Gastroenterology 2 Flashcards
How does Crohn’s disease present?
May mimic anorexia nervosa Abdominal pain Diarrhoea Weight loss Growth failure Delayed puberty General ill health Fever Lethargy Weight loss
What are extra-intestinal manifestations of Crohn’s?
Oral lesions or perianal skin tags
Uveitis
Arthralgia
Erythema nodosum
What are the investigations for Crohn’s?
Raised inflammatory markers (platelet count, erythrocyte sedimentation rate, CRP)
Iron-deficiency anaemia
Low serum albumin
How is Crohn’s diagnosed?
Based on endoscopic and histological findings
Upper GI endoscopy
Ileocolonoscopy
Small bowel imaging (may reveal narrowing, fissuring, mucosal irregularities and
bowel wall thickening)
Non-caseating epithelioid cell granulomata are the histological hallmark, although are not present in 30% of cases
What is the management for Crohn’s?
Induce remission with nutritional therapy, aka replace normal diet by whole protein modular feeds (polymeric diet) for 6-8 weeks. Effective in 75%, but if not then systemic steroids are needed
Immunosuppressants (azathioprine or methotrexate) to maintain remission.
Anti-tumour necrosis factor agents (e.g. infliximab) may be needed when that fails.
Long-term supplemental enteral nutrition (often via overnight NG tube)- growth failure
Surgery is needed for correcting complications or for severe localised disease unresponsive to medical treatment
How does ulcerative colitis present?
Rectal bleeding, diarrhoea, colicky pain
Weight loss & growth failure (although less common than in Crohn’s disease)
Extra-intestinal complications:
Erythema nodosum
Arthritis
In contrast to adults 90% of children and pancolitis
How is ulcerative colitis diagnosed?
based on endoscopy and histological features, after exclusion of infective causes of colitis
Upper GI endoscopy Ileocolonoscopy
Small bowel imaging (to confirm absence of extra-colonic inflammation suggestive of Crohn’s disease)
• Mucosal inflammation
• Crypt damage
• Ulceration
What is the management for Crohn’s disease?
Mild: aminosalicylates (e.g. mesalazine)
Disease confined to rectum and sigmoid colon (rare in children): may be managed
with topical steroids
More aggressive or extensive disease: systemic steroids for acute exacerbations
and immunomodulatory therapy (with or without low-dose corticosteroid therapy)
for maintaining remission
Resistant disease: biological therapies
Severe fulminating disease: medical emergencyrequiring IV fluids and steroids
Regular colonoscopy screening for adenocarcinoma is performed after 10 years
from diagnosis
What contributes to the pathology of GORD?
Predominantly fluid diet, mainly horizontal posture and short intraabdominal length of oesophagus contribute to the pathology. Very common in 1st year of life, usually resolves once child starts taking solids and learns to sit up (should resolve by 12 months of age)
How does GORD present?
most infants have recurrent regurgitation or vomiting, but are putting on weight normally and are otherwise well and not distressed by the reflux
What are the investigations for GORD?
Usually a clinical diagnosis and no investigations are needed
24h oesophageal pH monitoring to quantify the degree of acid reflux
• 24h impedance monitoring
• endoscopy with oesophageal biopsies to identify oesophagitis and exclude other
causes of vomiting
What is the management for GORD?
Reassurance
Food thickeners
Ranitidine or PPIs
Don’t use drugs that cause stomach emptying
Nissen fundoplication is the surgery of choice (oesophageal stricture or unresponsive to intensive medical treatment)
Who is GORD more common in?
children with cerebral palsy or other neurodevelopmental disorders
preterm infants, especially those with bronchopulmonary dysplasia
following surgery for oesophageal atresia or diaphragmatic hernia
What are the complications of GORD?
Faltering growth from severe vomiting
• Oesophagitis- hematemesis, discomfort on feeding, heartburn, iron-deficiency
anaemia. May lead to Barrett’s oesophagus
• Recurrent pulmonary aspiration- recurrent pneumonia, cough, wheeze or apnoea
in preterm infants
• Dystonic neck posturing (Sandifer syndrome)
• Apparent life-threatening events or SIDS
What is colic?
paroxysmal, inconsolable crying or screaming often accompanied by drawing up of the
knees and passage of excessive flatus. May happen several times a day and typically starts within first few weeks of life and resolves gradually from 3-12 months of age.
Occurs in up to 40% of babies
