Pediatric GI Issues

Question 1

c. Suggest initial investigations for dysphagia

Answer 1

barium swallow

consider PPI

early referral to GI

Question 2

c. Suggest initial investigations for abdo pain

Answer 2

CBC, CRP

Iron stores, liver enzymes, lipase, electrolytes, albumin

Celiac (TGA, EMA)

Question 3

• History:
o HPI: location of food sticking, solid v liquids, food types, reflux sx, regurg sx, progressive

o PMHx: asthma, allergies, eczema o Family history: asthma, allergies, eczema, EoE

DDX?

Answer 3

EOSINOPHILIC ESOPHAGITIS

M>F:

Mechanism: isolated eosinophilic infiltration of esophagus. Thought to be triggered by food

Symptoms:
• Adolescents: dysphagia, food sticking, impaction
• Younger Children: vomiting, dysphagia, GERD, FTT

Question 4

management of eosinophilic esophagitis

Answer 4

Management:
• Elimination diet or dietary modification. If allergen is found, can reverse disease
• Topical steroids, trial of PPI Complications: chronic, strictures and dysmotility are common

Question 5

primary risk factors for celiac disease

Answer 5

Populations at risk: white northern european

Celiac is less common in chinese, japanese.

Primary Risk factors for celiac disease: 1st degree relative with celiac disease, type I DM, trisomy 21, igA def, Autoimmune conditions like Thyroid, JJIA, syndromes (turner, williams)

Question 6

symptoms of celiac disase

Answer 6

Definition: gluten-induced enteropathy→ immune-mediated, genetically sensitive individuals

Presentation:

Classic form is rare: malabsorption, diarrhea, bloating, gas, FTT

Atypical: fatigue, iron def, infertility, rash

Silent: first degree relatives, asymptomatic, may have unrecognized symptoms.

Question 7

confirmatory test of celiac disase

Answer 7

biopsy. Diagnosis: Biopsy is confirmatory→ endoscopy. DO NOT start gluten free diet until you do the endoscopy.

Question 8

key genetics for celiac disease

Answer 8

Genetics: HLA alleles: DQ2 and DQ8. → positivity in DQ2/8 is necessary but not sufficient for the dx of CS. However, negatively in both DQ2 and 8 makes celiac disease extremely unlikely.

Question 9

management of celiac disease

Answer 9

gluten free for life

Question 10

T/f you can try eliminating gluten from the diet before doing teh biopsy

Answer 10

false. need a endo biopsy to confirm celiac

Question 11

in addition to doing the biopsy and genetics, what other markers are an indicator for celiac disease

Answer 11

o First line: TTG (IgA); Second line: EMA (IgA)

Question 12

orally ingested protein leads to inflammatory response in colon, leading to ___ ___. Often occurs in 2-8 week old infants

Answer 12

allergic colitis/food protein induced colitis.

Question 13

Management of allergic colitis/food protein induced colitis.

Answer 13

Management:
• Exclusively breast fed: remove all cow’s milk + soy

• Formula fed: protein hydrosylate formula
• Reintroduce diary over 3-5d. Long term food allergy/colitis is RARE

Question 14

definition of biliary atresia

Answer 14

progressive disease of bile ducts where the bile ducts are replaced by fibrous cords, causing neonatal cholestasis

Question 15

what kind of bilirubinemia does biliary atresia cause?

Answer 15

increase in DIRECT hyperbilirubinemia

Complications: 80% of infants die by 12mo and almost 100% die by 3yo