral cause for adult?

Answer 17

Norovirus

Question 18

What are non-infectious causes of gastroenteritis?

Answer 18

• NSAIDs.
• Lactose for those who are intolerant.
• Gluten in those with Coeliac disease.

Question 19

Rotavirus mechanism?

Answer 19

• Malabsorption occurs due to destruction of the enterocytes.
• Water reabsorption is disrupted by SGLT1 mediated actions from the bacterial toxin protein NSP4.
• Brush border membrane disaccharides have their activity reduced also by NSP4.

Question 20

Complications of gastroenteritis?

Answer 20

• Dehydration can lead to shock.
• Children have a greater surface area to volume ratio, and also higher basal fluid requirements.
• The loss of enterocytes can lead to secondary lactose intolerance.
• The enterocytes contain lactase.

Question 21

Diagnosis of gastroenteritis?

Answer 21

• Clinical diagnosis based on signs and symptoms.

* Diarrhoea with absence of blood in stools.

Question 22

Management of gastroenteritis?

Answer 22

• Encourage fluid intake.
• Oral rehydration solution.
• Antiemetic’s may also be given.
• There is a vaccine given with a first dose at 6 weeks, and then 2 doses a month later.

Question 23

What does lactase break lactose into? (hydrolysis)

Answer 23

Glucose and galatacose

Question 24

Where does lactase reaction occur?

Answer 24

Enterocytes on the brush border

Question 25

What is released when lactose is fermented with bacteria?

Answer 25

CO2
Hydrogen
Methane

Question 26

What do the gases do after being released from lactose fermentation with bacteria?

Answer 26

• These gases increase the colonic osmotic pressure, pulling water into the bowels to cause diarrhoea.

Question 27

Where can lactose not be broken down and its route?

Answer 27

cannot be broken down in duodenum so passes through small intestine through to the colon

Question 28

S+S of lactose intolerance?

Answer 28

• Nausea and vomiting.
• Diarrhoea.
• Failure to thrive.
• Flatulence.
• Symptoms disappear after avoiding lactose, and are brought back a couple of hours after ingesting it,

Question 29

What is primary hypolactasia?

Answer 29

Caused by the absence of the lactase persistence allele.

• Less lactase is produced over time, and so it only affects adults.

Question 30

Secondary hypolactasia?

Answer 30

Caused by injury to the small intestine.

• Caused by gastroenteritis, Crohn’s disease, ulcerative colitis.

Question 31

Primary congenital?

Answer 31

Complete lack of lactase

Question 32

Ways to diagnose lactose intolerance?

Answer 32

• Lactase hydrogen breath test:
- 25 grams of lactase are swallowed.
- Sample breath hydrogen at baseline, and at 30 minute intervals for 3 hours.
- >20ppm = diagnosis (high hydrogen levels).
• Stool studies:
- Infant drinks lactose.
- If stool pH is <5.5 then diagnosis is confirmed.
• Blood test:
- Lactose intolerance individuals will show a ‘flat-curve’ blood glucose level after ingesting lactose.
• Intestinal biopsy

Question 33

What food supplements must be taken for lactose intolerance?

Answer 33

Gluten free

High calcium diet e.g. green leafy vegetables, soya beans and tofu, bread, cereal, fish.