paeds- GI Flashcards
causes of gastroenteritis in children
rotavirus
norovirus
astrovirus
adenovirus
risk factors for gastroenteritis
- poor hygiene
- compromised immune system
- poorly cooked food = may lead to infection
clinical presentation of gastroenteritis
- sudden onset of diarrhoea/ vomiting
- pain
- complications- dehydration, malnutrition, intolerance to sugar
what tests would be done in a patient presenting with gastroenteritis?
stool sample- bacteria, ova, cysts, parasites
how is gastroenteritis managed?
- correct dehydration
- oral rehydration therapy
- IV therapy
what is a common complication of gastroenteritis and how is it managed?
transient lactose intolerance
managed via removal of lactose from diet for a few months followed by gradual reintroduction
describe colic in paediatric patients
paroxysmal crying with pulling up of the legs- for over 3 hours at least 3 days of the week for at least 3 months
how is a cows milk allergy confirmed?
confirmed with cows milk challenge- skin prick test and IgE antibodies in blood (RAST test)
what immunoglobulins is cows milk allergy associated with?
IgG , IgE
describe the clinical presentation of cows milk allergy
- widespread uricaria (itchy)
- facial swelling
- loose stools
- failure to thrive
- colic symptoms, GORD
give some severe symptoms a patient with a cows milk allergy may present with
wheeze, stridor, abdo pain, diarrhoea/ vomiting, blood/mucus in stools
shock/collapse
how is cows milk allergy managed?
- avoid cows milk
- if breastfed, ask mother to remove cows milk protein from diet
- antihistamines if allergic reaction
- adrenaline in severe reactions
resolves by 5 y/o commonly
describe the presentation post infective lactose intolerance
post gastroenteritis watery diarrhoea after reintroducing milk feeds
- weight loss
- stools green/ frothy
- increased frequency
how is post infective lactose intolerance managed and diagnosed?
diagnosis- +ve Clinitest
resolves with oral rehydration
describe Toddler’s diarrhoea
- chronic, non-specific diarrhoea
- commonest cause of persistent loose stools in preschool children
- presence of mucus and undigested vegetables
how is toddlers diarrhoea managed
adequate fat and fibre to slow motility
what is Coeliac Disease?
gluten sensitive enteropathy
what is Coeliac disease linked to genetically?
human leukocyte antigen (HLA) DQ2
risk factors for Coeliac disease
T1DM
autoimmune thyroid disease
Downs
1st degree relatives
describe the GI manifestations of coeliac disease
- malabsorption from 8-24 months of age after the introduction of wheat
- failure to thrive
- abdo distention
- WL
- buttock wasting
- abnormal stools (foul smelling) diarrhoea
describe the non-GI manifestations of coeliac disease
- dermatitis herpetiformis- erythematous macules
- dental enamel defects
- osteoporosis
how is coeliac disease diagnosed?
- positive serology- IgA tissue transgultaminase TTG antibodies
- endomysial antibodies
- small intestinal biopsy to confirm !!
will show mucosal changes (villous atrophy, intraepithelial lymphocytes and crypt hypertrophy)
how is coeliac managed?
gluten free diet
what is Crohn’s disease?
transmural focal disease most commonly affecting the distal ileum and proximal colon
what are the classical GI manifestations of crohn’s disease?
- abdo pain
- diarrhoea (bad smelling)
- weight loss
- nausea/ vomiting
give some non-intestinal manifestations of Crohns disease
- oral lesions
- clubbing
- uveitis
- arthralgia
- erythema nodosum
how is Crohn’s diagnosed?
- exclude infection- stool MCS
- histological findings on biopsy
- endoscopy
- abdo barium x ray
how will Crohn’s appear on histology?
non-caseating, epitheloid cell granulomata
how will Crohn’s appear on endoscopy?
- small bowel narrowing, fissuring and bowel wall thickened
skip lesions !
how is Crohn’s managed?
- prednisolone
- immunosuppression- azathioprine/ methotrexate
- anti-TNF- infliximab
how does ulcerative colitis present clinically?
characteristically:
- rectal bleeding
- bloody diarrhoea
- colicky pain
- weight loss
- growth failure
- non-GI manifestations- erythema nodosum and arthritis
how is UC diagnosed?
- exclude infection- stool MCS
- endoscopy
- histology
how would UC present on endoscopy?
- loss of goblet cells
- glandular distortion
- crypt abscesses
- mucosal ulcers
how would UC present on histology?
- mucosal inflammation
- crypt damage
- ulceration
how can crohn’s and UC be differentiated via a barium swallow X ray?
crohns- string sign (string like appearance of severely narrowed intestines)
UC- lead pipe colon
how is UC managed?
- aminosalicylates (5-ASA’s)- sulfasalazine
- topical steroids
- azathioprine
- smoking is protective !
what causes Kwashiorkor disease?
due to low intake of protein and essential amino acids
how does kwashiorkor present clinically?
- poor growth
- diarrhoea
- apathy
- anorexia
- oedema
- skin/hair depigmentation
- distended abdomen
how would a patient with kwashiorkor be managed?
- gradually increasing high protein diet + vitamins
- education on diet
what is Marasmus and what is it associated with?
lack of calories + discrepancy between height and weight
HIV-associated
describe the clinical features of Marasmus
- distended abdo
- diarrhoea/ constipation
- infection
- low albumin
how is Marasmus managed?
can be managed at home with fortified food
what is Intussusception?
one segment of the bowel invaginates into another distal to it, leading to obstruct
describe the epidemiology of Intussusception
- 6-18 months
- most common cause of obstruction in children
- M 3:1 F
describe the aetiology of Intussusception
- > 90% non-pathological
- pathological- meckels diverticulum, henoch-schonlein purpura, lymphoma, CF
how does Intussusception present clinically?
- sudden onset !
- paroxysms every 10-20 mins of colicky abdo pain
- early vomiting- bile stained
- lethargy
- sausage-shaped mass in RUQ
- dances sign
- ‘red currant jelly’ stools seen late on
what is Dances sign?
- seen in Intussusception
absence of bowel sounds in LRQ
how is Intussusception diagnosed?
- US- DOUGHNUT OR TARGET SIGN
- bowel enema- cresent sign
- abdo- x ray- proximal bowel is dilated and gas-filled
how is a patient with Intussusception treated?
- resus
- reduction with air enema
- laparotomy
when is a laparotomy indicated in a patient initially presenting with Intussusception?
- peritonitis
- perforation
- prolonged Hx
- failed enema
when does pyloric stenosis present?
3-8 weeks
how does pyloric stenosis present?
- projectile vomiting after feeds, no bile
- constipation
- dehydration
how is pyloric stenosis diagnosed?
hypochloraemic, hypokalaemic metabolic alkalosis
- urine output- dehydrated
on examination, what findings would make you suspect pyloric stenosis ?
- clearly visible LUQ peristalsis when feeding
- olive sized pyloric mass
how is pyloric stenosis managed?
- correct electrolyte imbalance
- if fails, Ramstedt’s pyloromyotomy
when does Mesenteric adenitis typically present, how is it differentiated from appendicitis and how is it managed?
- presents after viral infection
- differentiated as there is no guarding/ rebound tenderness
- managed- conservative
what is necrotising enterocolitis?
inflammatory bowel necrosis
most common GI emergency in neonates
serious intestinal insults to immature gut- toxins, vascular problems etc
how does NEC present clinically
- first 2 weeks of life
- feeding difficulties, vomiting, abdo distension
- bloody stool
how is NEC managed?
cefotaxime/ vancomycin
surgery if progressive
what is Hirschsprung’s disease and what genes is it associated with?
no bowel movements due to missing nerve cells (ganglia) in segment of baby’s colon
MEN 2A/B
how does Hirschsprung’s disease present?
- meconium ileus (no bowel movement in 1st 48 hours)
- abdo distension
- vomiting
- constipation
- megacolon
how is Hirschsprung’s disease diagnosed?
- barium x ray
- DIAGNOSTIC- rectal biopsy
how is a patient with Hirschsprung’s disease managed?
- bowel washouts/ irrigation- first line
- surgery- bypass affected colon, ileostomy/ colostomy
why do neonates have higher bilirubin levels then adults?
1) higher concentration of RBCs with short lifespan
2) RBCs breakdown = unconjugated bilirubin
3) unconjugated bilirubin becomes conjugated in liver = liver immaturity = slower conjugation
What may be the possible cause of jaundice in neonates at:
<24 hours?
> 14 days?
<24hrs = Rhesus haemolytic disease (+ve Coombs test)
> 14 days = Biliary atresia (pale stools)
risk factors for jaundice in neonates
- Low BW
- Prematurity
- Breast fed babies
- Maternal diabetes
- Family Hx
how does jaundice present clinically?
First seen normally on forehead and face
Neuro signs:
- change in muscle tone, altered crying
- Pale stools and dark urine
what is the name for continued high levels of jaundice?
Kernicterus
how is jaundice treated?
Phototherapy
exchange transfusion
what is kernicterus?
Acute bilirubin encephalopathy that can cause:
Athetoid movements
Deafness
Low IQ
(brain damage)
prevented by jaundice treatments
how does GORD present clinically?
- regurgitation
- distress after feeds, failure to thrive
- apnoea
- pneumonia
- anaemia
how is GORD diagnosed?
- clinical
- endoscopy
- ph probe- rarely
how is GORD managed?
- avoid over-feeding
- try thickened feed formula
- antacid + sodium/ magnesium alginate
- introduce PPI- ranitidine
what should be done after 6-9 months if GORD has not resolved?
fundoplication
if failure to thrive, apnoea, bleeding, severe oesophagitis
what is Meckel’s Diverticulum?
vestigal remnant of the vitellointestinal tract
how does Meckel’s diverticulum typically present?
-asymptomatic usually
give some complications of Meckel’s diverticulum
- haemorrhage (blood in stool)
- intestinal obstruction
- diverticulitis
- perforation
how is Meckel’s diverticulum diagnosed?
- always consider in paeds patients with rectal bleeding
- abdo x ray
- CT scan
how is a paediatric patient with Meckel’s diverticulum managed?
- laparotomy if symptomatic
how does a congenital diaphragmatic hernia occur?
developmental defect in diaphragm results in herniation of abdo contents into chest
what is the main complication of a congenital diaphragmatic hernia?
impaired lung development- pulmonary hypoplasia and pulmonary HTN
what is gastroschisis?
congenital defect, evisceration of abdo contents (opening greater than 5cm)
what is exomphalos?
herniation of the abdominal contents surrounded in peritoneum
how is exomphalos managed?
protect herniated viscera to prevent hypothermia and sespsi
closed
how does oesophageal atresia present clinically? (prenatally and postnatally)
prenatal- polyhydromnias
postnatal- cough, airway obstruction, cyanosis
what is biliary atresia?
biliary tree occlusion in 3rd week of life
how does biliary atresia present?
a healthy baby presenting with:
- jaundice
- yellow urine
- pale stools
how does acute appendicitis present clinically?
- pain in RIF
- aggrevated by movement
- patient will lie still with knees flexed
- mild fever.
symptoms of IBS
- abdominal pain
- pain relieved on defecation
- bloating
- change in bowel habit
- mucus
what is Intussusception?
most common cause of intestinal obstruction- one segment of the bowel invaginates onto the other
where does intussusception occur?
ileocaecal
how would a patient with Intussusception typically present?
- sudden onset
- paroxysms of colicky abdo pain
- bile stained vomit
describe the epidemiology of Intussusception
male between 6-18 months
symptoms of Malrotation with volvulus
bile stained vomiting
circulatory collapse
tender abdo
what is Wilsons disease?
rare autosomal recessive disorder leading to toxic accumulation of copper in the liver, and eventually in other tissues (brain and eyes)
how does Wilson’s disease present clinically?
- Kayser-Fleischer rings
- hepatic problems- hepatitis, cirrhosis,
how would you investigate a patient with Wilson’s disease?
- serum copper
- 24h urinary copper excretion- >100microgram
- molecular gene testing
how is Wilson’s disease treated?
- penicillamine
- liver transplant if end-stage hepatic failure
