Upper and Lower GI Disorders Flashcards
What are the signs and symptoms of constipation?
- Hard, painful stool
- Poor appetite
- Irritable
- Lack of energy
- Abdominal pain or distension
- Withholding or straining
- Diarrhoea
Why can children become constipated?
- Poor diet: insufficient fluids and excessive milk
- Potty training/ school toilet
- Intercurrent illness
- Medications
- Family history
- Psychological
- Organic
How can constipation be treated?
- Parent education
- Change in diet
- Reduce aversive factors
- Laxatives: osmotic laxatives (lactulose), stimulant laxatives (senna, picolax) and isotonic laxatives (movicol)
What are the advantages and disadvantages of using laxatives for constipation?
- Advantages: non invasive and given by parents
- Disadvantages: non compliance and side effects
- Empty impacted rectum
How does Crohn’s disease present in children?
- Weight loss
- Growth failure
- Abdominal pain
- Arthritis, mass, diarrhoea and rectal bleeding
How does UC present?
- Diarrhoea
- Rectal bleeding
- Abdo pain
- Tend not to get as many systemic symptoms as Crohn’s
What are you looking for on a history and examination in a child with suspected IBD?
- Intestinal symptoms
- Extra-intestinal manifestations (joint pain, red, painful, blurry eyes)
- Exclude infection
- FH
- Growth and sexual development
- Nutritional status
Which investigations would you do in a child with suspected IBD?
- FBC: anaemia, thrombocytosis and raised ESR
- Biochemistry: stool calprotectin , raised CRP and low albumin
- Microbiology: no stool pathogens
- Endoscopy and colonoscopy
- Mucosal biopsy
- MRI
- Barium meal
How is IBD managed in children?
- Induce and maintain remission
- Correct nutritional deficiencies
- Maintain normal growth and development
- Promote quality of life and normal psycho-social development
Name the methods of treatment for IBD
- Medical: anti-inflammatories (5-ASA), immunosuppressants (steroids), thiopurines and biologics (infliximab)
- Nutritional: immune modulation and nutritional supplementation
- Surgical
Name the stages of vomiting with retching
- Pre ejection: pallor, nausea and tachycardia
- Ejection: retch and vomit
- Post ejection
Name the causes of stimulation of the vomiting centre
- Enteric pathogens
- Intestinal inflammation
- Metabolic derangement
- Infection
- Head injury
- Visual stimuli
- Middle ear stimuli
How does pyloric stenosis present?
- Babies 4-12 weeks
- Projectile non-bilious vomiting
- Weight loss
- Dehydration +/-shock
- Metabolic alkalosis
- Hypochloraemia
- Hypokalaemia
How can pyloric stenosis be managed?
- Fluid resus
- Surgery: Ramstedts pyloromyotomy
What are the causes of bilious vomiting?
- Intestinal obstruction until proved otherwise
- Intestinal atresia
- Malrotation +/- volvulus
- Intussusception
- Ileus
- Crohn’s disease with strictures
How can bilious vomiting investigated?
- Abdo XR
- Contrast meal
- Surgical opinion re exploratory laparotomy
What is the main cause of effortless vomiting?
Gastro-oesophageal reflux
In which cases does gastro-oesophageal reflux not resolve on its own?
- Cerebral palsy
- Progressive neurological problems
- Oesophagial atresia +/- TOF operated
- Generalised GI motility problem
How does reflux present?
- Vomiting
- Haematemesis
- Feeding problems
- Failure to thrive
- Apnoea
- Cough
- Wheeze
- Chest infections
- Sandifer’s syndrome
How can reflux be assessed?
- History and exam
- Video fluroscopy
- Barium swallow
- pH study
- Oesophageal inpedance monitoring
- Endoscopy
How can reflux be treated?
- Feeding advice (thickness, texture, feeding position etc.)
- Nutritional support (calorie supplements, exclusion diet, NG tube and gastrostomy)
- Medical treatment (feed thickener, prokinetic drugs and acid suppressing drugs)
- Surgery
What are the indications for surgery for reflux?
Persisten failure to thrive, aspiration and oesophagitis
What is the definition of chronic diarrhoea?
4 or more stools a day for more than 4 weeks
What are the causes of diarrhoea?
- Toddler diarrhoea
- IBS
- Acute infective diarrhoea
- IBD
- Food allergy
- Coeliac disease
- CF
What are the features of osmotic diarrhoea?
- Movement of water into the bowel
- Usually a feature of malabsorption
- Generally accompanied by macroscopic and microscopic intestinal injury
- Clinical remission with removal of causative agent
- Mechanism of action of lactulose and movicol
What are the features of secretory diarrhoea?
- Associated with toxin production from vibrio cholerae and E coli
- Intestinal fluid secretion predominantly driven by active chlorine secretion via CFTR
What are the causes of motility diarrhoea?
- Toddlers diarrhoea
- IBS
- Congenital hyperthyroidism
- Chronic intestinal pseudo-obstruction
What are the features of inflammatory diarrhoea?
- Malabsorption due to intestinal damage
- Secretory effect of cytokines
- Accelerated transit time in response to inflammation
- Protein exudate across inflamed epithelium
How can diarrhoea be assessed?
- Age at onset
- Abrupt/gradual onset
- FH
- ? Nocturnal defecation
- Growth and weight gain of child
- Faeces analysis: appearance and stool culture
What are the causes of fat malabsorption?
- Pancreatic disease: CF
- Chronic liver disease
- Cholestasis
How does coeliac disease present?
- Abdominal bloatedness
- Diarrhoea
- Failure to thrive
- Short stature
- Constipation
- Tiredness
- Dermatitis herpatiformis
Which tests can be done for coeliac disease?
- Anti tissue transglutaminase
- Anti endomysial
- Anti gliadin
- IgA
- Duodenal biopsy
- Genetic testing: HLA DQ2 and DQ8
