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Paediatrics > Paediatric Gastroenterology > Flashcards

Paediatric Gastroenterology Flashcards

1
Q

name a few systemic signs of constipation in children

A 
irritability
poor appetite
abdominal pain
low energy
straining
overflow diarrhoea
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2
Q

name a few causes for constipation in children

A 
diet (lack of fibre, choices eg vegetarian)
dehydration
illness
medication
family history (IBD)
social circumstances (school toilets)
psychological circumstances (rushed by others)
organic cause
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3
Q

what is faecal holding in children, and why does it occur?

A

it’s conscious clenching to stop defecation. often a reflex after child has had previous painful bowel movement experience

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4
Q

social management of chronic constipation in children?

A
  • educate parents

- dietary advice

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5
Q

psychological management of chronic constipation in children?

A
  • remove adversive factors
  • soften stool/remove pain to stop faecal holding
  • promote praise for bowel movement
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6
Q

medical management of chronic constipation in children?

A
  • osmotic laxatives (movicol/laxido)

- stimulant laxatives (senna)

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7
Q

what is impaction and how is it treated?

A

large hard stool building up in rectum/colon

treated by emptying rectum/colon with laxatives/manually and promoting regular bowel movement

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8
Q

what happens to the internal anal sphincter during impaction in constipation?

A

internal sphincter is forced open, bowel becomes desensitised to stimulus of being full

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9
Q

what is the extent of ulcerative colitis often presented in children?

A

pancolitis

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10
Q

what is the extent of crohn’s disease often presented in children?

A

panenteric

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11
Q

how does ulcerative colitis present in children?

A

bloody diarrhoea
abdominal pain
no systemic symptoms

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12
Q

how does crohn’s disease present in children?

A 
depends on area affected, but in general:
no diarrhea
abdominal pain
weight loss
malabsorption
stunted growth
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13
Q

what laboratory investigations are carried out to diagnose IBD in children?

A
  • FBC
  • ESR & CRP
  • faecal calprotectin
  • stool sample (rule out infective cause)
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14
Q

how much of the GI tract wall if affected in CD and UC?

A

UC - only mucosa/submucosa

CD - transmural involvement

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15
Q

name a few non-GI symptoms that may be present in IBD in children

A

rash (erythema nodosum)
uveitis
arthritis

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16
Q

what are the main aims of IBD treatment in children?

A
  • initiate and maintain remission
  • correct any nutritional deficiencies
  • maintain growth and development
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17
Q

why are steroids not given to children under 2 years of age?

A

because steroids can cause significant growth stunting

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18
Q

what imaging investigations are carried out to diagnose IBD in children?

A
  • endoscopy/colonoscopy
  • mucosal biopsy
  • MRI/barium meal
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19
Q

how is crohn’s disease remission induced in children?

A
  • nutritional therapy

- steroids

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20
Q

how is crohn’s disease remission maintained in children?

A
  • thiopurines (azathioprine)
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21
Q

how is ulcerative colitis remission induced in children?

A
  • 5-ASA

- steroids

22
Q

how is ulcerative colitis remission maintained in children?

A
  • 5-ASA

- thiopurines (azathioprine)

23
Q

for which type of IBD could surgery be curative?

A

ulcerative colitis

24
Q

for which type of IBD is surgery not curative but aimed at alleviating complications?

A

crohn’s disease

25
Q

which type of IBD can present with systemic symptoms in children?

A

crohn’s disease

26
Q

on examination during a test feed of a child, what can be seen in pyloric stenosis?

A
  • olive tumour

- visible gastric peristalsis

27
Q

what type of vomit characterises pyloric stenosis?

A

projectile, non-bilious vomit

28
Q

name three signs of pyloric stenosis

A
  • olive tumour
  • visible gastric peristalsis
  • projectile, non bilious vomit
29
Q

what investigations should be done for a child with potential pyloric stenosis?

A
  • abdominal ultrasound

- FBC, U&E

30
Q

what metabolic picture is seen in children with pyloric stenosis, and why?

A

metabolic alkalosis, caused by loss of hydrochloric acid through vomit

31
Q

how is pyloric stenosis treated?

A

surgical pyloromyotomy

32
Q

how is pyloric stenosis diagnosed?

A
  • ultrasound
33
Q

name some symptoms of pyloric stenosis, noted by parents of child

A
  • poor feeding
  • projectile vomiting
  • weight loss
  • irritability
34
Q

why does bilious vomiting in children ring alarm bells?

A

because an intestinal obstruction is the most likely cause for it

35
Q

what is the most common cause of effortless vomiting?

A

gastroesophageal reflux

36
Q

what imaging investigation is done if a child presents with bilious vomiting?

A

abdominal xray with contrast

37
Q

what are the management options for gastroesophageal reflux in children?

A
  • feeding advice (thicken feed)
  • nutritional support (calorie increase, milk free, NG tube)
  • medical treatment (gaviscon, prokinetics, PPI)
  • surgery (fundoplication)
38
Q

which three types of diarrhoea can occur in children, and what are they associated with?

A

motility diarrhoea - toddler’s diarrhoea, IBS
osmotic diarrhoea - malabsorption (coeliac, allergy, CF)
secretory diarrhoea - inflammation (IBD, infection)

39
Q

how is an intestinal obstruction diagnosed in children who present with bilious vomiting?

A
  • abdominal xray + contrast

- exploratory laparotomy

40
Q

name a few causes of intestinal obstruction in children

A
  • intestinal atresia
  • volvulus/malrotation
  • ileus
  • intussusception
41
Q

name a few symptoms a child with gastroesophageal reflex may present with

A
  • vomiting
  • haematemesis
  • poor feeding
  • failure to thrive
  • recurrent chest infections
  • cough/wheeze
42
Q

when necessary, what investigations are carried out to diagnose gastroesophageal reflux in children?

A
  • fluoroscopy/barium swallow
  • pH/impendance monitoring
  • endoscopy
43
Q

do children always need to have investigations for gastroesophageal reflux?

A

no

44
Q

what is the pathophysiology of osmotic diarrhoea?

A

undigested/intolerated food stays in the digestive tract and draws water into the lumen by osmosis

45
Q

what is the pathophysiology of secretory diarrhoea?

A

toxin production by organism triggers electrolyte secretion into the lumen, drawing water in

46
Q

which genes are involved in coeliac disease?

A

HLA-DQ2

HLA-DQ8

47
Q

name a few symptoms of coeliac disease

A
  • bloatedness
  • diarrhoea
  • short stature
  • constipation
  • fatigue
  • dermatitis herpetiformis
48
Q

which skin condition is associated with coeliac disease?

A

dermatitis herpetiformis

49
Q

which antibodies found in serological tests indicate coeliac disease in children?

A

anti-tissue transglutaminase
anti-endomysial
anti-gliadin

50
Q

what is the treatment for coeliac disease in children?

A

gluten free diet

51
Q

against which protein contained in gluten does the immune system mount a reaction in coeliac disease?

A

gliadin

52
Q

which class of antibody is sometimes deficient in people with coeliac disease?

A

IgA

Paediatrics (10 decks)

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