Paediatric GI Flashcards
constipation
poor appetite
irritable lack of energy
abdominal pain or distension
withholding or straining
why? poor diet -insufficient fluid excessive milk -potty training
physical
-intercurrent illness
family history
psychological
organic
vicious cycle
holding stool
larger and harder stool
painful bowel movement
treatment of constipation
- explanation
- make sure stools never get hard (reinforces reflex)
- retrain bowel
- remove impaction
treatment of impaction empty impacted recturm empty colon dietary: fibre, fruit vegetables fluids up milk down -reduced aversive factors -soften stool and remove pain
retrain the bowel
soften stool and stimulate defecation
-osmotic laxatives
-stimulant laxatives
ulcerative colitis and crohns
Pancolitis very common Pan enteric disease Crohns vs UC \++Diarhhoea++++ \++Rectal bleeding++++ \+++abdominal pain++++ \+fever+ \++++weightloss + (not severe) \++++growth failure + \++arthritis ++ \++abdo mass-
crohns dont always have diarrhoea
diagnosis- definitive investigations
-radiology (MRI)
-Endoscopy Crohns-transmural, snail like pattern
find something in the rest of the bowel
treatment
crohns vs UC
Induce remission: Nutritional therapy vs 5-ASA (aspirin like drug)
maintain: thiopurines
step up therapy :5 TNF
surgery: not curative vs curative (major surgery)
stimulation of vomiting center
enteric pathogen intestinal inflammation metabolic derangment infection head injury visual stimuli middle ear stimuli
Differential diagnosis on projectile vomiting
gastroesophageal reflux
overfeeding
pyloric stenosis
cow’s milk allergy
Bilious vomiting
due to intestinal obstruction until proved otherwise intestinal atresia ( newborns only) malrotation volvulus
effortless vomiting
almost always due to gastro oesophageal reflux very common problem in infants self limiting few exceptions cerebral palsy neurological delay
investigations
PH testing for reflux
medica treatment
feed thickener erythromycin prokinetic drugs acid suppresing drug H2 receptor blockers proton pump inhibitors
nissen fundoplication
children with cerebral palsy most likely to have complications of bloat, dumping and retching after surgery
successful surgery may mask more generalised GI motility problems in the child
the post operative course may be more complicated in children with cerebral palsy
nissen fundoplication
children with cerebral palsy most likely to have complications of bloat, dumping and retching after surgery
successful surgery may mask more generalised GI motility problems in the child
the post operative course may be more complicated in children with cerebral palsy
tumour meningeal blastoma
vomiting + neurological benefits
secretory or osmostic diarrhea
stop the feed
if diarrhea doesnt stop means secretory
fat malabsorption
pancreatic disease
hepatobiliary disease
coeliac disease
genetic susceptibility DQ2 and DQ8 gluten sensitive enteropathy -autoimmunity -abdominal bloatedness -diarrhoea Failure to thrive short stature constipation tiredness dermatitis herpatiformis
