Gastroenterology Flashcards
Features of colic?
2 weeks - 4 months old
Bouts of excessive crying and pulling-up of legs, often worse in evenings.
Passage of excessive flatus several times a day.
Occurs in up to 20% of infants.
Diagnosis and treatment of colic?
Exclusion - GORD, cow’s milk protein allergy, incarcerated hernia, intussusception, otitis media, UTI.
No treatment needed.
Definition of constipation?
Delay or difficulty in passing stools for more than 2 weeks.
How often do infants usually open bowels?
<6 months - 3 times a day
Decreases to once a day after 3 years.
Causes of constipation?
Functional non-organic constipation Idiopathic Medication - eg opiates May follow acute febrile illness Psychological Organic - Hirschprung disease, coeliac disease, food allergies, bowel obstruction, CF, cerebral palsy, spina bifida, spinal cord injury, hypothyroidism, hypercalcaemia, learning disabilities.
Red flags for constipation?
Starts in first few weeks of life
Delayed meconium passage (>48 hours)
Abdominal distention (and bilious vomiting)
Faltering growth - coeliac disease, hypothyroidism
Delayed walking or lower limb neurology
Child protection concerns.
Diagnosis criteria for constipation in child <1 year of age
2 or more of following:
Fewer than 3 complete stools per week (type 3 or 4). Hard large stool, Rabbit droppings (type 1)
Distress on passing stool
Bleeding associated with hard stool
Straining
Previous episodes of constipation. Previous or current anal fissure.
Diagnosis criteria for constipation in child >1 year of age
2 or more of following:
Fewer than 3 complete stools per week (type 3 or 4). Overflow soiling - loose, smelly.
Poor appetite that improves with passage of stool.
Maxing and waning of abdominal pain with passage of stool
Evidence of retentive posturing - typically straight legged, tiptoed, back arching posture.
Straining
Anal pain
Previous episodes of constipation.
Painful bowel movement and bleeding with hard stools.
Management of constipation?
Treat underlying cause
Do coeliac screen and TFTs.
Adequate fluid intake and encourage good toileting habits.
First line - Movicol Paediatric Plain (osmotic laxative)
Second line - add stimulant laxative eg Senna if Movicol doesn’t work after 2 weeks.
If movicol not tolerated, use lactulose.
Reduce dose gradually over months once regular bowel habits are established.
Psychological support.
Praising behaviour and toileting routine.
Long-term complications of constipation?
Scquired megarectum (reduced sensation of full rectum)
Anal fissures
Overflow incontinence
Behavioural problems - fear of defection, embarrassment of overflow
Causes of gastroenteritis?
Viral - rotavirus (most common), adenovirus, provirus, atrovirus.
Bacterial - staph, enterotoxic E. coli, cholera, enteroinvasive E. coli, enterohaemorrhagic E. coli, shigella, campylobacter jejune, salmonella enteritidis.
Protozoal - giardia lamblia, cryptosporidium.
Features of gastroenteritis?
Acute onset diarrhoea and vomiting
Abdominal pain and distension
Mild pyrexia
Invasive bacterial infection - fever, unwell, blood and mucoid stool
May have dehydration
Acidosis, hypokalaemia, hypocalcaemia, hypogylcaemia.
Investigations of gastroenteritis?
Stool culture if:
Stool is bloody or child septic or immunocompromised.
child has recently been abroad.
Diarrhoea not improved by day 7.
Uncertain about diagnosis of gastroenteritis.
FBC, haematocrit, U&Es, creatinine, glucose.
Management of gastroenteritis?
Usually self-limiting - 14 days.
No signs of dehydration - continue normal fluid intake, breast feeding and other milk feeds. Discourage fruit juices and carbonated drinks.
If clinical dehydration signs -
50ml/kg ORS over 4 hours, in addition to maintenance fluids of ORS.
Continue breastfeeding.
If evidence of shock - 20ml/kg normal saline bolus, then IV rehydration with normal saline adding 100ml/kg maintenance requirements.
Complications of gastroenteritis?
Hypernatraemic dehydration -
Due to high insensible losses of water
Shift of water into extracellular space from intracellular compartment.
Depression of fontanelle, reduced tissue elasticity, sunken eyes.
Cerebral shrinkage with rigid skull - jittery movements, increased muscle tone with hyperreflexia, altered consciousness, seizures, multiple small haemorrhages.
Hyponatraemic dehydration -
Drink large quantities of water
Shift of water from extracellular to intracellular areas
Increases brain volume - seizures.
Definition of failure to thrive?
Failure to gain adequate weight/growth during infancy at a normal rate for age.
Fall in one or more weight centile spaces, or weight below 2nd percentile of weight for age.
What happens to weight changes in first few days of life?
Weight loss after birth is normal, and most babies return to their birth weight by week 3.
Non-organic causes of failure to thrive?
Undernutrition
Child abuse
