Conditions Part 4 Flashcards
What is malabsorption in a Child?
Lactose Intolerance
Lactase deficiency (lactose → glucose and galactose) -> lactose ferments in gut -> ↑ waste gas -> pain and bloating
affects 75% of world population - asian, African and hispanic
1 - lactase deficiency
2 - damage to gut, lactase deficiency - gastroenteritis, Crohn’s, coeliac, alcoholism
Signs and symptoms of malabsorption?
wind, diarrhoea, bloating with lactose ingestion, abdominal rumblings and pain
Investigations for malabsorption?
Clinical diagnosis
Breath Hydrogen Test - GIT bacteria, extend to small intestine from large intestine
Lactose Intolerance Test
FBC - to rule out secondary disease
Management of malabsorption?
Dietician referral
o Avoid milk and dairy products -> provide calcium and vitamin-D supplementation
What is Coeliac Disease?
Autoimmunity to gliadin (in gluten, wheat, barley and rye) -> shorter villi and flat mucosa
- damage to proximal small intestinal mucosa
- common in 1% of infants
- HLA DQ2 + DQ8
Signs - failure to thrive, abdominal distension, bloating, irritability, dermatitis herpetiformis - knee rash
Investigations of coeliac disease?
Serology - IgA tissue transglutaminase
FBC and blood smear - iron def, vitamin B12/ folate, vitamin D deficient
Management of coeliac disease?
remove wheat, rye, barley products
MDT - dietician, child psychologist, school involvement, GP, paediatric gastroenterologist
Dietician referral
What is Mesenteric Adenitis?
Mainly in children <15yo; recent viral/bacterial infection -> common cause of abdominal pain
abdominal pain - central or RIF nausea + diarrhoea decreased appetite high temperature, lymphadenopathy increased WCC
What are the investigations for mesenteric adenitis?
Large mesenteric lymph nodes seen at laparoscopy (w/ normal appendix) -> definitive
What is the management for mesenteric adenitis?
simple analgesia
antibiotics
safety net for increased pain and deterioration
What is a hernia? What are the types?
indirect inguinal, umbilical, epigastric, femoral
Describe features of an Indirect Inguinal Hernia?
testicle creates a passage (process vagialis) as it travels into the scrotum
failure of passage to close - abdominal lining and bowel protrude through defect
risk factors - male, prematurity, connective tissue disorders
Signs - scrotal sac enlarged, palpable bowel loops, swelling or bulge
Investigations - clinical diagnosis, more common on the right testicle
How to manage an indirect inguinal hernia?
Urgent Surgical correction (lap or open) = Elective herniorrhaphy (risk of strangulation/incarceration)
· <6w old correct within 2 days
· <6m old correct within 2 weeks
· <6yo correct within 2 months
What is an umbilical hernia?
common in new borns and often resolve
< 1 yo -> watch and wait
>1 -> large and symptomatic = surigcal repair at 2-3 , small/asymptomatic - surgery 4-5 years
What is a femoral hernia?
difficult to differentiate from indirect
located between inguinal canal
differentiation often made during operation
What is gastroschisis?
paraumbilical abdominal wall defect > abdominal contents outside body, without peritoneal covering
o Manage with immediate surgery (cover with cling-film)
What is omphalocele/exomphalos?
bowel protruding out the body with a peritoneal covering / umbilical attached
o Manage with staged closure starting immediately, finishing at 6-12 months
o Chromosomal abnormalities in 15% of cases (Trisomy 13 (Patau’s), 18 (Edward’s), 21 (Down’s); Turner’s)
What is Encopresis?
soiling of underwear with stool in children who are past the age of toilet training (>4yo)
o Usually due to constipation with overflow
Management of Encopresis?
enquire about psych stressors, changes in medications, food intolerances, etc
What is Acute Liver Failure?
massive hepatic necrosis with loss of liver function ± hepatic encephalopathy
o Uncommon; high mortality
o Majority from paracetamol overdose, infection and metabolic disease
Causes of acute liver failure in children under 2
infection metabolic disease seronegative hepatitis drug induced neonatal haemochromatosis
causes of acute liver failure in children over 2?
Paracetamol overdose mitochondrial disease seronegative hepatitis wilson's disease autoimmune hepatitis
Causes of acute liver failure in older children?
viral infection autoimmune hepatitis non-alcoholic fatty liver disease drug induced Wilsons disease
Signs and symptoms of Acute liver failure?
Jaundice
Encephalopathy (alternative irritable -> confusion/drowsiness episodes)
Coagulopathy
Hypoglycaemia
Electrolyte disturbance
Older children (aggressive, unusually difficult)
Investigations of Acute Liver failure?
LFTs - AST/ALT high, ALP HIGH, Liver function - INR Liver Inflammation - AST adn ALT clotting abnormal plasma ammonia - rasied EEG adn CT - Acute hepatic encephalopathy
management of acute liver failure?
refer to national paediatric centre
stabilise the child:
maintain blood glucose
preventing sepsis - antibiotics + antifungals
preventing haemorrhage - iv vitamin K
prevent cerebral oedema - fluid restriction and mannitol
Complications of acute liver failure
hepatic encephalopathy
cirrhosis or portal hypertension
Management of autoimmune hepatitis?
Prednisolone and azathioprine
sclerosing cholangitis - ursodeoxycholic acid - aids bile flow
liver transplants
Management of Wilson’s disease?
Zinc Pencillamine Pyridoxine Symptomatic treatment for tremor, dystonia and speech impediment liver transplantation
Management of Non-Alcoholic Fatty Liver Disease?
Weight loss
Statins
Ursodeoxycholic acid - improved bile flow
Treatment of insulin resistance and diabetes
vitamin E + C
