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Lecture 3

NURSE-UN 1255 Lecture Notes - Lecture 3: Coeliac Disease, Cottage Cheese, Abdominal Pain


Department
Nursing - Undergraduate
Course Code
NURSE-UN 1255
Professor
Nahum
Lecture
3

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Week 3 Peds: GI/GU
1
PEDIATRICS GI:
A child with Celiac Disease
o A mother brings her 6 year old son in to the office reporting a recent weight loss and an increase in
stools and abdominal pain.
o What initial questions will you ask?
o What assessments will you perform?
o History:
The mother reports no change in diet at home, no recent exposure to any illness, etc. This
change has been gradual.
Her son is complaining of abdominal pain intermittently. His stool pattern is foul-smelling
and she noticed what seemed to be “frothy” in the toilet.
His appetite is poor and he seems more lethargic lately.
o Diagnosis:
A series of tests have been done and a diagnosis of celiac disease is made (IgA IgG, biopsy of
small intestines).
How will you explain celiac disease to the mother?
Celiac Disease:
o An autoimmune disease caused by sensitivity to the protein gluten.
Gluten is found in wheat, barley and rye.
If these grains are consumed by a child with celiac disease, an immune response is triggered
and damage is caused to the lining of the small intestine.
o Once the lining of the small intestines is damaged, nutrients cannot be absorbed causing nutrient
deficiencies.
Some symptoms of celiac disease include:
diarrhea
abdominal pain
abdominal distention
weight loss
fatigue
o About 3 percent of the US population has celiac disease.
o Patient Education:
What are the key elements to include in education for a patient with celiac disease?
How will you determine if the teaching was understood?
What resources can you provide the patient and family?
o There is no treatment for Celiac Disease.
o This condition can be managed by following a gluten-free diet. Children with celiac disease can lead
long, healthful lives.
o A few days after starting a gluten free diet, children with celiac disease start gaining weight and
symptoms (diarrhea, abdominal pain) resolve
o Meal Planning:
Foods that are naturally gluten-free:
fruits, vegetables, beef, poultry, fish, nuts, eggs, most diary
Grains/Starches that are gluten-free:
corn, quinoa, millet, rice, buckwheat, flax, lentils, potato, wild rice, soy, yucca,
tapioca
Typical meals:
B=eggs, smoothies (blueberries, mango, strawberries),
L= tuna with basmati rice and vegetables,
S= cottage cheese (with fruits)
D= salmon fillet with vegetables and sweet potatoes

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Week 3 Peds: GI/GU
2
o Foods to Avoid:
Wheat, Rye, Barley
Pasta
Breads/Pizza
Cake/cookies
Processed foods
Read labels (gluten is added to many foods)
o Long Term:
Lifetime gluten free diet required
High calorie and proteins; low in fat
Compliance can be challenging
Hard to eat out
Difficulties with teenagers
Case Presentation:
o Sara’s mother calls the clinic reporting that Sara has been vomiting and having diarrhea. She now has
a fever. Sara is 4 years old.
o What is your initial thought?
o What additional information do you need from Sara’s mother?
o History:
Sara’s mother reports that other children in her preschool have had a stomach bug this past
week.
Sara has had diarrhea, about 3-5 times today. She vomited last night twice, but not since.
She is not drinking much, but did urinate once this morning, a small amount.
Sara currently has a temperature of 100.2
Diarrhea
o Acute diarrhea is leading cause of illness in children <5 years
o 1.5 million outpatient visits per year
o 200,000 hospitalizations per year
o 20-24% of all deaths in developing countries are related to diarrhea and dehydration
o Acute infectious diarrhea: variety of causative organisms
o Etiology:
Rotavirus
most common viral
new vaccine helping reduce incidence
Bacterial: more likely to have bloody diarrhea
Salmonella, E. Coli, Shigella, Campylobacter
Salmonella: food borne and person to person transmission
E. Coli: food borne
Gastroenteritis Viral
o Based on the clinical presentation described by the mother, and the history of other sick children in
preschool, it seems that Sara has viral gastroenteritis.
o Dehydration: results from excess fluid loss
o Cause: in this case: Vomiting and Diarrhea and poor po intake
o Fever

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Week 3 Peds: GI/GU
3
Dehydration
o Occurs whenever total output of fluid exceeds intake
o Water balance in infants
Body surface area (greater in infants and children)
Making them more at risk for insensible water loss thru skin and lungs
Basal metabolic rate
Kidney function
Fluid requirements
o Fluid Balance in Infants & Children
Rate of basal metabolism
Higher bmr in infants and children
Elevations in bmr : ie. Fever
Greater fluid requirements than adults
Need more water to excrete solutes than adults
Status of kidney function
Infants: immature kidney function: cannot concentrate urine
o Types of Dehydration:
Isotonic
Water and salt are lost in equal amounts
Primary form of dehydration in children
Hypotonic
Electrolyte deficit exceeds water deficit
Hypertonic
Water loss exceeds electrolyte deficit
o Fluid Distribution:
Intracellular fluid
Inside cells
K+, phosphate, sulfate, protein
Extracellular fluid
Predominantly saline: Na, Cl, bicarbonate
Interstitial fluid
Between cells & outside blood vessels
Intravasular fluid
Within vessels: plasma
o During Illness:
FIRST: Loss of fluid in the extracellular compartment
Greater risk of dehydration and alterations in fluid and electrolytes in children:
Greater percentage of water in extracellular compartment
o Clinical Manifestations:
Weight loss
Rapid pulse
Decreased blood pressure
Decreased peripheral circulation
Decreased urinary output
Increased specific gravity
Decreased skin turgor
Dry mucous membranes
Absence of tears
Sunken fontanel in infants
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