Paediatric GI Disorders Flashcards
What other symptoms can be associated with chronic constipation in children?
Poor appetite Irritable Lack of energy Abdominal pain or distension Withholding or straining Diarrhoea
What are some common causes of chronic constipation in children?
Social- poor diet, potty training/school toilet anxieties
Physical- intercurrent illness/medication
Family history
Psychological- including abuse
Organic
Describe the pathophysiology of worsening chronic constipation
Cycle in constipation; holding stools causes larger/harder stool, which leads to a more painful bowel movement, which leads to fecal holding. Chronic fecal holding can cause excessive stretching of the colon and a megarectum.
How is chronic constipation treated?
Explanation
Make sure stools don’t get hard again
Re-train bowel
Remove impaction- movicol impaction (first few days really unpleasant),
Social factors- diet
Psychological- reduce aversive factors, make going to the toilet a pleasant experience, reward good behaviour and retrain bowel
Soften stool and stimulate defecation- osmotic laxative (lactulose or movicol/laxido to soften stool) or stimulant laxatives (senna, picosulphate to aggravate bowel and make it start to notice presence of stools again) Keep treatment going for how long constipation has been present (ie 3 month history = 3 month treatment)
Why are incidences of colectomies higher in paediatric IBD than adult?
Crohn’s and ulcerative colitis are generally both much worse than adult presentations. Pancolitis is very common in paediatric IBD
What is the commonest presentation of Crohn’s disease in children?
Pan-enteric disease
What are the symptoms of ulcerative colitis in children?
Diarrhoea Rectal bleeding Abdominal pain Fever Weight loss Growth failure Arthritis
How do symptoms of crohn’s and ulcerative colitis vary from each other in children?
Crohns has similar symptoms to ulcerative colitis but vary depending on where the disease is. Systemic symptoms are more common in Crohns than UC and diarrhoea/rectal bleeding are less common in Crohns. Abdominal masses can be present in crohns but generally not so in UC
How is IBD diagnosed in children?
History and examination- exclude infection, extra-intestinal manifestations, growth and sexual development
Laboratory investigations- FBC, inflammatory markers, fecal calprotectin (normal FC rules out IBD), ESR
Definitive investigations- colonoscopy + endoscopy, MRI, mucosal biopsy, capsule endoscopy, enteroscopy
What are the aims of treatment of paediatric IBD?
Induce and maintain remission
Correct nutritional deficiencies (iron, Vit D)
Maintain normal growth and development
Promote quality of life and normal psycho-social development
How is paediatric Crohn’s treated?
Induce remission- Nutritional therapy first line, steroids second line
Maintain remission- Thiopurines
Step-up therapy- Anti-TNF
Surgery- For complications, not curative
How is ulcerative colitis treated?
Induce remission- 5-ASA first line, steroids second line
Maintain remission- 5-ASA first line, thiopurines second line
Step-up therapy- anti-TNF
Surgery- for failure to respond to medical therapy. Is curative
What are the types of vomiting in children?
Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting
What are the phases of vomiting with retching and what is each characterised by?
Pre-ejection: pallor, nausea + tachycardia
Ejection: retching and vomiting
Post-ejection: weakness, lethargy + shivering
What are the possible stimulants of the vomiting centre in children?
Enteric pathogens Intestinal inflammation Metabolic disorder Infection Head injury Visual stimuli Middle ear stimuli
Who is pyloric stenosis most common in?
Babies 4-12 weeks
Boys > girls
