Gastrointestinal diseases in children Flashcards
What are main causes of acute diarrhea in children?
Infections.
Medications, e.g. antibiotics.
Surgical conditions, e.g. appendicitis, intussusception, Mb. Hirschprung.
Allergic reactions and intolerance.
Vasculitis, e.g. Henoch-Schoenlein purpura.
How many episodes of infectious gastroentiritis are common during the first year of kindergarten?
1-3 episodes.
What are reasons for hospital admission in patients with gastroenteritis?
Moderate to severe dehydration.
Signs of complication.
Name some examples of viral agents causing gastroenteritis.
Norovirus, rotavirus and adenovirus.
What is it important to consider when making an estimation on the amount of fluid needed in rehydration therapy?
Basal need - Normal fluid intake.
Consecutive losses - How big is the loss of fluids.
How should oral rehydration therapy be managed?
Non-hypertonic fluid. Oral rehydration salts.
Small, frequent intake of fluids.
What is it important to monitor in children with vomiting and/or diarrhea?
Weight (at least daily).
Liquid balance. Intake: PO or IV. Loss: Urine output, stools and/or vomiting.
Vital parameters: RR, pulse and BP.
Electrolytes, creatinine and blood glucose.
What is the definition of functional diarrhea?
Painless passage of three or more large, unformed stools for four or more weeks, with onset in infancy or the preschool years, and without failure to thrive or a specific definable cause.
What are mechanisms of chronic diarrhea?
Sectretorial diarrhea (secretion > absorption). Osmotic diarrhea (malabsoption). Dysmotility. Combination causes (most common).
What is the most common type of chronic diarrhea in children?
Functional diarrhea.
What is the most common clinical presentation of constipation in children?
Soiling/encopresis (most common).
Defecation frequency < 3 times per week.
Large stools.
What are the criteria for functional constipation in children?
Less than 3 stools per week. At least 1 episode of soiling per week. History of excessive stool retention. History of painful hard bowel movement. Presence of large fecal mass in the rectum. History of large diameter stools.
At least 2 of the criteria must be fulfilled for a duration of 1 month in children under the of 4 and 2 months in children over the age of 4.
What is the most common cause of constipation in children?
Functional cause. (90-95 % of cases are functional.)
What are indications of surgery as treatment of constipation in children?
Mb. Hirschprung.
Anorectal malformations.
When dealing with chronic/recurrent abdominal pain in children, what are some potential causes?
Intestinal conditions/diseases: Inflammation (IBD), infection, malabsorption (Celiac), constipation/obstruction, acid reflux (GERD).
Extra-intestinal intra-abdominal: Inflammation, tumor, kidney and gallstones, etc.
Extra-intestinal extra-abdominal: Systemic disease, e.g. leukemia.
Functional disorders (IBS, etc.)
Psychosomatic disorders.
True or false: Visceral pain is associated with lower levels of anxiety and vasovagal reactions compared to somatic pain.
False. Visceral pain is associated with higher levels of anxiety and vasovagal reactions compared to somatic pain.
What are examples of functional abdominal pain disorders in children?
Irritable bowel syndrome (IBS). Functional dyspepsia (FD). Abdominal migraine (AM). Functional abdominal pain syndrome (FAPS).
Are functional abdominal pain disorders more common in girls or boys?
In girls.
What is the typical pain location in children with functional abdominal pain disorders?
The periumbilical region is common, although the location of pain often is diffuse.
What are warning signs/symptoms related to children with recurrent/chronic abdominal pain?
Apley’s law.
Atypical pain history, e.g. nightly pain, long duration of episodes, non-paroxysmal symptoms.
Progressive symptoms.
Permanent change of stool (with rectal bleeding or bloody stool).
Vomiting and/or reflux symptoms.
Fever.
Dysuria or other organ specific symptoms.
Failure to thrive.
Onset of symptoms before 3-4 years of age.
What is Apley’s law (in pediatrics)?
In pediatrics, the farther a chronically recurrent abdominal pain is from the umbilicus, the greater the likelihood of an organic cause for the pain.
What is treatment of functional abdominal pain disorders in children?
Peripheral mechanisms can be treated with dietary changes, like fiber and probiotics, and medications (to treat constipation/diarrhea).
Central mechanisms can be treated through reduction of “triggers” and psychotherapy, like psychoeducation, cognitive behavioral therapy (CBT), hypnosis or treatment of comorbid anxiety or depression.
What are the two main categories of causes for failure to thrive? What is the most common cause?
Organic and non-organic causes.
The cause is most commonly multifactorial. Only 10 % of causes are solely organic.
What are causes of malnutrition in children?
High energy demand, as in chronic disease.
Poor appetite due to illness, treatment or emotional distress.
Eating difficulties due to illness, treatment of care-failure.
Idiopathic (most common).
