Paediatric GI - Presentations Flashcards
How can vomiting episodes be described?
Acute - discreet episode
Chronic - low grade daily pattern associated with mild illness
Cyclical - discreet episodes + abdo pain. Child well in-between
What commonly causes children to vomit?
Gastroenteritis
Constipation
Appendicitis
Viral associated non specific vomiting
What commonly causes infants to vomit?
Intussusception
Pyloric stenosis
Malrotation/volvulus
Systemic infection
What is important to ask about in the history of vomiting?
Any blood or bile?
Projectile?
Duration?
Associated symptoms?
What does biliary vomit suggest?
Obstruction until proven otherwise
What does projectile vomiting indicate?
Pyloric stenosis
What do you assess on examination of a child who is vomiting?
Signs of dehydration Fever Abdominal distention Hernial orifices and genitalia Cranial signs Urinary signs FB ingestion
How is vomiting managed?
Support with fluids if dehydrated
Find and treat cause
What complications are associated with vomiting?
Dehydration
Electrolyte disturbance
Mallory Weiss
Aspiration
What is diarrhoea?
Change in frequency and consistency of stool with enough fluid and electrolyte loss to cause illness
What most commonly causes diarrhoea?
Viral illness - self limiting
What symptoms raise suspicion of another cause to diarrhoea?
Unwell child Abdo tenderness and guarding Shock Jaundice Reduced urine output Bloody stool Bilious vomit
What can cause bloody diarrhoea?
Infective - campylobacter, shigella, amoeba
Intussusception - est. 6-9 months
Haemolytic-uraemic syndrome
IBD
What are the viral causes of acute diarrhoea?
Rotavirus
Small round structured virus
Adenovirus
What are the bacterial causes of acute diarrhoea?
E. Coli Campylobacter spp. Salmonella spp. Shigella spp. Vibrio cholerae
What are the protozoal causes of acute diarrhoea?
Giardia lamblia
Entamoeba histolytica
Cryptosporidium parvum
What sign would suggest gastroenteritis has a bacterial cause?
Temperature very high
What is vital when assessing a child with diarrhoea?
Assessing their hydration status
If a child is systemically unwell with diarrhoea, what would you consider?
UTI
RTI
Meningitis
What surgical causes can lead to acute diarrhoea?
Appendicitis
Volvulus
What other diagnoses would you consider if a child had acute diarrhoea?
CF
IBD
Overflow from constipation
How do you assess hydration status?
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
When can diarrhoea be classified as chronic?
> 14 days
What must be done if a child has chronic diarrhoea?
Full investigation into cause:
Culture
Bloods - anaemia? infection? U&E
Specialist tests: Endomysial antibodies - coeliac Sweat test - CF Faecal calprotectin - IBD Biopsy
How is diarrhoea managed?
Supportive measurements - fluids, electrolytes
<6months - benefit to admitting
Continue breast feeding
What is toddlers diarrhoea?
Well child with no failure to thrive with diarrhoea
Usually 2 yo
Possibly due to maturational delay in intestinal motility
How does a child with toddlers diarrhoea present?
Undigested food
Flatus
Colicky intestinal pain
What can you treat toddlers diarrhoea?
High fat
Give recommended amount of milk
Reduce fruit juice and sugary drinks
How is constipation defined?
Infrequent (<3x/week) and painful defecation for more then 2 weeks
MUST BE DEVIATION FROM THE NORM
What signs would indicate a child may be constipated?
Palpable stool in abdomen Withholding behaviours Abdominal pain Faecal incontinence Distention Anorexia
When do organic causes for constipation occur?
Present in first few weeks of life
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
What red flags suggest an organic cause to constipation?
Within first weeks of life No meconium in 48hrs Associated vomiting Ribbon stool Motor delay
How commonly is constipation seen in children?
Very common in school aged children
What is done for generalised constipation?
Disimpaction and Maintenance
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
What maintenance managed is used for generalised constipation?
Increase fluid and fibre
Bowel chart
Regular unhurried toileting
Reward for using toilet
What questions would you ask about a child’s stools?
Frequency and consistency
Pain or blood on defecation?
Soiling?
History of delay passing meconium
How do you infer abdominal pain in babies?
Screaming and drawing up of legs
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
What should you look for on examination of a child with abdominal pain?
Fever Jaundice Rash Resp tract Hernial orifices Genitalia
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
What medical causes can lead to acute abdominal pain?
Gastroenteritis UTI Constipation IBD Mesenteric lymphadenitis Pancreatitis
What surgical causes are associated with acute abdominal pain?
<1yo - Intussusception, Volvulus, Hernia, Hirschprung
Child - Appendicitis, Volvulus
Older child - Appendicitis, Ovary/testicular torsion
What systemic causes can lead to acute abdominal pain?
DKA
HSP
Sickle cell disease
Lower lobe pneumonia
When is abdominal pain classified as chronic/recurrent?
> = 4 a month for >= 2 months
Pain limit activities
What is the pathophysiology of chronic abdominal pain?
Dysregulation of the visceral nerve paths lead to hyperalgesia
Commonly followed by acute GI inflammation
What are the main risk factors for chronic abdo pain?
Female Obese Stressed Bullied Parental anxiety
What are the red flags associated with chronic abdo pain?
Weight loss PR bleed Failure to thrive Severe D&V Fever Abnormal bowel sounds
What would suggest chronic abdo pain is due to IBS?
Pain improve with defecation
Stool consistency change
Feel incomplete evacuation
What would suggest chronic abdo pain is due to postprandial pain syndrome?
Fullness
Early satiety
Bloating and belching
What would suggest chronic abdo pain is due to epigastric pain syndrome?
Epigastric burning
Not relieved by defecation or flatus
What would suggest chronic abdo pain is due to abdominal migraine?
Intense periumbilical pain
Anorexia
N&V
Headache
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
