GI Disorders in childhood Flashcards
Causes of Abdo Pain
Constipation
Functional/RAP/IBS
Duodenal ulcer/ H. Pylori
IBD
GI disorders in children
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
Causes of chronic vomiting
GOR
Intestinal obstruction
Duodenal ulcers
Chronic diarrhoea causes
IBD
Malabsorption + failure to thrive
Constipation
Failure to thrive causes
Associated with diarrhoea
Coeliac disease
CF
Functional GI disorders
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
Constipation
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
Soiling
Escape of stool into underclothes
Accidental
Encopresis
The passage of normal stools in abnormal places
Not accidental
Constipation presentation
Diarrhoea Infrequent bowel movements Painful bowel movements Palpable rectal abdominal mass Acute abdominal pain Recurrent UTIs
Rare Organic causes of constipation
Hirschsprung’s
Hypothyroidism
Neurologic
Anal stenosis
Constipation presentation
Distended abdomen
Abnormal anus
Sacral dimples
Palpable rocks in abdomen
Constipation investigations
TSH/calcium
Marker studies
Rectal suction biopsy
Constipation treatment principles
Initial clear out- high does laxatives/lavage
Maintenance- too much better than too little
One softener, one stimulant
Constipation laxatives
Stool Bulking agents Osmotic laxatives Stool softeners Stimulant laxatives Specific receptor antagonists
Stool bulking agents
Fibre supplements e.g. bran
Increase stool bulk by drawing water around their fibres
Require adequate fluid intake
Osmotic laxatives
Non-absorbed sugars e.g. lactulose, magnesium and phosphate salts
Draw water into intestinal lumen
May cause dehydration + electrolyte abnormalities
Stool softeners
Liquid paraffin
Retained in stool
Ease passage of stools, defecation
Particularly with haemorrhoids + anal fissure
Stimulant laxatives
Senna
Stimulate mucosal entero-endocrine cells
–> stimulate motility + fluid secretion
Constipation specific receptor antagonists
5HT4 antagonists
Stimulate motility
Gastro-oesophageal reflux
Passive regurgitation of gastric/duodenal contents into oesophagus
–> don’t actively contract diaphragm + abdo muscles like vomiting does
GORD investigation
pH/impedance studies
Barium swallow
Upper GI endoscopy
GORD treatment- medical
Positioning
Thickening of feeds
Reduce acid- H2 antagonists, PPIs
Pro-motility agents e.g. domperidone
GORD treatment- surgical
Jejunostomy feeds
Nissen’s fundoplication
Eosinophilic Oesophagitis Diagnosis
Treatment- resistant symptoms of GORD
History of food sticking
History of atopy
Required endoscopy to diagnose
Eosinophilic Oesophagitis Treatment
Diet- food exclusion
Oral budenoside
Monteleukast
Recurrent abdominal pain definition
1 episode of pain per month for 3 months, sufficient to interfere with routine functioning
Gastritis Definition
Inflammation of gastric mucosa
H. Pylori infection
NSAIDs
Gastritis presentation
Vomiting
Abdo pain
Haematemesis
Anaemia
H. Pylori
High person to person transmission
Clustering in families
Higher prevalence in lower socioeconomic classes
Often asymptomatic
Gastritis Diagnosis
Endoscopy- CLO test, histology
Stool antigen
C14 urea breath test
CLO test (rapid urease test)
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
Gastritis treatment
2 weeks- amoxicillin, clarithromycin
6 weeks H2 antagonists/proton pump inhibitors
Rapid breath test/stool 3 months after treatment to ensure eradication
IBD
Crohn’s
Ulcerative Colitis
Crohn’s disease
Mouth to anus
Patchy disease ‘skip lesions’
Transmural inflammation
Ulcerative Colitis
Only rectum/colon
Continuous disease (starting from rectum)
Mucosal inflammation
Crohn’s disease presentation
Abdominal pain Weight loss Diarrhoea Insidious onset Growth/pubertal delay Fever Clubbing Arthropathy Oral ulcers Abdominal mass
Crohn’s investigations
Raised ESR
Raised CRP
Low albumin
Low Hb
Ulcerative colitis presentation
Chronic bloody diarrhoea Abdominal pain Weight loss Usually diagnosed within 2 months Sclerosing cholangitis Erythema nodosum Arthropathy
IBD Diagnosis
Endoscopy + Biopsies
–> Upper GI endoscopy: mouth to duodenum
–> Ileo-colonoscopy: terminal ileum and anus
MRI abdominal
IBD treatment- Induce remission
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
IBD treatment- Maintain remission
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
IBD Surgery
UC- Colectomy, curative of colitis
Crohn’s- Depends on disease localisation, likely to need further surgery in future
Juvenile polyps- hamartomas
Toddlers
Painless rectal bleeding
Benign
Treatment- excise them
