Paediatric upper and lower GI disorders Flashcards
What would constipation be defined as?
Hard to say since there is such variation in stool frequency etc
General rule: if the stool is hard and painful to pass then it’s constipation
What are some of the signs and symptoms associated with constipation?
Poor appetite Irritability Lack of energy Abdominal pain or distension Withholding or straining
Diarrhoea (liquid overflow)
What are some of the causes of children becoming constipated?
Social
- Poor diet (insufficient fluids / excessive milk)
- Potty training / school toilet
Physical
- Illness / medications
Psychological
Organic (hypothyroidism)
What is the “vicious cycle” when it comes to childrens constipation?
The kid will evacuate their bowels and this may be painful
They will then resist going to the toilet the next time round and the stool will become harder and bigger, making it more painful to evacuate
After the next bit of pain when going to the toilet the childs instinct to not go becomes even stronger
What differences to diets would you suggest in a child suffering from constipation?
Increased fibre
Increased fruit
Increased vegetables
Increased fluids
Decreased milk
What are some options for pharmaceutical management of constipation?
Osmotic laxatives (lactulose)
Stimulant laxatives (senna / picosulphate)
Isotonic laxatives (movicol / laxido)
What is one of the main complications that can occur if a child is experiencing severe, or recurrent constipation?
Megarectum
- Can lead to urinary retention and UTI’s
- Can lead to faecal incontinence due to inability to keep internal sphincter closed
What is one of the most important things to remember when prescribing laxatives to a kid?
Want to do it for long enough that they get their confidence back, want them to believe that it won’t be painful when they empty their bowels
What are three of the main symptoms of ulcerative colitis?
Diarrhoea *** (esp. nocturnal & bloody)
Rectal bleeding
Abdominal pain
What can be some important signs of Crohn’s in children that aren’t always seen in adults?
Growth failure
Weight loss
When looking at a childs growth and development charts, what is important to consider?
That longitudinal results are often more useful than one off results
Lot of variation so one off measurements might make a patient look very abnormal, but more important is their rate of growth etc. bc that shows they are developing
What is erythema nodosum? Crohns or UC?
Red patches on the fatty layer of the skin
More common in Crohn’s but can be both
What are some other important extraintestinal signs of IBD?
Angular cheilitis
Aphthous ulceration
Perianal signs (fissures)
What are some laboratory investigations that can be done with suspected IBD?
- FBC & ESR (anaemia, thrombocytosis, raised ESR)
- Biochemistry (raised stool calprotectin**, raised CRP, low albumin)
- Microbiology (rule out infections)
Which IBD are children more prone to getting? Are boys or girls more likely to be affected?
Crohn’s
Boys (slight)
What sort of colitis is a child with UC likely to display? How is this different from adults?
Pancolitis
Adults: More commonly proctitis / L sided colitis
Children have a much more severe phenotype
What parts of the GI tube are likely to be inflamed in children? In adults?
Children likely to have panenteric inflammation (entire tube) including upper GI.
Children also commonly present with ileocolonic inflammation
Adults are usually ileocolonic or isolated ileal
Children have the more severe disease phenotype
What non-lab investigations are done on children with suspected or diagnosed IBD?
Radiological:
- MRI (esp. Crohn’s)
- Barium meal and follow through
Endoscopy:
- Colonoscopy and upper GI endoscopy
- Mucosal biopsy
- Capsule enteroscopy
- Enteroscopy
What is the cardinal histological signs of Crohn’s disease?
Granuloma
Why does treatment of paediatric IBD need to be a lot more strict and intense than adult IBD?
A flare up in an adult produces some uncomfortable symptoms and all but isn’t the end of the world
In children it can be enough to give them growth abnormalities and developmental obstacles, so is more severe
Kids just also tend to have more severe disease
What are the classes of pharmaceuticals given to children with IBD?
Anti-inflammatory meds (steroids etc.)
Immunosuppressants
Biologics (eg. infliximab)
What is one nutritional method of inducing remission in children (and adults) with Crohn’s disease?
Elemental feeding
liquid nutrients
What is the stepwise management plan for Crohn’s?
- Nutritional support and steroids (prednisolone oral)
- Immune therapies (azathioprine, 6MP, methotrexate)
- Biologics (infliximab / adalibumab)
- Surgery
Should surgery ever be done before biologics in Crohn’s?
If the child has one very small isolated area of inflammaiton that is affecting their growth it can be better to just resect that area instead of stepping up to biologics if the rest of the GI tract is doing alright
