Infant Care: Diarrhea and Vomiting Management
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Questions and Answers

What is the most common cause of diarrhea and vomiting in infants and children?

Viral gastroenteritis.

What is the primary treatment for diarrhea and vomiting in this age group?

Fluid replacement with ORS (Oral Rehydration Solution).

What should be done regarding breastfeeding during an episode of diarrhea and vomiting?

Breastfeeding should be continued.

Are antibiotics generally recommended for diarrhea and vomiting in infants and children? Explain your answer.

<p>No, antibiotics are contraindicated. This is because the condition is typically caused by a virus, and antibiotics are ineffective against viral infections.</p> Signup and view all the answers

What type of medication is NOT recommended in the management of diarrhea and vomiting in infants and children? Why?

<p>Antiemetics are not recommended. This is because inducing vomiting can be harmful and does not address the underlying cause, which is usually viral.</p> Signup and view all the answers

How long should the bottle be boiled after each feeding?

<p>15 minutes</p> Signup and view all the answers

What is the boiling time required for the tip of the bottle?

<p>5 minutes</p> Signup and view all the answers

Why is it necessary to boil the bottle after feeding?

<p>To sanitize it and prevent bacterial growth.</p> Signup and view all the answers

What might happen if the bottle is not cleaned properly after feeding?

<p>Bacterial growth and potential illness.</p> Signup and view all the answers

What is the primary goal of boiling the bottle and its tip after use?

<p>To ensure hygiene and safety.</p> Signup and view all the answers

How many measures of food does the mother prepare for her baby in a full day?

<p>The mother prepares 20 measures of food for her baby in a full day.</p> Signup and view all the answers

If each Kg of the baby's weight requires 4-6 measures per day, what is the minimum and maximum measure range required for the 4 Kg baby?

<p>The minimum is 16 measures and the maximum is 24 measures.</p> Signup and view all the answers

What is the average number of measures needed per feeding if the baby is fed 8 times a day and receives a total of 20 measures?

<p>The average number of measures per feeding is 2.5 measures.</p> Signup and view all the answers

If a mother decides to feed her baby 3 measures per feeding instead of 2.5, how would this affect the total number of measures in one day?

<p>The total would increase to 24 measures in one day.</p> Signup and view all the answers

What is the total range of measures the baby would need per day based on the requirement of 4-6 measures per Kg of body weight?

<p>The total range is from 16 to 24 measures per day.</p> Signup and view all the answers

What is intussusception, and how can it affect gastrointestinal function?

<p>Intussusception is the telescoping of a segment of the intestine into an adjacent segment, which can lead to obstruction and decreased blood flow.</p> Signup and view all the answers

Define diarrhea in medical terms.

<p>Diarrhea is characterized by an increase in the fluidity, volume, and frequency of stools.</p> Signup and view all the answers

How does the volume of fluid in stools change during diarrhea?

<p>During diarrhea, the volume of fluid in the stools increases significantly, leading to more frequent bowel movements.</p> Signup and view all the answers

What are the potential consequences of untreated intussusception?

<p>Untreated intussusception can lead to intestinal perforation, infection, and potentially life-threatening complications.</p> Signup and view all the answers

Identify two common causes of diarrhea.

<p>Common causes of diarrhea include viral infections and food intolerances.</p> Signup and view all the answers

What systemic condition can cause diarrhea resulting in severe symptoms like vomiting and distension?

<p>A systemic condition such as a viral or bacterial infection can cause diarrhea leading to severe symptoms.</p> Signup and view all the answers

In what circumstances is Loperamide absolutely contraindicated?

<p>Loperamide is absolutely contraindicated if there is a suspicion of celiac disease.</p> Signup and view all the answers

What type of stool might be observed in a patient experiencing severe diarrhea due to a paralytic ileus?

<p>A patient may present with currant jelly stool.</p> Signup and view all the answers

Why is testing for gliadin antibodies no longer recommended?

<p>Testing for gliadin antibodies is no longer recommended due to its low sensitivity and specificity for celiac disease.</p> Signup and view all the answers

What does DRE stand for, and what is its relevance in diagnosing severe diarrhea symptoms?

<p>DRE stands for Digital Rectal Examination, which helps assess the presence of any abnormalities, including stool consistency.</p> Signup and view all the answers

What are the implications of using Loperamide in a patient with celiac disease?

<p>Using Loperamide in a patient with celiac disease could worsen their condition or mask symptoms.</p> Signup and view all the answers

What could be a potential consequence of untreated severe diarrhea as mentioned in the content?

<p>Untreated severe diarrhea can lead to complications such as dehydration and electrolyte imbalances.</p> Signup and view all the answers

How does the presence of distension relate to the diagnosis of paralytic ileus in patients with diarrhea?

<p>Distension in the abdomen often indicates obstruction or paralysis in the intestines, which may exacerbate the diarrhea.</p> Signup and view all the answers

What does low sensitivity and specificity imply about gliadin antibody testing?

<p>Low sensitivity implies it may miss cases of celiac disease, while low specificity means it may yield false positives.</p> Signup and view all the answers

How should clinicians approach diagnosing potential celiac disease given the issues with gliadin antibody testing?

<p>Clinicians should consider alternative, more reliable diagnostic methods rather than relying on gliadin antibody testing.</p> Signup and view all the answers

Flashcards

Cleaning baby bottles

Bottles must be cleaned after each feeding to ensure safety and hygiene.

Boiling bottles

Bottles should be boiled for 15 minutes to sterilize them thoroughly.

Boiling bottle tips

The tip of the bottle only requires boiling for 5 minutes instead of 15.

Importance of sterilization

Sterilization helps prevent infections and keeps baby safe.

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Feeding safety practices

Following these cleaning protocols ensures safe feeding for the baby.

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Viral gastroenteritis

A viral infection causing diarrhea and vomiting in children.

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Fluid replacement

Replenishing lost fluids in dehydration cases, especially through ORS.

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ORS

A solution used to replace fluids and electrolytes in dehydration.

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Continuing breastfeeding

Breastfeeding should be maintained during diarrhea/vomiting episodes.

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Contraindicated medications

Medications like antibiotics and antiemetics should not be used in these cases.

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Diarrhea

Frequent, watery bowel movements often caused by infections or other conditions.

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Bloody Diarrhea

Diarrhea that contains blood, indicating potential serious underlying conditions.

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Current Jelly Stool

Stool that appears similar to raspberry jelly, associated with severe intestinal conditions.

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K* Distension

Abdominal distension potentially linked to electrolyte imbalances or bowel obstruction.

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Feeding Frequency

The mother feeds her baby 8 times daily.

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Measure per Feeding

Each feeding involves preparing around 2.5 measures.

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Baby's Weight

The baby weighs 4 Kg.

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Daily Measure Requirement

Each Kg requires 4-6 measures of food daily.

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Total Daily Measures

For a 4 Kg baby, total measures range from 16 to 24 daily.

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Intussusception

A medical condition where part of the intestine telescopes into another section.

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Fluidity

The quality of being fluid or liquid; in diarrhea, it refers to loose stools.

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Stool Volume

The total amount of stool produced in a period, increased in diarrhea.

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Frequency of Stools

How often stools are passed; increases with diarrhea.

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Loperamide contraindication

Loperamide should not be used in certain medical conditions.

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Gliadin antibody testing

Testing for gliadin antibodies is no longer recommended for celiac disease.

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Celiac disease diagnosis

Celiac disease diagnosis has others tests with higher accuracy than gliadin testing.

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Sensitivity in testing

Sensitivity refers to a test's ability to correctly identify those with a condition.

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Specificity in testing

Specificity is a test’s ability to correctly identify those without a condition.

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Study Notes

Diarrhea and Gastroenteritis

  • Diarrhea is defined as an increase in stool fluidity, volume, and frequency.
  • Acute diarrhea lasts less than two weeks.
  • Chronic diarrhea lasts more than two weeks.
  • Important factors about formula feeding include needing a number of bottles each day, how to clean them, and how much milk or water is needed, and how to prepare it.
  • Babies need a certain amount of calories per kg (e.g., 80-120 Kcal/kg/day).
  • Feeding babies every 2-3 hours is typical for infants and young children.
  • A baby is typically considered well-fed if it is comfortable after a feeding and does not cry; it should sleep for around 2 hours after feeding.

Causes of Seizure in Patients with Diarrhea

  • Dehydration
  • Fever (Febrile Seizures)
  • Electrolyte imbalances (hyper/hypo natremia)
  • Hemolytic Uremic Syndrome (can lead to uremic encephalopathy or hypertensive encephalopathy).
  • Parental diarrhea (can be a symptom of meningitis but not always).
  • Systemic (non-GIT) conditions and infections can also cause diarrhea.

Mechanisms of Diarrhea

  • Osmotic (due to digestive enzyme deficiencies or ingestion of unabsorbable solutes with common examples include viral infections, lactase deficiency, or infections).
  • Secretory (increased secretion and decreased absorption common in cholera, and toxigenic E. coli).
  • Exudative (inflammation- decreased colonic reabsorption and increased motility common in bacterial enteritis).
  • Increased motility (decreased transit time common in Irritable bowel syndrome).

Causes of Acute Diarrhea in Infancy and Childhood

  • Non-enteric causes: otitis media, meningitis, sepsis, and parental diarrhea.
  • Non-infectious causes: food allergies, drug side effects, malabsorption.
  • Infections of the gastrointestinal tract (e.g., rotavirus).

Infantile Gastroenteritis: Principal Causes

  • Escherichia coli (EPEC, ETEC, EIEC).
  • Viruses (rotavirus, noroviruses).

Enteropathogenic E. coli (EPEC)

  • Affects the small intestine.
  • Causes local destruction of intestinal epithelial cells.
  • Causes infantile diarrhea and does not involve bloody stools.
  • Often accompanied by fever, nausea, and vomiting.
  • Self-limiting, no specific antibiotic treatment necessary.
  • Over 20 identified serotypes in outbreaks.
  • May affect maternity or neonatal units.

Enterotoxigenic E. coli (ETEC)

  • Affects the small intestine.
  • Causes low-grade fever, nausea, watery diarrhea, and cramps.
  • Produces heat-labile enterotoxin and heat-stable factors that have cholera-like effects.
  • Leads to fluid and electrolyte loss.

Enteroinvasive E. coli (EIEC)

  • Affects the large intestine, causing bloody diarrhea.
  • Develops into bacillary dysentery.
  • Causes invasion and local destruction of intestinal epithelial cells.
  • Not associated with enterotoxins.

Viral Gastroenteritis

  • Frequent cause of infantile gastroenteritis.
  • Up to 50% of cases caused by rotavirus (most common).
  • Short incubation period (2-4 days).
  • Often presents as diarrhea of mild to moderate severity, potentially with vomiting.
  • More common in winter months.
  • Diagnosed by detection of rotavirus antigen in stool.
  • Treatment is supportive care.

Other Viruses Causing Infantile Gastroenteritis

  • Noroviruses and sapoviruses (family Caliciviridae).
  • Astroviruses.
  • Adenoviruses.

Management of Infantile Gastroenteritis

  • Replacement of fluid and electrolytes.
  • Antibiotics are typically not indicated.
  • Breastfeeding should be continued.

Other Infectious Causes of Infantile Gastroenteritis

  • Salmonella
  • Shigella (bacillary dysentery)
  • Campylobacter jejuni.
  • Giardia lamblia.

Enterohaemorrhagic E. coli (EHEC)

  • Causes hemorrhagic colitis with abdominal cramps.
  • Bloody diarrhea.
  • Can cause hemolytic uremic syndrome (HUS).
  • Often caused by E. coli O157:H7.
  • Children are at greater risk than adults for complications.
  • Antibiotics are not recommended as they can increase the risk of HUS.

Haemolytic Uraemic Syndrome (HUS)

  • May follow uncomplicated diarrheal illness, with common symptoms like anemia, acute renal failure and thrombocytopenia.
  • Caused by verocytotoxin (VTEC).
  • Diagnosed by lab tests like sorbitol non-fermenting strains.

Cryptosporidiosis

  • Self-limiting diarrheal illness in children, often accompanied by nausea and vomiting.
  • Acquired by drinking or consuming contaminated water with cysts of Crypto parvum.
  • Extremely resistant to chlorination.
  • Usually caused by infected cattle.
  • More severe manifestations in immunocompromised persons (e.g. AIDS).

Gastroenteritis Associated with Travel

  • Enterotoxigenic E. coli (Traveller’s diarrhea).
  • Salmonella and Campylobacter spp (food poisoning).
  • Shigella spp (bacillary dysentery).
  • Giardia lamblia (giardiasis).

Giardiasis

  • Caused by Giardia lamblia (protozoan pathogen).
  • Cosmopolitan, affects globally.
  • Acquired by ingestion of contaminated food or water; cysts resist chlorination.
  • Develops into trophozoites in the duodenum.
  • Symptoms include cramping, flatulence, diarrhea, and steatorrhea.

Giardiasis: Diagnosis and Management

  • Identification of cysts in stool (acid-fast stain or PCR).
  • May need duodenal aspirate or small bowel biopsy for diagnosis in certain cases.
  • Treatment is typically with metronidazole.

Bacillary Dysentery (Shigellosis)

  • Caused by Shigella sonnei (most prevalent in developed countries).
  • Often presents as a mild, self-limiting illness.
  • Low infecting dose and is typically acquired via direct contact.
  • Locally invasive in the large bowel
  • Isolated on selective media
  • Other Shigella species (e.g. flexneri, boydii, dysenteriae) typically acquired abroad and can lead to severe illness in developing countries

Uncommon Causes of Diarrhea

  • Amoebic dysentery (causative organism: Entamoeba histolytica, often associated with eating contaminated food containing cysts and can cause colon ulceration. Variations in symptoms exist from mild cases to severe cases with blood and mucus in stool. Other severe symptom is liver involvement that can cause hepatitis and liver abscess).
  • Amoebic dysentery can have severe complications such as perforation of the large bowel and peritonitis.
  • Symptoms may also involve the liver.

Cholera

  • Severe diarrheal illness.
  • Rice water stools.
  • Vomiting and nausea may accompany the disease.
  • Leads to dehydration, prostration, and electrolyte loss.
  • Caused by toxigenic Vibrio cholerae (3 types e.g. classic, El Tor, and O139).
  • Usually transmitted through water.

Other Infections of the Intestinal Tract

  • Enteric fever (typhoid and paratyphoid) caused by Salmonella enterica.
  • Yersinia enterocolitica gastroenteritis.
  • Aeromonas hydrophila (aquatic organism).
  • Plesiomonas shigelloides colitis
  • Pseudomembranous colitis (C. difficile).

Complications of Diarrhea

  • Dehydration.
  • Metabolic acidosis.
  • Gastrointestinal Complications (e.g., perforation, and secondary lactase deficiency).
  • Nutritional complications.

Management of Diarrhea

  • Oral Rehydration Solutions (ORS).
  • Effective for all types and degrees of dehydration.
  • Prevention is important via good sanitation and hygiene.

Oral Rehydration Solution (ORS) Composition

  • Glucose.
  • Sodium Chloride.
  • Tri-Sodium Citrate (bicarbonate).
  • Potassium Chloride

Chronic Diarrhea (> 2 Weeks)

  • The diagnosis should be made for children who are growing well and who do not have fluid or electrolyte abnormalities or fail-to-thrive issues.
  • Focus on identifying if the cause is due to infectious etiology, or a secondary lactase deficiency).
  • Investigations can include stool, urinalysis, blood count, and electrolytes.
  • If FTT exists more investigation (e.g: nutritional status, antibody, genetic and other tests) may be needed.

Toddler's Diarrhea

  • Most common cause of chronic diarrhea during infancy.
  • Diagnosis is usually made by excluding other conditions (no weight loss, no fluid or electrolyte abnormalities, and no FTT).
  • Onset is typically between 6 and 36 months.
  • Usually ceases spontaneously between 2-4 years.
  • History of excessive fruit juice intake may cause disaccharide malabsorption.

Lactase Deficiency (Lactose Intolerance)

  • Clinical features include chronic watery diarrhea, abdominal pain, bloating, and borborygmus.
  • Diagnosis is made by trying off milk/ lactose free milk or performing a breath hydrogen test in patients over 6 years of age.
  • Management includes following a lactose-free diet.

Celiac Disease

  • Also known as gluten-sensitive enteropathy.
  • Mucosal defect associated with toxic or immunologic reaction to gluten found in foods such as barley, rye, oats and wheat.
  • Inappropriate immune response to the protein gluten.
  • May cause significant morbidity.

Dermatitis Herpetiformis

  • Skin rash.
  • Usually associated with celiac disease

Other Comorbidities Associated with Celiac Disease

  • Osteoporosis.
  • Thyroid dysfunction.
  • Deficiencies in folic acid, vitamin B12, fat-soluble vitamins, and iron.
  • Increased mortality due to increased risk of malignancy (e.g., lymphoma, esophageal, and small intestinal adenocarcinoma).

Cow Milk Intolerance

  • Can be associated with immune-mediated mucosal injury with possible anemia, hypoalbuminemia, or edema.
  • May have a high prevalence in children with atopic conditions such as eczema, asthma, allergic rhinitis and food allergies.
  • Two clinical scenarios exist, enterocolitis, and enteropathy.
  • Enterocolitis is characterized by acute symptoms (vomiting, diarrhea, anemia, and hematochezia).
  • Enteropathy is characterized by chronic symptoms (chronic diarrhea, hypoalbuminemia and associated treatments include starting with a casein hydrolysate formula).

Inflammatory Bowel Disease (IBD)

  • Specific enzyme deficiencies, liver disease or biliary atresia, a-ß-lipoproteinemia, short gut, and blind loop syndrome.
  • Diagnosis and treatment should be conducted together with a doctor.

Pancreatic Insufficiency

  • Cystic Fibrosis.
  • Schwachman-Diamond syndrome

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Description

This quiz covers essential knowledge regarding the causes and treatments of diarrhea and vomiting in infants and children. It explores breastfeeding practices, medication recommendations, and hygiene measures such as bottle boiling. Test your understanding of infant care and management practices in this critical area of health.

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