Paediatrics - GI Flashcards
What are some common medical causes of abdominal pain in children (9)?
- Non-specific abdominal pain/ unknown/ functional
- Constipation
- UTI/ pyelonephritis
- Gastroenteritis
- IBD
- Diabetic ketoacidosis
- Gynaecological causes
- Henoch Schonlein purpura
- Abdominal migraine
What are some common surgical causes of abdominal pain (5)?
- Appendicitis
- Intussusception
- Bowel obstruction
- Hernias
- Pancreatitis
What are some extra-abdominal causes of abdominal pain (2)?
- Lower lobe pneumonia
- Testicular torsion
What has been suggested to be a cause of non-specific abdominal pain in children?
Mesenteric adenitis
often occurs together with an URTI - causing enlarged lymph nodes
What are some common causes of diarrhoea in children (6)?
- Gastroenteritis
- IBD/IBS
- Coeliacs
- Chronic non-specific diarrhoea/ toddlers diarrhoea
- Cow’s milk protein allergy/ lactose intolerance
- Liver (or pancreatic) disease
What are the most common causes of constipation (7)?
- Idiopathic/ lifestyle = MC
- Hirschprungs
- CF
- Hypothyroidism
- Anal stenosis
- Intestinal obstruction
- Lactose intolerance
What would be the presentation of a child with constipation (6)?
- Less than 3 stool per week
- Hard, difficult to pass stools
- Abdo pain
- Holding abnormal posture
- Overflow diarrhoea
- Rectal bleeding
What is the term for faecal incontinence?
Encopresis
What may cause encopresis in children (5)?
- Constipation
- Hirschprungs disease
- Learning difficulties
- Cerebral palsy
- Stress/ abuse
When is encopresis considered abnormal?
Past the age of 4
What viscous cycle can occur that makes constipation progressively worse?
Impacted stool in the rectum –> stretched rectum –> desensitisation of rectum –> urge to defecate less frequently –> further impacted stool
How should constipation be managed in children (3)?
- Lifestyle advice/ factors
- Laxatives
- Schedule visits to toilet/ keep bowel diary
What laxatives should be used to treat constipation in children (3)?
- Macrogol (e.g. movicol) disempaction regimen - 2 weeks
- senna if needed
- others (e.g. lactulose)
What are the typical signs/ symptoms of appendicitis (8)?
- Central abdo pain, localising to McBurneys point
- Anorexia
- Nausea/ vomiting
- Fever
- Rosvings sign
- Guarding
- Rebound/ percussion tenderness (peritonitis)
- Psoas + obturator sign
How is appendicitis diagnosed (3)?
- Raised CRP/ESR
- Ultrasound/ CT (sometimes used)
- Diagnostic laparoscopy
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What is the most common cause of gastroenteritis in children?
Rotavirus
Norovirus most common in adults
What are some other viral causes of gastroenteritis other than rotavirus in children (2)?
- Norovirus
- Adenovirus
What are the most common causes of bacterial diarrhoea (4)?
- C. jejuni = MC
- E. coli (most strains don’t cause infection)
- Shigella
- Salmonella
What symptom may point more towards bacterial gastroenteritis?
Bloody diarrhoea
What are two parasitic causes of gastroenteritis?
- Gardia
- Cryptosporidium
mostly water born
What is the main risk associated with gastroenteritis?
Dehydration - the very old, young or vulnerable may need to be admitted for IV fluids
What are signs of dehydration in an infant (7)?
- Hypotension
- Cold extremities
- Reduced skin turgor
- Tachypnoea/ tachycardic
- Slow cap refill
- Sunken fontanelle
- Dry mucous membranes
How long should a child stay off school with gastroenteritis?
48 hours post diarrhoea/ vomiting
What are some post gastroenteritis complications (5)?
- GBS
- IBS
- Lactose intolerance
- Reactive arthritis
- Mesenteric adenitis
What is coeliacs disease?
Autoimmune reaction where exposure to gluten causes an immune reaction creating inflammation in the intestines
What are the signs/ symptoms of coeliacs in children (6)?
- Failure to thrive
- Diarrhoea
- Abdo pain
- Fatigue
- Weight loss
- Dermatitis herpetiformis
What other parts of the body (other than intestines) may be affected in those with coeliacs disease (2)?
- Brain - ataxia, epilepsy
- Skin - dermatitis herpetiformis
What part of the bowel is particularly affected by coeliac’s disease?
Jejunum
What genes are associated with coeliacs disease (2)?
- HLA-DQ2 (90%)
- HLA-DQ8
What is the first line investigation for coeliacs disease?
- anti TTG-IgA
- Total IgA
What antibody can also be tested for if anti TTG is inconclusive for coeliacs disease?
EMA-IgA
If there is IgA deficiency how can coeliacs be tested for?
- anti TTG-IgG
- anti EMA-IgG
How is a diagnosis of coeliacs disease confirmed?
Duodenal biopsy
What would a duodenal biopsy show in those with coeliacs (2)?
- Crypt hyperplasia
- Villous atrophy
What is important for those suspected of coeliac to carry on doing during investigation for coeliacs?
They must continue to eat a gluten diet
For which conditions is a serological screen for coeliacs disease indicated (3)?
- T1DM
- Autoimmune thyroid disease
- Downs syndrome
What are some complications of coeliacs disease (4)?
- Malabsorption
- Anaemia
- Osteoporosis
- Small intestine cancers (rarer)
How is coeliacs treated?
Gluten free diet
What is inflammatory bowel disease?
Inflammation of the walls of the GI tracts, with periods of remission and exacerbation
What age children are usually affected by IBD?
15+ year olds
What is the general presentation of a child/ teen with IBD (7)?
- Diarrhoea
- Abdo pain
- Bleeding
- Weight loss
- Anaemia
- Fever
- Dehydration
What are some extra-intestinal manifestations of IBD (6)?
- Finger clubbing
- Arthritis
- Aphthous mouth ulcers (mostly crohns)
- Primary sclerosing colangitis (UC only)
- Erythema nodosum
- Episcleritis + uveitis
What is the first line test for IBD?
Faecal calprotectin
What is the gold standard test for IBD?
OGD/ colonoscopy with biopsy
What other investigation can be done to investigate IBD?
Imaging (US/CT/MRI) to look for fistulas, abscesses and strictures
How is a flare of Crohns treated (3)?
- Steroids (oral prednisolone or IV hydrocortisone)
- Mesalazine
- (+ azathioprine, mercaptopurine, infliximab)
How is crohns remission maintained (2)?
- Azathioprine or mercaptopurine
- Methotrexate, infliximab, adalimumab
How is a mild - moderate flare of UC treated (2)?
- Aminosalicylate (mesalazine - oral or rectal)
- Oral steroids
How is a sever flare of UC treated (2)?
- IV hydrocortisone
- IV ciclosporin
How is remission maintained in UC (2)?
- Aminosalicylate (mesalazine)
- Azathioprine/ mercaptopurine
What other treatment as well as medication can be offered to those with IBD?
Surgery
What is a common cause of diarrhoea in toddlers?
Toddlers diarrhoea/ chronic non-specific diarrhoea (maybe a form of IBS)
What is the prognosis for chronic non-specific diarrhoea?
Most children usually grow out of it
What are some causes of vomiting in children (8)?
- Overfeeding
- GORD
- Pyloric stenosis
- Gastroenteritis
- Other infections e.g. UTI + meningitis
- Intestinal obstruction
- Bulimia nervosa
- Cows milk protein allergy
What are some red flag symptoms associated with vomiting in babies (5)?
- Not keeping any food down
- Projectile vomiting
- Bile stained vomit
- Haematemesis
- Abdominal distension
What age are children commonly affected by GORD?
Under 1 year
Why are children under 1 year commonly affected by GORD?
They have an underdeveloped/ immaturity of the lower oesophageal sphincter
What is the presentation of GORD in those under 1 (6)?
- Chronic cough
- Hoarse voice
- Distress/crying/ unsettled after feed
- Reluctance to feed
- Pneumonia
- Poor weight gain