Childhood Functional GI disorders and GERD Flashcards
What are functional GI disorders
disorders of the digestive system in which symtpoms cannot be explained by the presence of structural or tissue abormality based on clinical symptoms
Types of functional GI disorders
G1. infant regurgitation G2. Infant rumination syndrome G3. Cyclic vomiting syndrome G4. Infant colic G5. Functional diarrhea G6. Infant dyschezia G7. Functional constipation
Diagnostic criteria for infant regurgitation
must include all the follwing in otherwise healthy infants 3 weeks to 12 months of age
- regurgitation 2 or more times per day for 3 or more weeks
- no retching, hematemesis, aspiration, apnea, failure to thrive, feeding or swallowing difficulties, abnormal posturing
Diagnostic criteria for infant rumination syndrome
must include all the following for at least 3 months
- repetitive contractions of abdominal msucles, diaphragm and tongue
- Regurgitation of gastric content into the mouth which can also be reswallowed
- three or more of the following
- onset between 3mo and 8mo
- does not responed to management for GERD and anticholinergic drugs, formula changing…
- unaccompanied y signs of nausea or distress
- does not occur during sleep and when infant is interacting with others
Diagnostic Criteria for Cyclic Vomiting Syndrome
must include both:
- two or more periods of intense nausea and unremitting vomiting or retchign lasting hours to days
- return to usual state lasting weeks to months
Diagnostic Criteria for Infant Colic
must include all of the follwing from birth to 4 mo of age
- paroxysms of irritability, fussing, crying that start and stop wihtout abvious cause
- episodes lasting 3 or more hours per day and occuring at least 3 days per week for at least 1 week
- no failure to thrive
Diagnostic Criteria for Functional Diarrhea
must include all of the following
- daily painless, recurrent passage of 3 or more large, unformed stools
- Symtpoms that last more than 4 weeks
- onset of symtpoms that begins between 6 and 36 motnhs of age
- pasasge of stools that occurs during waking horus
- there is no failure to thrive if caloric intake is adequate
Diagnostic Criteria for Infant Dyschezia
must include both in an infant younger than 6 months
- at least 10 minutes of straning and crying before successful passage of soft stools
- no other health problems
Diagnostic Criteria for Functional Constipation
must include 1 month of at least 2 of the follwing in infants up to 4 years of age
- two or fewer defecations per week
- at least 1 episode per week of incontinence after the acquisition of toileting skills
- history of stool retention
- history of painful or hard bowel movements
- resence of a large fecal mass in the rectum
- histroy of large diameter stools that may obstruct the toilet
Irritable Bowel Syndrome
must include all of the follwing
- abdominal pain at least 4 day per month associated with one or more of the follwing:
- related to defecation
- a change in frequency of stool
- a change in form of stool - in children with constipation, the pain does not resolve with resolution of the constipation
- After appropriate evaluation, the symtpoms cannot be fully explained by other conditions
Functional dyspepsia
must include 1 or more of the follqing for at least 4 days per month
- postprandial fullness
- early satiation
- epigastric pain or burning not associates with defecation
- after appropriate evaluation the symtpoms cannot be fully explained by another medical condition
Functional Nausea
must include all of the follwing for the last 2 months
- boterhsome nausea as the presominant symtpom, at least twice per week and generally not related to meals
- no consistently associated with vomiting
- after appropriate evaluation, the nausea cannot be fully explained by another medical condition
GERD definiciton
- all individuals who are exposed to the risk of physical complictions form gastro-esophageal reflux
- or who experine clinically significant impairment of health-related well-being due to reflux related symtpoms
GERD: two main categories
- Patients with ENRD
- patients with esophagitis (with and without complications)
LA classification of esophagitis
GRADE A
one (or more) mucosal break, no longer than 5 mm, that does not extend between the tops of two mucosal folds
GRADE B (most common) - one (or more) mucosal break, more than 5 mm long, that does not extnd between the tops of two mucosal folds
GRADE C
- one (or more) mucosal break that is continuous between the tops of two or mroe mucosal folds, but which involves less than 75% of the circumference
GRADE D
one (or more) mucosal break that involves at least 75% of the esophageal circumference
