Gastro Presentations Flashcards
What is Encopresis and soiling, how does it present and what is its DDx?
= term for faecal incontinence
Involuntary loss of formed, semiformed, or liquid stool into the child’s underwear in the presence of functional (idiopathic) constipation
Not considered pathological until 4 years of age
S+S = soiled underpants, foul body odour (the smell of stool), lower abdo pain, streaks of blood, bedwetting
DDx = constipation (anxiety, diet, inactivity, dehydration, medication, pain), Spina bifida, Hirschprung’s disease, CP, LD, psychosocial stress, abuse
What is Functional abdo pain, how does it present and what is its DDx?
AKA intractable abdominal pain, is persistent stomach pain that does not resolve with usual therapeutic treatment
S+S = abdo pain, diarrhoea, constipation, N+V, indigestion
DDx = IBS, food allergy, Crohn’s
What is Malabsorption, how does it present and what is its DDx?
Child’s body has trouble absorbing nutrients from food
S+S = malodorous stools, chronic diarrhoea, failure to thrive, weight loss, and subnormal growth, oedema, rickets, bleeding/bruising, pot belly, bone fractures,
DDx = celiac disease, cystic fibrosis, Crohn’s disease, lactose intolerance, chronic pancreatitis
What is Toddler diarrhoea, how does it present and what is its DDx?
The cause is not completely understood (probably results for maturational delay in intestinal motility which leads to intestinal hurry), common between 1-5y in well and thriving children
S+S = >3 watery loose stools/d, pale stools
DDx = lactose intolerance, constipation
What is Mesenteric adenitis, how does it present and what is its DDx?
Inflamed lymph glands in the abdomen, which cause abdominal pain - infection (strep, staph, e.col, bartonella henselae, giardia lamblia, adenovirus)
S+S = abdo pain, fever, N+V, diarrhoea, malaise, weight loss
DDx = appendicitis, crohns, acute diverticulitis, cholecystitis, pancreatitis, perforated viscus
What is IBD, how does it present and what is its DDx?
- UC = chronic, idiopathic, diffuse mucosal inflammatory disease of the colon
- CD = chronic, idiopathic, trans-mural and patchy, inflammation of one or more segments of the GI tract (commonly distal ileum/proximal colon) - strictures, fistulae
S+S =
- UC = bloody diarrhoea, abdo pain, rectal bleeding, weight loss, growth failure, erythema nodosum, arthritis
- CD = diarrhoea, abdominal pain, fatigue, reduced appetite, weight loss, growth failure, oral lesions, perianal skin tags, uveitis, arthralgia, erythema nodosum
DDx = intestinal tuberculosis, Behçet’s disease, nonsteroidal anti-inflammatory drug enteropathy, IBS, coeliac disease
Outline paediatric viral hepatitis
Hepatitis virus: A, B, C, D, and E, CMV, EBV, varicella, enteroviruses, rubella, adenovirus, parvovirus
S+S = flu-like, jaundice, fever, N+V, abdo pain, loss of appetite, dark urine, hives
Ix = LFTs, coag, serology
Mx = antivirals, supportive
How does paediatric constipation present?
<3 stools a week Hard stools,difficult to pass Rabbit dropping stools Straining/painful Abdopain Holding abnormal posture (retentive posturing) Rectal bleeding Overflow soiling Hard stools may be palpable in abdo Loss of the sensation of the need to open the bowels
Outline how suspected paediatric constipation should be Ix?
DRE not routinely recommended for the diagnosis of constipation or faecal impaction
Dx by = stool pattern, associated Sx, Hx, previous or current anal fissure
Exam = abdo palpation (mass), spine (spina bifida, dimple), lower limb neurology (spinal pathology), anal exam
How should paediatric constipation be managed? and what are the possible complications?
Mx =
- Correct any reversible contributing factors, high fibre diet, good hydration
- 1st: movicol, 2nd: senna (stimulant), 3rd: lactulose (softener), 4th Na citrate enema
- Encourage and praise visiting the toilet: scheduling visits, bowel diary, star charts.
- Maintenance: movicol for several weeks after normal bowel movements are established, stop slowly and monitor
Comp =
- Pain
- Reduced sensation
- Anal fissures
- Haemorrhoids
- Overflow and soiling
- Psychosocial morbidity
What are the common causes of paediatric constipation?
Habitually not opening the bowels Low fibre diet Poor fluid intake and dehydration Sedentary lifestyle Psychosocial: diff home/school environment, sexual abuse (safeguarding) Hirschsprung’s disease CF (particularly meconium ileus) Hypothyroidism Spinal cord lesions (S2, 3, 4, urinary Sx) Sexual abuse Intestinal obstruction Anal stenosis Anal fissure Metabolic: hypoK, hyperCa
Rare: (typically diarrhoea)
- Cows milk intolerance
- Coeliac
What is ‘failure to thrive’ and its causes?
Poor physical growth and development in a child
- Mild = 2 centile spaces below the mid-parental height centile
- Severe = 3 centiles
Causes of Inadequate Nutritional Intake = maternal malabsorption if breastfeeding, iron deficiency anaemia, family or parental problems, neglect, poverty
Causes of Difficulty Feeding = poor suck (CP), cleft lip or palate, genetic conditions with an abnormal facial structure, pyloric stenosis
Causes of Malabsorption = CF, coeliac disease, cows milk intolerance, chronic diarrhoea, IBD
Causes of Increased Energy Requirements = hyperthyroidism, chronic disease (CHD, CF), malignancy, chronic infections (HIV or immunodeficiency)
Inability to Process Nutrients Properly = inborn errors of metabolism, T1DM
How should failure to thrive be Ix?
Assess:
- Pregnancy, birth, developmental and social history
- Feeding or eating history
- Observe feeding
- Mums physical and mental health
- Parent-child interactions
BMI is calculated as: (weight in kg) / (height in meters)2
Mid parental height is calculated as: (height of mum + height of dad) / 2
Urine dipstick (UTI)
Coeliac screen (anti-TTG or anti-EMA antibodies)
Outline the management of a child failing to thrive
Regular reviews to monitor weight gain
Encouraging regular structured mealtimes and snacks
Reduce milk consumption to improve appetite for other foods
Review by a dietician
Additional energy dense foods to boost calories
Nutritional supplements drinks
What is colic and how does it present?
Episodes of crying for more than three hours a day, for more than three days a week, for three weeks in an otherwise healthy child
Periods of crying most commonly happen in the evening and for no obvious reason
Associated Sx may include legs pulled up to the stomach, a flushed face, clenched hands, and a wrinkled brow, high-pitched cry
