Parents have adopted a child with the diagnosis of kwashiorkor. What is most likely to be observed when assessing this child? (Select all that apply)

Choice A reason: Rice is naturally gluten-free, safe for celiac disease, as it lacks gliadin, the protein causing intestinal villous atrophy. It provides carbohydrates without triggering immune-mediated damage, supporting nutrient absorption. Rice is an acceptable food choice, not causing the malabsorption or inflammation seen in celiac disease, making it a correct dietary option.

Choice B reason: Barley contains gluten, which triggers immune-mediated intestinal damage in celiac disease, causing villous atrophy, malabsorption, and symptoms like diarrhea. Consuming barley exacerbates the condition, leading to nutrient deficiencies and growth issues. It’s an unacceptable food choice, requiring strict avoidance to prevent disease flare-ups in affected children.

Choice C reason: Corn is gluten-free, safe for celiac disease, as it does not contain the proteins that cause mucosal damage. It supports nutrition without triggering inflammation or malabsorption. Corn is an acceptable choice, not contributing to the pathophysiology of celiac disease, making it a suitable dietary option for affected children.

Choice D reason: Wheat contains gluten, causing intestinal damage in celiac disease via immune-mediated villous atrophy, leading to malabsorption and symptoms like diarrhea. While unacceptable, the question specifies one choice, and barley is equally harmful. However, barley is often less recognized, making it the focus for teaching in this context.

Choice A reason: Intussusception causes bowel obstruction, leading to mucus in stools, often mixed with blood (“currant jelly” stools) due to mucosal irritation and ischemia. This results from the telescoping of intestinal segments, impairing blood flow and causing tissue damage, making mucus a hallmark sign expected in a toddler with this condition.

Choice B reason: Increased appetite is unlikely in intussusception, as bowel obstruction causes pain, vomiting, and reduced intestinal function, leading to anorexia. The toddler’s discomfort and nausea from ischemia and obstruction suppress appetite, making this an incorrect manifestation compared to mucus, which directly reflects the intestinal pathology.

Choice C reason: Jaundice results from bilirubin accumulation, typically in liver or biliary disorders, not intussusception. This condition affects the intestines, causing obstruction and mucosal bleeding, not hepatic dysfunction. Mucus in stools is a direct consequence of intussusception, making jaundice an unrelated and incorrect expected finding.

Choice D reason: Drooling is associated with upper airway or esophageal issues, like tracheoesophageal fistula, not intussusception. This intestinal condition causes abdominal symptoms like mucus in stools, not salivary pooling. Drooling is irrelevant to the pathophysiology of bowel obstruction, making it an incorrect manifestation for this toddler.