4th Year GI Flashcards
viral causes of gastroenteritis
norovirus
adenovirus
rotavirus
bacterial causes of gastroenteritis
e. coli 0157
c. diff
campylobacter
salmonella
cryptosporidium
parasitic cause of gastroenteritis
giardia
management of gastroenteritis
rehydration with dioralyte
water
ondansetron
loose stools can continue for a couple of weeks
define diarrhoea
more than 3 stools a day
what is toddler’s diarrhoea?
a benign condition due to colonic immaturity
what age does toddler’s diarrhoea improve?
5-6
presentation of toddler’s diarrhoea
up to 10 stools a day
thriving child
management of toddler’s diarrhoea
reduce excessive fruit juice
increase fat if on low fat diet
keep fibre normal
may need loperamide
causes of abdominal pain
colic intussusception mesenteric adenitis appendicitis constipation IBD Coeliac's testicular torsion obstruction
constipation criteria
at least 2 and present for 1 month:
- <3 defecations a week
- one episode of faecal incontinence after toileting skills
- history of excessive retention, painful/hard bowel movements
- obstruction to toilet/ large mass
RF for constipation
low fibre low fluid excessive dairy lack of exercise obesity
examples of softeners for constipation
magrocol (laxicod, movicol)
when might laxido be needed?
faecal impaction +/- soiling
how to wean off laxatives
aim for type 5 on Bristol stool chart for fortnight, then aim for type 4 for at least 6 months slowly weaning dose
examples of stimulants
docusate or senna
define infant dyschezia
problem in learning to defaecate with poor coordination of straining on stool and opening of external anal sphincter
management of infant dyschezia
usually resolves after 2-4 weeks
why do most babies get GORD?
milk all day + lying flat
management of GORD
thickening feed e.g. gaviscon or carobel reduce stomach acid (PPI/H2A) empty stomach faster e.g. domperidone assess for overfeeding consider CMPA and trial of hydrolysed formula
management of eosinophilic oesophagitis
dietary with 6 food elimination = seafood, nuts, dairy, eggs, wheat, soya
2nd line is topical viscous budesonide
complication of eosinophilic oesphagitis
oesophageal stricture
management of pyloric stenosis
pyloromyotomy
GOLD standard to diagnosis coeliac
endoscopy with duodenal biopsy
associations with coeliac’s
T1DM AI thyroid juvenile chronic arthritis Down's Turner's William's
complications of coeliac’s
OP anaemia short stature delayed puberty female infertility intestinal malignancy (T cell lymphoma)
what is the wPCDAI score?
weighted paediatric Crohn’s activity index
MILD UC
distal colon only <3 stools/day little blood no fever no weight loss
moderate UC
3-5 stools/day bloody abdominal pain/cramp low grade fever mild anaemia weight loss
severe UC
>5 stools a day frank blood fever anaemia leucocytosis hypoalbuminaemia pain
complications of UC
colon cancer growth failure arthropathy episcleritis erythema nodosum/ pyoderma gangrenosum PSC AI hepatitis
diagnosis of UC
3 stool cultures
stool calprotectin
endoscopy/ colonoscopy
typical histology of UC
polymorph nuclear leucocytes near base of crypts
crypt abscesses
no granulomas
acute management of UC
steroids
maintenance of UC
MILD= mesalazine MODERATE-SEVERE= mesalazine + azathioprine NON-RESPONDERS= mesalazine + azathioprine + infliximab or adalimumab
cure= colectomy
what is toxic megacolon?
transverse colon diameter >5cm in adults on AXR
is toxic megacolon a surgical emergency?
yes as risks perforation
management of toxic megacolon
drip and suck
IV antibiotics
early surgical review
what is hypernatraemic dehydration?
sodium level is very high and is seen in the first few weeks when breast feeding is difficult
profuse watery diarrhoea and drowsy baby
colic in neonates
paroxysmal crying with pulling of legs for more than 3 hours more than 3 days a week
can give lactase if lactose intolerance but REASSURE
what is biliary atresia?
jaundice as bile is not secreted from gall bladder as ducts are small or absent
bilirubin not broken down
fat soluble vitamins not absorbed
