Paediatric Gastroenterology Flashcards by Ailsa Morris

What are the 3 main types of vomiting in children?

Acute
Chronic
Cyclical

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What are the causes of acute vomiting in children?

GI infection
Other infection
GI obstruction
Adverse food reaction/poisoning
Raised ICP
Endocrine/metabolic disease

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What are the causes of chronic vomiting in children?

PUD
GORD
Chronic infection
Gastritis
Gastroparesis
Food allergy
Psychogenic
Bulimia
Pregnancy

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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

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What does early morning vomiting raise suspicion of?

CNS tumour

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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

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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

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In addition to the tests for chronic vomiting, what additional tests should be considered in cyclical vomiting?

Amylase, lipase, ammonia

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What supportive treatment should be given for vomiting?

PO or IV fluids

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What pharmacological treatment should be considered to treat vomiting?

Anti-emetics

Serotonin antagonists useful for prophylaxis of migraine/cyclical vomiting

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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

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What are the possible causes of psychogenic vomiting?

Anxiety
Manipulative behaviour
FHx of vomiting
Disordered family dynamics

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What are the treatments for psychogenic vomiting?

Exclude organic causes
Explanation and reassurance
Referral to child psychology

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What conditions commonly cause acute diarrhoea?

Infective gastroenteritis
Non-enteric infections
Food hypersensitivity
Drugs
HSP
Intussusception
HUS
Pseudomembranous enterocolitis

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What is the commonest virus responsible for viral gastroenteritis?

Rotavirus

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How does viral gastroenteritis typically present?

Watery diarrhoea
Vomiting
Crampy abdominal pains
Fever
Dehydration
URT signs common

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What is Norwalk agent?

Small, round structural virus - winter vomiting disease

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What investigations are needed in viral gatroenteritis?

Rarely needed
Stool culture useful in outbreaks
Bloods if significant dehydration

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When do children need admission to hospital with viral gastroeneteritis?

If >10% dehydration
Unable to tolerate PO fluids
Signs of shock

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How is viral gastroenteritis managed?

Rehydration PO/NG/IV

Continue breastfeeding in infants if able

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How long do the symptoms of viral gastroenteritis last?

Usually <7days
Adenovirus - >14days
Secondary lactose intolerance may last 6-8weeks

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What are the commonest causes of bacterial gastroenteritis?

Salmonella
Campylobacter
Shigella
Yersinia
E.coli
C.diff
Bacillus cereus
Vibro cholerae

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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