Paediatric gastroenterology Flashcards
Potential causes of abdominal pain in children
functional or recurrent abdominal pain
chronic constipation
IBD
duodenal ulcer
Duodenal ulcer presentation in children
central upper abdomen pain
wakes at night time
hunger pain
Infant reflux red flags
haematemesis
failure to thrive
severe symptoms
severe eczema
If reflux in an infant is not improving, or there are red flag features, what could be the cause?
GORD with oesophagitis +/- stricture
anatomic abnormality - hiatus hernia, malrotation
eosinophilic oesophagitis
other systemic disease (vomiting)
intestinal obstruction (if bile, intermittent)
Which paediatric patients should be suspected of having IBD?
lower GI symptoms for >6 weeks
When should you suspect hypernatraemic dehydration?
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness/coma
Management of acute gastroenteritis
oral rehydration solution (water, salt, sugar)
Fluid management for children with gastroenteritis
children without dehydration:
- continue breast/formula feeding
- encourage fluid intake - oral rehydration solution as supplement
clinical dehydration:
- IV fluids
- initially shocked = add 100ml/kg (10% body weight) to maintenance fluid amount
- not shocked = add 50ml/kg (5% body weight) to maintenance fluid amount
Chronic diarrhoea causes (after acute onset)
persisting infection (eg. giardia, crypto, EPEC)
immunocompromised host
residual damage (secondary lactose intolerance)
other causes of malabsorption:
- CF (pancreatic exocrine insufficiency)
- first presentation of coeliac disease
Describe adult hypolactasia
presents during adolescence or later
diarrhoea +/- other GI sx (bloating, flatulence, pain)
only when consuming lactose
How to diagnose coeliac disease in children
check patient is still eating gluten (do not start gluten free diet)
check TTG/EMA antibodies (and total IgA)
refer to paediatric gastroenterologist for final diagnosis
Differential diagnoses of rectal bleeding in children
constipation/fissure - painful to pass stool, intermittent fresh red blood on wiping, hard stool
polyps - well toddler, painless, can be intermittent
bacterial infections - acute, with diarrhoea
IBD - chronic bloody diarrhoea, every stool, pain, tiredness, weight loss
worms - itchy perianal skin, scratching
Juvenile polyps presentation
hamartomas
toddlers
painless rectal bleeding
If a child presents with soiling having been previously toilet trained, what is likely going on?
severe constipation/overflow
