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HD CC > GI Disorders in childhood > Flashcards

GI Disorders in childhood Flashcards

1
Q

Causes of Abdo Pain

A

Constipation
Functional/RAP/IBS
Duodenal ulcer/ H. Pylori
IBD

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2
Q

GI disorders in children

A 
Constipation
Recurrent abdominal pain (RAP)
Gastritis/duodenal ulcers (DU)
Gastro-oesophageal reflux (GOR)
Rectal bleeding
Inflammatory bowel disease (IBD)
Acute diarrhoea (year 4)
Chronic diarrhoea (year 4)- enteropathy, pancreatic insufficiency, lactase deficiency
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3
Q

Causes of chronic vomiting

A

GOR
Intestinal obstruction
Duodenal ulcers

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4
Q

Chronic diarrhoea causes

A

IBD
Malabsorption + failure to thrive
Constipation

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5
Q

Failure to thrive causes

A

Associated with diarrhoea
Coeliac disease
CF

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6
Q

Functional GI disorders

A

Criteria fulfilled at least once per week for at least 2 months before diagnosis
No evidence for inflammatory, anatomic, metabolic or neoplastic process that explains symptoms

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7
Q

Constipation

A

Infrequent, hard stools or difficulty/delay in defecation, leading to distress
Passing less than 3 stools per week if he/she has painful bowel movements

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8
Q

Soiling

A

Escape of stool into underclothes

Accidental

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9
Q

Encopresis

A

The passage of normal stools in abnormal places

Not accidental

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10
Q

Constipation presentation

A 
Diarrhoea
Infrequent bowel movements
Painful bowel movements
Palpable rectal abdominal mass
Acute abdominal pain
Recurrent UTIs
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11
Q

Rare Organic causes of constipation

A

Hirschsprung’s
Hypothyroidism
Neurologic
Anal stenosis

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12
Q

Constipation presentation

A

Distended abdomen
Abnormal anus
Sacral dimples
Palpable rocks in abdomen

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13
Q

Constipation investigations

A

TSH/calcium
Marker studies
Rectal suction biopsy

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14
Q

Constipation treatment principles

A

Initial clear out- high does laxatives/lavage
Maintenance- too much better than too little
One softener, one stimulant

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15
Q

Constipation laxatives

A 
Stool Bulking agents
Osmotic laxatives
Stool softeners
Stimulant laxatives
Specific receptor antagonists
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16
Q

Stool bulking agents

A

Fibre supplements e.g. bran
Increase stool bulk by drawing water around their fibres
Require adequate fluid intake

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17
Q

Osmotic laxatives

A

Non-absorbed sugars e.g. lactulose, magnesium and phosphate salts
Draw water into intestinal lumen
May cause dehydration + electrolyte abnormalities

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18
Q

Stool softeners

A

Liquid paraffin
Retained in stool
Ease passage of stools, defecation
Particularly with haemorrhoids + anal fissure

19
Q

Stimulant laxatives

A

Senna
Stimulate mucosal entero-endocrine cells
–> stimulate motility + fluid secretion

20
Q

Constipation specific receptor antagonists

A

5HT4 antagonists

Stimulate motility

21
Q

Gastro-oesophageal reflux

A

Passive regurgitation of gastric/duodenal contents into oesophagus
–> don’t actively contract diaphragm + abdo muscles like vomiting does

22
Q

GORD investigation

A

pH/impedance studies
Barium swallow
Upper GI endoscopy

23
Q

GORD treatment- medical

A

Positioning
Thickening of feeds
Reduce acid- H2 antagonists, PPIs
Pro-motility agents e.g. domperidone

24
Q

GORD treatment- surgical

A

Jejunostomy feeds

Nissen’s fundoplication

25
Q

Eosinophilic Oesophagitis Diagnosis

A

Treatment- resistant symptoms of GORD
History of food sticking
History of atopy
Required endoscopy to diagnose

26
Q

Eosinophilic Oesophagitis Treatment

A

Diet- food exclusion
Oral budenoside
Monteleukast

27
Q

Recurrent abdominal pain definition

A

1 episode of pain per month for 3 months, sufficient to interfere with routine functioning

28
Q

Gastritis Definition

A

Inflammation of gastric mucosa
H. Pylori infection
NSAIDs

29
Q

Gastritis presentation

A

Vomiting
Abdo pain
Haematemesis
Anaemia

30
Q

H. Pylori

A

High person to person transmission
Clustering in families
Higher prevalence in lower socioeconomic classes
Often asymptomatic

31
Q

Gastritis Diagnosis

A

Endoscopy- CLO test, histology
Stool antigen
C14 urea breath test

32
Q

CLO test (rapid urease test)

A

Involves inoculation of biopsy specimens into a liquid or gel medium containing urea and phenol red, which turns pink if pH rises above 6.0

  • -> change occurs when urea in gel is metabolised to ammonia by the urease of organism
  • -> red to pink
33
Q

Gastritis treatment

A

2 weeks- amoxicillin, clarithromycin
6 weeks H2 antagonists/proton pump inhibitors
Rapid breath test/stool 3 months after treatment to ensure eradication

34
Q

IBD

A

Crohn’s

Ulcerative Colitis

35
Q

Crohn’s disease

A

Mouth to anus
Patchy disease ‘skip lesions’
Transmural inflammation

36
Q

Ulcerative Colitis

A

Only rectum/colon
Continuous disease (starting from rectum)
Mucosal inflammation

37
Q

Crohn’s disease presentation

A 
Abdominal pain
Weight loss
Diarrhoea
Insidious onset
Growth/pubertal delay
Fever
Clubbing
Arthropathy
Oral ulcers
Abdominal mass
38
Q

Crohn’s investigations

A

Raised ESR
Raised CRP
Low albumin
Low Hb

39
Q

Ulcerative colitis presentation

A 
Chronic bloody diarrhoea
Abdominal pain
Weight loss
Usually diagnosed within 2 months
Sclerosing cholangitis
Erythema nodosum
Arthropathy
40
Q

IBD Diagnosis

A

Endoscopy + Biopsies
–> Upper GI endoscopy: mouth to duodenum
–> Ileo-colonoscopy: terminal ileum and anus
MRI abdominal

41
Q

IBD treatment- Induce remission

A 
Exclusive enteral nutrition
--> 6 weeks milk based formula- no food
--> Only Crohn's
--> reduce inflammation
--> correct undernutrition
Steroids
5-Aminosaliacylic acid - mesalazine
Biologicals- Anti-TNF, infliximab
42
Q

IBD treatment- Maintain remission

A

5-ASA (especially UC)
–> pH-dependent coating- dissolves pH>6/7
–> microgranules encased in ethyl cellulose coating
–> given as prodrug that is converted into active form by bacterial enzymes- target colon + terminal ileum as bacterial colonies are mainly located there
–> once daily dosing
Immunosuppressants- Azathioprine
Biologicals- Infliximab, adalimumab

43
Q

IBD Surgery

A

UC- Colectomy, curative of colitis

Crohn’s- Depends on disease localisation, likely to need further surgery in future

44
Q

Juvenile polyps- hamartomas

A

Toddlers
Painless rectal bleeding
Benign
Treatment- excise them

HD CC (22 decks)

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