GI problem in children Flashcards
What are some differential for a vomiting child?
- GORD
- Oesophagitis
- Peptic ulcer disease
- Food allergy/intolerance
- Neurological: raised ICP Eg. meningitis/brain tumour
- Metabolic: urea cycle defect, DKA
- Psychological
- Infection-UTI/LRTI
- Intestinal obstruction Eg. pyloric stenosis, malrotation, volvulus, duodenal atresia
What are some signs of intestinal obstruction?
- Bilious vomit
- Severe abdo pain/cramps
- Feelings of fullness or swelling in abdomen
- Loud bowel sounds
- Flatulence
- Constipation
What are some causes of bilious vomiting in children?
- Malrotation: midgut twist in clock wise direction
- Necrotising enterocolitis
- Duodenal atresia: narrowing of the duodenum
How does GI malrotation happen?
It’s congenital and occurs if there is a disruption in the steps that the intestine takes to arrive at the correct position
What is pyloric stenosis?
When the pyloris becomes narrow, restricting passage of food into the intestines
Treated with a pyloromyotomy
- Causes non-bilious projectile vomiting
- Onset: 3-8 weeks of age
- Symptoms: hungry after feeds, eight loss, olive mass, visible gastric , metabolic alkalosis, electrolyte derangement
What is the management of Crohn’s disease?
- Nutritional rehab
- Azathioprine: immunosuppressant
- Methotrexate: Immunosuppressant
- Biologics
- 5-ASA (aminosalicylates): anti-dampen down inflammatory process
What is the management of ulcerative colitis?
- 5-ASA (aminosalicylates): anti-dampen down inflammatory process
- Steroids
- Azathioprine: immunosuppressant
- Cyclosporin: immunosuppressant
- Biologics
What are the symptoms of a Cow’s milk protein allergy?
Eczema, diarrhoea, constipation, vomiting, nappy rash, bloody stools, irritability, poor sleep, urticaria rash
How is a Cow’s milk protein allergy diagnosed?
- Immediate food allergy-IgE RAST, skin prick test
- Delayed onset-exclusion followed by challenge
Prognosis-resolution-55% by 1 yr, 75% by 2 yrs, 87% by 3 yrs
What are the causes of gastroenteritis in children?
Virus:
Rotavirus, norwalk-like, adenovirus, astrovirus, norovirus
Bacteria
Campylobacter, salmonella, shigella,E coli, C.difficile
Parasites
Giardia lamblia, cryptosporidium
Up to 50%-unknown cause
What are some signs of severe dehydration?
- Abnormally sleepy/ lethargic
- Sunken eyes
- Drinking poorly
- Very low skin pinch
What are some different type of laxatives?
Osmotic agents (lactulose, movicol* )
Stimulants (senna, bisacodyl, picosulfate, docusate)
Lubricants (mineral oil, liquid paraffin, docusate)
Bulking agents (fibre, bran, methylcellulose)
