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Paediatrics > Constipation / Diarrhoea / IBD > Flashcards

Constipation / Diarrhoea / IBD Flashcards

1
Q

What is acute - intermediate diarrhoea

A

<1 week or <3 weeks

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2
Q

What is chronic

A

> 3 weeks

Always investigate

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3
Q

What causes acute

A

Gastroenteritis = most common
Intussception
NEC

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4
Q

What causes chronic

A 
CMPI
Toddler
Coeliac
IBD
Lactose intolerance
Post gastritis lactose intolerance
Pancreatic disease - CF / Schwan
Hyperthyroid 
IBS
Obstruction
Constipation + overflow
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5
Q

What is the mechanism behind diarrhoea

A

Active secretion e.g. infection
Osmotic diarrhoea e.g. malabsorption
Motility disorder = toddler / IBS / constipation

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6
Q

What is toddler’s diarrhoea

A

Common cause
Stools vary and contain undigested food
Child well

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7
Q

What does nocturnal defection suggest

A

Organic pathology

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8
Q

What is important if child has diarrhoea

A

Height and weight

Dehydration

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9
Q

What is secretory diarrhoea and what causes

A

Large volume due to toxin production - Cl via CFTR
Infection
Gastroenteritis
IBD

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10
Q

What is osmotic and what causes

A 
Small volume
Large osmotic gap and water moves to equilibrate
Malabsorption
Pancreatic - CF
Hepatobiliary 
Allergy
Coeliac
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11
Q

How do you Rx osmotic

A

Stops when remove offending agent

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12
Q

How do you differentiate

A

Stop trigger in osmotic
Osmotic = large osmotic gap and small vol
Secretory = high electroyte and pH

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13
Q

What is Schwaman Diamond

A

Pancreatic and bone marrow dysfunction

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14
Q

What is most common cause of gastroenteritis

A

Rotavirus

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15
Q

What are other causes of gastroenteritis

A 
Adenovirus
Enterovirus
Norovirus
E.coli 
Cambylobacter
Shigella 
Salmonella 
Giardiasis
Amoebiasis
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16
Q

What should you beware of / have to report

A

E.coli 0157

Cholera

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17
Q

What is Ddx

A 
Sepsis
Local infection - UTI 
Surgical causes 
DKA
All causes of diarrhoea 
Obstruction if no fever
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18
Q

How does gastroenteritis present

A

Diarrhoea 5-7 days and resolves 2 week
Vomit 1-2 days and resolves 3 day
Fever

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19
Q

Cambylobacter

A

Bloody
Very high fever
Red flags

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20
Q

What are red flags

A 
High fever
Tachypnoea
Altered consciousness
Stiff neck
Bloody stool
Bile vomit 
Severe abdo pain or distension
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21
Q

What increases risk of dehydration

A 
<1 
LBW 
>6 stools 24 hours
>3 vomit 24 hours
Malnutrition
Not tolerating fluid
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22
Q

Hx

A 
Food
Travel
Contact
Sexual
Medication
Bowel
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23
Q

How do you Dx

A

Clinical if well

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24
Q

When do you do stool culture

A 
Red flag
Septicaemia
Blood / mucous
Immunocompromised
Foreign travel
\+7 days 
Uncertain
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25
Q

What are complications

A 
Dehydration = common
Electrolyte imbalance - Hypokalaemia
Paralytic ileus
Transient lactose intolerance
IBS 
Ketoacdisois if persistent
26
Q

Moderate signs of dehydration

A

Unwell / lethargic
Decreased urine
Pale
Cold

27
Q

What are signs of shock

A 
Decreased consciousness
Sunken eyes
Dry membrane
Decreased fontanelle
Decreased turgur
Tachycardia
Weak pulses
Prolonged CRT
Hypotension
28
Q

How do you treat

A

Fluid replacement
Oral if no dehydration
ORS (diorite) - 50ml /kg 4 hourly
IV if shock - 4,2,1

29
Q

What do you do once rehydrated

A

ORS every watery stool

30
Q

What are signs of hypernatraemic dehydration

A 
Increase tone
Hyper-reflexia
Convulsion
Drowsy
Coma
31
Q

How do you treat

A

Isotonic to rehydrate over 48 hours

Decrease Na <0.5mol / l /hour

32
Q

DDX of coeliac in children

A

CMPI
GORD
Intolerance
Iron deficiency anaemia

33
Q

What is constipation and other symptoms

A 
<3 stools per week  
Hard and large or
Rabbit dropping
Large stool in rectum or palpable per abdomen 
Overflow soil >1 episode 
Other Sx 
Distress on passing = constipation or ano-rectal 
Rectal bleeding
Poor appetite / pain - improves when pass
Abdo distension
Irritable 
Lack of energy
Withholding behaviour

Can present like appendicitis

34
Q

What are idiopathic causes of constipation / RF

A

Idiopathic = most common
Low fibre
Dehydration
Excessive milk

RF
Diet
Withholding stool
Change to daily routine
Not enough exercise 
FH
35
Q

What are other causes

A 
Intercurrent illness
Spinal cord lesion = always do LL neurology 
Opiates
Hypothyroid
Hypercalcaemia
Hirschprung
Meconium ileus
Imperforate anus
Obstruction 
Anal stenosis
Gut atresia
CMPI 
Coaliec 
IBD
Sexual abuse
36
Q

What is physiological cause

A 
Constipation
Hard / large stool 
Followed by pain when passing 
Avoidance / fear
Child withholds 
Leads to fissure 
Megarectum -> soiling as sphincter open
UTI
37
Q

What are RED FLAGS

A 
From birth - no stool >48 hours  
Occur in first few weeks after birth 
Ribbon stool - anal stenosis 
Faltering growth / FTT
Neuro signs e.g. leg weakness
Motor delay
Acute, severe abdominal pain + vomting 
Distension
No associated with diet change
38
Q

What are symptoms of faecal impaction

A

Severe constipation
Mass
Overflow

39
Q

How do you Dx constipation / impaction

A

Abdominal exam + anus
Weight + height
LL neurology / spine for dimples - spina bifida
X-Ray

40
Q

What is important in Hx

A 
How often 
How hard 
Previous episode
Fissure / painful movement
PR bleed
Soiling? 
Withholding behaviour
Toilet training 
Diet / appetite
Daily activity
Any worries
Medication
Rx tried
Development
41
Q

How do you treat 1st line

A 
Increased fluid and fibre
Decrease milk
Toilet = pleasant
Regular toilet
Reward good behaviour
Pharmacologicla = 2nd line
42
Q

What is pharmacological Rx

A

Movicol (isotonic) = 1st line
Senna (stimulant) = after 2 weeks if stool now soft
Lactulose (osmotic) = if stool hard
- Not useful as need to drink loads and children don’t

43
Q

What do you do after

A

Continue laxatives for several weeks then decrease dose

44
Q

When is constipation unusual

A

Breast feeding

45
Q

What is rare in children

A

Haemorrhoids

46
Q

What is IBD in children

A

More severe

More extensive

47
Q

What is important

A

Maintaining growth

48
Q

U.C

A

Proctitis rare

Pancolitis common

49
Q

Chron’s

A

Malabsorption - b12 may be only Sx

Upper GI / pan enteric more common

50
Q

What are biochemical disturbances

A 
Raised ESR / CRP
Anaemia
Thrombocytosis
Leucocytosis
Low albumin
51
Q

How do you Dx

A 
Exclude infection
FBC, U+E, CRP, LFT
Blood and stool culture
Coeliac -ve
Thyroid -ve
Raised calprotectin 
Endoscopy
MRI / barium meal if inconclusive
52
Q

What is gold standard test

A

Endoscopy

53
Q

How do you treat

A 
Nutrition - supplement
FODMAP
Elemental feeding = 85% remission and healing
Anti-inflammatory
Immune suppression
Biologics
Steroids = last ditch
54
Q

What immune suppression

A

Azathioprine - not in UC
Methotrexate
Cyclosporin

55
Q

Biologic

A

Infliximab (anti-TNFa)

56
Q

What is impotant

A

Maintain growth and development

57
Q

When do you do surgery

A

Poor growth
No puberty
Unresponsive to medical Rx

58
Q

What are consequences

A 
Poor growth / puberty
Colon cancer
Haemorrhage
Electrolyte
Toxic dilatation and megacolon
Obstruction
Perforation
59
Q

What are SE of steroid

A 
Infection
Weight gain
Appetite
Moon face
Adrenal gland failure
Poor growth
60
Q

If failure to pass stool first 72 hours

A

Hirshprung
CF - meconium ileus
Imperforate anus

61
Q

Constipation + FTT

A

Coeliac
IBD
CF
Hypothyroid

Paediatrics (35 decks)

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