Pediatric Gastroenterology Flashcards
Second only to respiratory illnesses, this is the most common reason children see us
GI complanints
Stomach pain can arise from
strep throat
UTI
food allergy
Visual inspection
Distention, discoloration, veins, jaundice, scars, ostomies
Bowel sounds
Normal, hypo or hyperactive, absent, high pitched
Palpation
Organomegaly, retained feces, masses
Rectal exam
Masses, fissures, abscesses, fistulas, rectal tone, content
Abdominal Pain in Children
Frequent presentation
Often benign or associated with another illness
Can be difficult to assess severity (FACES scale)
For frequent or persistent pain, ask the parent “ Can you tell when the child is in pain, or only if they tell you?”
When pain is severe, (>6/10) a child will not be very functional.
When there are psychological overtones, pain may be experienced as much more severe than appears. Typical for chronic pain
Abrupt onset of abd pain can indicate a
bowel obstruction, rupture
Gradual onset of abd pain is likely
inflammatory – appendicitis, inflammatory bowel
Common Diagnoses in Children with Acute Abdominal Pain
Viral illness Acute gastroenteritis Food intolerance Pneumonia Gastritis (food related or post-infectious) Constipation UTI
Chronic Abdominal Pain in Children
Will affect over 10% of all children at some point
Peak incidence between age 7-12 years
Extensive differential diagnosis
Most children have a benign process
warning signs of underlying illness
Vomiting Abnormal lab tests Fever Bilious emesis Growth failure/weight loss Pain wakens child from sleep Blood in stool or emesis Location other than periumbilical
When to assess as opposed to offering reassurance
Anxious child
Anxious parent
Missed school
Comprehensive history of chronic abd pain
Family history of GI disorders (think about role modeling)
Family history of anxiety
Careful dietary history- especially too much of one thing, not enough variety
Lifestyle history – sleep, meals, school, stressors
Lab assessment of chronic pelvic pain
CBC, ESR, CRP
Amylase, lipase
ALT, AST, GGT, bilirubin
Urinalysis
Common Causes of Chronic Abdominal Pain in Children
Functional abdominal pain
Irritable bowel syndrome
Functional abdominal pain
Often will have daily episodes of pain
Not associated with meals, bowel movements
Tendency toward anxiety and perfectionism
No warning signs present
Irritable bowel syndrome
Subset of functional abd pain
Associated with alternating diarrhea and constipation
Symptoms linked to gut motility
Treatment of Functional Abdominal Pain
Will rule out any possible causes first
Particularly focus on possible dietary intolerances
Encourage participation in school and activities
Do not treat as “sick”
Avoid giving medications as an initial placebo effect will often drive a demand to try different medications every few weeks as the placebo effect wears off.
Vomitting and diarrhea
one of the most common office visits
a great place to find zebras
newborn V/D
special circumstances are rarely typical
vomitting in newborn
obstruction stomach/small bowel/malrotation/imperforate anus feeding intolerance ingested maternal blood metabolic disease
diarrhea in newborn
allergic diarrhea
overfeeding
malabsorption
vomitting infant or child
viral illness
normally in an outbreak
febrile
acute onset
