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PAEDIATRICS > GI problems > Flashcards

GI problems Flashcards

1
Q

Non-bloody diarrhoea causes:

Infectious
Malabsorption
Dietary
Autoimmune disease

A

Gastroenterititis

Coeliac, CF

Cow’s milk protein allergy
Lactose intolerance

IBD - Crohn’s commonor than UC
IBS

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2
Q

Blood diarrhoea causes:

Infectious and inflammatory
Obstruction
Allergy
Neonatal

A

Bacterial GE
IBD
Necrotising enterocolitis, haemolytic uraemic syndrome

Intussusception, midgut volvulus

Cows milk allergy (flecks of blood)

Juvenile polyps or Meckel’s diverticulum - may just be PR bleeding

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3
Q

Toddler diarrhoea

What is it?

What is the cause?

When does it usually resolve?

A

Quite common - chronic diarrhoea syndrome but the child is well

Bits of poorly-digested vegetables often the D

5 yrs

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4
Q

DDx for acute abdo pain

Inflammatory causes

A

Appendicitis, GE, UTI, Mesenteric adenitis (post URTI), mumps pancreatitis, hepatitis

Lower lobe pneumonia

Autoimmune: IBD, HSP, DKA

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5
Q

DDx for acute abdo pain

Anatomical causes

A

GI obstruction, constipation

Meckel’s complication - usually assymptomatic

Renal and genitourinary - hydronephrosis, menstration

Compressed anatomy - strangulated inguinal hernia, testis torsion

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6
Q

DDx for chronic and recurrent abdo pain

Upper GI 
Dietary
Lower GI
Abdo migraines 
Genitourinary 
Hepatobillary 
Anatomical
A

Usually functional

GORD, PUD

Cows milk allergy, lactose intolerance, coeliac disease

IBD, constipation

headaches, paroxysmal midline pain, facial pallorm nausea

Recurrent UTI, gynaecological problems

Pancreatitis, hepatitis

Malrotation

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7
Q

Vomiting in children

Define posseting
Define regurgitation - usually due to?
Define vomiting - usually due to?

A

non-forceful return of milk with wind

non-forcefull but more volume than posseting, usually due to GORD

forceful return of upper GI contents
GORD, gastroenteritis

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8
Q

Vomiting in children

DDx - acute vomiting

A

infection - gastroenteritis, respiratory tract infection, UTI, meningitis
pyloric stenosis

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9
Q

Vomiting in children

DDx - blood stained vomit

A

oesophagitis/PUD
Malrotation
Pertussis

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10
Q

Vomiting in children

DDx - bile stained vomit

A

Bowel obstruction - GORD - Overfeeding

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11
Q

Gastroenteritis

Causes

S+S - what may they have if bacterial?

A

Viral - rotavitrus, adenovirus, norovirus

Bacterial - campylobacter, salmonella, shigella, e. coli

Diarrhoea 
Vomiting 
May have bloody stool if bacterial 
Fever 
Hydration
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12
Q

Gastroenteritis

When to do MC+S?

Bloods

A 
Blood or mucus in stool 
<7 days of diarrhoea 
Immunosuppression 
Recent travel 
Possible E. coli contact

U&E, FBC - only if severly

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13
Q

Gastroenteritis

Management:

Conservative
Medical

Complications

A

Oral rehydration

Antiemetics (e.g. ondasetron)
Antibiotics rarely used

Post-GE enteropathy (e.g. lactose intolerance)
HUS after E. coli

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14
Q

Appendicitis

If someone is under 5 yrs, what is there a risk of?

S+S

A

Perforation

Anorexia 
Vomiting 
Abdo pain (starts central then moves to RIF)
Peritonism (abdo pain on moving/cough)
Fever
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15
Q

Appendicitis

Diagnosis

Bloods

Management

A

Clinically

Abdo USS or CT

Increased neutrophils

Appendectomy

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16
Q

Mesenteric adenitis

What is it?

S+S - 2

What is the main differential?

What would you see on bloods?

Management - 2

What can be done to prevent future confusion?

A

Mesenteric lymph node enlargement, associated with URTI or other viral infection

Abdo pain (general)
May have headache adnd photophobia

Appendicitis

Increased lymphocytes instead of neutrophils in appendicitis

Simple analgesia
Exploratory lapartomy

Appendix

17
Q

GORD in children

When it common?

In who is it worse? - 3

Why are infants more predisposed to GORD?

A

<1 yr

Cow’s milk protein allergy
CF
Premature babies

LOS is underdeveloped
They have a liquid diet
They often lie flat

18
Q

GORD in children

S+S - 2

A

Regurg or vomiting

Distress after feeds

19
Q

GORD in children

Management

Advice given
What to do about liquid diet?
Meds

A

Reassure - usually improve by 6 months

Avoid overfeeding

Consider fluid thickeners - Gaviscon, thick and easy

Omeprazole in young infants especially if there oesophagitis

20
Q

GORD in children

Complications:

oesophagus

Peptic stricture

Growth

Resp

A

Oesophagitis - pain, bleeding, haematemesis, anaemia

Peptic stricture

Failure to thrive

Resp - apnoea, pulmonary aspiration leading to pneumonia

21
Q

Non-organic abdo pain

What does it mean?

Why is this important?

A

Functional abdo pain

Accounts for 90% of abdo pain in children
There is usually a FH

22
Q

Non-organic abdo pain

Presentation

SITE

A

Umbilical pain even though child is well and is growing normally

May improve on weekends and holidays - dont want to go to school

Other symtoms suggests non-organic cause

23
Q

Non-organic abdo pain

Specific syndromes

A

IBS

Non-ulcer dyspepsia

24
Q

Non-organic abdo pain

Management

Conservative

While accepting the pain is real, …..

Prognosis

A

Education and reassurance to patient and family

CAMHS - CBT and family therapy

Dont overplay it - they should still continue normal activities

Most resolve but 25% continue into adult hood

25
Q

Infant colic

What is it?

Cause

When is it usually worse?

At what age does it usually occur

Advice given to parents?

A

Paroxysms of inconsolable crying in otherwise well child

Idiopathic
GI cause - cows milk protein allergy, GORD or constipation

Late afternoon/evening

<4 months of age and self resolves

Reassure paretnts
Advice baby may be soothed by being held, gently, motion, white noise or warm bath

26
Q

Constipation - define

Causes - what is functional faecal retention

Other behavioural causes

Organic causes:

  • neurological - 2
  • endrocrine and metabolic - 1
  • other - 4
A

<3 stools per week

A painful episode of defacation may lead to deliberate retention, leading to rectal dilatation and eventual weakening of defecation reflex. (>3 yrs)

Diet - low fluid and fibre
Weaning

Hirschsprung’s, spina bifida
Hypothyrodism, hypercalciemia
Coeliac, CF, anal ring stenosis, opiods

27
Q

Constipation

Sym + Signs on abdomen
What about actualy faecal contents?
Weight?
What about genitourinary?

What suggests impaction?

A

Abdo pain and distention and mass

PR bleeding due to fissure caused by hard stool
Encopresis (aka soiling) and overflow diarrhoea

Anorexia
Recurrent UTI due to compression which prevents urinary outflow

Abdo mass or overflow D

28
Q

Constipation

Inv:

Where do you look for signs of spina bifida?

What could be present in the perineum?

What suggests IBD and a neurological cause?

When is a digital rectal exam needed?

What is the last invesigation if there is overflow D and colonostomy is being considered?

A

Base of spina and feet

Fissures may be present
Fistulae suggests IBD
Absent anal wink and strange reflexes suggests neurological

If there is suspicion of impaction, Hirschsprung’s or anatomical abnormality

Colon transit study

29
Q

Constipation

Management

Step 1 - laxatives + …..

Name laxatives used?

What should be warned to parents?

Non-medical

A

Laxatives
Non-punitive encouragement of regular toileting
Dietary modification

Polyethylene glycol and electrolytes + senna if ineffective

Child may experience increased soiling and abdominal pain

Manual evacuation or antergrade conlonic enema (ACE)

30
Q

Cows milk protein allergy

What is it?

Risk Factors

A

Allergic reaction to casein or whey proteins in cows milk which can be type 1/4

Non IgE mediated CMPA is still an allergy but referred to as an intolerance.

FH of atopy
Breast-feeding increases the risk of non-IgE but reduces the risk of IgE mediated

31
Q

CMPA

S+S - Non-IgE mediated

S+S - IgE mediated

A 
Failure to thrive and poor feeding 
Loose stools which may contain blood streaks
Abdo pain 
Vomiting with blood 
Rx resistant GORD, eczema or colic

Immediate urticaria and face swelling
If severe: diarrhoea, vomiting and anaphylaxis

32
Q

CMPA

Inv

A

Skin prick testing if igE mediated

Withdrawal of cows milk for 4 weeks and see

33
Q

CMPA

Management

Prognosis

A

Extensively hydrolyse cows milk formula in which proteinsare broken down - Aptamil Pepti
Rechallange cows milk at 1 yr
Use other mammalian milk

Usually outgrown by 3 yrs if not much sooner

34
Q

Coeliac Disease

When does it start?

S+S

A

Starts as early as weaning when infacts is first exposed to gluten

Similar to adults - altered stool, anaemia 
Constipation and/or diarrhoea 
Poor growth 
Irritable 
Wasted buttocks 
Abdominal protrusion 
High RR

PAEDIATRICS (49 decks)

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