20. Paediatric Gastroenterology Flashcards
Common paediatric GI symptoms
- Abdo pain
- Constipation
- Vomiting and reflux
- Diarrhoea
- Rectal bleeding
- Failure to thrive
Abdominal pain in paeds:
- Functional or recurrent
- IBS
- Duodenal ulcer
Constipation with overflow treatment
- Softener (Movicol/lactulose)
- Stimulant (Senna/picosulphate)
ROME IV classification
- Functional dyspepsia (Epigastric pain and fullness)
- IBS (recurrent pain with defecation changes)
- Abdominal migraine (paroxysmal pain with anorexia, N&V, headache, photophobia)
- Functional abdominal pain, not otherwise specified (>4x episodes/month, not any of the above)
Differentials for infant reflux:
- GORD
- Eosinophilic oesophagitis
- Anatomic abnormalities
- Intestinal obstruction
Red flags in infant reflux:
- Severe symptoms (+ other problems, eg eczema)
- Haematemesis
- Failure to thrive
Poor appetite and weight loss: CD or UC?
CD
Bloody diarrhoea: CD or UC?
UC
Investigations for IBD:
- Hb (normal)
- Platelets (raised)
- CRP (raised)
- Faecal calprotectin (raised)
When to suspect IBD?
Lower GI symptoms for >6 weeks; 4 week referral to specialist assessment
UC histology:
Diffuse inflammation
Chron’s disease:
Snail track ulcers, histopathology, COBBLESTONING, thickened abnormal terminal ileum
Clinical dehydration:
5% of body mass dehydration
Clinical shock:
10% of body mass dehydration
Children at increased risk in D&V:
- <6 months old
- Low birth weight
- > 6 diarrhoeas
- > 3 vomits
- Not tolerating fluids or breast milk
Signs of clinical dehydration:
- Altered responsiveness
- Sunken eyes
- Tachycardia
- Tachypnoea
- Reduced skin turgor
Clinical shock signs:
- All clinical dehydration signs+
- Cold extremities
- Pale skin
- Hypotension
- Prolonged capillary refill time
Maintenance fluid volume:
1ST 10kg: 100ml/kg/day
2ND 10kg: 50 ml/kg/day
Subsequent kg: 20ml/kg/day
Clinical dehydration fluid maintenance:
Initial: 50ml/kg over 4 hours in addition to maintenance
Rehydration: Maintenance requirements + 50 ml/kg (=5% body weight) replacement over 4 hours
Clinical shock fluid maintenance:
Initial: 20ml/kg stat
Rehydration: Maintenance PLUS 100ml/kg (10% body weight)
Coeliac disease diagnosis condition:
Do not start gluten free diet before the diagnosis/test
When is coeliac disease diagnosis confirmed?
- Symptoms (diarrhoea and weight loss)
- TTG >10x upper limit
- EMA+ve
Also signs and symptoms must improve on a gluten free diet
When is biopsy done in coeliac disease?
If only 1 or 2 criteria out of 3 for diagnosis are met
Coeliac antibodies in diagnosis:
- Tissue TransGlutaminase = 200 >10x upper limit
- Anti-endomysial antibody = positive
Chronic diarrhoea after acute onset:
- Persisting infection
- Immunocompromised host
- Residual damage (1st presentation of coeliac disease, 2nd lactose intolerance – hypolactasia)
- Rectal bleeding (constipation fissure, polyps, IBD, worms, bacterial infections)
