GI disorders in childhood Flashcards
What might be the possible causes of abdominal pain?
- constipation
- function/recurrent abdominal pain/IBS
- duodenal ulcer/H pylori
- IBD
What might be the possible causes of chronic vomiting and haematemesis?
- Gastro-oesophageal reflux
- Intestinal obstruction
- Duodenal ulcer
What might be the possible causes of chronic diarrhoea?
- IBD (weight loss, abdo pain, tiredness, rectal bleeding)
- Malabsorption (enteropathy, fat malabsorption, sugar malabsorption)
- Constipation
What might be the possible causes of failure to thrive/weight loss?
- Coeliac
- CF
- IBD
What might be the possible causes of rectal bleeding/bloody stools?
- IBD (Crohn’s, Ulcerative colitis)
- Fissures/haemorrhoids/constipation (with fissures/overflow diarrhoea)
- Polyps/Polyposis syndrome
- Infection (bacterial)
- Worms
Define:
a. constipation
b. soiling
c. encopresis
Constipation: infrequent, hard stools (or delay/difficulty in defecation leading to distress)
Soiling: escape of stool into the underclothes
Encopresis: passage of normal stools in abnormal places
How does constipation typically present?
- Diarrhoea/soiling
- Infrequent bowel movements
- Painful bowel movements
- Palpable rectal abdominal mass
- Acute abdominal pain
- Recurrent UTIs
How are functional and organic constipation diagnosed?
Functional (no physical/physiological cause)
Organic, could be:
- Hirschsprung’s (rectal biopsy)
- Hypothyroidism (check TSH0
- Neurologic (examine spine + lower limbs)
- Anal stenosis
Take a history of constipation in neonatal period (delayed passage of meconium?) Clinical examination would include looking for: - failure to thrive - distended abdomen - abnormal anus - empty rectum - sacral dimples - other neurologic abnormalities
What S+S might a child with GORD present with - what is indicative of subjective severe/objective damage, what are the red and pink flags?
Objective damage: oesophagitis Subjective severe damage: vomiting + heartburn Red flags: - haematemesis - failure to thrive - Sandifers syndrome (back arching) - aspiration pneumonia
Pink flags:
- daily symptoms
- failed empiric therapy
Uncertain:
- feeding refused
- irritability
- acute life-threatening events
- chest infections
What investigations might be carried out for GORD?
- pH study/impedance = symptom association
- only record acid reflux (<4) - Barium swallo = anatomical abnormalities
- Upper GI endoscopy = mucosal abnormalities
- Clinical score = 12-part questionnaire about overall effect on pt and family
What treatment options are there for GORD?
Medical:
- positioning
- thickening of food
- reduce acid (H2 antagonists, PPIs)
- pro-motility agents (Domperidone)
Surgical:
- jejunostomy
- Nissen’s fundoplication
What treatment options are there for eosinophilic oesophagitis?
- dietary (food exclusions)
- oral budesonide (corticosteroids)
- montelukast
What is recurrent abdominal pain? What are the differences between functional and organic causes?
1 episode of pain per month for 3 months (interferes with daily life)
functional:
- > 5 y/o
- healthy
- midline/poorly localised
- occurs in the morning/at school
- psychosocial/family problems
organic:
- <5 y/o
- other S+S
- away from umbilicus/referred pain
- nocturnal awakening
- FH IBD/ulcers etc
*it is a diagnosis of exclusion
What conditions can have some overlap with recurrent abdo pain?
- Migraine
- IBS
- Non-ulcer dyspepsia
What is gastritis? what are the potential causes? what is the typical presentation?
Inflammation of the gastric mucosa Can be due to: H. Pylori; NSAIDs; IBD Presentation: - vomiting - abdo pain - haematemesis - melaena (dark black, tarry faeces = associated with upper GI bleeding) - anaemia
