Conditions 3 Flashcards
What is Crohn’s Disease?
- Affects any part of the GI tract mouth to anus
- Transmural and most commonly affects the distal ileum and proximal colon
Signs and symptoms of Crohn’s disease?
Abdominal pain diarrhoea weight loss growth failure delayed puberty fever lethargy aphthous ulcers uveitis arthralgia erythema nodosum
Investigations for Crohn’s disease?
FBC - iron, B12, folate CRP + ESR faecal calprotectin Upper GI and small bowel contrast scan colonoscopy + biopsy stop
Management of Crohn’s disease?
Induce remission:
- nutritional management - 85-100% effectiveness
- whole protein + liquid
- steroids - prednisolone
Maintain remission:
- aminosalicyclates - mesalazine
- immunosuppressants - azathioprine, methotrexate
- no live vaccines
- pneumococcal and influenza vaccines
- surgery for complications - obstruction, fistula, abscess,
PACES COUNSELLING
What is Ulcerative Colitis
a long-term condition that results in inflammation and ulcers of the colon and rectum.
Signs and symptoms of Ulcerative Colitis?
Rectal Bleeding Diarrhoea Abdominal Pain Weight loss Growth Failure Erythema Nodosum Arthritis
Complications of Ulcerative Colitis?
PSC Enteric Arthritis Toxic Megacolon Haemorrhage Perforation Bowel Cancer
Investigations for Ulcerative Colitis?
Endoscopy + Histological Features
- mucosal inflammation/ulceration, crypt damage
PAEDS - 90% have pancolitis
Management for Ulcerative Colitis?
Oral Aminosalicyclates
- maintains remission
Topical or Oral Corticosteroids
Oral Tacrolimus
Biological agents - infliximab, adalimumab
Surgery
Medical Education
What is Severe Fulminating Disease?
This is persistent symptoms despite treatment.
Severe diarrhea and cramps Fever Leukocytosis Abdominal distention.
What is Toddler Diarrhoea?
- Chronic and non-specific diarrhoea
- Commonest cause of loose stools in preschool kids
- maturational delay in intestinal mobility
Signs:
- varying consistency stools
- child well and thriving
Management of Toddler’s Diarrhoea?
Increased fibre and fat in the diet = relieves symptoms
avoid fruit juice and squash
What is Constipation?
very common and frequency can be variable in children
exclude the following
<24hrs = hirschprung disease
faltering growth = hypothyroid/coeliac
gross abdominal distension = hirschprung disease
abnormal lower limb neurology = lumbosacral pathology
sacral dimple = spina bifida occulta
abnormal appearance anus = abnormal anorectal anatomy
perianal bruising = sexual abuse
perianal fistulae/abscesses/fissures = Crohn’s disease
Management of Constipation?
adequate fluid intake
good toilet habits
coeliac screen + thyroid function
stimulate laxative +laxative therapy
What is 1st line management for Constipation?
Advise behavioural interventions - scheduled toileting, bowel habit diary
Advise diet and lifestyle advice
Medications - disimpaction or mild constipation - movicol paediatric plain
Paces counselling
What is Hischprung’s Disease?
An absence of ganglion cells from the myenteric (Auerbach) and submucosal (Meissner’s) plexuses; begins at the rectum and spreads proximally for a variable distance (75% rectosigmoid), ending at normally innervated, dilated colon
Signs and Symptoms and Complications of Hirschprung’s Disease?
Failure to pass meconium <24hrs
Explosive passage of liquid/foul stools
Complications - meconium plug syndrome, hirschprung’s enterocolitis
Investigations of Hisrchsprung’s disease?
Abdominal X ray
Contrast Barium enema
Definitive - suction-assisted full thickness rectal biopsy - abscence of ganglion cells
Management of Hirschprung’s Disease?
Bowel Irrigation
endorectal pull through - colostomy followed by anastomosing normally innervated bowel.
What is an anal fissure?
Tears in skin around the anus, usually as a side effect of constipation
painful passing of stool
bright red blood on tissue
Management of anal fissures?
Conservative - make sure stools are soft and easy to pass
- increase dietary fibre
- increase fluid intake
- manage pain - simple analgesia
- anal hygiene
What is Threadworm? What is its Management?
Single dose of an anti-helminth (e.g. mebendazole / “Ovex”) for the whole household
The dose may be repeated in 2 weeks if the infection persists
Rigorous hygiene for 2 weeks
