48. GI Conditions in Children Flashcards
List some GI disorders in children.
What are some causes of the following:
a) abdo pain
b) chronic vomiting/haematemesis
c) chronic diarrhoea
d) rectal bleeding/bloody stools
Constipation, RAP (recurrant abdo pain), gastritis.duodenal ulcers, GOR, IBD, diarrhea (acute/chronic).
a) Constipation, functional/RAP/IBS, duodenal ulcer/H.pylori, IBD
b) GOR, intestinal obstruction, duodenal ulcer.
c) IBD, malabsorption (enteropathy (coeliac), fat malabsorption pancreatic insufficiency - CF, sugar malabsorption (lactose intolerance), constipation (overflow soiling).
d) IBD (Chrohns or ulcerative colitis), fissures/haemorrhoids, polyps, infection.
What are some functional/organic and rare causes of constipation?
What might you notice on examination, and what investigations might you do?
What are some treatments?
Functional: Hirschsprung’s, hypothyroidism, neurologic, anal stenosis. Rare: rectal biopsy, growth failure…
Examination: palpable rocks in abdomen. Ix: TSH/Ca, marker studies (transit time), rectal suction biopsy, anorectal manometry.
Stool bulking agents, osmotic laxatives, stool softeners, stimulant laxatives, specific receptor antagonists to stimulate motility.
What are some principles of GOR investigations?
How is GOR treated?
What is eosinophillic oesophagitis and how is it treated?
pH study (only record ‘acid reflux’ ph<4)/impedence (measure both acid and non-acid refluc)(symptom association), barium swallow/meal (anatomical abnormalities), upper GI endoscopy (mucosal abnormalites), clinical score (I-GERQ-R, filled out by carars, 12 Qs, over the last week).
Medical: positioning, thickening of feeds, reduce acid (H2 antagonists, PPIs), promotility agents (e.g. domperidone). Surgical: jejunostomy feeds, Nissen’s funfoplication.
Allergic inflammatory condition of the esophagus that involves eosinophils. Tx: dietary (food exclusions, pragmatic trials), oral budesonide, monteleukast.
Define recurrent abdominal pain.
What are some overlapping conditions that could cause RAP?
What is gasritis and how does it present?
How is it diagnosed and treated?
1 episode of pain/month for 3m, sufficient to interfere with routine functioning. 10-15% school children, F>M.
Migraine, IBS, non-ulcer dyspepsia.
Inflammation of gastric mucosa, caused by H. pylori (clustering in families) or NSAIDs. Presentation: vomiting, abdo pain, haematemesis/melaena, anaemia.
Dx: endoscopy (Clo/rapid urease test, histology), stool antigen. Tx: amoxycillin, clarithromycin for 2w, +6/52 H2 antagonists/PPIs, repeat breath test/stool 3/12 after treatment to ensure eradication.
What are some possible diagnoses of rectal bleeding?
Define IBD: Crohn’s and UC and their presentations.
Constipation (with fissues, overflow diarrhoea), bacterial infections (acute, with diarrhoea), IBD, polyps, worms.
Crohn’s: mouth to anus, patchy disease ‘skip lesions’, transmural inflammation, granulomas. Presentation: abdo pain, weight loss, diarrhoea, insidious onset, growth failure/pubertal delay, raised ESR/CRP/low albumin/Hb
Ulcerative colitis: only rectum/colon, continuous disease (starting from rectum), mucosal inflammation. Presentation: chronic bloody diarrhoea, abdo pain, weight loss, usually diagnosed in 2m.
Paediatric onset IBD have worse disease.
How is IBD diagnosed?
How is IBD treated medically?
How is IBD treated surgically?
Endoscopy and biopsies (upper GI, ileo-colonoscopy), MRI abdo.
Induce remission: exclusive enteral nutrition (only Crohn’s), steroids, 5-ASA - Mesalamine (delivered via pH dependant coat/microgranules encased in cellulose coat), biologicals (e.g. anti-TNF infliximab). Maintain remission: 5-ASA (esp UC), immunosupressants (azathioprine), biologicals (infliximab, adalimumab).
If meds not working/obstruction/poor growth and localised Crohn’s then operation. UC: colectomy - curative of colitis. Crohn’s: depends on disease localisation.
What GI condition is this in the oesophagus?
Eosinophillic Oesophagitis.
What is this condition?
Crohn’s disease.
What are these in the rectum?
Polyps.
