Paediatric Gastroenterology Flashcards
Moderate dehydration
6-9% body weight loss Lethargic but irritable Raised HR, normal BP Sunken eyes and Fontainebleau Oliguria usually obvious Skin turgor 1-2 seconds
Severe dehydration
10% body weight loss Infants: drowsy, limp, cold, sweaty, cyanotic limbs, comatose Older children: apprehensive, cold, sweaty, cyanotic limbs Rapid feeble pulse Reduced BP Sunken eyes and fontanelles Skin turgor >2 seconds Deep acidotic breathing
Management of dehydration
Mild:
Oral rehydration solution 45-90mmol/L Na + 90mmol/L glucose to facilitate
Oral or NG tube (if vomiting) over 4 hours
Severe:
IV therapy if circulatory insufficiency
Bolus 20mls/kg normal saline
Once normal perfusion restored, begin ORS
Contraindications for oral rehydration solution
Coma Ileus Intussusception Perforated viscus Malabsorption syndrome Liver disease
IV fluid volume calculations
Maintenance fluids:
0-6m - 120-140mls/kg/day
>6m - first 10kg: 4mL/kg/day, next 10kg: 2ml/kg/day, subsequent >20kg: 1ml/kg/day
+deficit: estimate % dehydration x (BW x 10) in ml/day (divide by 24 for hourly rate)
Resuscitation fluids = normal saline, maintenance fluids = .45% saline + 5% glucose
Causes of gastroenteritis in paediatrics
Viral: rotavirus (50%), adenovirus (5-15%)
Bacterial: campylobacter (5-10%), salmonella, shigella, e. Coli
Parasitic: giardia, cryptosporidium
Differentials for chronic diarrhoea in a child
Toddler's diarrhoea Coeliac disease Giardiasis Spurious/overflow diarrhoea Inflammatory bowel disease Cow's milk protein intolerance Excessive ingestion of fluids Amoeba
Red flags of chronic diarrhoea in a child
Blood in stool Failure to thrive Abnormal stool microscopy - fat globules - red cells - White cells
Mild dehydration
Loss of less than 5% body weight
- dry mucous membranes
- decreased peripheral perfusion (slow cap refill)
- Thirsty
- Alert, restless
What is dermatitis herpetiformis
Coeliac disease
Causes of constipation in children
Functional (95% of healthy children older than 1y) Cow's milk intolerance Coeliac disease CF Lead poisoning Intestinal obstruction IN INFANTS: - Hirschsprung disease - Spinal dysraphism - Sacral teratoma - Infantile botulism
Define functional constipation for a child with developmental age 4y+
At least 2 of the following symptoms occurring for at least 2 months:
- 2 or fewer defecations per week
- at least one episode of foecal incontinence per week
- history of retentive posturing or excessive volitional stool retention (withholding)
- history of painful or hard bowel movements
- presence of large foecal mass in the rectum
- history of large-diameter stools that may obstruct the toilet
History of constipation suggestive of organic disease
Delayed passage of meconium Fever, vomiting, diarrhoea Rectal bleeding Abdominal distenstion Present from birth Ribbon stools (very narrow diameter) Urinary incontinence or bladder disease Weight loss/Poor weight gain Delayed growth Extraintestinal symptoms (esp. neurological) Congenital anomalies or syndrome associated with Hirschsprung disease Family history of HD
When is antibiotic therapy indicated in paediatric gastroenteritis?
ALWAYS in shigella and giardia
LESS THAN 3M olds: salmonella and C. jejuni
Immunocompromised children
Systemically unwell children
Definition of coeliac disease
A small bowel disorder characterised by mucosal inflammation, villous atrophy and hyperplasia, which occur on exposure to dietary gluten and which demonstrate improvement following withdrawal of gluten from the diet
