Coeliac disease and recurrent abdo pain Flashcards
1
Q
what age do coeliac children present?
how do they present?
A
- before age 2 years
- failure to thrive
- irritability
- anorexia
- D + V
- most prominent features are decrease in weight gain and linear growth
2
Q
what will the stools be like?
what physical signs may you see on a child?
A
- pale and foul
- mouth sore, smooth tongue
- excessive bruising
- finger clubbing
- peripheral oedema
3
Q
what investigations would you like?
how is the diagnosis made? and what would it show?
A
- FBC: shows anaemia
- folate is low, IDA
- faecal smear: demonstrates fat globules
- jejunal biopsy: subtotal villous atrophy
4
Q
what could you do to stop them being gluten free all their life?
A
- re-challenge with gluten after 2 years of the diet
5
Q
what is the physiology behind recurrent abdo pain?
A
- no identifiable organic cause
- functional rather than organic pain
- mainly psychosomatic
6
Q
what are the clinical features?
A
- real, severe abdo pain
- sensitive, highly- strung and high- achieving individuals usually
7
Q
how should you manage this?
A
- reassurance, maximise normal lifestyle and minimise school absence
- address psychosocial causes
- understanding attitude, pain resolves over time
8
Q
what would you do if a child is not eating because:
- easily distracted by tv/ runs around
- changing their mind about what they are willing to eat
- slow/picky eater
- drinking too much fluid/ pop/ milk
A
- Turn off TV, eat together
- allow child to help in prep
- present food for fixed amount of time, if they are good weight then don’t worry
- give drinks and snacks after, not before meals
9
Q
what investigations would you do if child not eating well ?
how should it be managed?
A
- weight and measurements accurately, based on food diary
- eating together as a family, feeding at mealtimes and social context
