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GI Disorders in Childhood Flashcards

1
Q

What are the causes of chronic diarrhoea in childhood? (6)

A 
Enteropathy (coeliac, CMPI)
Pancreatic Insufficiency
Lactase Deficiency
IBD - weight loss, abdominal pain, tiredness, rectal bleeding
Constipation (overflow soiling)
CF (malabsorption)
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2
Q

What causes abdominal pain? (4)

A

Constipation
Functional/RAP/Irritable Bowel Syndrome (IBS)
Duodenal ulcer/H. Pylori
IBD

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3
Q

What causes chronic vomiting? (3)

A

GORD
Intestinal Obstruction
Duodenal ulcer

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4
Q

What are some reasons for failure to thrive and weight loss? (2)

A

Coeliac

CF

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5
Q

What causes rectal bleeding? (4)

A

IBD (Crohns or Ulcerative colitis)
Fissures/haemarrhoids
Polyps/Polyposis syndromes
Infection (Bacterial)

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6
Q

What is the mean intestinal transit time in young children?

A

33 hours

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7
Q

85% of 1-4 year olds pass stools ____ a day.

A

Once or twice

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8
Q

How are functional GI disorders diagnosed/defined?

A

Criteria fulfilled at least once per week for at least 2 months before diagnosis.

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9
Q

What are the main categories of functional GI disorders?

A

Vomiting, abdominal pain, functional diarrhoea, disorders of defecation

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10
Q

Define constipation.

A

Infrequent, hard stools (or difficulty/delay in defecation leading to distress).
Passing less than 3 stools per week OR if they have painful bowel movements and stool retention in spite of passing stools more than 3 times per week.

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11
Q

Define soiling.

A

Escape of stool into the underclothes

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12
Q

Define encopresis.

A

The passage of normal stools in abnormal places

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13
Q

How many % of visits to paediatric practice are due to constipation? How many % presenting to a paediatric GI clinic?

A

3%

25%

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14
Q

How does constipation present? (6)

A 
Diarrhoea/soiling
Infrequent bowel movements 
Painful bowel movements
Palpable rectal abdominal mass
Acute abdominal pain 
Recurrent urinary tract infections
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15
Q

What are the types of causes of constipation?

A

Functional

Organic

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16
Q

What are the organic causes of constipation? (4)

A

Hirschsprung’s
Hypothyroidism
Neurologic
Anal stenosis

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17
Q

What suggests an organic cause of constipation?

A 
History of constipation in neonatal period
Delayed passage of meconium
Failure to thrive 
Distended abdomen
Abnormal anus
Sacral dimples
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18
Q

What is noticed on PR exam for Hirschsprung’s?

A

Empty rectum

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19
Q

How is constipation diagnosed by examination?

A

Palpable rocks in the abdomen, hard faeces on PR exam, and anal tone patulous

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20
Q

How is constipation diagnosed by investigation?

A

Transit time is measured by marker studies
TSH/Calcium
Rectal suction biopsy
Anorectal manometry

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21
Q

How is constipation treated?

A

Initial clear out - high dose laxatives/lavage
Maintenance treatment
One softener, one stimulant

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22
Q

What are the different types of laxatives? (5)

A

Stool bulk formers, osmotic laxatives, stool softeners, stimulants, specific 5HT4 receptor antagonists.

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23
Q

How do stool bulk formers work? Give some examples.

A

They increase stool bulk by drawing water around their fibres. This requires adequate fluid intake. E.g. fibre supplements, sterculia.

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24
Q

How do osmotic laxatives work? Give some examples.

A

They draw water into the intestinal lumen. They may cause dehydration and electrolyte abnormalities. E.g. lactulose, magnesium.

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25
How do stool softeners work? Give an example.
These are retained in the stool, they ease passage. E.g. liquid paraffin.
26
How do stimulants work? Give some examples.
They stimulate mucosal entero-endocrine cells which stimulate motility and fluid secretion, e.g. senna, dantron.
27
How do specific 5HT4 receptor antagonists work? Give an example.
They stimulate motility, e.g. tergaserod.
28
What is the difference between GOR and vomiting?
GOR - passive regurgitation of gastric/duodenal contents into oesophagus. Vomiting involves active contraction.
29
How does GOR differ from GORD?
In GORD, there is objective damage (e.g. oesophagitis) and subjective severe symptoms (vomiting/heartburn etc).
30
How many % of babies age 1-3 months have GOR? What about at 12 months?
50% | 5%
31
What are the 'red flags' for GORD? (4)
Haematemesis Failure to thrive Sandifers syndrome (back arching in infants) Aspiration Pneumonia
32
How is GORD investigated? (4)
pH Study(records acid reflux, pH <4) Impedance (measures both acid and non-acid reflux) Barium swallow/ meal Upper GI Endoscopy
33
What is the principle of impedance study?
Change of electrical impedance during passage of a bolus - there is a decrease of impedance during passage of a bolus with high conductivity (e.g. most liquids).
34
How is GOR treated?
``` Positioning Thickening of feeds H2 antagonists and proton pump inhibitors Promotility agents (e.g domperidone) Jejunostomy feeds Nissen’s fundoplication ```
35
Eosinophilic oesophagitis - what is the history?
Treatment resistant symptoms of GORD History of food sticking History of atopy
36
How is eosinophilic oesophagitis treated?
Dietary (food exclusions, pragmatic trials) Oral budesonide Monteleukast
37
What is recurrent abdominal pain?
1 episode of pain per month for 3 months, sufficient to interfere with routine functioning.
38
Is recurrent abdominal pain more common in boys or girls?
Girls
39
How many % of recurrent abdominal pain is organic?
33%
40
How many % of school children are affected by recurrent abdominal pain?
10-15%
41
Where is functional RAP felt?
Midline, poorly localised
42
Where is organic RAP felt?
Away from umbilicus or referred
43
What overlaps with RAP?
Migraine Irritable bowel syndrome Non ulcer dyspepsia
44
How many % of those with RAP get complete resolution? How many % continue to adulthood?
50 % | 25 %
45
Define gastritis.
Inflammation of the gastric mucosa
46
What causes gastritis?
H. pylori infection | NSAIDs
47
How does gastritis present?
Vomiting, abdominal pain, haematemesis/melaena, anemia
48
How is H pylori infection diagnosed?
Endoscopy (Clo Test and histology) Stool antigen C13 Breath Test (rarely used now)
49
What does H pylori convert urea to?
It uses urease to convert urea to carbon dioxide and NH3 (ammonia).
50
What is the Clo test?
It turns pink if it is positive for urease (pH rises above 6) and yellow if it is negative.
51
How is HP treated?
2 weeks - Amoxycillin, clarithromycin | 6 weeks - H2 antagonists/proton pump inhibitors
52
What causes painless rectal bleeding in toddlers?
Juvenile polyps
53
Rectal bleeding differential diagnoses.
``` Constipation Bacterial infections Inflammatory bowel disease Polyps Worms ```
54
What two conditions compose IBD?
Crohn’s and ulcerative collitis
55
What is Crohn's disease?
Mouth to anus, patchy disease 'skip lesions' Transmural inflammation Granulomas
56
What is UC?
Only rectum/colon Continuous disease (starting from rectum) Mucosal inflammation
57
How does Crohn's disease present?
``` Abdominal pain Weight loss Diarrhoea Growth failure/pubertal delay Raised ESR/CRP/low albumin/Hb Other presentations - fever, clubbing, PR bleeding, arthropathy, oral ulcers, abdominal mass.. ```
58
How does UC present?
Chronic bloody diarrhoea Abdominal pain Weight Loss Other presentations - sclerosing cholangitis, erythema nodosum, arthropathy
59
How is IBD diagnosed?
Endoscopy + Biopsies MRI Abdo Radiolabelled white cell scans
60
How is remission induced in IBD?
Exclusive enteral nutrition (only Crohn’s) Steroids 5-ASA Biologicals e.g. Anti-TNF (Infliximab)
61
How is remission maintained in IBD?
5-AS Immunosuppressants e.g. azathioprine Biologicals (infliximab, adalimumab)
62
How is 5-ASA delivered?
pH dependent coat which dissolves in pH > 7 Microgranules encased ethyl cellulose coat Once daily dosing
63
What is the surgical treatment for IBD?
UC: Colectomy (curative) | Crohn’s: Depends on disease localisation, likely to need further surgery in future

HD 2 (25 decks)

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