Gastroenterology Flashcards
What is GERD?
What is possetting?
Gastro-oesophageal reflux (GOR) is the non-forceful regurgitation of milk and other gastric contents into the oesophagus
A small regurgitation of milk after breast feeding (this is quite normal)
What are the symptoms of GERD?
- Recurrent regurgitation or vomiting.
- Witnessed episode of choking or apparent life-threatening event can sometimes occur.
- Respiratory problems (eg, cough, apnoea, recurrent wheeze and, less commonly, aspiration pneumonia).
- Typically develops before 8 weeks
What are the red flags which don’t suggest GERD?
- Frequent, forceful (projectile) vomiting - may suggest hypertrophic pyloric stenosis in infants up to 2 months old.
- Bile-stained (green or yellow-green) vomit may suggest intestinal obstruction
- Haematemesis may suggest a bleed from the oesophagus, stomach or upper gut
What are the investigations for GERD?
Not usually performed in mild cases In severe cases
FBC.
24-hour ambulatory oesophageal pH study
Usually will show frequent dips in pH <4.
Barium meal
To exclude underlying anatomical abnormalities in the oesophagus, stomach and duodenum that may cause symptoms similar to GORD
Endoscopy
Where oesophagitis is suspected.
Manometry
To assess oesophageal motility and lower oesophageal sphincter function.
What is the treatment for GERD?
- Advise regarding position during feeds - 30 degree head-up
- Infants should sleep on their backs as per standard guidance to reduce the risk of cot death
- Ensure infant is not being overfed (as per their weight) and consider a trial of smaller and more frequent feeds
- A trial of thickened formula (for example, containing rice starch, cornstarch, locust bean gum or carob bean gum)
- A trial of alginate therapy e.g. Gaviscon. Alginates should not be used at the same time as thickening agents
- Trial of a PPI
What are the complications of GORD?
- Failure to thrive
- Aspiration
- Frequent otitis media
- Barrett’s oesophagus
- In older children dental erosion may occur
What is poor feeding?
Poor feeding in infants is used to describe an infant with little interest in feeding
What are the causes for poor feeding in infants?
Premature birth
Herpes
Jaundice
Viral gastroenteritis
When should you seek emergency care for poor feeding?
- Has not fed in over four hours
- Has a fever of over 100 degrees F
- Is vomiting after feeding is vomiting blood
- Has a persistent and worsening cough
- Is crying constantly
- Has bloody stool
- Is wheezing
- Is becoming unresponsive to touch
What is the treatment for poor feeding?
Poor feeding that is caused by an infection will normally stop when the infection is treated.
Treatment is the same for other causes of poor feeding.
This can involve changing the feeding schedule to consist of smaller, more frequent meals.
It can also involve switching feeding methods from breast to bottle
How is poor feeding different to poor growth?
Poor growth can lead to a separate condition called failure to thrive, this is through lack of feeding rather than disinterest in feeding
What is pyloric stenosis?
Pyloric stenosis is a condition where the passage (pylorus) between the stomach and small bowel (duodenum) becomes narrower
What is the cause of pyloric stenosis and when does it normally develop?
Unknown
six weeks after birth
What are the symptoms of pyloric stenosis?
Begin bringing up small amounts of milk after feeding, typically 30 minutes
Projectile vomiting
Milk can curdle and become yellow in colour
Signs of dehydration include lethargy, wet nappies less frequently than normal and the soft spot (fontanel) on the top of the head may be sunken.
How is pyloric stenosis diagnosed?
- Ultrasound scan to get a picture of the thickened muscle
- Hypokalaemic and hypochloraemic
- The thickened pyloric muscle can be felt - hard lump on the right side of the baby’s stomach.
- The muscles around the stomach can be seen straining
- Examine the baby during a feed to observe any vomiting
How is pyloric stenosis treated?
Ramstedt pyloromyotomy
What is IBS?
Irritable bowel syndrome (IBS) is a long-term (chronic) disorder that affects the large intestine or colon.
IBS causes painful belly (abdominal) and bowel symptoms
What is the cause of IBS?
The exact physical cause of IBS is not known.
Children may feel IBS symptoms because of:
Problems with how food moves through their digestive system
Extreme sensitivity of the inside of their bowel to stretching and motion
Stress
Too much bacteria growing in their bowel
What are the symptoms of IBS?
A positive diagnosis of IBS should be made if the patient has Abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:
Altered stool passage (straining, urgency, incomplete evacuation)
Abdominal bloating (more common in women than men), distension, tension or hardness
Symptoms made worse by eating
Passage of mucus
What are the investigations for IBS?
- Full blood count
- ESR/CRP
- Coeliac disease screen (tissue transglutaminase antibodies)
What is the management for IBS?
First line:
Pain: antispasmodic agents
Constipation: laxatives but avoid lactulose
Diarrhoea: loperamide is first-line
Second line:
Amytriptiline
What is gastroenteritis?
Your stomach and intestines are irritated and inflamed.
What is the most causative organism for gastroenteritis?
Rotavirus
In adults it’s norovirus or food poisoning
What are the symptoms of gastroenteritis?
- Sudden, watery diarrhoea feeling sick vomiting, which can be projectile a mild fever
- Some people also have other symptoms, such as a loss of appetite, an upset stomach, aching limbs and headaches.
What is the management for gastroenteritis?
Drink plenty of fluids to avoid dehydration
Take paracetamol for any fever or aches and pains.
Get plenty of rest.
If you feel like eating, try small amounts of plain foods, such as soup, rice, pasta and bread.
Rehydration drinks
Take anti-vomiting medication (such as metoclopramide) and/or antidiarrhoeal medication (such as loperamide) if
When should you seek medical advice for gastroenteritis?
You’re not able to keep liquids down for 24 hours
You’ve been vomiting for more than two days
You’re vomiting blood
You’re dehydrated — signs of dehydration include excessive thirst, dry mouth, deep yellow urine or little or no urine, and severe weakness, dizziness or lightheadedness
You notice blood in your bowel movements
You have a fever above 104 F (40 C)
What is constipation in children?
Constipation in children is a common problem.
A constipated child has infrequent bowel movements or hard, dry stools.
What are the symptoms of constipation in children?
They have not done a poo at least 3 times in the last week
their poo is large and hard their poo looks like “rabbit droppings” or little pellets
they are straining or in pain when they poo
they have some bleeding during or after having a poo, because their poo is large and hard
they have a poor appetite or stomach pain that improves after they poo
What are the causes of constipation in children?
- Withholding
- Not eating enough high-fibre foods like fruit and veg
- Not drinking enough fluids
- Feeling pressured or being regularly interrupted while potty (or toilet) training
- Feeling worried or anxious about something
- Family history
- Medical conditions
What is the treatment for constipation in children?
Laxatives
1) Macrogols/osmotic e.g. Movicol/Lactulose
2) Stimulant e.g. Sodium picosulfate, bisacodyl, senna
3) Osmotic e.g. Lactulose
Laxatives are normally continued even after symptoms have ceased.
Regular exercise
Drinking plenty of fluids
When should you seek medical advice for constipation?
- Fever
- Not eating
- Blood in the stool
- Abdominal swelling
- Weight loss
- Pain during bowel movements
- Part of the intestine coming out of the anus (rectal prolapse)
What is appendicitis?
The appendix is a small organ attached to the large intestine in the lower right side of the belly. When it gets infected, it’s called appendicitis.
What are the symptoms of appendicitis?
Pain in the middle of your tummy (abdomen) that may come and go.
Within hours, the pain travels to your lower right-hand side, becomes constant
Nausea and vomiting
What causes appendicitis?
When the appendix gets blocked, too much bacteria can grow and cause an infection. Some of the things that might block the appendix are: hard, rock-like stool (poop) undigested seeds swollen lymph nodes in the intestines parasites and other infections
How is appendicitis treated?
Appendicectomy
What are the bacteria in appendicitis?
E. coli
Bacteroides fragilis
What is a hernia?
Hernias develop when there is a weak area in the abdomen or a small opening in the abdominal muscles, causing the tissues below to bulge
What are the different types of hernias?
Umbilical hernias form when the opening for the umbilical cord does not closely properly, which allows the abdominal lining and bowel to bulge out to form a lump.
Epigastric hernias form when tissues joining the muscles in the upper part of the abdomen have not formed properly and allow fatty tissue to bulge out to form a lump.
What is the treatment for hernias?
Umbilical hernia
- Not noramlly repaired
- If still present at 3 years old, an operation to repair it will usually be suggested.
Epigastric hernias
- Repaired only if they are causing discomfort or getting in the way of normal everyday life and activities
Inguinal hernia
- Surgery
How is a hernia diagnosed?
The child’s doctor will be able to diagnose the hernia by a clinical examination, as it appears as a characteristic lump in the abdomen.
WHAT IS AN UMBILICAL GRANULOMA?
- These consist of cherry red lesions surrounding the umbilicus, they may bleed on contact and be a site of seropurulent discharge.
- Infection is unusual and they will often respond favourably to chemical cautery with topically applied silver nitrate.
What is inflammatory bowel disease?
Term mainly used to describe 2 conditions:
ulcerative colitis and Crohn’s disease.
What is the cause of inflammatory bowel disease?
Unknown
What are the symptoms crohn’s disease?
presentation may be non-specific symptoms such as weight loss and lethargy
diarrhoea: the most prominent symptom in adults. Crohn’s colitis may cause bloody diarrhoea
abdominal pain: the most prominent symptom in children
perianal disease: e.g. Skin tags or ulcers
extra-intestinal features are more common in patients with colitis or perianal disease
What are the symptoms ulcerative colitis?
- Bloody diarrhoea
- Urgency
- Tenesmus
- Abdominal pain, particularly in the left lower quadrant
- Extra-intestinal features (see below)
What is the difference between ulcerative colitis and crohn’s?
Ulcerative colitis is limited to the colon while Crohn’s disease can occur anywhere between the mouth and the anus
In Crohn’s disease, there are healthy parts of the intestine mixed in between inflamed areas. Ulcerative colitis, on the other hand, is continuous inflammation of the colon
Ulcerative colitis only affects the inner most lining of the colon while Crohn’s disease can occur in all the layers of the bowel walls
How is ulcerative colits diagnosed?
Endoscopy
- Colonoscopy + biopsy is generally done for diagnosis
- However in patients with severe colitis colonoscopy should be avoided due to the risk of perforation - a flexible sigmoidoscopy is preferred
- Typical findings:
- Red, raw mucosa, bleeds easily
- No inflammation beyond submucosa (unless fulminant disease)
- Widespread ulceration with preservation of adjacent mucosa which has the appearance of polyps (‘pseudopolyps’)
- Inflammatory cell infiltrate in lamina propria
- Neutrophils migrate through the walls of glands to form Crypt abscesses
- Depletion of goblet cells and mucin from gland epithelium
- Granulomas are infrequent
Barium enema
- Loss of haustrations
- Superficial ulceration, ‘pseudopolyps’
- Long standing disease: colon is narrow and short -‘drainpipe colon’
How is crohn’s diagnosed?
-
Bloods
- C-reactive protein correlates well with disease activity
-
Endoscopy
- Colonoscopy is the investigation of choice
- Features suggest of Crohn’s include deep ulcers, skip lesions
-
Histology
- Inflammation in all layers from mucosa to serosa
- Goblet cells
- Granulomas
-
Small bowel enema
- High sensitivity and specificity for examination of the terminal ileum
- Strictures: ‘Kantor’s string sign’
- Proximal bowel dilation
- ‘Rose thorn’ ulcers
- Fistulae
What is the treatment for crohns?
Maintenance:
- Azathioprine
- Mercaptopurine / Methotrexate
- TNF-alpa inhibitors (all the –imabs)
- Surgery eg. Strictures, resection
Flares:
- 7 days prednisolone then taper dose for 7 weeks
- If systemically unwell – admit for IV hydrocortisone and monitoring (incl Xrays). Supportive – fluids, transfusion if <80Hb).
- Switch to oral pred once improving or biologics if not improving
What is the treatment for ulcerative colitis?
Maintenance:
- Mesalazine (which is an aminosalicylate or 5-ASA)
- Azathioprine
- Methotrexate / Mercaptopurine
- TNF-alpa inhibitors (all the –imabs)
- Surgery eg. Strictures, resection, stoma
Flares:
- Mesalazine
- 7 days prednisolone then taper dose for 7 weeks
- If unwell – admit for IV steroids and monitoring (incl Xrays). Supportive – fluids, transfusion if <80Hb).
What is coeliac disease?
Celiac disease, sometimes called celiac sprue or gluten-sensitive enteropathy, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.
What is the cause of coeliac disease?
Your genes combined with eating foods with gluten and other factors can contribute to celiac disease, but the precise cause isn’t known
What are the symptoms of coeliac disease?
- Diarrhea
- Fatigue
- Weight loss
- Bloating and gasa
- Abdominal pain
- Nausea and vomiting
- Constipation
- Dermatitis herpetiformis
How do you diagnose coeliac disease?
Immunology
- Tissue transglutaminase (TTG) antibodies (IgA)
- Endomyseal antibody (IgA)
- Anti-gliadin antibody (IgA or IgG) tests are not recommended by NICE
- Anti-casein antibodies are also found in some patients
Duodenal biopsy
- Villous atrophy
- Crypt hyperplasia
- Increase in intraepithelial lymphocytes
- Lamina propria infiltration with lymphocytes
What is the treatment for coeliac disease?
Gluten-free diet
WHAT IS FAILURE TO THRIVE?
Failure to maintain a normal rate of growth such that the individual’s growth rate falls significantly behind that of the normal population.
What are some causes of failure to thrive?
- Poor calorie input
- Vomiting
- Inadequate absorption of food
- Organ failure - including cardiac, renal, neurological, and serious chronic disease
What are the investigations for failure to thrive?
- Parental and siblings’ heights
- History of pregnancy
- History of neonatal period
- Nutritional history, including current nutrition, which should be assessed by a dietician
- Any relevent systemic symptoms
- Social and family history
What are some investigations for failure to thrive?
- Stool and urine microscopy and culture
- Hospitalize and observe feeding
- Full blood count and film, followed by serum and ferritin, B12 and folate as indicated
- Creatinine and electrolytes, plus liver and bone function
- Thyroid function and other endocrine investigations
- Sweat test
- Chromosomal analysis
- Metabolic analysis
What is Marasmus?
Marasmus is a form of severe malnutrition
What is the cause of marasmus?
Not eating enough protein, carbohydrates or calories
Iron
Iodine
Zinc
Vitamin A
What are the symptoms of marasmus?
Low weight
Chronic diarrhea
Respiratory infections
Intellectual disability
Stunted growth
How is marasmus diagnosed?
Take height and weight
Lack of motion
What is the treatment for marasmus?
Dried skim milk powder mixed with boiled water
Later includes sesame, casein, and sugar
What is Kwashiorkor?
Kwashiorkor is a form of acute malnutrition that occurs due to protein deficiency.
What is the cause of kwashiorkor?
How is it different from marasmus?
Diets consisting mainly of maize, cassava, or rice, exact cause unknown
Kwashiorkor is the result of severe malnutrition or lack of protein.
It is different than marasmus, a form of malnutrition that is due to lack of calories
What are the symptoms of kwashiorkor?
- Loss of appetite
- Changes in the color of the hair, which may appear yellow or orange
- Dehydration
- Pitting edema or swelling, usually on the legs and feet, when pressing the skin leaves a finger mark
- lethargy and irritability
- Dermatosis, or skin lesions that are cracked, flaky, patchy, depigmented
How is kwashiorkor diagnosed?
Medical history and examination
Electrolyte levels - Creatnine, total protein, prealbumin
What is the difference between kwashiorkor and marasmus?
Marasmus: Severe weight loss and muscle wasting due to lack of nutrition and calories.
Kwashiorkor: Swelling or edema due to water retention from lack of protein.
Marasmic-kwashiorkor: A combination of muscle wasting and bilateral edema.
What is the treatment for kwashiorkor?
Carbohydrates, then proteins
They can develop lactose intolerance so need to avoid dairy
What is Hirschprung’s disease?
Ganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses.
What is the cause of Hirschsprungs disease?
Unknown, genetic factors
The nerves that control peristalsis are missing from a section at the end of the bowel, which means poo can build up and form a blockage
What are the symptoms of Hirschsprung’s disease?
- Failure to have a bowel movement (meconium) 48 hours after brith
- Swollen belly
- Vomiting, including vomiting a green or brown substance
- Constipation or gas, which might make a newborn fussy
- Diarrhea
- Can develop later when 2-3 years old
How do you diagnose Hirchsprung’s disease?
Biopsy - gold standard
Abdo X-ray using a contrast dye
Measuring control the muscles around the rectum (anal manometry)
What is the treatment for Hirschsprung’s disease?
Bowel Irrigation/Rectal Washouts
Anorectal pull through is the definitive management, not initial.
Ostomy surgery
What is intussusception?
Intussusception is a condition where the bowel ‘telescopes’ in on itself
What is the cause of intussusception?
-
In children
- Unknown
- Meckel’s diverticulum - lead point
-
In adults
- A polyp or tumour
What are the symptoms of intussusception?
Loud crying and abdominal pain lasting 3 minutes
Pull legs into chest
Stool mixed with blood and mucus - currant jelly
Vomiting
How is intussception diagnosed?
Ultrasound
Target sign
Air or barium enema
What is the treatment for intussception ?
1) Air sufflation
2) Barium eneama
3) Surgery
What is Meckel’s diverticulum?
A diverticulum is an abnormal sac or pouch that develops at a weak point in the intestines.
Various types of diverticula can develop as you age.
When you’re born with a diverticulum in your intestines, it’s referred to as Meckel’s diverticulum.
What is the cause of Meckel’s diverticulum?
When the vitelline duct is not fully absorbed, a Meckel’s diverticulum develops
What are the symptoms of Meckel’s diverticulum?
- Gastrointestinal bleeding (which can be seen in the stool)
- Most common cause of painless massive GI bleeding requring a transfusion between 1 and 2 years.
- Abdominal pain and tenderness near the navel (belly button)
-
Obstruction
Pain, bloating, diarrhea, constipation, and vomiting. - Diverticulitis (swelling of the intestinal wall)
How do you diagnose Meckel’s diverticulum?
- Technetium scan: This test is a scan. Radioactive technetium is injected into the body. This substance is absorbed by stomach cells in the diverticulum and can be detected by a special camera.
- Colonoscopy
- Wireless capsule endoscopy
What is the treatment for Meckel’s diverticulum?
Usually does not require treatment as no symptoms
If needed removal of the diverticulum can be conducted
What is Toddler’s diarrhoea?
Toddler’s diarrhea (also known as chronic nonspecific diarrhea of childhood) is one of the most common causes of chronic diarrhea in otherwise healthy children
What are the causes of toddlers diarrhoea?
Excessive fluid intake
Carbohydrate malabsorption
Low fat/high fiber diet
Immature digestive tract
What are the symptoms of toddler’s diarrhoea?
Between five and 10 loose, watery large stools per day
Stools with undigested food particles
Diarrhea lasting weeks followed by weeks of normal bowel movements
How is toddler’s diarrhoea diagnosed?
Doctors will suspect toddler’s diarrhoea if the child is gaining weight normally and are six months to five years old
What is the treatment for toddler’s diarrhoea?
Limit furit juice
Avoid grazing
High fat
High fiber
What is colic?
Colic is when a baby cries a lot but there’s no obvious cause
All babies cry, but your baby may have colic if they cry more than 3 hours a day, 3 days a week for at least 1 week.
What is the cause of colic?
Exact cause is uknown
What are the symptoms of colic?
- Intense crying that may seem more like screaming or an expression of pain
- Crying for no apparent reason
- Extreme fussiness even after crying has diminished
- Predictable timing
- Facial discoloring
- Bodily tension
How do you diagnose colic?
- Energy level
- Skin tone
- Breathing
- Body temperature
- Weight
What is the treatment for colic?
Soothing techniques
What is biliary atresia?
Biliary atresia is a blockage in the tubes (ducts) that carry bile from the liver to the gallbladder.
This congenital condition occurs when the bile ducts inside or outside the liver do not develop normally
What is the cause of biliary atresia?
Exact cause is unknown
What are the symptoms of biliary atresia?
Jaundice after two or three weeks
Dark urine
Enlarged spleen
Pale, foul-smelling, floating stools
How is biliary atresia diagnosed?
-
Blood tests
- Liver function tests - bile acids and aminotransferase high
- Conjugated bilirubin is abnormally high
-
X-rays
- Enlarged liver and spleen
-
Abdominal ultrasound
- Distension
- Liver biopsy
-
Serum alpha 1-antitrypsin
- Defieiency may be a cause of neonatal cholestasis
What is the treatment for biliary atresia?
A Kasai procedure (also known as a hepatoportoenterostomy)
What is Wilson’s disease?
Wilson’s disease is a rare inherited disorder that causes copper to accumulate in your liver, brain and other vital organs
What is the cause of Wilson’s disease?
Autosomal recessive chromosome 13
What are the symptoms of Wilson’s disease?
- Fatigue, lack of appetite or abdominal pain
- A yellowing of the skin and the whites of the eye (jaundice)
- Golden-brown eye discoloration (Kayser-Fleischer rings)
- Fluid buildup in the legs or abdomen
- Problems with speech, swallowing or physical coordination
- Uncontrolled movements or muscle stiffness
How do you diagnose Wilson’s disease?
Slit lamp examination for Kayser-Fleischer rings
Reduced serum caeruloplasmin
Reduced total serum copper (counter-intuitive, but 95% of plasma copper is carried by ceruloplasmin)
Free (non-ceruloplasmin-bound) serum copper is increased
Increased 24hr urinary copper excretion
What is the treatment for Wilson’s disease?
1) Penicillamine (chelates copper)
Increases urinary excretion
Improvement is slow and at least six months continuous
Urinary copper level is monitored indicate normal limits.
Cover with Prednisolone if allergic
2) Trientine hydrochloride
What are choledochal cysts?
Rare congenital dilations (enlargements) of the bile ducts
What are the symptoms of choledochal cysts?
- Often asymptomatic
- Abdominal mass
- Pain in the right upper belly
- Jaundice
- Nausea and vomiting
- Fever
How is choledochal cysts diagnosed?
- Ultrasound - first line
- CT / MRI
What is the treatment for choledochal cysts?
-
Surgical
- Primary excision of the cyst and a Roux-en-Y choledochojejunostomy.
What is neonatal hepatitis?
Neonatal hepatitis is inflammation of the liver that occurs only in early infancy, usually between one and two months after birth
What is the cause of neonatal hepatitis?
- 20% - Hepatitis A, B or C viruses, Cytomegalovirus, Rubella (measles)
- 80% - No cause identified
What are the symptoms of neonatal hepatitis?
Jaundice (yellow eyes and skin), that appears at one to two months of age,
Not gaining weight and growing normally and has an enlarged liver and spleen
How do you diagnose neonatal hepatitis?
Biopsy
Four or five cells that don’t function as well as a normal cell
Enlarged spleen
What is the treatment for neonatal hepatitis?
Vitmanin supplements
Phenobarbital, a drug used to control seizures but which also stimulates the liver to excrete additional bile.
Hepatitis B serology positive woman gives birth to a healthy baby girl.
The mother is surface antigen positive.
What treatment should be given to the baby?
First dose of hepatitis B vaccine soon after birth
AND those born to mother’s who are surface antigen positive should also receive 0.5 millilitres of hepatitis B immunoglobulin within 12 hours of birth.
THEN
Baby should then further receive a second dose of hepatitis B vaccine at 1-2 months and at 6 months.
What is liver failure?
Liver failure is the severe decline of liver function
Can be acute or chronic
What are the causes of acute liver failure?
Infections
Metabolic diseases
Autoimmune liver disease
Blood disorders
Medication (including alternative medicines)
Paracetamol overdose (often accidental)
Recreational drugs, especially ecstasy
Poisonous substances
Complications caused by another illness
What are the causes of chronic liver failure?
Biliary atresia
Metabolic liver disease
Hepatitis B or hepatitis C or cirrhosis.
What are the symptoms of liver failure?
Abdominal pain
Nausea and vomiting
Weight loss
Jaundice
Poor blood clotting which may cause bruising and bleeding
Low blood sugar levels (hypoglycaemia)
Fluid and salt imbalance including swelling
Encephalopathy can cause symptoms ranging from a loss of concentration and irritability to drowsiness
What tests are needed for liver failure?
LFTs
Prothrombin time
Albumin level
What is the treatment for liver failure?
Controlling the cause of the liver damage
Preventing additional damage
Treating symptoms and complications
Treating underlying medical conditions
What are the management steps for peadiatric constipation?
- First-line: Osmotic laxative - Movicol Paediatric Plain
- Second-Line: Add a stimulant laxative if no response - Senna
- Substitute a stimulant laxative if Movicol Paediatric Plain is not tolerated. Add another laxative such as lactulose or docusate if stools are hard
- Continue medication at maintenance dose for several weeks after regular bowel habit is established, then reduce dose gradually
WHAT ARE THREADWROMS?
Infestation with threadworms (Enterobius vermicularis, sometimes called pinworms) is extremely common amongst children in the UK. Infestation occurs after swallowing eggs that are present in the environment.
What are the features of threadworms?
- perianal itching, particularly at night
- girls may have vulval symptoms
What are the investigations for threadworms?
Diagnosis may be made by the applying Sellotape to the perianal area and sending it to the laboratory for microscopy to see the eggs. However, most patients are treated empirically and this approach is supported in the CKS guidelines.
What is the management of threadworms?
- CKS recommend a combination of anthelmintic with hygiene measures for all members of the household
- mebendazole is used first-line for children > 6 months old. A single dose is given unless infestation persists
WHAT ARE THE FEATURES OF MALROTATION?
- High caecum at the midline
- Features include exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia
- May be complicated by the development of volvulus, an infant with volvulus may have bile stained vomiting
What is used for diagnosis of malrotation?
upper GI contrast study and USS
What is the treatment of malrotation?
Laparotomy, if volvulus is present (or at high risk of occurring then a Ladd’s procedure is performed
WHAT IS MESENTERIC ADENITIS?
- Mesenteric adenitis is inflamed lymph nodes within the mesentery.
- It can cause similar symptoms to appendicitis and can be difficult to distinguish between the two.
- It often follows a recent viral infection and needs no treatment
