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
Causes of obstruction causing vomitting that occur distal down the GI tract?
Volvulus, intussusception, malrotation, atresia
How do IEM tend to present? which is the most common in children?
introduced to milk feeds - starts to vomit 2/3 days later
jaundice
hepatomegaly
poor weight gain
What feature alongside vomiting makes you worried about increase ICP?
Lethargy
7 causes of vomiting in children?
GOR Overfeeding CMP intolerance obstruction raised ICP Infection IEM
How do you diagnose pyloric stenosis in a child? What will results show?
Venous pH and USS of the abdomen
Hypokalaemic hypochloraemic acidosis
Alkolotic blood
What type of acidosis is caused by pyloric stenosis?
Hypokalaemic hypochloraemic acidosis
Investigations into vomiting babies?
blood - FBC, UE, LFT, CRP, venous pH, USS, CT abdomen
What needs to be excluded in order to diagnose GOR?
Pyloric stenosis excluded
If a baby is well but has GOR, what 3 measures can be put given to improve symptoms?
Carobel to thicken feeds
Postural methods
Gaviscon
If a baby is in pain because of GOR, what 2 medications can be given?
Ranitidine
Omeprazole
What surgical treatment for GOR can be given to children with learning difficulties or autism?
Fundoplication
8 main causes for recurrent chronic diarrhoea in children?
Toddler's diarrhoea Cows milk protein intolerance Coeliac Pancreatic insufficiency Primary or secondary disaccharidase deficiency (lactase) immundeficiency Chronic infection IBD Gluten intolerance
Ages usually effected by Toddler’s diarrhoea?
18 months and 4-5 years of age
Which are the only 2 reasons for chronic diarrhoea in children that present with a thriving child?
Toddler’s diarrhoea
Cows milk protein intolerance
Presentation of cows milk protein intolerance?
Atopic features
Difficult to feed from the get go
Presentation of pancreatic insufficiency?
CF - recurrent chest infections, steatorrhoea, not thriving
Primary or secondary disaccharidase deficiency refers to what?
Lactose intolerance
What is the most common cause of secondary lactose intolerance?
Viral gastroenteritis which wipes out the small bowels ability to absorb for a few weeks
What does FBP exclude when investigating chronic diarrhoea in baby?
Crohns or Coeliac
What does ESR/CRP exclude when investigating chronic diarrhoea in baby?
Infection
IBD
What does LFT/albumin exclude when investigating chronic diarrhoea in baby?
liver cause
What does stool culture look for specifically in chronic diarrhoea?
Giardiasis
What does a stool pH look for in chronic diarrhoea ?
Acid stool with sugars indicative of lactose intolerance
How do you exclude CF?
Sweat test
Viruses most likely to cause acute diarrhoea in babies?
Rotavirus
SRSV, norwalk, winter vomiting
Adenovirus
Enterovirus
5 bacteria that can cause acute diarrhoea? which can cause dysentry?
Campylobacter Salmonella E.Coli Shigella (dysentry) Cholera
3 main protozoa that can cause acute diarrhoea?
Crytosporidium
Giardiasis
Malaria
Most likely cause of acute watery diarrhoea?
Rotavirus
2 most likely cause of acute bloody diarrhoea?
Shigella and Campylobacter
How do you manage acute diarrhoea in infant?
oral fluids/IV/ORS
Reintroduce milk and feeds quickly
What does oral rehydration solution act on in the SI?
The sodium glucose co-transport pores and water by osmosis
Signs that a child is 5% dehydrated or 10% dehydrated
sunken eyes/very sunken eyes
no tears
dry mucus membranes/very dry mucus membranes
drinks rampantly/ poor drinking (10%)
skin prick test goes back slowly/ very slowly
What is RIglers Sign on X-ray and what is it indicative of?
Rigler’s sign is when you can see both sides of the intestine and stomach walls signifying pneumoperitoneum
What patients are meconium ileus almost always contributed by?
CF
what study can be performed to determine bowel transit time?
transit study/pellet study
What is the study of choice for malrotation of the gut?
Fluoroscopy
How much weight should i new born gain per week? how many calories?
200 grams
115 cal/kg/day
Protein, calcium and iron requirements in first few months of life?
protein = very high calcium = steady throughout first year of life iron = low (born with stores)
Which minerals are good for wound healing?
zinc, copper, vitamin c, protein, energy
How many months is it recommended a baby is breast fed for?
6 months
Immune benefits of breast milk?
immunological compounds enzymes to improve digestions antimicrobial elements anti-inflam hormone and GF
What difference is breast milk in first 14 days of life?
Colostrum - rich in immunological compounds
Immediate benefits of breast milk to the baby?
Reduces chances of necrotizing enterocolitis, acute otitis media, atopic conditions developing, RTI
Benefits of breastfeeding to the mother?
Reduces risk of breast and ovarian cancer Delayed return of fertility Reduces chances of developing T2DM Reduced post menopausal hip fractures Post partum weight loss
2 examples of long chain polyunsaturated FAs and why breast milk is an important source?
Arachadonic acid and docosahexanoic acid
Babies cant produce themselves untill 4-6 months
What are long chain polyunsaturated FAs used for?
CNS and retinal tissue
What is the purpose of prebiotics in breast milk?
gut barrier
decolonises harmful bacteria
Immune system
What 2 infections mean breastfeeding is contraindicated?
HIV
TB
What conditions mean breast feeding is contraindicated for the baby?
IEM - galactossaemia, PKU
Premature feeds contain what constituents for babies?
more calories and protein Calcium Iron Phosphate Vitamin A Copper
What does partly hydrolysed formula contain and why?
Shorter chains less likely to cause allergic reaction
AA based formulas used for who?
Multiple allergies and malabsorption in the gut
Can you feed babies soya milk?
Not under 6 months
Types of foods you can initially wean babies onto?
Puree fruit and vegetables, custard, potatoes, baby rice
Second stage of weaning occurs at what age? what is food like? examples
7-9 months
minced and mashed
Weetabix, oats, cereal
toast, soft fruit, cooked veg
Third stage of weaning occurs at what age?
10-12 months
no more bottle feeds
When can gluten be introduced to a babies diet?
6 months
When can shellfish be introduced to a babies diet?
6 months
When can citrus fruits be introduced to a babies diet?
6 months
When can eggs be introduced to a babies diet?
6 months (well cooked)
When can processed foods be introduced to a babies diet?
12 months
When can sugary foods be introduced to a babies diet?
12 months
When can whole milk be introduced to a babies diet?
12 months
When can honey be introduced to a babies diet?
12 months
When can nuts be introduced to a babies diet?
12 months
Causes of iron deficiency anaemia in children?
low birth weight
early use of cows milk
poor weaning diet
chronic disease
What happens to children who have iron deficiency anaemia?
immune - prone to infection, general health
Coordination - locomotor skills, hand/eye
Behavioural
Physical wellbeing
Overweight can be classified at what weight percentile?
over the 85th
Obesity can be classified at what percentile?
over the 95th
“nature” role in childhood obesity?
Low birth weight - programmed to retain calories
Parental gene influence
Babies with Prader Willi Syndrome - initial presentation and as they develop?
Floppy baby
Difficult to feed initially
Gain appetite
Eat continuously
What congenital conditions can cause obestiy in children?
Prader willi syndrome
Cohen
Cushing’s
Hypothyroidism
Problems caused by childhood obestiy
depression dyslipidaemia hypertension SUFE T2DM sleep apnoea Benign intracranial hypertension
name a brand of oral rehydration solution?
Deoralyte
What are the two important componenets of oral rehydration solution?
Glucose and salt
When are IV fluids indicated in dehydration?
Persistent vomiting, still dehydrated despite ORS, in shock
How much of a fluid bolus do you give in a child presenting with dehydration? How much dextrose IV?
20ml/kg 0.9% saline
2ml/kg 10% dextrose
Hypopack is used to assess any underlying causes of hypoglycaemia. What 7 blood tests does it send off for?
Insulin AA Lactate GH Cortisol Serum glucose Hydroxybutyrate
Difference in the signs for 5 and 8% dehydration?
5% = dry mucous membranes, decreased skin turgour, altered neuro, deep breathing 8% = Increased CRT over 2 seconds, cold and peripherally shut down, cold and clammy, circulatory collapse
At what time period are fluid deficits replaced over?
48 hours
What does MCADD invovle?
doesnt have medium chain acyl coA dehydrogenase and therefore cannot break down fats to be used in a fasting state, dependant on glucose
Chance of having another baby with MCADD?
25% autosomal recessive
