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Phase 3a > Paeds - GI + liver > Flashcards

Paeds - GI + liver Flashcards

1
Q

Cow’s milk protein allergy (CMPA) pathophysiology

A

Immune-mediated allergic response to CASEIN and WHEY.

Can be IgE-mediated; non-IgE-mediated, and mixed

One of most common childhood food allergies (7% of formula/mixed-fed infants have)

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2
Q

CMPA Pathophys

A

IgE-mediated = type-I hypersensitivity reaction

  • CD4+ TH2 cells stimulate B cells to produce IgE antibodies against cow’s milk protein which trigger the release of of histamine and other cytokines from mast cells and basophils

Non-IgE-mediated = T cell activation against cow’s milk protein.

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3
Q

CMPA RFx

A

Personal or family Hx of ATOPY

Exclusive breaastfeeding is possibly protective

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4
Q

Presentation of CMPA

A

IgE-mediated:

  • Acute/rapid onset:
    • Pruritis, Erythema, Urticaria, Acute angio-oedema on face
    • Oral pruritis + angio-oedema; Nausea/vomiting; Diarrhoea; colicky abdo pain
      - Lower and upper resp tract Sx

Non-IgE mediated:

  • Non-acute (48hrs - 1 week after ingestion)
    • Pruritis, erythema, ECZEMA
    • GORD, Loose or frequent stools, Blood and/or mucus in stools, Abdominal pain, Infantile colic, Food refusal or aversion, Constipation, Perianal redness, Pallor and tiredness, Faltering growth
      • Lower resp Sx only
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5
Q

Dx of CMPA

A

Allergy-focussed Hx:

  • Personal and family history of atopy
  • Diet and feeding history of infant
  • Mother’s diet if breastfed
  • Any previous management used for symptoms
  • Which milk/foods
  • Age of onset
  • Speed of onset following exposure
  • Duration
  • Severity and frequency of occurrence
  • Setting of reaction
  • Reproducibility of symptoms

GI exam; review GROWTH CHART; signs of atopic co-morb

Bloods: RAST (specific IgE antibodies)
- sensitive but non-specific (false +ves)
- fbc + iron study if concerned about anaemia

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6
Q

CMPA DDx

A
  • Food intolerance
  • Allergy to other things
  • Chronic GI disease (GORD, coeliac, IBD, gastroenteritis, constipation)
  • Pancreatic insufficiency (cystic fibrosis)
  • UTI
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7
Q

When to refer for RAST test

A
  • Faltering growth with at least of the above symptoms
  • One or more acute systemic or severe delayed reactions
  • Confirmed IgE-mediated food allergy with asthma
  • Persistent parental suspicion of a food allergy despite lack of clear history
  • Clinical suspicion of multiple food allergies, especially with concomitant significant eczema
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8
Q

CMPA Mx

A

Eliminate cow’s milk from diet

If formula fed -> hypoallergenic:

  • Extensively hydrolysed formula
  • Amino acid formula (more expensive, for kids who keep having Sx from hydrolysed, or v severe Sx)

Soya-based formulas not recommended under 6 months

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9
Q

Why are soya based formulas not recommended in < 6 months

A

Isoflavones have weak oestrogenic effect, and absorption of minerals and trace elements may be inhibited by phytate found in this milk

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10
Q

Complications of CMPA

A
  • MALABSORPTION or reduced intake
  • Rarely anaphylaxis
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11
Q

Kwashiorkor vs Marasmus

A
  • Marasmus is a deficiency of all macronutrients
    - Emaciated, no oedema
  • Kwashiorkor is a deficiency in protein specifically (typically in people who have access to carbs but less protein).
    • Develop oedema which counterbalances fat + muscle loss
      - Higher risk of death

Both are life threatening

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12
Q

Biliary atresia

A

Bile duct narrowed or absent (prevents excretion of conjugated bilirubin)

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13
Q

Biliary atresia Px

A

Neonates with significant, persistant jaundice (14 days if term; 21 terms if prem)

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14
Q

Bilary atresia Ix

A

Conjucgated + uncong bilirubin in blood

  • high conj = liver processing bilirubin but unable to excrete
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15
Q

Biliary atresia Mx

A

‘Kasai portoenterostomy’ surgery
- section of small intestine is attached to liver opening

Oft full liver transplant needed to resolve condition

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16
Q

Choledochal cyst

A

Congenital swelling of bile duct which can cause blockage and lead to significant, prolonged neonatal jaundice (conjugated bilirubin)

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17
Q

Hirschspurng’s disease

A

Congenital:

  • ABSENCE of PARASYMPATHETIC ganglionic cells of the MYENTERIC (Auerbach’s) PLEXUS in large bowel + rectum
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18
Q

Subtypes of Hirschsprung’s

A
  • Short-segment (recto-sigmoid only - most common)
  • long-segment (till splenic flexure)
  • total colonic agangliogenesis

Most common site is actually at ileocolonic junction

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19
Q

Which gene has strongest association with Hirschsprung’s + other associations

A

Receptor Tyrosine Kinase (RET) gene

Also associated with:
- Down’s
- Neurofibromatosis
- Waardenburg syndrome (genetic: pale blue eyes, hearing loss, patches of white skin/hair)
- Multiple endocrine neoplasia type 2
+ more common in MALES

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20
Q

Hirschsprung’s pathophys

A

The neuroblast which would develop into the enteric nervous system, is arrested in its migration from the vagal segment of neural crest

(or it gets there but doesn’t develop
- apoptosis, bad differentiation, failure to proliferate)

Aganglionic segment = TONIC STATE -> FAILURE of PERISTALSIS + bowel movements
- the internal anal sphinter is not relaxed by presance of faeces
-> FUNCTIONAL OBSTRUCTION
-> Proximal bowel DILATION -> distension

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21
Q

What is a complication of Hirschsprung’s

A

Increased intraluminal pressure -> reduced mural blood flow -> stasis + BACTERIAL PROLIFERATION
-> At risk for HIRCHSPRUNG’S ASSOCIATED ENTEROCOLITIS

  • fluids, bowel decompression, broad-spectrum IV Abx

Esp likely in year after surgery

Also rupture

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22
Q

RFx for Hirschsprung’s

A
  • Males
  • Chromosomal abnormalities (esp Down’s)
  • FHx - tho usually genetically sporadic
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23
Q

Hirschsprung’s Px

A

Classical triad:

  • Failure to pass MECONIUM within 48 hrs of birth
  • Abdo DISTENSION
  • BILIOUS VOMITING

Also:
- palpable faecal mass in left lower abdo
- sometimes tympanic

Rectal examination -> EMPTY RECTAL VAULT
- oft results in forceful discharge of gas + fecal material

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24
Q

DDx of Hirchsprung’s

A
  • Meconium plug syndrome
  • Meconium ileus
  • Intestinal atresia
    • DUODENAL ATRESIA PARTICULARLY ASSOCIATED WITH DOWNS
      • Double bubble sign
      • NG decompression + nil by mouth
  • Intestinal malrotation (midgut volvulus)
  • Anorectal malformation (found on exam)
  • Constipation (if it’s nothing else)
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25
Q

Hirschsprung’s Ix

A
  1. Plain abdo radiograph
  2. Contrast/barium enema (CI if there’s perforation)
    - short transition zone +/- rectal diameter similar to sigmoid colon

Gold: rectal suction biopsy (bedside, high acurracy. Need antibiotic cover + good decompression as can’t washout for 48hrs after.)
-> stained for acetylcholinesterase

          - risk of perforation, bleeding + inadequate sample 
          - NICE says try to avoid
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26
Q

When should a rectal suction biopsy be considered?

A
  • Delayed passage of meconium (more than 48 hours after birth in term babies)
  • Constipation since first few weeks of life
  • Chronic abdominal distension plus vomiting
  • Family history of Hirschsprung’s disease
  • Faltering growth in addition to any of the previous features
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27
Q

Management of Hirschsprungers

A

Symptomatic relief:
- IV Abx
- NG tube
- Bowel decompression

Liase with paeds surgeon

Surgery is only definitive Tx (in first few months)
- resecting the aganglionic section of bowel and connecting the unaffected bowel to the dentate line (pull through)

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28
Q

Complications of surgery for Hirschsprunger’s

A

constipation,
enterocolitis,
perianal abscess,
faecal soiling
adhesions

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29
Q

Difference in appearance between vomit after repeated vomiting and bilious vomiting

A

Bile only turns green after mixing with stomach acid (hence green = obstruction)
If repeated vomiting -> bile from gall bladder coming up = more golden

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30
Q

Big complication of bowel obstruction

A

Necrosing bowel

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31
Q

Malrotation

A

Umbrella term but most common:

  • Lack of fixation to retro-peritoneum (-> volvulus + obstruction)
  • Narrow midgut mesenteric base
  • Can get abnormal attachment of caecum to right UPPER peritoneal cavity (Ladd bands) -> partial obstruction
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32
Q

Malrotation Sx

A
  • Bilious vomiting in neonate/infant < 1 y/o
  • Abdo pain
  • Distension + tenderness

Present earlier if more proximal ie in duodenum

When upper mesenteric artery gets compressed by Ladd bands -> tend to present at older age with malneutrition

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33
Q

Malformation Dx

A
  • Upper gastrosintestinal CONTRAST series
  • CT abdomen (with oral + IV contrast)
  • Abdo X-ray
  • FBC

Consider:

  • USS
  • Lower GI contrast
  • ABG
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34
Q

Malformation Tx

A

Urgent or timely surgery depending on if it has gone ischaemic or not

  • Open Laprotomy + Ladd band procedure

Pre op:

  • NG tube
  • Abx for gram -ve (cefotaxime)
  • IV fluid resuscitation

Post op: Bowel rest until activity resumes

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35
Q

Malformation complication

A

Volvulus -> Acute ischaemia -> Necrosis within a few hours

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36
Q

Pathophys of why bicarb increases in excess vomiting

A

Bicarb secreted from blood into intestine after acid leaves stomach

When acid can’t leave stomach - bicarb not secreted so get build up of bicarb in blood while acid is projectile vomited

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37
Q

Intussusception

A

Invagination (telescoping) of proximal bowel into diatal bowel (usually ileum into caecum)

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38
Q

Intussusception Epid

A
  • Primarily in 3 months - 2 YRS
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39
Q

Intussusception aet

A
  • can be triggered by recent/recurrent viral infection as bowel becomes hypermobile + enlargement of Payer’s patches
  • Lymphoid hyperplasia (acts as lead point for bowel to telescope)
  • Meckel’s diverticulum
  • Polyps (esp larger ones)
  • CF (increased viscosity -> blockage -> lead point)
  • Henoch-Schonlein Purpura (inflam)
  • Rotavirus vaccination

Can be idiopathic

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40
Q

Intussusception Sx

A
  • Severe, paroxysmal, COLICKY PAIN (child draws up leg to improve)
    • Lethargy + decreased activity inbetween
  • Refusing feeds
  • Vomiting - may be bilious
  • REDCURRENT JELLY (almost black) stool
  • DISTENSION
  • Susage shaped mass in RIF on palpation (not always)
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41
Q

Intussusception Ix

A
  • Abdo USS - Target sign (concentric echogenic + nonechogenic bands)
    - can also show free air or gangrene if present
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42
Q

Intussusception Mx

A
  • Rectal air inflation +/- contrast enema (can sometimes resolve in this way)
    - only if child is stable as if there is ischaemia - air inflation can cause perforation
  • Operative reduction if:
    - non-op failed
    - Child has PERITONITIS or PERFORATION
    - HAEMODYNAMIC INSTABILITY
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43
Q

DDx for RIF pain

A

GI:

  • Appendicitis
  • Intussusception
  • Inflamed Meckel’s diverticulum
  • Diverticulitis (more common in LIF)
  • IBD (esp CROHN’S - terminal ileitis)
  • Mesenteric adenitis

Gynae:

  • Ectopic preg (if gone through puberty)
  • Ovarian torsian
  • Ovarian cyst (torsion or rupture)
  • Pelvic Inflam Disease (lower abdo pain, fever, abnormal vaginal discharge - less common in kids)

Urology:

  • Pyelonepritis
  • Uretric colic (kidney stones related usually; can also get blood clots in PKD)
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44
Q

Meckel’s diverticulum

A

Outpouching in the distal ileum caused by persistance of VITELLINE DUCT during embryo development.

May contain ECTOPIC gastric / pancreatic tissue which can secrete acid.

45
Q

Meckel’s Px

A

Oft asymp + found incidentally

  • Painless rectal bleeding from ulceration of surrounding tissue if it contains ectopic gastric tissue which is secreting acid
  • Abdo pain from inflam
  • Intussusception
  • Obstruction (if herniated)
  • Perforation by foreign body (unusual)
46
Q

Meckel’s epid

A

Typically presents in infants / TODDLERS

47
Q

Meckel’s Ix

A
  • CT scan
  • 99mTC (technetium 99) scan
    - technetium injected IV -> highlights areas of gastric tissue on x-ray
  • Small bowel enema (not really done)

Oft found incidentally in surgery for something else

48
Q

Meckel’s rule of 2

A
  • male:female = 2:1
  • 2 feet proximal to caecum
  • oft ~ 2 inches long
  • ~2% of population
49
Q

Complications of Meckel’s

A
  • Intussusception / volvulus
  • Obstruction (in Littre’s hernia)
  • Perforation
  • Diverticulitis

HAEMORRHAGE

50
Q

Meckel’s Mx

A

Oft nothing needed but if presenting acutely:

  • Treat clinical issue e.g. obstruction or infection
  • Resect diverticulum (surgery)
51
Q

Pyloric stenosis

A

Hypertrophy of pyloric sphincter muscles -> narrowing + obstruction of gastric outlet

Typically progresses from birth so presents with projectile vomiting at ~6-8 WKS when the hypertrophy is significantly blocking

52
Q

Pyloric stenosis epidem

A
  • 1-3 per 1000 babies
  • Mainly in infants 6-8 WKS olds
    - as the hypertrophy progresses from the point of birth
  • More prevalent in MALES
53
Q

Pyloric stenosis RFx

A
  • FHx
  • MALE SEX
  • PREMMIES
54
Q

Pyloric stenosis Px

A
  • Post-prandial vomiting 6-8wks after birth
    - Usually PROJECTILE
    - Can increase in intensity as obstruction worsens
  • Palpable SMOOTH, OLIVE-SIZED mass in RUQ or Epigastric
  • Baby seems hungry + FAILING TO THRIVE
55
Q

Complications of pyloric stenosis

A
  • Metabolic ALKALOSIS (from loss of gastric acid + build up of bicarb)
    - Hypochloremic + Hypokalaemic
  • DEHYDRATION
56
Q

What causes the projectile vomiting in pyloric stenosis

A

Increasingly powerful peristalsis due to + combined with the pyloric hypertrophy

57
Q

Pyloric stenosis Ix

A
  • ABDO USS
    - Length >16-18mm and muscle wall thickness > 3-4 mm = pyloric stenosis
58
Q

Pyloric stenosis Mx

A

Supportive:

  • NIL by mouth + IV FLUIDS (may need fluid resus if very dehydrated)

Definitive:

  • Laproscopic PYLOROMYOTOMY - cuts hypertrophic smooth muscle + widens gastric outlet
    • good prognosis
59
Q

Toddler’s diarrhoea

A

Chronic diarrhoea of infancy
- Passing 3 or more loose/watery bowel movements a day for 2-4 wks or more

Typically in kids 1-5 y/o - more common in MALES

60
Q

Toddler’s diarrhoea Sx

A
  • Change in stool frequency/consistancy
  • Chills / Fever
  • Abdo pain / Cramping
  • Nausea / Vomiting

May see undigested food / Mucus in stools

Kids will usually seem well in themselves: normal weight, appetite + activity levels

More serious:

  • Bloody stools; Greasy stools
  • Weight loss
  • Severe abdo pain
61
Q

Complications of toddler’s diarrhoea

A
  • Malabsorption
  • Dehydration
62
Q

Toddler’s diaerrhoea aet

A
  • Underdeveloped digestive tract - food doesn’t stay in tract long enough for water to be sufficiently absorbed
  • Imbalanced diet - Excess fibre (shortens amount of time food is in tract) OR Low fat (fat normally slows food down in tract)
  • Inability to absorb carbs (typically those found in fruit juice)
  • CF
  • Coeliac’s
  • Food allergy
  • Acrodermatitis enteropathica (can’t absorb zinc)

Rare in neonates but can be caused by Congenital diarrhoea and Enteropathies (CODEs) - genetic mutations causing severe diarrhoea -> malabs, poor feeding + failure to thrive

63
Q

Toddler’s diarrhoea Ix

A

Examine + check BP/HR for signs of dehydration

  • Stool samples: blood?; MS+C
  • Bloods: Inlfam markers + cultures
  • X-rays: GI causes - anatomy?
  • Endoscopy/colonoscopy - location of inflam
  • BREATH HYDROGEN TEST - sugar intolerance
    - could be due to small intestinal bacterial overgrowth

Genetic testing for CODEs

64
Q

Toddler’s diarrhoea Mx

A
  • Diet managment: balanced diet, reduce fruit sugars + gluten
  • Oral rehydration if needed (sodium + 2% glucose)
  • Zinc supplementation
65
Q

Common sites of hernias in kids

A

Inguinal (typically indirect due to processus vaginalis remaining patent) + umbilical

66
Q

Main complication of hernias

A

Strangulation -> Ischaemia -> Necrosis -> sepsis + bowel perforation

  • surgical emergancy
67
Q

Strangulated hernias epid

A
  • less common in children
  • typically tend to be small hernias that go mostly unnoticed that tend to strangulate
68
Q

Strangulated hernia Px

A
  • Severe abdo pain (previously intermitant pain/bulging when hernia was reducible)
  • Vomiting
  • SIgns of bowel obs - distension, not passing stools
69
Q

Incarcerated vs Strangulated hernia

A

Incarcerated just means the hernia has become stuck and non-reducible but the blood supply may not be compromised
- stranulation specifically refers to compromised blood supply

70
Q

Strangulated hernia Ix

A
  • CT abdo - signs of ischaemia
  • Bloods: Inflam/infection
71
Q

Strangulated hernia Tx

A

Surgical repair

  • Release herniated bowel + restore blood flow
  • Remove any necrotic tissue (will cause sepsis otherwise)
  • Reinforce weakened area (Mesh or specific suturing technique) - to prevent recurrence
72
Q

Irritable Bowel Syndrome (IBS)

A

Chronic GI condition characterised by abdo pain / discomfort associated with change in bowel habits - but not identifiable structural/biochem abnormalities

73
Q

IBS Sx

A
  • Recurring/persistent abdo pain
  • Diarrhoea, constipation or both OR the pain is improved with defecation (pain may get worse)

May also get:
- altered passage (straining/urgency);
- bloating;
- mucus in stool
- tenesmus
- Sx worse on eating;

lethargy, nausea, back ache, headache, bladder problems etc

74
Q

IBS Dx

A

Clinical - if Sx have been present for at least 6 MONTHS

Stricter Dx criteria = ROME IV criteria:

  • Recurrent abdo pain at least 1 day per week in LAST 3 MONTHS
  • Sx started at least 6 months ago
  • Associated with 2 or more of following:
    • Pain is related to defecation
    • Change in frequency
    • Change in form
75
Q

IBS Ix

A

To rule out other causes mainly:

  • Bloods: anaemia, infection, digestive issues (e.g. coeliac)
  • Stool: MS+C, Fecal calprotectin
    • may do rectal exam to check constipation or tenderness

If other cause suspected:

  • Abdo USS
  • Upper GI endoscopy + biopsy
  • Colonoscopy
76
Q

IBS Tx

A
  • Balanced diet (Temporarily reduce FODMAPs)
  • Mental health therapies:
    - CBT
    - Gut-directed hypnotherapy
  • Consider probiotics

Consider Meds:

  • Antidepressants (SSRIs/Tricyclics)
  • Antispasmodics (mebeverine, hyosine bromide)
  • Peppermint oil capsules
  • Fiber supps
77
Q

Features of Crohn’s

A

Crows’ NESTS

  • No blood/mucus (more common in crohn’s)
  • ENTIRE tract affected
  • SKIP LESIONS
  • TRANSMURAL / Terminal ileum mostly
  • Smoking RISK FACTOR
78
Q

UC main features

A

U C CLOSEUP

  • CONTINUOUS inflam
  • Limited to COLON + RECTUM
  • ONLY SUPERFICIAL
  • Smoking PROTECTIVE
  • Excrete BLOOD + MUCUS
  • Use AMINOSALICYLATES
  • PRIMARY SCLEROSING CHOLANGITIS
79
Q

IBD presentation

A
  • Perfuse DIARRHOEA
  • Abdo PAIN
  • BLEEDING
  • Anaemia
  • WEIGHT LOSS
  • Systemic Sx: Fever, malaise, Dehydration
  • Failure to thrive + vit ADEK + B12 def (in crohn’s)

Comes in flares (remission + exacerbation)

80
Q

Extra-Intestinal manifestations of IBD

A

A PIE SAC

  • Aphthous ulcers (More common in Crohns)
  • Pyoderma gangrenosum
  • Iritis/Episcleritis
  • Erythema Nodosum
  • Sclerosing Cholangitis (Ulcerative colitis)
  • ANKYLOSING SPONDILITIS / Amyloidosis
  • CLUBBING (more in crohns)
81
Q

IBD Ix

A
  • Bloods: FBC - anaemia, WCC - infection, thyroid, kidney, LFTs, CRP, ESR, Albumin, Iron studies, B12 + folate
  • Faecal calprotectin (intestinal inflam)
  • Endoscopy (GOLD) - only DIAGNOSTIC TEST
  • Imaging - USS, CT, MRI - to check if anatomical complications suspected
82
Q

FIndings on endoscopy + biopsy of Crohn’s

A
  • Skip lesions
  • Cobble stone appearances with deep fissures
  • Deep transmural ulcers +/- fistulae or abscesses
  • Non-caseating granulomas
  • Cryptitis
83
Q

Colonoscopy + biopsy of UC

A
  • Continuous inflam
  • Not transmural
  • Only in colon / rectum
  • Crypt abscesses + irregular crypts
  • Anal abscess + perianal fissures more likely
84
Q

Inducing remission in Crohn’s

A
  1. Steroids
  2. Add immuno suppress
    • Azathioprine
    • Mercaptopurine
    • Methotrexate
    • Infliximab
    • Adalimumab
85
Q

Maintaining remission in Crohn’s

A
  1. Azathioprine / Mercaptopurine
  2. Methotrexate / Infliximab / Adalimumab

Surgical resection (not curative in crohn’s as it affects everything)

86
Q

Inducing remission in UC

A
  1. AMINOSALYCILATE (Mesalazine)
  2. STEROIDS

If severe (go straight to strong immunosuppres):

  1. IV STEROIDS
  2. IV CICLOSPORIN
87
Q

Maintaining remission in UC

A
  1. AMINOSALICYLATE
  2. Azathioprine
  3. Mercaptopurine

Surgery - requires ILEOSTOMY or ILEOANAL ANASTOMOSIS
- curative

88
Q

Coeliac disease pathophys

A

Autoantibodies made in response to GLIADIN (the digested product of gluten). CD8 cells also activated.

Targets gut epithelium ->

  • COMPLETE VILIOUS ATROPHY
  • CRYPT HYPERPLASIA
  • INTRAEPITHELIAL LYMPHOCYTES
89
Q

Coeliac Px

A

Oft asymp / vague -> low thershold to test:

  • FAILURE TO THRIVE
  • Fatigue
  • Weight loss
  • Diarrhoea / Steatorrhoea
  • MOUTH ULCERS
  • ANAEMIA
  • DERMATITIS HERPETIFORMIS (typically on abdo)

Rarely get neuro Sx: periph neuropathy, ataxia, epilepsy

90
Q

AutoAb associated with coeliac’s

A
  • Tissue transglutaminase antibodies (anti-TTG)
  • Endomysial antibodies (EMAs)
  • Deaminated gliadin peptides antibodies (anti-DGPs)

Make sure to check the patients total IgA and compare these to that as some people have IgA def

91
Q

Genetic associations (which tissue types)

A
  • HLA-DQ2 gene (90%)
  • HLA-DQ8 gene
92
Q

Coeliac Dx

A

Check IgA levels first for IgA def. Then:

  1. Anti-TTG
  2. Anti-EMA

ENDOSCOPY + BIOPSY:

  • Crypt hypertrophy
  • Vilious atrophy
  • Intraepithelial lymphocytes

All done while on a gluten including diet

93
Q

Coeliac is associated with which conditions

A
  • T1DM (always do coeliac scan for T1 diabetics even if no Sx)
  • Thyroid
  • Autoimmune hep
  • Primary BILIARY CIRRHOSIS
  • Primary sclerosing cholangitis
  • DOWN’S
94
Q

Complications of untreated Coeliac’s

A
  • Vitamin deficiency
  • Anaemia
  • Osteoporosis
  • Ulcerative jejunitis
  • Enteropathy-associated T-cell lymphoma (EATL) of the intestine
  • Non-Hodgkin lymphoma (NHL)
  • Small bowel adenocarcinoma (rare)
95
Q

Presentation of constipation

A
  • < 3 stools / week (tho this varies depending on the person)
  • Hard stool
    - Straining + painful passage
    - Rectal bleeding
  • RABBIT DROPPING stools
  • Abdo pain
  • Retentive posturing (to prevent defecation)
  • Fecal impaction -> OVERFLOW SOILING
    - particularly loose smelly stools
  • Palpable mass in abdo

May have lost the sensation to defecate

96
Q

How can constipation cause encopresis + what are other causes

A

Encopresis = fecal incontinence
- the hard stool in rectum becomes impacted -> stretches rectum -> loss of sensation -> only loose stools able to bypass blockage - leak out

Also caused by:

  • Neuro problems:
    • spina bifida
    • Hirchsprung’s
    • Cerebral palsey / Learning disability
  • Psychosocial stress / Abuse
97
Q

Lifestyle factors that can cause constipation

A
  • Habitually not defecating
  • Low fibre diet
  • Dehydration
  • Sedentary lifestyle
  • Psychosocial problems
98
Q

Red flags of constipation

A
  • Not passing meconium within 48hrs of birth
  • Neuro signs (spinalc cord/cerebral palsey)
  • Vomiting (obstruction)
  • Ribbon stool (Anal stenosis)
  • Abnormal anus (stenosis, IBD, abuse)
  • Abnormal lower back or buttocks (spina bifida; cord lesion; sacral agenesis)
  • Failure to thrive (coeliac, hypothyroid, neglect)
  • Acute severe abdo pain + bloating (obs or intussusception)
99
Q

Complications of constipation

A
  • Pain
  • Anal fissures
  • Haemorrhoids
  • Loss of sensation
  • Overflow + soiling
  • Psychosocial morbidity
100
Q

Constipation Mx

A
  • Correct reversible lifestyle factors e.g. diet + fluids
  • LAXATIVES:
    - Movicol
    - Disimpaction regimen with high dose laxatives for impaction
  • Encourage going to loo:
    - Schedule visitis, keep bowel diary + star chart

Wean of laxatives as more normal bowel habits developed

Make sure to investigate + manage potential serious underlying causes + reassure family if it is idiopathic

101
Q

Gastroenteritis

A

Common paediatric condition - inflam of stomach + intestines -> nausea, vomiting + diarrhoea

Viral is most common + easily spread so must keep isolated

102
Q

Viral causative organisms of gastroenteritis

A
  • Rotavirus
  • Norovirus
  • Adenovirus (less common + more subacute)
103
Q

Bacterial causes of gastroenteritis

A
  • E coli
  • Campylobacter jejuni
  • Salmonella
  • Shigella
  • Bacillus cereus
    - vomiting within 5 hrs; watery diarrhoea after 8hrs; resolves within 24hrs
  • Yersinia Enterocolitics
  • Staph aureus enterotoxin
  • Giardia

Please read the zero to finals page or your notes from last year to get info about each organism

104
Q

Gasteroenteritis Mx

A
  • Infection control + barrier nursing
    - Quarantine till 48hrs after Sx finished
  • MS+C of stool to get cause
  • Fluid challange / rehydration to keep hydrated
    - May need IV if can’t drink
  • Light, dry diet once oral intake tolerated

Only give Abx if risk of complications + specific causative organism is known

DON’T give anti diarrhoeal or antiemetic

105
Q

Possible complications post Gasteroenteritis

A
  • Lactose intolerance
  • IBS
  • Reactive arthritis
  • Guillain-Barre syndrome
106
Q

Oesophageal atresia

A

Lower + upper parts of oesophagus aren’t connected
- sometimes connected to trachea

107
Q

Gastroschisis vs exomphalos

A

Gastroschisis = bowels outside body, usually to right of belly button

Exomphalos = bowels form inside umbilical cord - will be contained within a sac

108
Q
A

Phase 3a (26 decks)

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