Paediatric GI Flashcards
Symptoms of problems
Stool: (Too hard vs Too Soft vs doesn’t look right!) Vomiting - Colour, frequency, timing (vs nausea) Abdominal Pain (SOCRATES) Weight loss (planned vs unplanned; also think Diet)
What to look for on examination of a child with gastroenteritis?
Examination: HR, skin turgor, fontanelles, sunken eyes, mucous membrane, weight, CRT, urine output)
mild vs moderate vs severe
Investigations generally unnecessary
stools tests more than blood tests
Treatment for child with gastroenteritis
Fluids (orally, breastfed if infants)
- if oral not working, nasogastric tube
- last resort is IV
Drug therapy: Anti-emetics vs Anti-diarrhoeal agents not usually indicated
GORD in children
Reflux/regurgitation in GORD
High risk groups: Premature infants w Developmental Delay
Infants: during/feeds, back arching, irritability, persistent crying, Sandifer syndrome,
Older children: Heartburn/chest pain, Epigastric pain
Management of GORD at diagnosis
pH study
Impedance study for infants (bc get false negatives doing pH study with them)
Barium study
Endoscopy (to rule out other options)
Treatments for GORD in children
Conservative Rx: positional/prone/thickeners
Medical: gaviscon, H2RAs, PPIs, prokinetics
Interventional: feed tube insertion, Nissen’s Fundoplication
RED FLAGS in children with GORD
Bilious vomiting (small bowel obstruction)
Vomiting in 6 week old hungry infants (Pyloric Stenosis)
Vomiting + fever + headache and no diarrhoea (Raised ICP)
Metabolic presentation (vomiting)
Bloody diarrhoea (infection)
Weight loss
CASE:
Vomiting settled Ongoing loose stools 3-4 times daily weight loss vague abdominal pain early satiation
Diagnosis?
Coeliac disease
Coeliac disease
Definition: Multi-factorial autoimmune disorder characterised by damage to small bowel mucosa due to inappropriate immune response to gluten
Very common: 1% of Caucasians
Females > males
HLA DQ2, HLA DQ8
Coeliac disease pathophysiology
Gliadin + glutenin = gluten
Deamidated by tissue Transglutaminase (tTG) =>increase binding by APCs
Presented to CD4+ T-Cells – TH1 helper response
Proliferation of B-Cells producing Anti tTG and excessive immune response IL-15 driven; CD8+ cytotoxic T-Cells/IELs
Damage to small bowel mucosa – villous atrophy
Coeliac disease presentation
GI – diarrhoea, FTT (AFTER Weaning)
Malabsorption - Anaemia
Failure to thrive, poor growth, depression, poor school performance
Extra intestinal manifestations – Neurological, skin
Often asymptomatic
Presents at any age
HIGH INDEX OF SUSPICION
CASE:
17 year old girl
2/52 hx of severe headache
1/52 hx of difficulty getting out of the boat
2/7 hx of difficulty speaking
O/E Left sided weakness and expressive dysphasia
Abnormal CT/MRI: Superior Sagittal vein thrombosis
Severe microcytic Anaemia (Hb 6 MCV 64)
Diagnosis?
Coeliac disease
Coeliac management
Serological Tests: TTG vs EMA vs HLA testing
Tissue diagnosis (on endoscopy) vs Non Tissue diagnosis
Response to Gluten exclusion diet
Treatment is life long gluten exclusion
MDT management
Crohns vs UC vs IBD-U
Pathophysiology: genetic (monogenic vs polygenic with increasing age) vs immune response vs environment (microbiome)
Px: Chronic diarrhoea (+/- blood/mucus), abdo pain, weight loss, impaired growth, extra GI signs,
Ix: Blood tests (inflammatory markers, autoantibodies) vs Stool tests (calprotectin) vs imaging vs endoscopy
Management goals for CD vs UC
Induce Remission and Maintain Remission; Treat to target (mucosal healing vs symptom control) Avoid complications (Cancer, growth impairment)
CD:
Induction: EEN vs steroids (vs surgery) vs Diet (!)
Maintenance: Azathioprine/immunomodulators vs Biologic agents (Anti-TNFa, Anti-integrin, small molecules)
UC:
Induction: 5-ASA (PO vs Rectal) vs steroids
Maintenance: Azathioprine/immunomodulators vs Biologic agents
