GI Flashcards
GORD prevalence
40% of infants
within 1st 2 weeks of life
pathophysiology Gord infants
tone of muscular portion of lower oesophagus is too low..made worse by
- short, narrow oesophagus
- delayed gastric emptying
- shorter, lower oesophageal sphincter is above diaphragm
- liquid diet and high calorie intake - distending the stomach
- larger ratio of gastric volume to oesophageal volume
- recumbent position
risk factors GORD infants
prematurity
parental hx of heartburn
obesity
hiatus hernia
hx of repaired congenital diaphragmatic hernia or oesophageal atresia
neurodisability such as cerebral palsy
symptoms GORD infants
crying, unusual neck postures, back arching
feeding difficulties
hoarseness
chronic cough
episode of pneumonia
faltering growth
retrosternal or epigastric pain
hx gord infants
full feeding history
relationship of sx to feeds
GORD infants ddx
pyloric stenosis
intestinal obstruction
acute surgical abdomen
upper GI bleed
sepsis
raised ICP
bacterial gastroenteritis
UTI
GORD when consider other diagnoses
if onset >6 mths of age or sx persist beyond 1 year
GORD infants management
reassurance - effortless regurgitation
alginate mixed with water after feeds if breastfed
make sure not over ded or decreased frequency, can try feed thickener if formula fed
GORD infants complications/prognosis
90% spontaneously resolve within 1st year of life
complications - reflux oesophagitis, recurrent aspiration pneumonia, recurrent acute otitis media, dental erosion
apnoea
ALTE
coeliac immune mechanisms
T cell mediated immune disorder, development of anti-gluten CD4 T cell response, anti gluten antibodies, autoantibodies against tissue transglutaeminase, endomysium and activation of intraepithelial lymphocytes…result in epithelial cells destruction and villous atrophy
gluten foods
bread
beers
biscuit
breakfast cereal
cakes
pasta
pies
coelic associated conditiions
type 1 DM
down’s
turner’s
thyroid disease
RA
addison’s
coeliac younger children sx
GI sx - loose stools, steatorrhoea, anorexia, abdo pain
9-24 mths of age
failure to thrive
weight loss
histology - crypt hyperplasia and villous atrophy
coeliac older children sx
more likely to have extra-intestinal sx
can also have intestinal
silent form coeliac
damaged small intestine mucosa + positive serology
no clinical sx
latent form coeliac
predisposing gene HLADQ2 and/or HLADQ8
normal intestinal mucosa
posittive serology is possible
potential form coeliac
normal mucosa,positive autoimmune serology, geneticallly predisposed to develop at some point, may or not have sex
atypical form coeliac
osteoporosis, peripheral neuropathy, anaemia, infertility
no intestinal sx
extra-intestinal sx coeliac
dermatitis herpetiformis
dental enamel hypoplasia
osteoporosis
delayed puberty
short stature
iron def anaemia
liver and billiary tract disease
arthritis
peripheral neuropathy
coeliac ddx
tropical sprue
CF
IBD
investigations coeliac
offer serological testing - gluten in diet for at least 6mths
- total IgA and tTG
- then try EMA
- if total IgA deficient consider IgG EMA
- genetic testing
- endoscopic intestinal biopsy
gold standard is duodenal biopsy, classified by Marsh
complications coeliac
anaemia
osteoporosis
refractory coelic disease
malignancy
fertility issues
depression/anxiety
cow’s milk protein allergy epidemiology
7% of formula or mixed fed infants
0.5% of exclusively breastfed infants
cow’s milk protein allergy pathophysiology
IgE mediated - type 1 hypersensitivity. CD4 TH2 cells stimulate B cells to produce IgE antibodies against cow’s milk protein…triggers histamines and other cytokines from mast cells and masophils
non IgE - T cell activation
cow’s milk protein allergy risk factors
personal hx of atopy
fhx of atopy
not breastfeeding (exclusively breastfeeding is protective factor)
clinical features cow’s milk allergy
ige - acute,prutirits, eyrhtema, acute urticaria, angioedema, nausea, vomiting, diarrhoea
lower and upper resp sx
non ige - non acute, delayed, pruritus, erythema, atopic eczema, GORD,loose stools, blood in stool, infantile colic, food aversion, constipation, perianal redness, apllor, faltering growth, lower resp sx
CMPA investigations
clinical feature
specific IgE antibodies but low specificity
non IgE - clinically diagnosed
CMPA management
avoidance of cow’s milk including in mothers die
for at least 6 mths of until 9-12 months old
if formula fed - alternative formula - extensively hydrolyed or amino acid
CMPA complication
malabsoprtion
iron def anaemia
faltering growth
anaphylaxis (rare)
rotavirus
most common cause of infantile gastoenteritis
vaccine against at 8 and 12 weeks
faecal oral route or by environmental contamination
peaks over winter mths
norovirus
commonest cause in all age groups
faecal oral or environmental contamination
adenovirus
resp infection too
gastroenteritis <2 yrs of age
campylobacter
most common
bloody diahrroea
undercooked meat and unpasteurised milk
e.coli
some strains such as VTEC - haemorhhagic colitis and haemolytic uraemic syndrome
contaminated food, person to person contact, contact with infected animals
increased risk of dehydration in infants gastroenteritis
children <6mths
children >5 diarrhoeal stools in last 24 hrs
childre vomited >2x in last 24 hrs
children who stopped breastfeeding during illness
when should ddx be considered in children with gastroenteritis
temp >38 if <3mths or >39 if >3mths old
breathlesness
altered GCS
meningism
blood in stool
bilious vomit
severe abdo pain
abdo distention`
gastroenteritis investigations
stool sample - if septicaemia, blood in stool or child is immunocompromised
blood test - Na, K, Cr, Ur and glu if IV fluids going to be used or signs of hypernatraemia
gastoenteritis manegemtn
continue breast feeding
encourage fluid intake
decreased diuretic drink intake
oral rehydration salt solution
(50ml/kg over 4 hrs plus maintenance fluid)
if dehydrated Iv hydration
gastroenteritis following rehydration
full strength milk and slowly re introduce child’s solidfood
hygiene
not return to school until at least 48 hours passed since last episode and not swim for 2 weeks after last episode
gastroenteritis complications
haemolytic uraemic syndrome - which can result in acute renal failure and haemolytic anaemia
arthritis, carditis, erythema nodosum and conjuncitivits, reiter’s syndrome
toxic megacolon
acquired lactose intolerance
see crohn’s
see UC
