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Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is vomiting?

A

Physical act that results in gastric contents forcefully brought up to and out of the mouth aided by sustained contraction of the abdominal muscles and the diaphragm at a time when the cardia of the stomach is raised and the pylorus is contracted

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2
Q

What is regurgitation?

A

Effortless expulsion of gastric contents

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3
Q

What is rumination?

A

Frequent regurgitation of ingested food

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4
Q

What is possetting?

A

Small volume vomits during or between feeds in otherwise well child

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5
Q

What controls vomiting?

A

Vomiting centre

Chemoreceptor trigger zone

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6
Q

What neurotransmitters are involved in vomiting?

A

Histamine (H1), dopamine (D2), serotonin (5-HT3), acetylcholine (muscarinic), neurokinin (substance P)

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7
Q

What are the key precipitants of vomiting?

A 
Toxic material in lumen of GI tract
Visceral pathology
Vestibular disturbance
CNS stimulation
Toxins in blood/CSF
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8
Q

What are the different types of antiemetics?

A

Antihistamines - H2 receptor antagonists, CI acute porphyrias, for motion sickness and PONV treatment
Dopamine D2 antagonist for medication related N&V
Serotonin 5-HT3 antagonists - CI in long QT syndrome, for treatment of PONV
Steroids
Neurokinin receptor antagonist

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9
Q

Name 2 antihistamines for anti sickness treatment and their dose

A

Cyclizine 50mg

Promethazine 20-25mg

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10
Q

Name 2 dopamine D2 antagonists for anti sickness treatment and their dose

A

Prochlorperazine 12.5mg
Metoclopramine 20mg over 3 mins, CI 3-4 days post intra-abdominal surgery, obstruction, haemorrhage, perforation, or obstruction and phaeochromocyomas
Droperidol 0.625-1.25mg, CI bradycardia, CNS depression, coma, hypokalaemia, hypomagnesaemia, phaeochromocytoma, long QT syndrome

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11
Q

Name 2 serotonin 5-HT3 antagonists used for anti-sickness treatment and their dose

A

Ondansetron 4mg

Granisetron 1mg diluted to 5ml given over 30s

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12
Q

Name a steroid used for anti-sickness treatment and their dose

A

Dexamethasone 3.3-6.6mg

For chemotherapy related N&V

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13
Q

Name a neurokinin receptor antagonist for anti-sickness treatment and its dose

A

Aprepitant 80mg

For chemotherapy related N&V

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14
Q

What questions are important to ask in a vomiting history?

A

Bilious/non-bilious (helps localise)
Bloody/non-bloody (inflammation/damage)
Projectile/non-projectile (specific diagnosis)
Age
Febrile/afebrile
Nausea, abdominal pain, distention, diarrhoea, constipation
Headache, changes in vision, polyuria, polydipsia, weight loss - rule out increased ICP or DKA
Hydration status

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15
Q

What are the red flags in a vomiting history?

A

Meningism
Costovertebral tenderness
Abdominal pain
Any evidence of raised ICP

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16
Q

What is the examinations you should do in a vomiting child?

A

General - hydration, temp, obs, weight loss, jaundice/pallor
Abdo - distension, scars, tenderness, rigidity, bowel sounds
Neuro - GCS, meningism, neurological deficit
Plot growth
Assessment of hydration status
Evidence of infection
Presence of dysmorphic features, ambiguous genitalia or unusual odours

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17
Q

What are the GI obstruction differentials for vomiting?

A 
Pyloric stenosis
Malrotation with intermittent volvulus
Intestinal duplication
Hirschsprung's disease
Antral/duodenal web
Foreign body
Incarcerated hernia
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18
Q

What other GI problems are differentials for vomiting?

A 
Achalasia		Gastroparesis
Gastroenteritis
Peptic ulcer
Eosinophilic oesophagitis/gastroenteritis
Food allergy
IBD
Pancreatitis
Appendicitis
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19
Q

What are some neurological differentials for vomiting?

A 
Hydrocephalus
SDH
Intracranial haemorrhage
Intracranial mass
Infant migraine
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20
Q

What are some infectious differentials for vomiting?

A 
Sepsis
Meningitis
UTI
Pneumonia
Otitis media
Hepatitis
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21
Q

What are some metabolic/endocrine differentials for vomiting?

A 
Galactosemia
Hereditary fructose intolerance
Urea cycle defects
Amino and organic acidaemias
Congenital adrenal hyperplasia
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22
Q

What are some renal differentials for vomiting?

A

Obstructive uropathy

Renal insufficiency

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23
Q

What are some toxic differentials for vomiting?

A

Lead
Iron
Vit A and D
Medications - digoxin, theophylline

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24
Q

What are some cardiac differentials for vomiting?

A

Congestive HF

Vascular ring

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25
Q

What are some psychiatric differentials for vomiting?

A

Munchausen syndrome
Child neglect or abuse
Self induced

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26
Q

What are the most common causes of vomiting in children 0-2 days old?

A

Duodenal or other intestinal atresia

TEF (types A/C)

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27
Q

What are the most common causes of vomiting in children 3 days-1 month old?

A 
Gastroenteritis
Pyloric stenosis
Malrotation +/- volvulus
TEF (types B/D/H)
Necrotising enterocolitis
Milk protein intolerance
CAH
IEM
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28
Q

What are the most common causes of vomiting in children 1-36 months old?

A 
Gastroenteritis
UTI, pyelonephritis
GOR/GORD
Ingestion
Intussusception
Milk protein intolerance
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29
Q

What are the most common causes of vomiting in children 36 months-12 years old?

A 
Gastroenteritis
UTI
DKA
Increased ICP
Eosinophilic oesophagitis
Appendicitis
Ingestion
Post-tussive vomiting
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30
Q

What are the most common causes of vomiting in children 12 -18 years old?

A 
Gastroenteritis
Appendicitis
DKA
Increased ICP
Eosinophilic oesophagitis
Bulimia
Pregnancy
Post-tussive vomiting
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31
Q

How does malrotation/volvulus present and how is it managed?

A

Sudden bilious vomit, abdominal distension
As progresses - abdomen can feel peritonitic
Blood per rectum
Metabolic acidosis
Contrast study essential for diagnosis and USS
Urgent surgical referral - division of Ladd bands (Ladds procedure) - return SB to right and LB to left, caecum in LUQ

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32
Q

How does Hirschsprung’s disease/meconium ileus/intestinal atresia present and how is it managed?

A

Delayed passage of meconium, abdominal distension, bilious vomiting
Surgical referral

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33
Q

How does necrotising enterocolitis present and how is it managed?

A

Usually pre-term infant, abdominal distension, bilious vomiting
Antibiotics, enteral rest, surgical referral if severe

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34
Q

How does infection present and how is it managed?

A

May be non-specific or point to source of infection
Investigations to establish cause
May require fluid resuscitation and empirical antibiotic treatment

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35
Q

How does GORD present and how is it managed?

A

Vomiting associated with feeds
Poor feeds
Cough, wheeze
Step-wise approach

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36
Q

How does food intolerance present and how is it managed?

A

Vomiting, loose stools, constipation, eczema

Elimination diet

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37
Q

How does pyloric stenosis present and how is it managed?

A 
Progressive projectile vomiting, hypokalaemia, hypochloraemic metabolic acidosis
FTT
Palpable olive shaped mass
Dehydration
Fluid and electrolyte replacement prior to surgery
NG tube
NBM
Ramdtedt's pyloromyotomy
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38
Q

How does intussusception present and how is it managed?

A

Usually 3-36 months of age, colicky abdominal pain, bilious vomiting, red-currant jelly stools
Distended abdomen
Peritonitic
IVI
IVabx
Pneumatic air insufflation or barium enema for reduction
Surgery

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39
Q

How does strangulation hernia/adhesion obstruction present and how is it managed?

A

Bilious vomiting, abdominal pain

Surgical referral

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40
Q

How does raised ICP present and how is it managed?

A

Early morning vomiting, bulging fontanelle

CT/MRI

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41
Q

How does acute appendicitis present and how is it managed?

A

Anorexia, central abdominal pain migrating to RIF, vomiting, pyrexia
Appendectomy

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42
Q

How does pancreatitis present and how is it managed?

A

Vomiting, abdominal pain

Fluids, analgesia

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43
Q

How does cyclical vomiting syndrome present and how is it managed?

A

Recurrent episodes of vomiting, child well in between

Exclusion of other causes

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44
Q

How does DKA present and how is it managed?

A

Polydipsia, polyuria, hyperglycaemia, ketonuria, metabolic acidosis on blood gas
As per national and local guidance

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45
Q

How does medication/alcohol/illicit drug intoxication present and how is it managed?

A

History of ingestion, recently commenced on new medication

Remove offending substance, supportive care

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46
Q

How is post-operative/pain managed?

A

Analgesia

Anti-emetics

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47
Q

How do psychiatric causes of vomiting present and how is it managed?

A

As part of eating disorder

Psychiatry referral

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48
Q

How does pregnancy present and how is it managed?

A

Weight gain
May not admit to being sexually active
Pregnancy test

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49
Q

How does infection present in older children and how is it managed?

A

Pyrexia, tachycardia, identifiable source of infection

Antibiotics

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50
Q

What investigations should you do in a child that is vomiting?

A

Depends on underlying cause, history, presentation, and age of patient
Acute - U&E, stool virology, abdo XR, surgical opinion, exclude systemic disease
Chronic - FBC, ESR/CRP, U&E, LFT, H pylori serology, urinalysis, upper GI endoscopy, abdo USS, small bowel enema, brain imaging, test feed
Cyclic - amylase, lipase, glucose, ammonia

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51
Q

What are the metabolic consequences of vomiting?

A

K+ deficiency
Alkalosis
Sodium depletion

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52
Q

What are the consequences of vomiting?

A

Metabolic
Nutritional
Mechanical injuries to oesophagus and stomach
Dental
Oesophageal stricture, Barrett’s, broncho-pulmonary aspiration, FTT, anaemia

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53
Q

What types of mechanical injury can you get to oesophagus and stomach due to vomiting?

A

Mallory-Weiss
Boerhaave’s syndrome
Tears of short gastric arteries resulting in shock and haemoperitoneum

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54
Q

What is the treatment for vomiting?

A

Supportive - IV fluids, analgesia, antiemetics
Treat cause - medical/surgical
Pharmacological

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55
Q

What signs may suggest disorders other than GORD?

A 
Bilious vomiting
GI bleeding
Persistently forceful vomiting
New onset of vomiting > 6 months
Failure to thrive
Diarrhoea
Constipation
Fever
Lethargy
Hepatosplenomegaly
Bulging fontanelle
Macro/microcephaly
Seizures
Abdominal tenderness or distension
Suspected metabolic syndrome
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56
Q

When is reflux normal?

A

Reflux is normal physiological response in children, often resolves by a year in most children

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57
Q

What is GOR?

A

Passage of gastric contents into oesophagus, with or w/o regurgitation or vomiting

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58
Q

What is GORD?

A

Presence of troublesome symptoms and/or complications of persistent GOR

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59
Q

What complications can you get from GORD in children?

A 
Faltering growth
Oesophagitis +/- stricture
Apnoea, ALTE, SIDS
Aspiration, wheeze, hoarseness
IDA
Seizure-like events, torticolis
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60
Q

How does GORD present in children?

A

Heart burn

Epigastric pain

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61
Q

What investigations should you do for GORD?

A 
pH
Barium swallow and meal
Endoscopy
Nuclear scintigraphy, tests on ear, lung and oesophageal fluids, USG, combined multiple intraluminal impedance
PPI test
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62
Q

What is the management of GORD?

A 
Conservative
- Optimise position
- Parental education and support
- Thicken eg carobel/change feeds 
- Avoid over feeding
- Smaller, more frequent feeds
- Weight monitoring
- Gaviscon
Drugs - antacid, H2 blocker, PPI
Surgery - fundoplication
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63
Q

What is a food allergy?

A

Body’s immune system reacts adversely to specific foods, characterised by multisystem reaction - skin, GI, resp, cardio, immediate reaction

64
Q

What is a food intolerance?

A

Food intolerance - unpleasant physical reaction to food due to difficulty digesting them, characterised by mainly GI symptoms, bloating, abdominal pain, diarrhoea, delayed reaction few hours after eating food

65
Q

What are the different types of food allergy?

A

IgE mediated - acute, urticaria, oral allergy
Non-IgE mediated - food protein induced enteropathy
Mixed IgE and non-IgE mediated - gastroenteritis
Cell mediated - allergic contact dermatitis

66
Q

What are the different types of food intolerance?

A

Metabolic (lactose intolerance)
Pharmacologic (caffeine)
Toxic (fish toxin)
Other idiopathic/undefined

67
Q

What is the most common food allergy?

A

Cow’s milk protein alelrgy

68
Q

What is CMPA associated with?

A

Atopy, IgA deficiency, and IgG subclass abnormalities

69
Q

How common is CMPA?

A

Prevalence varies from 2% to 7.5%

70
Q

How do you diagnose CMPA?

A

Elimination diet
Skin prick testing
RAST
Oral food challenge

71
Q

How is CMPA managed?

A

Hydrolysed or AA feeds - broken down into smaller peptides

72
Q

What are the symptoms of IgE mediated allergy? GI

A 
Angioedema of lips, tongue, palate
Oral pruritis
Nausea
Colicky abdominal pain
Vomiting
Diarrhoea
73
Q

What are the symptoms of non-IgE mediated immunity? GI

A 
GORD
Loose or frequent stools
Blood and/or mucus in stools
Abdominal pain
Infantile colic
Food refusal or aversion
Constipation
Perianal redness
Pallor and tiredness
Faltering growth in conjunction with at least one or more GI symptom (with or without significant atopic eczema)
74
Q

What skin symptoms do you get with IgE mediated allergy?

A

Pruritus
Erythema
Acute urticaria - localised/generalised
Acute angioedema - most commonly around lips, face, and eyes

75
Q

What skin symptoms do you get with non-IgE mediated allergy?

A

Pruritus
Erythema
Atopic eczema

76
Q

What respiratory symptoms do you get with IgE mediated allergy?

A

Upper - nasal itching, sneezing, rhinorrhoea, congestion

Lower - wheezing/SOB

77
Q

What respiratory symptoms do you get with non-IgE mediated allergy?

A

Cough, chest tightness

78
Q

What are the different types of lactose intolerance?

A

Primary - rare

Late onset - common

79
Q

What are the symptoms of lactose intolerance?

A

Explosive watery stools, abdominal distension, flatulence, audible bowel sounds

80
Q

How do you diagnose lactose intolerance?

A

Stool chromatography, lactose hydrogen breath test, small bowel biopsy and elimination diet

81
Q

How do you treat lactose intolerance?

A

Lactose free formula/milk-free diet with calcium and vitamin D supplements

82
Q

What is constipation?

A

Infrequent passage of stool associated with pain and difficulty, or delay in defecation

83
Q

What is encopresis?

A

Involuntary faecal soiling or incontinence secondary to chronic constipation

84
Q

What is the ROME IV criteria for constipation?

A

2/fewer defecations per week for at least one month
At least 1 episode of faecal incontinence per week
Retentive posturing or stool retention
Painful or hard bowel movements
Presence of large faecal mass in rectum
Large diameter stools that may obstruct the toilet
After appropriate evaluation, the patient symptoms must not be fully explained by another medical condition

85
Q

What is the pathogenesis of constipation?

A

Cycle of painful defecation, voluntary withholding, prolonged fecal stasis, re-absorption of fluids and increase in size and consistency, more pain

86
Q

What should you ask about in the history of a child with constipation?

A

Frequency and consistency of stools (Bristol Stool chart)
Pain with passing stool or straining, rectal bleeding, ever clog the toilet, changes in appetite, abdominal pain, medications (opioids)

87
Q

What examination should you do in a child with constipation?

A

General physical examination, palpable faecal mass on abdominal examination
Visual inspection of anorectal area completed for all patients to identify possible organic aetiologies
Rectal examination - often not required

88
Q

What are the red flags in a constipation history?

A 
Delayed passage of meconium
Fever, vomiting, bloody diarrhoea
Failure to thrive
Tight, empty rectum with presence of palpable abdominal faecal mass
Abnormal neurological exam
89
Q

What are possible differentials for constipation?

A 
Hirschsprung's disease 
Anorectal malformations
Neuronal intestinal dysplasia
Spina bifida
Neuromuscular disease
Hypothyroidism
Hypercalcaemia
Coeliac disease
Food allergy/intolerance
CF
Perianal group A streptococcal infection
Anal fissure
Pelvis/spinal tumours
Child sexual abuse
Drugs
90
Q

What are the short term complications of constipation?

A

No sequelae

91
Q

What are the long term complications of constipation?

A

Acquired megacolon, anal fissures, overflow incontinence, behavioural problems

92
Q

What investigations can you do for constipation?

A

Usually not necessary
Only if organic cause suspected, remain constipated despite medical treatment
T4/TSH, serum Ca, coeliac panel, sweat test, AXR, anal manometry, rectal biopsy, spinal imaging

93
Q

What is the management of constipation?

A 
Explanation of normal bowel function
Diet/fluids and exercise
Behavioural advice
Toilet training advice
Simple reward schemes
Medications 
- Softener - lactulose, liquid parafin
- Bulking agent - fybogel
- Movicol
- Senna, dulcolax - stimulants
- Enema
- Anal fissure - anaesthetic cream +/- vasodilator
If treatment for constipation is unsuccessful or organic cause of constipation suspected refer to paediatric gastro
94
Q

What is diarrhoea?

A

Change in consistency of stools and/or increase in frequency of evacuations with or without fever or vomiting which lasts less than 7 days and not longer than 14 days

95
Q

What questions should you ask in a diarrhoea history?

A

When did it start?
What’s its progression been?
How many times per day?
Watery? Blood? Mucus?
ssociated symptoms - fever, vomiting, urine output, abdominal pain, lethargic, weight loss
Context - immune status, recent hospitalisation, antibiotic use, any recent medications, recent travel, vaccination

96
Q

What are the causes of infection causing acute diarrhoea?

A

Viruses
Bacteria
Parasites

97
Q

What viruses can cause acute diarrhoea?

A

Rotavirus
Calicivirus
Astrovirus
Enteric-type adenovirus

98
Q

What bacteria can cause acute diarrhoea?

A 
Campylobacter jejuni
Salmonella
E coli
Shigella
Yerninia enterocolitica
Aeromonas hydrophilia
C difficile
99
Q

What parasites can cause acute diarrhoea?

A

Giardia lamblia

Cryptosporidium

100
Q

What other things can cause acute diarrhoea?

A

Other infections - otitis media, tonsilitis, pneumonia, septicaemia, UTI, meningitis
Allergy/food hypersensitivity reactions
Drugs
Haemolytic uraemic syndrome
Surgical causes - pyloric stenosis, intestinal obstruction, appendicitis, intussusception

101
Q

How common is diarrhoea?

A

24 of 1000 consultations with GPs in children under 5 for gastroenteritis
Annual hospital admission rate about 7 per 1000

102
Q

How does diarrhoea present?

A

Diarrhoea +/- blood stools (dysentry)
Fever +/- vomiting
Dehydration and reduced consciousness

103
Q

What investigations should you consider for a child with diarrhoea?

A

Perform stool microscopy if
- Suspect septicaemia
- Blood or mucus in stool
- Child immunocompromised
Consider performing stool microscopy if
- Recently travelled abroad
- Diarrhoea has not improved by day 7
- Uncertain about diagnosis of gastroenteritis
Bloods not necessary in simple gastroenteritis but measure serum electrolytes including glucose if
- Severe dehydration
- IV fluid therapy required
- Symptoms and/or signs suggesting hypernatraemia
- Altered conscious state
- Co-morbidity of renal disease or on diuretics
Ileostomy

104
Q

What examination should you do in children with diarrhoea?

A

Assess for dehydration

Best clinical indicators > 5% dehydration are prolonged CRT, abnormal skin turgor and absent tears

105
Q

How do you treat diarrhoea?

A

Most cases self resolving
Antibiotics - bacterial GE complicated by septicaemia or systemic infections or immunocompromised and malnourished patients
Probiotics
No antiemetics/anti-motility drugs

106
Q

What is hypernatraemic dehydration?

A

Unusual and serious
Irritable with doughy skin
Water shifts from intracellular to extracellular
Rehydration should be slow

107
Q

What is chronic diarrhoea?

A

> 2 weeks

108
Q

What can cause chronic diarrhoea?

A 
Continued infection with first pathogen
Infection with second pathogen
Post enteritis syndrome
Spurious - constipation
Chronic non-specific diarrhoea
Food intolerance
Malabsorption
109
Q

How common is IBD in children?

A

Prepubertal males > females
Ileo-colonic or colonic UC
Inflammatory phenotype, non-structuring, non-penetrative
More have surgery than adults 40% in 10 years from diagnosis vs 20%
Similar presentation depending on location
Extrintestinal manifestations
Same treatment

110
Q

What is the most significant difference between adult and paediatric IBD?

A 
Growth
- Poor growth
- Delayed puberty
- Reduced final adult height
- Catch up growth
Persistent poor growth - only sign of disease activity
111
Q

How is IBD diagnosed?

A
  • Nuclear medicine
  • Clinical evaluation
  • Biochemical - faecal calprotectin in stool
  • Endoscopic
  • Radiological
  • Histological - biopsy
112
Q

What treatment might you give for Crohn’s?

A 
Exclusive enteral nutrition
Corticosteroids (prednisolone/budesonide) - problems with bone health
Aminosalicylates (topical and oral)
Antibiotics
Immunomodulators (6-mercaptopurine, azathioprine, methotrexate)
Biologics (infliximab, adalimumab)
Surgery
Parenteral nutrition
113
Q

What treatment might you give for UC?

A

Mild to moderate induction - aminosalicylate
Moderate to severe induction - corticosteroids
Mild to moderate remission - aminosalicylate
Moderate to severe remission - 6 MP/azathioprine
Surgical resection

114
Q

What is chronic abdominal pain?

A

Long lasting, intermittent or constant that is functional or organic disease, 3 attacks over at least 3 months duration

115
Q

What is functional abdominal pain?

A

Abdominal pain w/o evidence of disease/pathologic process - functional dyspepsia, IBS, abdominal migraine, functional abdominal pain syndrome

116
Q

What is recurrent abdominal pain?

A

One of most common recurrent pain syndromes in children
Classic definition based on 4 criteria
- Hx of at least 3 episodes of pain
- Pain that is severe enough to affect activities
- Episodes that occur over 3 months
- No known organic cause

117
Q

What are the organic causes of abdominal pain?

A 
GORD
PUD
H pylori infection
Food intolerance
Coeliac disease
IBD
Constipation
UTI
Dysmenorrhoea
Pancreatitis
Hepato-biliary disease
118
Q

What functional disorders can cause abdominal pain?

A 
Functional dyspepsia
IBS
Functional abdominal pain
Abdominal migraine
Aerophagia
119
Q

What is the pathogenesis of functional disorders?

A

Abnormal bowel reactivity to
- Physiological stimuli (meal, gut distension, hormonal)
- Noxious stressful stimuli (inflammatory process)
- Psychological stressful stimuli (parental separation, anxiety)
Leading to development of visceral hyperalgesia

120
Q

What questions should you ask in an abdominal pain history?

A 
Onset, duration
Location and radiation
How long does it last?
Character
Aggravating/relieving factors
Intermittent/constant
Associated symptoms
121
Q

What in the history suggests functional disorder?

A 
Concurrent stressful event in life
Peri-umbilical or epigastric
Prolonged duration with no clear signs
Vague, gradual onset, variable severity
Reinforcement from parents
No relationship to interventions
Constant
Signs of anxiety
FHx of IBS
Migraines
122
Q

What in the history suggests organic cause?

A

Trauma/travel
Well localised away from umbilicus
Variable duration
Isolated sudden onset pain
Sometimes medications or position change help
Intermittent
Associated with fever, rash, weight loss, growth faltering, FHx of ulcers or IBD

123
Q

What are red flags in an abdominal pain history?

A

Weight loss or poor growth
Pain that is not periumbilical
Change in bowel habits, nocturnal or diarrhoea/constipation
Disturbed sleep due to pain
Repeated vomiting, especially bilious
Any constitutional symptoms such as fever, lethargy, reduced appetite

124
Q

What are red flags in an abdominal examination?

A

Weight loss or decreased growth velocity suggest serious underlying cause
Any organomegaly
Abdominal tenderness that is localised, especially if not periumbilical
Perianal abnormalities like fissures, skin tags, ulcerations
Swollen, warm or hot joints
Ventral hernias of the abdominal wall

125
Q

What alarm S&S warrant diagnostic testing in children with abdominal pain?

A 
Involuntary weight loss
Deceleration of linear growth
GI blood loss (visible or occult)
Significant vomiting (including bilious, protracted, cyclical)
Chronic severe diarrhoea
Persistent R upper/lower quadrant pain
Unexplained fever
Family Hx IBD
Abnormal or unexplained physical findings
126
Q

What are the primary aims of treatment for abdominal pain?

A

Return to normal function
Avoidance of reinforcement of pain behaviours
Distraction, providing attention, rest, identifying triggers for pain
Reassurance
Education for family
Emphasize that no serious life-threatening process/condition

127
Q

What are the secondary goals of treatment for abdominal pain?

A 
Relief of symptoms
Pharmacologic
Cognitive therapy
Relaxation
Massage/PT/OT/exercise
128
Q

What is acute abdominal pain?

A

Less than 7 days duration, sudden onset and severe

129
Q

What are the 2 most common cause of acute abdominal pain in children?

A

Non-specific abdominal pain and appendicitis in children presenting to hospital

130
Q

What is guarding?

A

Contraction of abdominal wall musculature, classically in response to underlying peritoneal inflammation

131
Q

How can you tell the difference between voluntary and involuntary guarding and why is this important?

A

Voluntary - contraction of the abdominal wall muscles in anticipation of painful stimulus
Involuntary - true guarding, conducted at reflex arc level, when patient distracted or relaxed, voluntary guarding disappears
Causes of involuntary guarding often need surgery

132
Q

How does your examination of the abdomen differ in a child compared to an adult?

A

Hop/jump test - get child out of bed to jump up and down, positive if provokes pain
In/out tummy test - blow abdominal wall in/out
Stethoscope test - pretend listening to abdomen while gently pressing with stethoscope, useful if considering non-organic pain
Percussion test - looks for peritonism and rebound tenderness

133
Q

What are the 6 most useful clinical indicators of acute appendicitis?

A 
Migration of pain to RIF
Anorexia
Guarding
Nausea
Elevated temperature
Tenderness in RIF
134
Q

What colour vomit is associated with malrotation?

A

Green

135
Q

What colour vomit is associated with intussusception?

A

Milky the green

136
Q

What colour vomit is associated with pyloric stenosis?

A

Milky

137
Q

What are the 4 most common causes of vomiting in young babies?

A

Overfeeding
GORD
Sepsis
Pyloric stenosis

138
Q

Why does an intussusception happen?

A

A lead point in bowel wall causes peristalsis to drag the bowel forward into itself

139
Q

Name 3 causes of acute vomiting

A 
GI infection
Non-GI infection eg UTI
GI obstruction - congenital/acquired
Adverse food reaction
Poisoning 
Raised ICP
Endocrine/metabolic disease eg DKA
140
Q

Name 3 causes of chronic vomiting

A 
PUD
GI obstruction eg pyloric stenosis
GORD
Chronic infection
Gastritis
Gastroparesis
Food allergy
Psychogenic
Bulimia
Pregnancy
141
Q

Name 3 causes of cyclic vomiting

A 
Idiopathic
CNS disease
Abdominal migraine
Endocrine eg Addison's
Metabolic eg acute intermittent porphyria
Intermittent GI obstruction
Fabricated illness
142
Q

How is pyloric stenosis diagnosed?

A

USS but don’t need if can feel olive shaped mass

143
Q

What is malrotation?

A

Midgut volvulus
Failure of gut to rotate 90 of the 270 anticlockwise before returning to the abdominal cavity
Normally DJ flexure is to left of midline and terminal ileum is in RIF - broad mesentery
In malrotation
- DJ to right
- SMV to left of SMA
- Narrow base of mesentery
- Caecum displaced to epigastrium or right hypochondrium
- Ladd bands

144
Q

What happens in volvulus?

A

Ladd bands can cause duodenal obstruction

SM vessels can twist and cause ischaemia

145
Q

Name 2 differentials for duodenal obstruction

A

Duodenal web

Annular pancreas

146
Q

What can cause intussuception?

A

Most cases idiopathic

10% - Meckel’s diverticulum, Peutz Jaghers polyps, SB lymphoma

147
Q

What are the different types of intussuception?

A

SB into SB
SB into LB
LB into LB
LB into rectum

148
Q

Name 5 causes of acute diarrhoea in children

A 
Infective gastroenteritis - tends to be viral
Non-enteric infections eg resp tract
Food poisoning
Colitis
Food intolerance/hypersensitivity reactions
NEC
Drugs eg antibiotics
HSP
Intussusception
Haemolytic-uraemic syndrome
Pseudomembranous enterocolitis
149
Q

Name 5 causes of chronic diarrhoea in children aged 0-24 months

A 
Malabsorption eg post-enteritis syndrome due to lactose intolerance, CF, coeliac disease
Food hypersensitivity
Toddler's diarrhoea
Excessive fluid intake
Protracted infectious gastroenteritis
Immunodeficiencies eg HIV
Hirschsprung's disease
Congenital mucosal transport defects
Autoimmune encephalopathy
Tumours (secretory diarrhoea)
Fabricated illness
150
Q

Name 5 causes of chronic diarrhoea in older children

A 
IBD
Constipation
Malabsorption
IBS
Laxative abuse
Infections including bacterial overgrowth and pseudomembranous colitis
Excessive fluid intake
Fabricated illness
151
Q

Name 2 other causes of diarrhoea in children

A

Loss of sphincter control

Spina bifida

152
Q

What is the treatment for chronic diarrhoea?

A

Oral disimpaction

153
Q

What is the treatment for oral regimen for disimpaction?

A

Movicol

Stimulant laxative +/- osmotic laxative

154
Q

What is the treatment for maintenance therapy for constipation?

A

Movicol

155
Q

Name an osmotic laxative

A

Movicol

Lactulose

156
Q

Name a stimulant laxative

A

Sodium picosulfate
Bisacodyl
Senna

157
Q

Name a stool softener

A

Docusate

Paediatrics (21 decks)

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