Feeding and GI Flashcards
What is the pathogenesis of a megacolon secondary to constipation occuring in infants?
Acute episode - hard stool, pain, fissure
Learn pooing means pain
Withhold stool
Decreased rectal sensation - down regulated stretch receptors
Distended bowels and megacolon
Causes of faecal impaction/ megacolon?
Genetic predisposition - coeliac, CMP intolerance
neurological - spinal problems
anatomical - hirschsprungs
endocrine - hypothyroidism
When would you be suspicious of Hirschsprung’s disease? What is it>
Failure to pass meconium after 48 hours
Denervation of the distal colon
Symptoms of coeliac?
Failure to thrive
Anaemia
occasional diarrhoea
Bloating
Children with cows milk protein intolerance tend to present with what features?
Atopic features - hayfever, eczema, asthma
Uncomfortable at start of feed
Allergic medicated enterocolitis
How does hypothyroidism present in a baby?
Jaundice
constipation
skin colour changes
obesity
Questions to ask in a history of a child suffering constipation?
Frequency Consistency Pain School issues Family issues Any bed wetting
Describe the 7 stages of Bristol Stool Chart
type 1 - hard nut like balls type 2 - sausage with lumps type 3 - sausage with cracks type 4 - snake type 5 - soft blobs with clear edges type 6 - fluffy pieces ragged edges Type 7 - water
On examination what would you look at on a child with constipation?
Perianal sensation
Any fissures?
Back
Palpate abdomen - any faecal masses especailly LIF and suprapubic
Advice do you give children who are chronically constipated?
Increase fibre intake
Increase fluid intake
Better toileting technique
How do you initially treat a child who is suffering faecal overload?
Enema - clear
Faecal softener, sitmulant - maintain
What is an antegrade colonic enema? ACE
Permanent fistula created to allow saline in to wash out colon
Name 3 types of stool softener
Lactulose
Movicol
Macrogols
Which stool softener is best used in children?
Movicol
Name 3 types of stimulants that are used to help constipation?
Senna
Ducosate
Sodium Picosulfate
Features of NSAP?
periumbilical, worse in day, headaches, stress/anxiety
3 types of NSAP?
Non-ulcer dyspepsia
Abdominal migraine
IBS
Presentation of Crohn’s disease?
Intermittent fever Mouth ulcers perianal fissures weight loss blood in diarrhoea abdominal pain
What do you always have to rule out on GI pain investigation
UTI
What investigations are performed to rule out coeliac and Crohn’s
One specific test for coeliac?
FBP, CRP, ESR, LFT, amylase
Anti-transglutaminase antibodies
What investigations can you perform on a child with abdominal pain?
Urine dipstick bloods - FBP, CRP, ESR, amylase, LFT, antitransglutaminase antibodies USS of renal tracts Barium meal Endoscopy and H.Pylori breathe test
What can be given for abdominal migraine?
Pizotifen
Causes of vomiting in young children?
GOR feeding issues (overfeeding) cows milk protein intolerance obstruction - pyloric stenosis, more distal obstruction Infections IEM Raised ICP
How and when does pyloric stenosis obstruction present in children?
Usually 4-8 weeks of life
Non-bilious