GI Flashcards
GORD
sx, rf, mx
sx:
chronic cough
hoarse cry
reluctance to feed
pneumonia
poor weight gain
vomiting
Rf
- premature
- obesity
- neurodisability
- hernia
Mx
- change feeding routine and position
- PPIs
- additives (thickener)
- gaviscon
- reduce volume and increase frequency
Gastroenteritis
Cause, sx, ix, mx
Causes
- Rotavirus
- Norovirus = most common
- E.coli
- Campylobacter jejuni
- Shigella
- Salmonella
sx:
diarrhoea
vomitng
blood in stool if bacterial
malaise
fever
Ix
- urine dip
- stool culture
- bloods
Mx
- hydration
- prevention
- antibiotics if bacterial
- notify public health
- safety net
Pyloric stenosis
Def, sx, mx
Hypertrophy (thickening) and therefore narrowing of the pylorus is called pyloric stenosis. This prevents food traveling from the stomach to the duodenum as normal.
sx
postprandial nonbilious vomiting
palpable mass
reduced bowel movements
persistent hunger
weight loss
ix
abdo ultrasound showing lenght >16-18mm and thickness >3-4mm
electrolytes showing hypokalaemic hypochloraemic metabolic alkalosis
Mx
Treatment involves a laparoscopic pyloromyotomy (known as “Ramstedt’s operation“). An incision is made in the smooth muscle of the pylorus to widen the canal allowing that food to pass from the stomach to the duodenum as normal.
Appendicitis
Hx, ix, mx
Hx
• Abdominal Pain – Starts central, radiates to RIF
• Associated Symptoms – nausea/vomiting/fever
• Also sometimes develop diarrhoea, constipation or polyuria
• Reduced oral intake
• Often not a typical history/presentation
• Rovsing Sign (palpation of the left iliac fossa causes pain in the RIF)
• Guarding on abdominal palpation
• Rebound tenderness is increased pain when quickly releasing pressure on the right iliac fossa
• Murphy’s Triad (abdo pain, vomiting, fever)
• McBurney’s Point (this is a localised area one third the distance from the anterior superior iliac spine (ASIS) to the umbilicus)
Ix
- Urinanalysis
- BM
- Bloods- raised WCC, U&E, CRP
- Ultrasound
Mx
Appendectomy
Peritonitis
Sx, mx
Sx
- Guarding
- Rigidity
- Rebound tenderness
- Cough test (does cough cause pain)
- Percussion tenderness
- Localised peritonitis = underlying organ
inflammation e.g. appendicitis.
- Generalised peritonitis = perforation in
abdominal cavity e.g. ruptured appendix
Mx
- A to E assessment
- Senior review
- NBM
- IV fluids
- IV abx
- Analgesia
Mesenteric adenitis
Def, pathogen, cause, sx, ix, mx
• Inflammation of intra-abdominal lymph nodes following a viral infection
path
• most common pathogen is yersinia enterocolitica
Cause
• History of recent infection, usually an upper respiratory tract infection or gastroenteritis
sx
• Acute pain can mimic appendicitis
• No signs of peritonism or guarding on examination with red throat or cervical lymphadenopathy
ix
• FBC and US abdo showing enlarged lymph nodes and hypervascular
mx
• Self-limiting
• Conservative management with analgesic
Food allergies
Most common, sx, ix
Most common food allergies include: Cows Milk, Eggs, Soya, Gluten, Seeds, Nuts, Shellfish
Ix
Skin-prick or blood tests (IgE mediated)
● Skin-prick only when available, safe and with competent staff
● Need facility safe to deal with anaphylaxis
● Not for use in primary care
Elimination Trial (non-IgE mediated)
● Trial elimination of suspected allergen for 2-6 weeks
● Reintroduce after the trial
● Dietician support for nutritional advice/suppor
Cows milk protein allergy
Classification, sx, mx
Classification
IgE: Typically < 2hrs
Non-IgE: 2 – 72hrs
Sx
IgE: Urticaria, angioedema, wheeze
Non-IgE: GORD, abdo pain, diarrhoea/constipation,
eczema, faster resolution
Mx
- Breast feeding mothers should avoid dairy products
- Replace formula with special hydrolysed formulas designed for cow’s milk allergy
Intussusception
Def, Hx, sx, ix, mx
Invagination of proximal bowel into a distal segment
Commonly involves ileum passing into the caecum through ileocaecal valve
Hx
• Paroxysmal, colicky pain with pallor and draws up the legs during episodes of pain
• Recovery between the painful episodes
• Increasingly lethargic
• May refuse feeds, vomit bile-stained
• Passage of a characteristic redcurrant jelly stool with blood- stained mucus
Sx
• Palpable sausage-shaped mass
• Abdominal distension and shock
• AXR: distended small bowel and absence of gas in the distal colon or rectum
• Abdo USS: target/donut sign
Ix
Ultrasound or contrast enema
Mx
Therapeutic enemas can be used to try to reduce the intussusception. Contrast, water or air are pumped into the colon to force the folded bowel out of the bowel and into the normal position.
Surgical reduction may be necessary if enemas do not work.
Hirschsprung disease
Def, sx, ix, mx
Hirschsprung’s disease is a congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum. The myenteric plexus, also known as Auerbach’s plexus, forms the enteric nervous system. It is the brain of the gut. This nerve plexus runs all the way along the bowel in the bowel wall, and is a complex web of neurones, ganglion cells, receptors, synapses and neurotransmitters. It is responsible for stimulating peristalsis of the large bowel. Without this stimulation the bowel looses its motility and stops being able to pass food along its length. The key pathophysiology in Hirschsprung’s disease is the absence of parasympathetic ganglion cells. During fetal development these cells start higher in the GI tract and gradually migrate down to the distal colon and rectum. Hirschsprung’s occurs when the parasympathetic ganglion cells do not travel all the way down the colon, and a section of colon at the end is left without these parasympathetic ganglion cells.
Sx
Delay in passing meconium (more than 24 hours)
Chronic constipation since birth
Abdominal pain and distention
Vomiting
Poor weight gain and failure to thrive
Ix
Abdo X-ray
Rectal biopsy- gold standard
Mx
Surgical colostomy
Surgical removal of anganglionic section of the bowel
Inflammatory bowel disease (IBD)
Types, sx, ix, mx
Inflammatory bowel disease is the umbrella term for the two main diseases that cause inflammation of the GI tract: ulcerative colitis and Crohn’s disease. They both involve inflammation of the walls of the GI tract and are associated with periods of remission and exacerbation.
Extra-intestinal manifestations:
Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis and iritis
Inflammatory arthritis
Primary sclerosing cholangitis (ulcerative colitis)
Ix
- Bloods – FBC, UE, LFTs, TFTs, CRP
- Facael calprotectin
- Endoscopy (gold standard)
- USS, CT, MR
Toddler diarrhoea
• Now known as chronic non specific diarrhoea
• Most common cause of persistent loose stools in preschool children
• Stools of varying consistency, sometimes well formed, explosive and loose at times
• Presence of undigested vegetables in the stools common
• Well and growing otherwise
• May due to undiagnosed coeliac or excessive ingestion of fruit juice (apple juice)
• Occasionally due to temporary CPMA after gastroenteritis- trial of protein free diet
• Result from dysmotility of gut, fast transit diarrhoea
• Improves with age
Constipation
Sx, mx, secondary causes
Sx
Less than 3 stools a week
Hard stools that are difficult to pass
Rabbit dropping stools
Straining and painful passages of stools
Abdominal pain
Holding an abnormal posture, referred to as retentive posturing
Rectal bleeding associated with hard stools
Faecal impaction causing overflow soiling, with incontinence of particularly loose smelly stools
Hard stools may be palpable in abdomen
Loss of the sensation of the need to open the bowels
Mx
Correct any reversible contributing factors, recommend a high fibre diet and good hydration
Start laxatives (movicol is first line)
Faecal impaction may require a disimpaction regimen with high doses of laxatives at first
Encourage and praise visiting the toilet. This could involve scheduling visits, a bowel diary and star charts.
Secondary Causes
Hirschsprung’s disease
Cystic fibrosis (particularly meconium ileus)
Hypothyroidism
Spinal cord lesions
Sexual abuse
Intestinal obstruction
Anal stenosis
Cows milk intolerance
Functional abdominal pain
Def, dx, mx
A diagnosis of recurrent abdominal pain is made when a child presents with repeated episodes of abdominal pain without an identifiable underlying cause. The pain is described as non-organic or functional. This is common and can lead to psychosocial problems, such as missed days at school and parental anxiety. There is overlap between the diagnoses of recurrent abdominal pain, abdominal migraine, irritable bowel syndrome and functional abdominal pain. Recurrent abdominal pain often corresponds to stressful life events, such as loss of a relative or bullying. The leading theory for the cause is increased sensitivity and inappropriate pain signals from the visceral nerves (the nerves in the gut) in response to normal stimuli.
Dx
• Abdominal pain occurring at least once per week for a few months.
• Pain is unrelated to eating or bowel movements.
• Absence of warning signs like fever, anemia, or gastrointestinal bleeding.
Mx
Distracting the child from the pain with other activities or interests
Encourage parents not to ask about or focus on the pain
Advice about sleep, regular meals, healthy balanced diet, staying hydrated, exercise and reducing stress
Probiotic supplements may help symptoms of irritable bowel syndrome
Avoid NSAIDs such as ibuprofen
Address psychosocial triggers and exacerbating factors
Support from a school counsellor or child psychologist
