GI problems Flashcards
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
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
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
DDx for acute abdo pain
Inflammatory causes
Appendicitis, GE, UTI, Mesenteric adenitis (post URTI), mumps pancreatitis, hepatitis
Lower lobe pneumonia
Autoimmune: IBD, HSP, DKA
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
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
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
Vomiting in children
DDx - acute vomiting
infection - gastroenteritis, respiratory tract infection, UTI, meningitis
pyloric stenosis
Vomiting in children
DDx - blood stained vomit
oesophagitis/PUD
Malrotation
Pertussis
Vomiting in children
DDx - bile stained vomit
Bowel obstruction - GORD - Overfeeding
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
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
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
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
Appendicitis
Diagnosis
Bloods
Management
Clinically
Abdo USS or CT
Increased neutrophils
Appendectomy
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
