Paediatric GI Disorders Flashcards
What are the types of vomiting?
Vomiting with Retching
Projectile vomiting
Bilious vomiting
Effortless vomiting
What drugs cause constipation?
Gaviscon
Opiates
What social factors cause constipation?
Poor diet - insufficent fluids, excessive milk
Potty training/school toilets
Pre-ejection phase of vomiting with retching
Pallor
Nausea
Tachycardia
Ejection phase of vomiting with retching
Retch
Vomit
Post-ejection phase of vomiting with retching
Weakness
Shivering
Lethargy
Causes of vomiting centre stimulation
Enteric pathogens Intestinal inflammation Metabolic derangement Infection Head injury Visual stimuli Middle ear stimuli
When does pyloric stenosis typically occur?
Babies 4-12 weeks
Is pyloric stenosis more common in boys or girls?
Boys
Is pyloric stenosis more common in boys or girls?
Boys
Causes of bilious vomiting
Intestinal obstruction until proved otherwise Intestinal atresia Malrotation +/- volvulus Intussusception Ileus Crohn’s disease with strictures
What is generally the cause of effortless vomiting?
Gastro-oesophageal reflux
In which cases is it less certain that effortless vomiting is self limiting with spontaneous resolution?
Cerebral palsy
Progressive neurological problems
Generalised GI motility problem
Oesophageal atresia
Presentation of gastroesophageal reflux
Vomiting Haematemesis Feeding problems (failure to thrive) Apnoea Cough Wheeze Chest infections
Treatment of reflux
Feeding advice
Nutritional support
Medical treatment
Surgery
Feeding advice for reflux
Thickeners for liquids
Appropriateness of foods (texture, amount)
Behavioural programme (oral stimulation, removal of aversive stimuli)
Feeding position
Paediatric UC
Pancolitis (higher rate of colectomies) Diarrhoea Rectal bleeding Abdominal pain (Not as many systemic symptoms)
Paediatric Crohn’s
Panenteric disease Weight loss Growth failure Abdominal pain (Less often bloody diarrhoea)
Nutritional support for reflux
Calorie supplements
Exclusion diet
Nasogastric tube
Gastrostomy
Reflux medical treatment
Feed thickner (gaviscon, thick & easy)
Prokinetic drugs
Acid suppressing drugs (H2 receptor blockers, proton pump inhibitors)
Diagnosis of IBD
Faecal calprotectin
Indications for surgery in reflux
Failure of medical treatment
Persistent
- Failure to thrive
- Aspiration
- Oesophagitis
Treatment of Crohn’s
Nutritional therapy
Steroids
Treatment of UC
5-ASAs
Steroids
How is remission maintained in Crohn? (and UC?)
Thiopurines
5ASAs
Thiopurines
Step up therapy in Crohn’s and UC
Anti-TNF
Surgery in Crohn’s
For complications - not curative
Surgery in UC
For failure to respond to medical therapy - curative
5ASA
Aspirin like drug with a carrier
Antibiotics for UTI
Trimethoprim
Chronic diarrhoea deifinition
4 or more stools per day
For more than 4 weeks
Causes of diarrhoea
Modality disturbance
Acute secretion
Malabsorption of nutrients
Modality disturbance diarrhoea
Toddler diarrhoea
IBD
Active secretion diarrhoea
Acute infective diarrhoea
IBD
Malabsorption of nutrients diarrhoea
Food allergy
Coeliac disease
Cystic fibrosis
What are the trpes of diarrhoeas?
Osmotic
Secretory
Motility
Inflammatory
Osmotic diarrhoea
Movement of water into the bowel to equilibrate osmotic gradient
Usually a feature of malabsorption
Generally accompanied by macroscopic and microscopic intestinal injury
Clinical remission with removal of causative agent
Toxin production from which organisms is secretory diarrhoea classically associated with?
Vibrio cholerae
E. coli
How is intestinal fluid secretion predominantly driven in secretory diarrhoea?
Active Cl-secretion via CFTR
Inflammatory diarrhoea
Malabsorption due to intestinal damage
Secretory effect of cytokines
Accelerated transit time in response to inflammation
Protein exudate across inflamed epithelium
Causes of fat malabsorption
Pancreatic disease
Hepatobiliary disease
Pancreatic disease
Diarrhoea due to lack of lipase and resultant steatorrhoea
Classically cystic fibrosis
Hepatobiliary disease
Chronic liver disease
Cholestasis
Coeliac disease presentation
Abdominal bloatedness Diarrhoea Failure to thrive Short stature Constipation Fatigue Dermatitis herpatiformis
Screening tests for coeliac disease
Serological Screens
duodenal biopsy
Denetic testing
Serological screens in coeliac disease
Anti-tissue transglutaminase
Anti-endomysial
