Paediatrics: Gastrointestinal Flashcards
Causes of infectious diarrhoea?
Viral (most common):
• Norovirus
• Adenovirus
• Rotavirus
Bacterial: • E. coli O157 • C. diff • Campylobacter • Salmonella • Cryptosporidium
Parasites:
• Giardia
Definition of diarrhoea?
> 3 stools/day
Causes of diarrhoea?
Infection
Malabsorption / enteropathies: • Coeliac disease • Crohn's disease • CF • Other food allergies • Lactose intolerance • Other rarer causes
What is Toddler’s diarrhoea?
Benign condition that occurs due to colonic immaturity
Symptoms of Toddler’s diarrhoea?
Can have up to 10 stools per day
No other abdominal symptoms in an otherwise thriving child
Ix of Toddler’s diarrhoea?
Consider FBC, U&Es, LFTs
Coeliac screen
Mx of Toddler’s diarrhoea?
Self-limiting and improves by the age of 5-6 years
Options: • Reduce excessive fruit juice • Increase fat if on low fat diet • Keep fibre content normal • May rarely need loperamide to help with toilet training
Occurrence of GORD?
Very common in infancy (~50%)
Generally benign and self-limiting; resolves by the ago of 2 years
Ix of GORD?
Assess for overfeeding
Consider Cow’s milk protein allergy
Further Ix, if the patient is losing weight
Mx of GORD?
Reassurance
Gaviscon initially and then add ranitidine
Diagnosis of coeliac disease?
In paediatrics only, it can be diagnosed on the basis of blood tests only if they have:
• Classical symptoms
AND
• Anti-TTG >10 times the upper limit of normal
A second sample is then require for:
• Anti-endomesial antibodies
• HLA DQ2 and DQ8 phenotyping
The gold standard diagnostic tool is an endoscopy with duodenal biopsy
Biopsy features of coeliac disease?
Crypt hyperplasia
Flattening of villi
Lymphocytic infiltration
Complications of coeliac disease?
Osteoporosis
Anaemia
Short stature, delayed puberty
Female infertility
Intestinal malignancies (T-cell lymphomas)
Management of coeliac disease in paediatrics?
Lifelong gluten-free diet
Annual review by a dietitian
Aetiology of Crohn’s disease?
Autoimmune and multifactorial
+ve FH is common