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Paediatric GI - Presentations Flashcards

1
Q

How can vomiting episodes be described?

A

Acute - discreet episode
Chronic - low grade daily pattern associated with mild illness
Cyclical - discreet episodes + abdo pain. Child well in-between

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2
Q

What commonly causes children to vomit?

A

Gastroenteritis
Constipation
Appendicitis
Viral associated non specific vomiting

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3
Q

What commonly causes infants to vomit?

A

Intussusception
Pyloric stenosis
Malrotation/volvulus
Systemic infection

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4
Q

What is important to ask about in the history of vomiting?

A

Any blood or bile?
Projectile?
Duration?
Associated symptoms?

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5
Q

What does biliary vomit suggest?

A

Obstruction until proven otherwise

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6
Q

What does projectile vomiting indicate?

A

Pyloric stenosis

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7
Q

What do you assess on examination of a child who is vomiting?

A 
Signs of dehydration
Fever
Abdominal distention
Hernial orifices and genitalia
Cranial signs
Urinary signs
FB ingestion
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8
Q

How is vomiting managed?

A

Support with fluids if dehydrated

Find and treat cause

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9
Q

What complications are associated with vomiting?

A

Dehydration
Electrolyte disturbance
Mallory Weiss
Aspiration

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10
Q

What is diarrhoea?

A

Change in frequency and consistency of stool with enough fluid and electrolyte loss to cause illness

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11
Q

What most commonly causes diarrhoea?

A

Viral illness - self limiting

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12
Q

What symptoms raise suspicion of another cause to diarrhoea?

A 
Unwell child
Abdo tenderness and guarding
Shock
Jaundice
Reduced urine output
Bloody stool
Bilious vomit
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13
Q

What can cause bloody diarrhoea?

A

Infective - campylobacter, shigella, amoeba

Intussusception - est. 6-9 months

Haemolytic-uraemic syndrome

IBD

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14
Q

What are the viral causes of acute diarrhoea?

A

Rotavirus
Small round structured virus
Adenovirus

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15
Q

What are the bacterial causes of acute diarrhoea?

A 
E. Coli
Campylobacter spp.
Salmonella spp.
Shigella spp.
Vibrio cholerae
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16
Q

What are the protozoal causes of acute diarrhoea?

A

Giardia lamblia
Entamoeba histolytica
Cryptosporidium parvum

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17
Q

What sign would suggest gastroenteritis has a bacterial cause?

A

Temperature very high

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18
Q

What is vital when assessing a child with diarrhoea?

A

Assessing their hydration status

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19
Q

If a child is systemically unwell with diarrhoea, what would you consider?

A

UTI
RTI
Meningitis

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20
Q

What surgical causes can lead to acute diarrhoea?

A

Appendicitis

Volvulus

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21
Q

What other diagnoses would you consider if a child had acute diarrhoea?

A

CF
IBD
Overflow from constipation

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22
Q

How do you assess hydration status?

A 
Skin turgor
Mucus membranes
Urine output
Sunken Fontanelles
Heart rate - inc. with dehydration
Resp rate - inc. with dehydration
Cap refill
Appearance - alert, lethargic
Extremities - cool or warm
23
Q

When can diarrhoea be classified as chronic?

24
Q

What must be done if a child has chronic diarrhoea?

A

Full investigation into cause:
Culture
Bloods - anaemia? infection? U&E

Specialist tests:
Endomysial antibodies - coeliac
Sweat test - CF
Faecal calprotectin - IBD
Biopsy
25
How is diarrhoea managed?
Supportive measurements - fluids, electrolytes <6months - benefit to admitting Continue breast feeding
26
What is toddlers diarrhoea?
Well child with no failure to thrive with diarrhoea Usually 2 yo Possibly due to maturational delay in intestinal motility
27
How does a child with toddlers diarrhoea present?
Undigested food Flatus Colicky intestinal pain
28
What can you treat toddlers diarrhoea?
High fat Give recommended amount of milk Reduce fruit juice and sugary drinks
29
How is constipation defined?
Infrequent (<3x/week) and painful defecation for more then 2 weeks MUST BE DEVIATION FROM THE NORM
30
What signs would indicate a child may be constipated?
``` Palpable stool in abdomen Withholding behaviours Abdominal pain Faecal incontinence Distention Anorexia ```
31
When do organic causes for constipation occur?
Present in first few weeks of life
32
What are some organic causes for constipation?
``` Hirschprung's Anorectal malformation Spinal cord problem Hypothyroidism Cow's milk allergy Coeliac's Neuromuscular disorders - cerebral palsy ```
33
What red flags suggest an organic cause to constipation?
``` Within first weeks of life No meconium in 48hrs Associated vomiting Ribbon stool Motor delay ```
34
How commonly is constipation seen in children?
Very common in school aged children
35
What is done for generalised constipation?
Disimpaction and Maintenance
36
How are children with generalised constipation dis-impacted?
1 Osmotic agent - macrogol 2 Can add stimulant - Senna 3 Switch to osmotic laxative - lactulose 4 Give medication rectally
37
What maintenance managed is used for generalised constipation?
Increase fluid and fibre Bowel chart Regular unhurried toileting Reward for using toilet
38
What questions would you ask about a child's stools?
Frequency and consistency Pain or blood on defecation? Soiling? History of delay passing meconium
39
How do you infer abdominal pain in babies?
Screaming and drawing up of legs
40
What features are important in the history of abdominal pain in children?
Duration - >4hr likely to be significant Location - further from umbilicus likely to be significant Nature Associated symptoms
41
What should you look for on examination of a child with abdominal pain?
``` Fever Jaundice Rash Resp tract Hernial orifices Genitalia ```
42
What investigations would you carry out on a child with abdominal pain?
``` Urinalysis FBC Stool sample Sickling test? - if African/afro-caribbean U&E and glucose Image - AXR/Ultrasound/CT ```
43
What medical causes can lead to acute abdominal pain?
``` Gastroenteritis UTI Constipation IBD Mesenteric lymphadenitis Pancreatitis ```
44
What surgical causes are associated with acute abdominal pain?
<1yo - Intussusception, Volvulus, Hernia, Hirschprung Child - Appendicitis, Volvulus Older child - Appendicitis, Ovary/testicular torsion
45
What systemic causes can lead to acute abdominal pain?
DKA HSP Sickle cell disease Lower lobe pneumonia
46
When is abdominal pain classified as chronic/recurrent?
>= 4 a month for >= 2 months Pain limit activities
47
What is the pathophysiology of chronic abdominal pain?
Dysregulation of the visceral nerve paths lead to hyperalgesia Commonly followed by acute GI inflammation
48
What are the main risk factors for chronic abdo pain?
``` Female Obese Stressed Bullied Parental anxiety ```
49
What are the red flags associated with chronic abdo pain?
``` Weight loss PR bleed Failure to thrive Severe D&V Fever Abnormal bowel sounds ```
50
What would suggest chronic abdo pain is due to IBS?
Pain improve with defecation Stool consistency change Feel incomplete evacuation
51
What would suggest chronic abdo pain is due to postprandial pain syndrome?
Fullness Early satiety Bloating and belching
52
What would suggest chronic abdo pain is due to epigastric pain syndrome?
Epigastric burning | Not relieved by defecation or flatus
53
What would suggest chronic abdo pain is due to abdominal migraine?
Intense periumbilical pain Anorexia N&V Headache
54
How is chronic abdo pain managed?
``` Explain there is no likely cause Investigate for causes Explain symptoms Stress coping strategies Don't allow gains from pain - miss school Peppermint oil, mebeverine, ranitidine ```

Child Health (30 decks)

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