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Year 4 Child Health > Paediatrics: Gastrointestinal > Flashcards

Paediatrics: Gastrointestinal Flashcards

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1
Q

Causes of infectious diarrhoea?

A

Viral (most common):
• Norovirus
• Adenovirus
• Rotavirus

Bacterial:
• E. coli O157
• C. diff
• Campylobacter 
• Salmonella
• Cryptosporidium

Parasites:
• Giardia

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2
Q

Definition of diarrhoea?

A

> 3 stools/day

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3
Q

Causes of diarrhoea?

A

Infection

Malabsorption / enteropathies:
• Coeliac disease
• Crohn's disease
• CF
• Other food allergies
• Lactose intolerance
• Other rarer causes
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4
Q

What is Toddler’s diarrhoea?

A

Benign condition that occurs due to colonic immaturity

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5
Q

Symptoms of Toddler’s diarrhoea?

A

Can have up to 10 stools per day

No other abdominal symptoms in an otherwise thriving child

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6
Q

Ix of Toddler’s diarrhoea?

A

Consider FBC, U&Es, LFTs

Coeliac screen

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7
Q

Mx of Toddler’s diarrhoea?

A

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
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8
Q

Occurrence of GORD?

A

Very common in infancy (~50%)

Generally benign and self-limiting; resolves by the ago of 2 years

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9
Q

Ix of GORD?

A

Assess for overfeeding

Consider Cow’s milk protein allergy

Further Ix, if the patient is losing weight

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10
Q

Mx of GORD?

A

Reassurance

Gaviscon initially and then add ranitidine

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11
Q

Diagnosis of coeliac disease?

A

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

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12
Q

Biopsy features of coeliac disease?

A

Crypt hyperplasia

Flattening of villi

Lymphocytic infiltration

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13
Q

Complications of coeliac disease?

A

Osteoporosis

Anaemia

Short stature, delayed puberty

Female infertility

Intestinal malignancies (T-cell lymphomas)

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14
Q

Management of coeliac disease in paediatrics?

A

Lifelong gluten-free diet

Annual review by a dietitian

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15
Q

Aetiology of Crohn’s disease?

A

Autoimmune and multifactorial

+ve FH is common

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16
Q

Regions affected by Crohn’s disease?

A

Entire GI tract from mouth to anus can be affected

Extraintestinal manifestations can occur, e.g: liver, eyes, skin

17
Q

Ix for coeliac disease?

A

FBC, U&Es, LFTs, CRP (ESR), ferritin, coeliac screen, plasma viscosity

Faecal calprotectin

Stool cultures x 3 (inc. C. diff)

Upper and lower GI endoscopy

MRI small bowel study; in young children, a barium study can be carried out

18
Q

Histology of Crohn’s disease?

A

Skip lesions

Oedema, inflammation, cryptitis, abscesses

Only 30% have granulomas

19
Q

Mx of Crohn’s disease?

A

Induce remission with:
• Elemental diet for 6-8 weeks (for upper GI disease)
• Steroids

Maintenance:
• Initially azathioprine
• Step-up to methotrexate +/- infliximab or adalimumab

Avoid surgery if possible

20
Q

Nutrition in patient’s with Crohn’s disease?

A

Diet rich in calories and low in bulk, to avoid obstruction

21
Q

Complications of Crohn’s?

A

Perforation

Fistulae

Colon CA in colitis

PSC, autoimmune hepatitis

Small increased risk of malignancy

22
Q

Diagnostic criteria for constipation?

A

Symptoms must be present for at least 1 month and include at least 2 of the following:
• <3 defecations per week
• At least one episode per week of faecal incontinence (after the child has acquired toileting skills)
• Hx of excessive stool retention or retentive posturing
• Hx of painful or hard bowel movements
• Presence of a large faecal mass in the rectum
• Hx of stools with large diameter that may obstruct the toilet

23
Q

Features of constipation suggestive of organic disease?

A

Delayed passage (>24 hours) of meconium after birth

Recurrent rectal prolapse (suggests CF)

Failure to thrive

Abnormal position of anus
inspect anus in all children
rectal examination in all children <6 months -1year

Explosive passing of stool following PR exam (suggests Hirschsprung’s disease)

Skin tags (usually caused by healed fissures); consider Crohn’s disease, sexual abuse

24
Q

Risk factors for constipation?

A

Low fibre and fluid intake

Excessive dairy products

Lack of exercise

Obesity

Problems with toilet training

25
Q

Mx of constipation?

A

Stools softeners, e.g: magrocol, laxido, movicol; may require laxido clear out if constipation if severe and/or child has soiling

Adjust dose to achieve goal:
• Initially aim for type 5 daily stools on Bristol stool chart for a fortnight
• Then aim for type 4 daily stools for at least 6 months before slowly weaning the dose if possible

May require addition of a stimulant laxation, e.g: docusate sodium or senna

26
Q

Aetiology of UC?

A

Multifactorial autoimmune disease

+ve FH is common

27
Q

Regions affected by UC?

A

Confined to colon

28
Q

Grades of UC?

A 
Mild:
• Only affects distal colon
• <3 stools/day
• Little blood
• No fever or weight loss
Moderate - 
• 3-5 stools/day
• Bloody stools
• Abdominal pain + cramps
• Low grade fever and weight loss
• Mild anaemia

Severe:
• >5 stools/day
• Frank blood
• Pain
• Fever
• Anaemia, leukocytosis, hypoalbuminaemia
• Risk of toxic megacolon and perforation

Most paediatric patients have moderate - severe pancolitis

29
Q

UC complications?

A

Long-term risk of colon cancer

Growth failure

30
Q

Extra-intestinal manifestations of UC?

A

Enteropathic arthritis

Skin (erythema nodosum / pyoderma gangrenosum)

Autoimmune liver disease

31
Q

What is toxic megacolon?

A

Transverse colon diameter >5cm in adults on plain AXR; it is a surgical emergency

It is rare in children and so there are no paediatric parameters

32
Q

Mx of toxic megacolon?

A

‘Drip and suck’ (NG tube)

IV Abx

Early surgical review

33
Q

Ix for UC?

A

Stool cultures x 3 (inc. C. diff)

FBC, U&Es, CRP (ESR), ferritin, plasma viscosity

Stool calprotectin

Upper and lower GI endoscopy

MRI small bowel follow-through to assess for Crohn’s disease

34
Q

Typical histology of Crohn’s?

A

PMN cells near base of crypts

Crypt abscess

NO GRANULOMAS

35
Q

Treatment of UC?

A

Steroids to induce remission

Maintenance therapy:
• Mild (mesalazine only)
• Moderate-severe (mesalazine + azathioprine)
• Non-responders (mesalazine + one of methotrexate, infliximab or adalimumab)

CURE with colectomy

36
Q

Obstructive causes of vomiting?

A

Pyloric stenosis (USS)

Intestinal volvulus (USS, AXR, contrast study)

Intussusception (USS)

Adhesions after previous surgery (AXR)

Year 4 Child Health (4 decks)

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