Gastro Flashcards
How is abdominal pain present in babies?
Crying, drawing up of legs
With regard to abdominal pain in older children what are 3 important features in the history?
Pain lasting more than 4 hours
pain further away from umbilicus likely significant (except appendicitis)
Timing and character
What is the significance of the following symptoms/signs associated with abdominal pain? vomiting stools anorexia dysuria cough
Vomiting - bilious suggests obstruction stools - blood suggests inussusception in infact or IBD in older children anorexia - normal appetite reassuring dysuria - UTI cough - pneumonia
What 4 conditions does a fever suggest in a child with abdominal pain?
Appendicitis
mesenteric adenitis
UTI
pneumonia
What 2 conditions does Jaundice suggest in a child with abdominal pain?
infectious hepatitis
biliary colic
3 useful investigation in a child with abdominal pain
FBC - neutrophilia
Urinalysis - nitrites/leucocytes/glucose
CRP
5 features of functional recurrent abdominal pain
pain usually periumbilical
no associated anorexia or change in bowel habits
thriving and no physical signs
fam history of recurrent abdominal pain/IBS
sources of stress/anxiety
It’s quite common for babies to vomit up small quantities of milk but what does projectile vomiting suggest, particularly if the baby is hungry afterwards?
Pyloric stenosis
What does vomiting after a feed suggest? 3
Overfeeding
gastro-oesophageal reflux
pyloric stenosis
What does early morning effortless vomiting indicate?
raised inter-cranial pressure
6 red flag features associated with vomiting?
bilious vomiting localised abdominal pain persistent fever altered consciousness/bulging fontanelle petechial rash respiratory distress
What is the most common case of persistent loose stools in thriving pre-school child?
toddler diarrhoea
7 organic causes of constipation in children
Coeliac disease Food allergies (non-IgE) bowel obstruction Hirschsprung disease CF neuromuscular disorder Hypothyroidism
6 red flags associated with constipation?
Starts in first few weeks of life Meconium passed >24hours Abdominal distension of bilious vomiting Faltering growth delayed walking child protection concerns
Management of constipation
High fibre and adequate fluid.
Laxatives may be needed - MOVICOL first line
What factors would suggest that a child is just constitutionally small?
Small parents low birth weight for gestational age proportionally small normal height and weight velocities healthy normal physical examination
In a child with faltering growth what factors must be considered of inadequate food intake is the suspected cause?
psychosocial deprevation
neglect
fabricated of induced illness
What is characterised by recurrent inconsolable crying, often accompanied by drawing up of the legs and occurs from 2 weeks to 4 months.
infantile colic
Aside from colic 6 other causes of recurrent inconsolable crying in an infant?
Gastro-oesophageal reflux cow's milk protein allergy incarcerated hernia intussusception otitis media UTI
What are the symptoms/signs associated with gastro-oesophageal reflux?
Vomiting
some abdominal discomfort indicated by back arching and crying after feeds
worse when lying down
feed aversion
What is the typical management of gastro-oesophageal reflux in infants?
reassurance - 95% will resolve by 18 months
Thickening feeds might help
Management of more severe gastro oesphageal reflux?
H2 antagonists
PPI
Domperidone
When does pyloric stenosis usually present?
First 2-8 weeks of life
5 Clinical features of pyloric stenosis?
Persistent projectile non- bilios vomiting after feeds. Infant remains hungry after vomiting Weight loss Dehydration Jaundice
What is the investigation for pyloric stenosis?
Palpation of the hypertrophied pyloris during test feed
ultrasound
What type of metabolic disturbance might develop as a result of pyloric stenosis and why?
Metabolic alkalosis
No gastric acid goes through so the kidneys retain hydrogen at expense of potassium.
Pain localised to the right iliac fossa over a period of hours, which is worse on movement is indicative of what?
Acute appendicitis
What are 5 common associated symptoms with acute appendicitis?
anorexia nausea vomiting diarrhoea constipation
What is Rovsing sign?
Palpation of the left iliac fossa causes pain in the right iliac fossa
What condition is where one segment of the bowel telescopes into an adjacent distal part of the bowel.
Intussusception
At what age is intussescption most common?
between 5 and 10 months
Presenting triad of Intussusception
Paroxysmal colicky abdominal pain
Abdominal mass
Redcurrant jelly stool - (late sign)
Management of Intussusception?
Surgical emergency - refer to surgery
What is the main core of management for gastroenteritis?
Oral rehydration
Antibiotics rarely indicated except for specific bacterial infection
No role for anti diarrhoea meds
4 clinical features of EITHER Crohns or ulcerative colitis?
abdominal pain
bloody diarrhoea with mucus
weight loss faltering growth
If a patient is systemically unwell with malaise, tachycardia and fever is this more likely to be Crohns or UC?
Ulcerative colitis
In a patient with aphthous ulceration and perianal disease is this more likely to be Crohns disease or ulcerative colitis?
Crohns
How might IBD present in the eyes?
Anterior uvitis
episcleritis
How might IBD present in the liver?
Gallstones
Cirrhosis
Fatty liver
How might IBD affect the bones?
Osteoporosis
Arthritis
Spondylitis
How might IBD present in terms of haematology?
Anaemia
Increased risk of thrombosis
How might IBD present in the skin?
Erythema nodosum
Pyoderma gangrenosum
For a patient with suspected IBD what investigations would you consider ordering other than endoscopy?
Faecal calprotectin - show inflammation
Stool sample - rule out bacterial infection
FBC - inflammation and anaemia
Classical triad of coeliac disease presentation?
faltering growth
steatorrhoea
abdominal distension
What is the first line investigation for coeliac disease?
IgA tissue transglutaminase
