Constipation and diarrhoea Flashcards
What are the types of cause of cnstipation?
Social
Pathological
What are some pathological causes of constipation in babies?
Impaction MEconium ileus Volvulus Bowel obstruction Hirschsprung's disease
What is the management of faecal impaction?
Empty impacted rectum and colon
Maintain regular stool passage- Movicol- with slow weaning off treatment
What is meconium ileus?
Meconium becomes thick and congested in intestines and fails to pass
What is meconium ileus a red flag for?
CF
What is the presentation of meconium ileus?
Within first 48 hours
Bilious vomiting
Abdo distension
No passage of meconium, constipation
What is the investigation of meconium ileus?
AXR- fluid levels
Investigate for CF
What s the management of meconium ileus?
Surgical decompression
What are the risk factors for volvulus?
Malrotation
Hirschsprung’s
What is the presentation of volvulus?
Bowel obstruction
Peritoneal signs
Haemodynamic instability
What is the management of volvulus?
Emergency surgery
What causes bowel obstruction in newborns?
Imperforate anus
Congenital atresia/stenosis
Volvulus
Meconium uleus
What is the most common cause of bowel obstruction in 2-3 months?
Strangulated hernia
What is the most common cause of bowel obstruction in 3-18 months?
Intususseption
What is Hirschsprung’s disease?
Absence of ganglion cells from myenteric and submucosal plexuses causing chronic constipation
What is the presentation of Hirschsprung’s?
Delayed passage of meconium
Chronic constipation
Abdo distension
What is the management of Hirschsprung’s?
Anorectal pull through
What is the most common cause of gastroenteritis?
Rotavirus
What is the presentation of gastroenteritis?
Fever, vomiting and diarrhoea
What are the types of cows milk protein allergy?
Immediate IgE related- 45% remain intolerant
Delayed non IgE mediated- majority tolerant by age 3
What s the presentation of CMPA?
Regurgitation, vomiting
Diarrhoea
Irritability, crying
Failure to thrive
How is CMPA diagnosed?
Clinically via removal of cow’s milk protein
What is the management of CMPA in breastfeeding?
Maternal avoidance of cow’s milk protein
What is the management of CMPA in formula feeding?
1st line= extensive hydrolysed formula
2nd= amino acid based formula
When does IBD normally present?
Adolescence
What is the histology of Crohn’s?
Inflammation of all layers at any level
Skip lesions, non caseating granulomas, crypt abscesses
What is the presentation of Crohn’s?
Non bloody diarrhoea
Prominent weight loss
Abdo pain
What is the histology of UC?
Lesions start at rectum and move proximally
Continuous mucosal inflammation with pseudo polyps
What is the presentation of UC?
Bloody diarrhoea
Abdo pain
What investigations should eb done for IBD?
Bloods- raised CRP, anaemia, low vit D and B12
Faecal calprotectin- increased
MR enterography- gold standard
Endoscopy, colonoscopy and biopsy- diagnostic
What is the emergency imaging in IBD?
CT abdomen
What are some causes of malabsorption?
Pancreatic disease- classically CF
Chronic liver disease
Cholestasis
What can cause both diarrhoea and constipation?
IBS
Coeliac
What is coeliac?
Autoimmune disease causing sensitivity to gladin fraction of gluten, leading to villous atrophy
What are some risk factors for coeliac?
FH
Other autoimmune conditions
HLA DQ2 and DQ8
What is the presentation of coeliac?
Abdo bloating and pain Diarrhoea/constipation Failure to thrive Tiredness Dermatitis herpetiformis
What investigations are done for coeliac?
Coeliac serology and IGA
HLA DQ2 and DG8
Duodenal biopsy
What is done on a coeliac serology?
Anti tissue transglutaminae TTG
Anti endomysial
Anti-gladin
What are the indications to diagnose coeliac without biopsy?
Anti TTG >10x upper limit
+ anti E
+ HLA
What is the management of coeliac?
Gluten free diet
Refractory- steroids
