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Paediatrics > GI Disorders > Flashcards

GI Disorders Flashcards

1
Q

What are some features of constipation in a child?

A 
Infrequent passage of stool (usual range is 4 per day to 1 per week). 
Poor appetite
Irritable
Lack of energy
Abdominal pain/distension
Withholding or straining
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2
Q

What are some causes of constipation?

A

Poor diet - insufficient fluids, excessive milk.
Intercurrent illness
Medications - opiates, gaviscon
Family history
Psychological - not want to do it in public etc.
Anorectal malformations
Hypothyroidism

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3
Q

What is the cycle of constipation?

A

Holding in stool
Larger/harder stools form - water sucked out by bowel longer it stays there.
Painful bowel movement.
Stretching of back passage results in megarectum.

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4
Q

What is the treatment for constipation?

A

Reassure that it is not child’s fault.
Make stools never get hard again by re-training bowel.
Remove impaction - osmotic laxatives (lactulose, movicol), stimulant laxatives (Senna, picosulphate).

Treatment will last as long as constipation has been going on for.

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5
Q

What is the difference between inflammatory bowel disease in children compared to adults?

A

More extensive and worse in children.
Normal for children to get pancolitis in UC.
Rate of colectomy is higher than in adults.
Child with Crohn’s has more systemic symptoms but less obvious symptoms e.g. diarrhoea.

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6
Q

How does a child with Crohn’s commonly present?

A 
Weight loss
Abdominal pain
Panenteric disease
Systemic symptoms
Extra intestinal manifestations - arthritis, uveitis, erythema nodosum, mouth ulcers, sore bottom.
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7
Q

What tests would you do for a child with suspected Crohn’s?

A 
Inflammatory markers
Serum albumin
FBC
Calprotectin
Colonoscopy
Endoscopy
MRI
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8
Q

What are some features of Ulcerative colitis in children?

A

Calesocrypt abscesses
Don’t see as many systemic symptoms with UC than in Crohn’s.
MRI good to see small bowel inflammation.

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9
Q

What is the treatment for Crohn’s?

A

Nutritional therapy - liquid feed for 8 weeks (Modulin) to change microbiome.

Thiopurines 1st line to maintain remission.
Anti-TNF therapy if need to step up.

Steroids as last resort as they affect growth.

Surgery

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10
Q

What is the treatment for Ulcerative colitis?

A

5-ASAs 1st line and to maintain remission.
Thiopurines 2nd line to retain remission e.g azothiprine.
Anti-TNF for step up therapy.
Surgery

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11
Q

What are different types of vomiting that can occur in children?

A

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting

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12
Q

What are the features of vomiting with retching?

A 
Pallor
Nausea
Tachycardia
Retching
Vomit
Weakness
Shivering
Lethargy
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13
Q

What can stimulate the vomiting centre in children?

A 
Enteric pathogens
Intestinal inflammation
Metabolic derangement 
Infection
Head injury
Visual stimuli
Middle ear stimuli

Very non-specific symptom!

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14
Q

What is visible gastric peristalsis?

A

Trying to push the food through the thickened pyloris. Can see the baby’s stomach moving.

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15
Q

What rules out pyloric stenosis?

A

Tinge of yellow/green in vomit then not pyloric stenosis.

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16
Q

why would pH be raised in pyloric stenosis?

A

Losing hydrochloric acid from stomach when vomiting.

17
Q

What is the management of pyloric stenosis?

A

Fluid resuscitation -correct electrolyte imbalance.

Refer to surgeons: Ramstedts pyloromyotomy - small nick in muscle to allow food to pass through.

18
Q

How does Pyloric stenosis present?

A 
Babies 4-12weeks
B>G
Projectile non-bilious vomiting
Weight loss
Dehydration +/- shock
Characteristic electrolyte disturbance - metabolic alkalosis, hypochloraemia, hypokalaemia.
19
Q

What are some causes of Bilious vomiting?

A 
Intestinal atresia
Malrotation +/- volvulus
Intussusception
Ileus
Crohn's disease with strictures
20
Q

What investigations would you carry out for bilious vomiting?

A

Abdominal x-ray
Consider contrast meal
Surgical opinion re exploratory laparotomy.

21
Q

What are some features of Effortless vomiting?

A

Almost always due to gastro-oesophageal reflux.
Self-limiting and resolves spontaneously in majority.
Few exception are cerebral palsy, progressive neurological problems, oesophageal atresia, generalised GI motility problem.
Usually starts at 2 weeks and gets worse 3-4 months. Gets better on solid foods and usually recovers fully by 18months.

22
Q

How does Gastrooesophageal reflux present?

A 
Vomiting
Haematemesis
Feeding problems
Failure to thrive
Apnoea
Cough
Wheeze
Chest infections
Sandifer's syndrome
23
Q

What is Sandifer’s syndrome?

A

Spastic torticollis and dystonic body movements.

Nodding and rotation of head, neck extension, gurgling sounds, writhing movements of limbs, severe hypotonia.

24
Q

What are some investigations for gastro-oesophageal reflux?

A 
Video fluoroscopy
Barium swallow
pH study
Oesophageal impedance monitoring- see how far travels up oesophagus. 
Endoscopy
25
Q

What is the treatment for Gastro-oesophageal reflux?

A

Feeding advice - thickeners, behavioural programme, feeding position.
Nutritional support - calorie supplements, exclusion diet (milk free), NG tube, gastrostomy.
Medical treatment - gaviscon, prokinestic drugs, H2 receptor blockers, PPIs.
Surgery

26
Q

What is Nissen Fundoplication?

A

Surgery for GORD.

Wrap stomach around oesophagus to prevent food/acid leaking up.

27
Q

What is chronic diarrhoea?

A

4 or more stools per day for more than 4 weeks.

28
Q

What are some causes of diarrhoea?

A

Motility Disturbance:

  • Toddler diarrhoea
  • Irritable Bowel Syndrome

Active Secretion:

  • Acute infective diarrhoea (cholera most common)
  • Inflammatory Bowel Disease

Malabsorption of nutrients:

  • Food allergy
  • Coeliac disease
  • Cystic fibrosis
29
Q

What are the features of osmotic diarrhoea?

A

Movement of water into bowel to equilibrate osmotic gradient. Usually a feature of malabsorption - enzymatic defect (lactulose intolerance) or transport defect (glucose-galactose malabsorption or congenital chloride diarrhoea.
Generally accompanied by macroscopic and microscopic intestinal injury.

30
Q

What are the features of Secretory diarrhoea?

A

Classically associated with toxin production from vibrio cholerae and enterotoxigenic Escherichia coli.
Intestinal fluid secretion predominantly driven bu active Cl- secretion via CFTR.

31
Q

What are the features of inflammatory diarrhoea?

A

Malabsorption due to intestinal change
Secretory effect of cytokines
Accelerated transit time in response to inflammation
Protein exudate across inflamed epithelium.

32
Q

What type of diarrhoea is it if it stops when you also stop the feed?

A

Osmotic

33
Q

What are some causes of fat malabsorption?

A

Pancreatic disease - diarrhoea due to lack of lipase and resultant steatorrhoea, CF classically.
Hepatobiliary disease - chronic liver disease, cholestasis.

34
Q

What is Coeliac’s disease?

A

Gluten sensitivity enteropathy - wheat, barley, rye.
HLA-DQ2/DQ8 are genetic component.
Autoimmune condition in which multisystemic antibodies form complexes with gluten and harm villi.

35
Q

How does Coeliac’s present?

A 
Abdominal bloatedness
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpatiformis
36
Q

What are the screening tests for Coeliac’s?

A

Serological screens;

  • Anti-tissue transglutaminase
  • Anti-endomysial
  • Anti-gliadin
  • Concurrent IgA deficiency in 2% may result in false negatives.

Duodenal biopsy = gold standard.

Genetic testing

37
Q

What is the treatment for Coeliac’s disease?

A

Gluten free diet for life.
Gluten must not be removed prior to diagnosis.
In very young (<2yrs) re-challenge and re-biopsy.
Increased risk of rare small bowel lymphoma in untreated.

38
Q

What are the ESPGHAN/BSPGHAN guidelines for coeliac’s?

A

Symptomatic children with anti-TTG >10x upper limit of normal and with positive anti endomysial antibodies and HLA DQ2/8 positive canoe diagnosed without biopsy.

Paediatrics (12 decks)

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