PBL 4: Faltering Growth Flashcards
Define gastroenteritis
Inflammation of the GI tract, involving the stomach and small intestine, causing infectious diarrhoea. Commonly affects infants between 6 months and 2 years old.
Define diarrhoea
Passing 3 or more watery stools per day, or more than what is normal for that individual.
Define Rotavirus
Double stranded RNA virus, which is the most common cause of diarrhoea in children.
What is faltering growth?
Inadequate weight gain in an infant.
What are reasons to assess faltering growth?
- 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.
What is mid faltering growth?
A drop of 2 centile spaces
What is severe faltering growth?
A drop of 3 centile spaces
What are organic causes of faltering growth?
- Genetic metabolism disorders (Crohn’s, liver disease).
- Gas and acid reflux.
- Coeliac disease.
- Cystic fibrosis.
- Cleft palate.
- Parasites (raise metabolism).
- Lactose intolerance.
- UTIs.
What are organic causes of faltering growth?
Due to the child
Accounts for 5% of cases
What are non organic causes?
- Physical inability to produce breast milk.
- Child abuse and neglect.
- Maternal depression.
- Lack of money for food.
Define non-organic causes?
Due to environment around the child
S+S of gastroenteritis?
- 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.
Causes of gastroenteritis?
bacteria, viruses or parasites.
Transmission occurs from eating contaminated food or water, or through close contact to an infected person.
What is the main bacterial cause?
• Campylobacter
Through undercooked meat
What is the main parasite?
Giaridia
Through infected water
What is most common viral cause of gastroenteritis for children?
Rotavirus
What is most common viral cause for adult?
Norovirus
What are non-infectious causes of gastroenteritis?
- NSAIDs.
- Lactose for those who are intolerant.
- Gluten in those with Coeliac disease.
Rotavirus mechanism?
- 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.
Complications of gastroenteritis?
- 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.
Diagnosis of gastroenteritis?
- Clinical diagnosis based on signs and symptoms.
* Diarrhoea with absence of blood in stools.
Management of gastroenteritis?
- 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.
What does lactase break lactose into? (hydrolysis)
Glucose and galatacose
Where does lactase reaction occur?
Enterocytes on the brush border
What is released when lactose is fermented with bacteria?
CO2
Hydrogen
Methane
What do the gases do after being released from lactose fermentation with bacteria?
• These gases increase the colonic osmotic pressure, pulling water into the bowels to cause diarrhoea.
Where can lactose not be broken down and its route?
cannot be broken down in duodenum so passes through small intestine through to the colon
S+S of lactose intolerance?
- Nausea and vomiting.
- Diarrhoea.
- Failure to thrive.
- Flatulence.
- Symptoms disappear after avoiding lactose, and are brought back a couple of hours after ingesting it,
What is primary hypolactasia?
Caused by the absence of the lactase persistence allele.
• Less lactase is produced over time, and so it only affects adults.
Secondary hypolactasia?
Caused by injury to the small intestine.
• Caused by gastroenteritis, Crohn’s disease, ulcerative colitis.
Primary congenital?
Complete lack of lactase
Ways to diagnose lactose intolerance?
• 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
What food supplements must be taken for lactose intolerance?
Gluten free
High calcium diet e.g. green leafy vegetables, soya beans and tofu, bread, cereal, fish.
