GI/Surgery Problems Flashcards
What is the differential for non-bloody diarrhoea in children?
Infectious: gastroenteritis or any infection (UTI, appendicitis)
Malabsorption: CF, Coeliac (also causes constipation)
Dietary: cow’s milk protein allergy, lactose intolerance
IBD
IBS
What is the differential for bloody diarrhoea in children?
Infectious + inflammatory:
- bacterial GE, IBD, NEC, HUS
Obstruction:
- intussusception, midgut volvulus
Cow’s milk protein allergy (flecks of blood)
Juvenile polyps or Meckel’s may cause PR bleeding without diarrhoea
What is Toddler diarrhoea?
Chronic diarrhoea syndrome
No other abdominal symptoms –> thriving child
Usually resolves by 5 years
What are the differentials for acute vomiting in children?
Infection:
- gastroenteritis or any other infection
- pyloric stenosis
What are the differentials for blood-stained vomiting in children?
Oesophagitis
PUD
Malrotation
Pertussis
What does bile stained vomit suggest in children?
GI obstruction
- obstruction below the sphincter of Oddi
What does chronic vomiting suggest in children?
GORD
Overfeeding
What are the risk factors for GORD in children?
Prematurity Parental history of heartburn or reflux Obesity Hiatus hernia Repaired congenital diaphragmatic hernia Repaired congenital oesophageal atresia Neurodisability e.g. cerebral palsy
What is the difference between GOR + GORD?
Gastro-oesophageal reflux is normal in infants if asymptomatic
GORD is the presence of symptoms/complications from the reflux
What are the symptoms of GORD in infants?
Distressed behaviours e.g. excessive crying, unusual neck postures, back arching
Unexplained feeding difficulties e.g. refusing, gagging, choking
Hoarseness +/- chronic cough
Episode of pneumonia
Faltering growth
What is the management for effortless regurgitation after feeds?
If otherwise well –>
no intervention, improves with age, reassurance is key
What is the management for GORD in breastfed infants?
Alginate (Gaviscon) mixed with water immediately after feeds
What is the management for GORD in formula-fed infants?
Ensure infant not over-fed (no more than 150ml/kg/day)
Decrease feed volume by increasing frequency
Use feed thickener if still no better
Stop thickener and start alginate added to formula
If there is no improvement following alginate therapy for two weeks, what should be done next for an infant with GORD?
Try ranitidine
or omeprazole
When should serological testing for Coeliac disease be offered to children?
Persistent, unexplained GI symptoms Faltering growth Prolonged fatigue Unexpected weight loss Severe or persistent mouth ulcers Unexplained iron, B12 or folate deficiency T1DM or AI thyroid disease at diagnosis
How is Coeliac disease diagnosed?
Patient must have gluten in diet for at least 6 weeks before test
Test for total IgA + IgA tissue transglutaminase (tTG)
If serology positive –> duodenal biopsy:
- lymphocytic infiltration
- crypt hyperplasia +/- villous atrophy
- biopsy sometimes not necessary in children if classic symptoms + tTG > 10x upper limit of normal
Second sample for:
- anti-endomesial antibodies (EMA)
- HLA DQ2 + DQ8 phenotyping
Which conditions are associated with Coeliac disease?
T1DM AI thyroid disease Juvenile chronic arthritis Down's syndrome Turner syndrome Williams syndrome
What are the complications associated with Coeliac disease?
Osteoporosis Anaemia Short stature Delayed puberty Female infertility Intestinal malignancies (T cell lymphoma)
How is constipation diagnosed in children?
At least 2 of the following, present for at least 1 month:
- < 3 bowel movements per week
- faecal incontinence at least once per week (after toilet trained)
- excessive stool retention or retentive posturing
- painful or hard bowel movements
- large faecal mass in rectum
- large diameter stools