Paediatric Gastroenterology Flashcards
What are the 3 main types of vomiting in children?
Acute
Chronic
Cyclical
What are the causes of acute vomiting in children?
GI infection Other infection GI obstruction Adverse food reaction/poisoning Raised ICP Endocrine/metabolic disease
What are the causes of chronic vomiting in children?
PUD GORD Chronic infection Gastritis Gastroparesis Food allergy Psychogenic Bulimia Pregnancy
What are the causes of cyclical vomiting in children?
Idiopathic CNS disease Abdo migraine/cyclical vomiting syndrome Endocrine (Addison's) Metabolic Intermittent obstruction Fabricated induced illness
What does early morning vomiting raise suspicion of?
CNS tumour
What investigations should be done for acute vomiting?
Bloods:
- FBC, U&Es, Glucose
Stool for C&V
Consider AXR
Surgical opinion if vomit bile coloured or if obstruction suspected
Test feed +/or abdo USS for ?pyloric stenosis
What investigations should be done for chronic vomiting?
Bloods: - FBC, ESR/CRP, U&Es, Glucose, LFTs, coeliac antibody, H.pylori Urinalysis If indicated: - Abdo USS Brain imaging Urine pregnancy test Upper GI endoscopy Small bowel imaging
In addition to the tests for chronic vomiting, what additional tests should be considered in cyclical vomiting?
Amylase, lipase, ammonia
What supportive treatment should be given for vomiting?
PO or IV fluids
What pharmacological treatment should be considered to treat vomiting?
Anti-emetics
Serotonin antagonists useful for prophylaxis of migraine/cyclical vomiting
What are the potential complications of vomiting in children?
Dehydration Electrolyte abnormalities Acute/chronic GI bleeding Oesophageal stricture Barrett's metaplasia Pulmonary aspiration Faltering growth FTT IDA
What are the possible causes of psychogenic vomiting?
Anxiety
Manipulative behaviour
FHx of vomiting
Disordered family dynamics
What are the treatments for psychogenic vomiting?
Exclude organic causes
Explanation and reassurance
Referral to child psychology
What conditions commonly cause acute diarrhoea?
Infective gastroenteritis Non-enteric infections Food hypersensitivity Drugs HSP Intussusception HUS Pseudomembranous enterocolitis
What is the commonest virus responsible for viral gastroenteritis?
Rotavirus
How does viral gastroenteritis typically present?
Watery diarrhoea Vomiting Crampy abdominal pains Fever Dehydration URT signs common
What is Norwalk agent?
Small, round structural virus - winter vomiting disease
What investigations are needed in viral gatroenteritis?
Rarely needed
Stool culture useful in outbreaks
Bloods if significant dehydration
When do children need admission to hospital with viral gastroeneteritis?
If >10% dehydration
Unable to tolerate PO fluids
Signs of shock
How is viral gastroenteritis managed?
Rehydration PO/NG/IV
Continue breastfeeding in infants if able
How long do the symptoms of viral gastroenteritis last?
Usually <7days
Adenovirus - >14days
Secondary lactose intolerance may last 6-8weeks
What are the commonest causes of bacterial gastroenteritis?
Salmonella Campylobacter Shigella Yersinia E.coli C.diff Bacillus cereus Vibro cholerae
What are the most common sources of bacterial gastroenteritis?
Contaminated water
Poor food hygiene
Faecal-oral route
In what ways do the symptoms for bacterial gastroenteritis differ from viral?
Malaise, abdo pain, tenesmus
Dysentery (bloody and mucousy diarrhoea)
Which bacterial gastroenteritis’ may lead to Reiter’s syndrome?
Shigella
Campylobacter
Which bacterial gastroenteritis’ may lead to HUS?
E.coli 0157, Shigella
Which bacterial gastroenteritis’ may lead to G-BS?
Campylobacter
Which bacterial gastroenteritis’ may lead to Reactive arthropathy?
Yersinia
Which bacterial gastroenteritis’ may lead to bacteraemia or secondary infections?
Salmonella
Campylobacter
What investigations should be done in bacterial gastroenteritis?
Stool culture
Blood culture
Stool C.diff toxin
Endoscopy if IBD a Differential and cultures -ve
In what instances should antibiotics be used for bacterial gastroenteritis?
High risk disseminated infection Artificial implants Sever colitis Severe systemic illness age <6months Cholera or e.coli 0157
What antibiotic can be used to treat campylobacter infection
Erythromycin
What antibiotics can be used to treat c.diff
Oral vancomycin or metronidazole
How does intestinal parasite infection tend to present?
Fever Abdo pain Diarrhoea Dysentery Flatulance Malabsorption and FTT Abdo distension/intestinal obstruction Biliary obstruction, liver disease, pancreatitis
What investigations should be done for intestinal parasite infection?
Stool MC&S for ova, cysts, paracytes
Stool ELISA
Blood specific serology
Duodenal fluid aspiration and biopsy
How does Giardia lamblia infection affect the body?
Attach to small intestinal villi, causing mucosal damage
How does Giardia lamblia infection present?
Diarrhoea
Flatulence
Abdo discomfort
FTT
How is Giardia lamblia infection treated?
Metronidazole
What are the symptoms of Entamoeba histolytica infection?
Usually mild but can cause: Fulminating colitis Obstruction Hepatitis Liver abscess
What is the treatment for Entamoeba histolytica infection?
Metronidazole
How does cryptosporidium infection present?
Mild self-limiting illness
How can cryptosporidium infection present in immunocompromised individuals?
Severe chronic diarrhoea Flatulence Malaise Abdo pain Weight loss
How is cryptosporidium infection treated?
Erythromycin, metronidazole or spiramycin
What is the commonest parasitic worm infection in humans?
Ascaris lumbricoides
Which antibiotics tend to be used to treat nematode infections?
Mebendazole and albendazole
Which nematode infection causes severe anaemia and hypoproteinaemia?
Hookworms
Which nematode infection causes anal pruritus?
Enterobius vermicularis (thread or pinworm)
How is tapeworm infection treated?
Praziquantel
What type of hypersensitivity causes immediate allergic reaction to food?
Type I Hypersensitivity
What percentage of children with food allergy have a FHx of atopy?
70%
What are the commonest food allergies in children?
Cow’s milk proteins, eggs, peanuts, wheat, soya, fish, shellfish, tree nuts
What are the symptoms of an immediate allergic reaction to food?
Urticaria Wheeze Circulatory disturbance Anaphylaxis Perioral rash
What are the delayed symptoms of allergic reaction to food?
Vomiting Rash Eczema Asthma Diarrhoea FTT Abdo pain Dysphagia GORD symptoms
What is the dietary treatment for food allergy/intolerance?
Exclusion of offending food(s)
Paediatric dietician
Extensively hydrolysed or amino-acid based milks
Dietary exclusion in mother if breastfeeding
What are the drug treatments used in food allergy/intolerance?
Oral sodium cromoglicate
Antihistamines
Corticosteroids
When can food challenge be considered in a child with a previous allergy?
If severe - only in hospital if at all
After 6-12 months
