Lower GI disorders Flashcards
What are the clinical features of constipation?
- Infrequent passage of stool
- Poor appetite
- Irritable
- Lack of energy
- Abdominal pain or distension
- Withholding or straining
- Diarrhoea
What quastions should be asked when someone presents with constipation?
- how often ?
- how hard ?
- is it painful ?
- has there been a change ?
- What is normal stool frequency ?
□ (4 per day to 1 per week)
□ depends on age
□ depends on diet
What are the causes of contipation in children?
- Social □ poor diet ® Insufficient fluids ® Excessive milk (can also make iron deficient) □ potty training / school toilet - Physical □ intercurrent illness □ Medication: Gaviscon, antispasmodics, opioids - Family history - Psychological (secondary) □ Vicious cycle ® Pain or anal fissure ® Withholding of stool ® Constipation ® Large hard stool ® Back to the start again- reinforcement □ Need to break cycle - Organic: anterior anus, anatomical, hypothyroidism
What are the social treatments of children with constipation?
□ Explain treatment to parents □ Dietary ® Increase fibre ® Increase fruit ® Increase vegetables ® Increase fluids ® Decrease milk
What are the psychological treatments of children with constipation?
□ Reduce aversive factors ® Make going to the toilet a pleasant experience ◊ Correct height ◊ Not cold ◊ School toilets □ Soften stool and remove pain □ Avoid punitive behaviour from parents □ Reward ‘good’ behaviour ® General praise ® Star charts
How does one soften stool and stimulate defication in children with constipation?
□ osmotic laxatives (lactulose or Movicol/ Laxido) □ stimulant laxatives (senna, picosuphate, picolax) □ isotonic laxatives (movicol) ® It fights for water ® Good for making them better ® Advantages ◊ Non-invasive ◊ Given by parents ® Disadvantages ◊ Non-compliance ◊ Side effects
How much treatent should be given to a child with constipation?
Enough to make them go!
How long should you give treatment to a child with constipation?
® until no longer required
® related to duration of problem
How do you treat the impact of constipation in children?
□ Empty impacted rectum
□ Empty colon
□ Maintain regular stool passage
□ Slow weaning off treatment
What are the presenting features of Crohn’s disease in children?
□ Diarrhoea ++ □ Rectal bleeding ++ □ Abdominal pain +++ □ Fever + □ Weight loss ++++ □ Growth failure ++++ □ Arthritis ++ □ Abdominal mass ++
What are the presenting features of Ulcerative colitis in children?
□ Diarrhoea +++++ □ Rectal bleeding +++++ □ Abdominal pain +++ □ Fever + □ Weight loss + □ Growth failure + □ Arthritis ++ □ Abdominal mass - □ If you have diarrhoea and abdominal bleeding for more than 2 weeks then you should be investigated for UC
How is IBD diagnosed in children?
□ Intestinal symptoms □ Extra-intestinal manifestations ® Joint pain ® Uveitis ® Erythema nodosum ® Moth ulcers ® Perianal pain □ Exclude infection □ Family History □ Growth and sexual development □ Nutritional status
What labratory investigations should be done on a child with IBD?
□ Full blood count & ESR ® Anaemia ® Thrombocytosis ® Raised ESR □ Biochemistry ® Stool calprotectin ◊ Low rules out IBD ® Raised CRP ® Low Albumin □ Microbiology ® No stool pathogens
What definitive investigations should be done in children with IBD?
□ Radiology (especially Crohn’s disease) ® MRI ® Barium meal and follow-through (younger kids) □ Endoscopy ® Ileocolonoscopy ® Upper GI endoscopy ® Mucosal biopsy ® Capsule endoscopy ® Enteroscopy
What are the treatment aims of treatment for children with IBD?
□ Induce and maintain remission
□ Correct nutritional deficiencies
□ Maintain normal growth and development
□ Promote quality of life and normal psycho-social development
