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Lecture notes, cheat sheets
Childhood diseases. Constitutional anomalies in children. Options for diathesis (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) LECTURE No. 3. Anomalies of the constitution in children. Diathesis options Constitution - this is a set of relatively stable morphological and functional properties of a person, due to heredity, age and long-term intensive influence of the environment, which determines the functional abilities and reactivity of the body. Diathesis - this is a genetically determined feature of the body, which determines the originality of its adaptive reactions and predisposes to a certain group of diseases. Diathesis is not a disease, but a predisposition that, under certain environmental conditions, can transform into a disease. 1. Allergic diathesis Allergic diathesis is a constitutional anomaly characterized by the body's predisposition to allergic and inflammatory diseases. This constitutional anomaly is quite common. It is usually detected at the age of 3-6 months and lasts for 1-2 years; in most children it subsequently disappears. Atopic diathesis is distinguished, associated with an allergic reaction to food and non-infectious antigens in contact with the mucous membrane of the respiratory tract. Autoimmune diathesis, where there is increased sensitivity of the skin to UV irradiation, a significant increase in the level of γ-globulins in the blood, frequent detection of LE cells, antinuclear factors in a state of complete clinical well-being, polyclonal activation of B lymphocytes, as well as T helper cells with decreased activity T-suppressors, increased blood levels of immunoglobulins M. Infectious-allergic diathesis, where there are long periods of increased ESR and low-grade temperature, after acute respiratory viral infections and diseases of the nasopharynx. Etiology, pathogenesis, clinic, treatment similar to exudative-catarrhal diathesis. 2. Exudative catarrhal diathesis Exudative-catarrhal diathesis is a peculiar state of reactivity in young children, characterized by a tendency to recurrent infiltrative-desquamous lesions of the skin and mucous membranes, the development of pseudo-allergic reactions and a protracted course of inflammatory processes, with lymphoid hyperplasia, lability of water-salt metabolism. Etiology and pathogenesis are not fully understood, but hereditary predisposition, as well as the influence of environmental factors, play an important role. A positive family “allergic history” is detected in 2/3-3/4 of children with allergic diathesis. In such children, a high level of immunodepth E in the blood or excessive secretion and release of histamine from mast cells, its insufficient inactivation, which determines the tendency to allergic reactions, is determined. Provoking factors may be toxicosis of the first and second half of pregnancy, infectious diseases, use of medications during pregnancy, violation of the pregnant woman’s diet, especially in the last months of pregnancy (monotonous diet with excessive consumption of one of the obligate allergens - eggs, honey, confectionery, milk, tangerines), as well as during breastfeeding. Even in the prenatal period, a child can become diaplacentally sensitized to allergens circulating in the mother’s body. In the extrauterine period, allergens are transmitted with breast milk and food through the intestinal wall, which has increased permeability, especially in infants, especially after gastrointestinal diseases, as well as during the period of recovery from various diseases, with weight loss and exhaustion. A potential sensitizing agent can be food that has not been subjected to heat treatment (egnog, berries whipped with protein, etc.), as well as products such as fish, nuts and some others that do not reduce their allergenic properties when cooked. Allergization can also be caused by ordinary foods if the child receives them in excess (overfeeding), especially with a monotonous set of nutrients. Foods that are consumed in a particular season or infrequently become allergens when they are included in the diet in large quantities (berries, vegetables, nuts, etc.), as well as when foods that are not age-appropriate are introduced into the diet (caviar, shrimp, chocolate and etc.). Disordered eating, abuse of sweets, spicy, salty foods, and the introduction of many new foods into the child’s diet in a short period of time are important. A child with allergic diathesis easily becomes hypersensitive not only to nutrients, but also to external allergens such as wool and house dust. Allergens can enter the child's body through the skin and mucous membranes (conjunctiva, etc.), as well as during numerous injections and vaccinations. In children with allergic diathesis, disturbances in cortical-subcortical relationships are found, parasympathetic mood or dystonia of the autonomic nervous system is detected, functional changes in the liver in the form of metabolic disorders (fat, carbohydrate, protein, water, salt, vitamin, acid-base balance), which is not indifferent to the body in the process of its adaptation to the external environment and nutrition. The development of an allergic reaction is accompanied by an increase in the blood of a number of biologically active substances: histamine, serotonin, leukotrienes, etc. In the pathogenesis, autoallergic processes play a certain role, which most likely occur secondarily in the course of the disease. The development of autoallergization processes with a constant intake of autoallergens into the blood contributes to a more torpid course of allergic diathesis. Clinic. Such children are characterized by high birth weight, especially if this is the first child in the family; Diaper rash that appears early and persists for a long time under conditions of proper care; disappearing and reappearing seborrhea of the scalp; significantly exceeding the age norm of body weight gain and its large fluctuations under the influence of unfavorable conditions; positive skin tests for exogenous allergens in the absence of any clinical manifestations of allergic diathesis. On examination, attention is drawn to a puffy pale face, excessive body weight, decreased tissue turgor (pastose type) or thinness, geographical tongue, abdominal pain, flatulence. In the first year of life, children with increased nervous excitability, irritability, sleep disorders, reduced appetite are capricious, nervous. Children do not tolerate heavy physical exertion. Often, children with immunoglobulin A deficiency develop chronic foci of infection, enlarged peripheral lymph nodes, spleens, prolonged subfebrile conditions, and a protracted course of infectious diseases. Gneiss occurs only in infants: dirty gray or brown seborrheic scales in the form of a cap or shell on the scalp, mainly on the crown and crown. The course of gneiss is usually favorable, but in some children it transforms into seborrheic eczema (swelling, redness, weeping, increased crusting), which often spreads to the auricles, forehead, cheeks. The most common symptom of allergic diathesis, especially in children of the first year of life, is a milk scab (or crust): on the skin of the cheeks, often near the auricles, redness, swelling, sharply separated from healthy skin, is formed, often with signs of peeling. In some children, the milk scab is accompanied by itching, sometimes it can transform into eczema. The persistent form of diaper rash - intertrigo - is one of the important symptoms of allergic diathesis. The diaper rash may be dry, in other cases there is maceration of the skin (usually in obese, pasty infants). The most severe form of allergic diathesis should be considered childhood eczema, which occurs in older children. In older children, it can transform into neurodermatitis. Diagnosis established on the basis of anamnesis and clinical findings. Differential diagnosis carried out with true eczema, erythroderma, dermatitis, immunodeficiency, psoriasis, and the syndrome of impaired intestinal absorption. Treatment. There is no standard diet. A balanced diet and breastfeeding are necessary, although the presence of allergens is possible. The mother's diet should be low in carbohydrates, fats, table salt and possible allergens. In some cases (fat breast milk), expressed breast milk is pasteurized (for 30 minutes at a temperature of 65 ° C) and the top film is removed or the milk is placed in the refrigerator for 3-4 hours, and then the cream is skimmed, after which it is pasteurized. Older children are advised to exclude jelly, mousse, pork, beef broth, fish, eggs in any form, legumes, nuts, spices, seasonings (moderately limit fats and proteins, liquid). Among porridges, preference is given to buckwheat; in the evening, vegetables, salads, and casseroles are recommended. If eczema is the result of consuming an allergen, then it can subside within 24 hours with the following diet: dishes of rice water, 1 dish of fruit (not yellow), 1 dish of vegetables (potatoes), 1 dish of rice with fruit juice (not yellow color). On each subsequent day, a new dish is added to this basic diet under the control of the dynamics of the disease. If dysbiosis is diagnosed against the background of allergic diathesis, then 10-day courses of Lactobacterin and Bifidumbacterin may be effective. Prescribed medications that help reduce itching and permeability of the vascular wall, sedatives: 3-5% sodium bromide solution, diphenhydramine or antihistamines in age-appropriate dosages. B vitamins are also prescribed5, AT6, AT12, AT15, A, C (ascorbic acid can increase itching) in therapeutic doses for at least 3-4 weeks. Local treatment: first lotions, after swelling and weeping disappear - ointment therapy. In addition, moderately warm baths (not higher than 38 ° C) are prescribed for 10-15 minutes with wheat bran or potato flour (400-600 g per bath), with oak bark, string, celandine, with the addition of lagochilus, potassium permanganate (up to light pink color). Apply general ultraviolet irradiation from 1/4 to 1 erythemal dose 15-20 times (daily or every other day). Elimination of foci of secondary infection also improves the general condition of the patient. Prevention. Rational nutrition for pregnant and nursing mothers, especially if they have allergies, with the consumption of moderate amounts of varied, well-cooked foods, excluding eggs from the diet, limiting milk (up to 1-2 glasses per day), sugar, honey, chocolate, sweets, nuts, as well as sausages, sausages, canned fish. Organization of child nutrition in accordance with age. During illness and during convalescence, it is recommended to give the child well-processed food in moderation, avoiding the introduction of new foods. It is necessary to comply with the rules of vaccination, which is desirable to be carried out only during the period of remission and after appropriate preparation. Need hygienic care for an infant. It is better to avoid the use of perfumes, shampoos, toilet water. The prognosis, subject to all preventive and treatment measures, is favorable. 3. Lymphatic diathesis Lymphatic diathesis (lymphatic-hypoplastic) is a hereditary insufficiency of the lymphatic system associated with a reduced function of the thymus gland as the main organ that controls the maturation of lymphocytes; characterized by a generalized persistent enlargement of the lymph nodes, dysfunction of the endocrine system (hypofunction of the adrenal glands, sympathoadrenal system, etc.), a tendency to allergic and hyperergic reactions and infectious diseases. One of the manifestations of lymphatic diathesis may be the pathology of local immunity of the mucous membranes, the insufficiency of the synthesis of secretory immunoglobulins. Clinic. Dysplastic physique - often a short body, somewhat elongated limbs. The skin is pale, the skin fold is flabby, the muscles are poorly developed, its tone is reduced, the tissues are pasty. The lymph nodes are enlarged, the tonsils and adenoids are hyperplastic and loose. Adenoids after adenotomy are prone to re-growth. X-rays show enlargement of the thymus gland in 70% of cases, which can cause obstruction of bronchial obstruction. There is a tendency to arterial hypotension. In the blood - slight leukocytosis, lymphocytosis, monocytosis, anemia, neutropenia. Diagnosis is established on the basis of the anamnesis, the characteristic appearance of the child, the detection of hyperplasia of the lymph nodes and the thymus gland. Differential diagnosis carried out with immunodeficiency states. Treatment. Maintaining a daily routine, sufficient time in the fresh air, hardening procedures, massage, gymnastics, physiotherapy, vitamin therapy. Prescription of adaptogens and agents that stimulate the body's defenses and adrenal function (dibazole, metacil, aloe, eleutherococcus, ginseng). In case of persistent viral infection and the presence of chronic foci of infection, a course of Viferon is prescribed. Prevention. Rational nutrition for pregnant women and proper feeding of the child in accordance with age. Maintaining a daily routine, walks, hardening, massage and gymnastics. Constant use of adaptogen plants (Eleutherococcus, etc.) in combination with vitamins (separate courses of 2 weeks). Forecast at observance of treatment-and-prophylactic measures favorable. 4. Nervous-arthritic diathesis Nervous-arthritic diathesis is characterized by increased nervous excitability, a tendency to ketoacidosis, and in the future - a predisposition to the development of obesity, interstitial nephritis, urolithiasis, atherosclerosis, diabetes mellitus, gout. Violation of uric acid metabolism is the leading, but not the only laboratory marker. Etiology. On the one hand, the formation of inheritance of pathological properties of metabolism, on the other hand, disturbances in nutrition in the family, work and rest regime, and environment. Pathogenesis. Of particular importance are the high level of excitability at any level of reception, impaired purine metabolism with an increase in their content in the blood and urine, low acetylating ability of the liver and other undeciphered mitochondrial defects. Clinic. Already in infancy, increased nervous excitability is noted; with age, children become even more excitable. Mental development is ahead of age norms: they are inquisitive, animated, remember what they hear or read. Sometimes such children have night terrors, tics, choreo-like attacks, and emotional lability. Periodically or suddenly, after a short period of illness, attacks of headache, nausea, vomiting, abdominal pain, and the smell of acetone from the mouth may occur, which indicates the development of an acetonemic crisis. During a crisis, the level of ketone bodies, ammonia, and uric acid in the blood increases, and the pH decreases. Diagnosis established on the basis of anamnesis, clinical and laboratory data. Differential diagnostics performed with neurosis, rheumatism, diabetes, etc. Treatment. Rational regime and diet, hardening, walks, physical education. Avoid mental stress, limit TV viewing. At the initial symptoms of an acetonemic crisis or its precursors, give sweet tea, fruit juices, and alkaline mineral water to drink. It is advisable to hospitalize the child in a hospital. They do a cleansing enema and gastric lavage to improve the removal of ketone bodies from the intestines. Prescribe Essentiale or vitamin B12, with acetonemic vomiting, treatment is aimed at combating acytosis and enhancing the excretion and utilization of ketone bodies: a 5% glucose solution, a 0,9% sodium chloride solution are injected. Prevention: observance of the child's day regimen, rational nutrition, protecting the child from mental stress. Author: Gavrilova N.V. << Back: Feeding children. Prevention of hypogalactia. Characteristics of milk mixtures >> Forward: Chronic eating disorders, hypovitaminosis in children (Hypotrophy. Hypovitaminosis. Vitamin A deficiency. Vitamin B1 deficiency (thiamine). Vitamin B2 deficiency (riboflavin). Nicotinic acid deficiency (vitamins PP, B3, etc.). Vitamin B6 deficiency (pyridoxine). Vitamin C deficiency (ascorbic acid) . Vitamin D deficiency. Vitamin K deficiency)
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