GI problems Flashcards by William Madu

Non-bloody diarrhoea causes:

Infectious
Malabsorption
Dietary
Autoimmune disease

Gastroenterititis

Coeliac, CF

Cow’s milk protein allergy
Lactose intolerance

IBD - Crohn’s commonor than UC
IBS

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Blood diarrhoea causes:

Infectious and inflammatory
Obstruction
Allergy
Neonatal

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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Toddler diarrhoea

What is it?

What is the cause?

When does it usually resolve?

Quite common - chronic diarrhoea syndrome but the child is well

Bits of poorly-digested vegetables often the D

5 yrs

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DDx for acute abdo pain

Inflammatory causes

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

Lower lobe pneumonia

Autoimmune: IBD, HSP, DKA

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DDx for acute abdo pain

Anatomical causes

GI obstruction, constipation

Meckel’s complication - usually assymptomatic

Renal and genitourinary - hydronephrosis, menstration

Compressed anatomy - strangulated inguinal hernia, testis torsion

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DDx for chronic and recurrent abdo pain

Upper GI 
Dietary
Lower GI
Abdo migraines 
Genitourinary 
Hepatobillary 
Anatomical

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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Vomiting in children

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

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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Vomiting in children

DDx - acute vomiting

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

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Vomiting in children

DDx - blood stained vomit

oesophagitis/PUD
Malrotation
Pertussis

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Vomiting in children

DDx - bile stained vomit

Bowel obstruction - GORD - Overfeeding

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Gastroenteritis

Causes

S+S - what may they have if bacterial?

Viral - rotavitrus, adenovirus, norovirus

Bacterial - campylobacter, salmonella, shigella, e. coli

Diarrhoea 
Vomiting 
May have bloody stool if bacterial 
Fever 
Hydration

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Gastroenteritis

When to do MC+S?

Bloods

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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Gastroenteritis

Management:

Conservative
Medical

Complications

Oral rehydration

Antiemetics (e.g. ondasetron)
Antibiotics rarely used

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

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Appendicitis

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

S+S

Perforation

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

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Appendicitis

Diagnosis

Bloods

Management

Clinically

Abdo USS or CT

Increased neutrophils

Appendectomy

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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?

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

GORD in children

When it common?

In who is it worse? - 3

Why are infants more predisposed to GORD?

<1 yr

Cow’s milk protein allergy
CF
Premature babies

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

GORD in children

S+S - 2

Regurg or vomiting

Distress after feeds

GORD in children

Management

Advice given
What to do about liquid diet?
Meds

Reassure - usually improve by 6 months

Avoid overfeeding

Consider fluid thickeners - Gaviscon, thick and easy

Omeprazole in young infants especially if there oesophagitis

GORD in children

Complications:

oesophagus

Peptic stricture

Growth

Resp

Oesophagitis - pain, bleeding, haematemesis, anaemia

Peptic stricture

Failure to thrive

Resp - apnoea, pulmonary aspiration leading to pneumonia

Non-organic abdo pain

What does it mean?

Why is this important?

Functional abdo pain

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

Non-organic abdo pain

Presentation

SITE

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

Non-organic abdo pain

Specific syndromes

IBS

Non-ulcer dyspepsia

Non-organic abdo pain

Management

Conservative

While accepting the pain is real, …..

Prognosis

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

Infant colic What is it? Cause When is it usually worse? At what age does it usually occur Advice given to parents?

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

Constipation - define Causes - what is functional faecal retention Other behavioural causes Organic causes: - neurological - 2 - endrocrine and metabolic - 1 - other - 4

<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

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

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

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?

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

Constipation Management Step 1 - laxatives + ..... Name laxatives used? What should be warned to parents? Non-medical

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)

Cows milk protein allergy What is it? Risk Factors

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

CMPA S+S - Non-IgE mediated S+S - IgE mediated

``` 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

CMPA Inv

Skin prick testing if igE mediated | Withdrawal of cows milk for 4 weeks and see

CMPA Management Prognosis

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

Coeliac Disease When does it start? S+S

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 ```