Acute Abdo Paeds Flashcards

Question

What is the Dx if the patient is unresponsive to H.Pylori Tx and the biopsy is -Ve?

Answer 1

Functional Dyspepsia

Answer 2

3. Coeliac's - Developmental stunting with irritability and abnormal stools following a recent change in diet suggests Coeliac's - IBS/IBD would be more likely if there was constipation/Diarrhoea - Gastroenteritis would present with a more acute/infective picture: Fevers, diarrhoea +/- mucus/blood and inconsolable with growth retardation unlikely

Answer 3

- Anti-tTG and/or EMA antibodies -> villous atrophy and malabsorption within the SI - Dx confirmed via duodenal biopsy showing villous atrophy, crypt hyperplasia and lymphocyte:epithelial cell >25:100 (confirm via CD3 staining)

Answer 4

- Crohn's = Crampy abdominal pain and diarrhoea that is rarely bloody +/- mucous. Children also tend to present with growth retardation. Erythema nodusum may be present - UC = Colicky abdominal pain with bloody diarrhoea and PR bleeding. Growth retardation is uncommon and Eryhtema Nodosum is not seen

Answer 5

1st line = Induce remission • Enteral nutrition with whole protein modular feeds if concerned about growth defects/side-effects of drugs • Drugs o Oral prednisolone or IV Hydro (ONLY Tx FOR EXACERBATIONS OR SEVERE PRESENTATIONS)  Budesonide if traditional steroids refused/contraindicated or distal ileum, ileo-caecal or right sided disease • Explain there are fewer side-effects but is less effective • DO NOT OFFER FOR SEVERE PRESENTATIONS OR EXACERBATIONS o ASA if steroids refused/contraindicated  Explain they are less effective  DO NOT OFFER FOR SEVERE PRESENTATIONS OR EXACERBATIONS o Add Azathioprine or 6-Mercaptopurine if:  2 or more exacerbations in previous 12 months or steroids cannot be tapered  ASSESS TMPT ACTIVITY BEFORE ADMINISTRATION o Biologics (Infliximab or Adalimumab) if above fails to induce remission • Surgery o Consider if disease limited to distal ileum and have growth retardation or refractory disease - 2nd line = Maintain • Follow-up if maintenance refused • Azathioprine or mercaptopurine monotherapy following drug therapy o Methotrexate if TMPT deficient or intolerant to above o Add metronidazole if surgical remission o PACES Counselling - Explain the diagnosis (a disease with an unknown cause that causes inflammation of the digestive system leading to malabsorption and bloody diarrhoea) - Explain that it is a life-long condition and there is always a risk of relapse - Reassure that there are many medications that can be used to settle down the inflammation any time it flares up (and explain that they will be seen by a gastroenterologist) - Explain complications (malabsorption and bowel cancer) - There is no special diet but you may find that certain foods will make it worse - Support: Crohn’s and Colitis UK

Answer 6

o UC (Induce remission and then maintain) - Assess severity using PUCAI (Paediatric Ulcerative Colitis Activity Index) • Severe >65 • Mild-moderate 10-64 - Mild-moderate proctitis/proctosigmoiditis • Induce o 1st line = Topical Aminosalicylates (Mesalazine)  Oral if they decline 1st line but explain this is less effective o If no response after 4 weeks, add Oral Aminosalicylates o If further Tx, add Oral or topical corticosteroid o Consider adding Tacrolimus if still no response • Maintain o Topical +/- oral ASA  Oral inferior to topical as stand-alone o Oral Azathioprine or mercaptopurine if:  2 or more exacerbations within a year requiring steroids  ASA remission failure - Mild-moderate left-sided • Induce o 1st line = Topical Aminosalicylate  Oral if they decline 1st line but explain this is less effective o If no response after 4 weeks + high-dose oral Aminosalicylates or switch to high-dose oral Aminosalicylates + Oral Corticosteroid o Consider adding Tacrolimus if still no response • Maintain o Oral ASA o Oral Azathioprine or mercaptopurine if:  2 or more exacerbations within a year requiring steroids  ASA remission failure - Mild-Moderate Extensive • Induce o 1st line = Topical and Oral Aminosalycylate o If no response after 4 weeks  Stop Topical  Continue oral and add oral Corticosteroid o Consider adding Tacrolimus if still no response • Maintain o Oral ASA o Oral Azathioprine or mercaptopurine if:  2 or more exacerbations within a year requiring steroids  ASA remission failure - Further Treatments • Biologics if azathioprine fails o Infliximab, Adalimumab an Golimumab (Anti-TNF α) - Severe - EMERGENCY • MDT assessment including Paeds gastro • Asses likelihood of surgery and give IV steroids o IV Ciclosporin or Surgery if steroids declined or contraindicated o Add IV Ciclosporin to steroids if no improvement after 72hrs or worsening o Use infliximab if Ciclosporin contraindicated • Factors increasing likelihood of surgery o >8 stools per day o Pyrexia o Tachycardia o Dilation on AXR o Low albumin or Hb o High Plt or CRP • Maintenance o Oral Azathioprine or Mercaptopurine  ASA if above contraindicated or intolerable • PACES Counselling • Explain the diagnosis (condition with unknown cause that leads to inflammation of the bowel, which leads to symptoms) • Explain that it isn’t common but is a well-known disease • Explain that there is no cure and it is a condition that tends to come and go in flare-ups every so often • Reassure that there are medications that can be used to reduce the likelihood of flare-ups and to treat flare-ups when they happen • Explain the complications (growth issues, bowel cancer and surgery) • Explain that they will be seen by a gastroenterologist • Support: Crohn’s and Colitis UK