Upper and Lower GI Disorders Flashcards
1
Q
What are the signs and symptoms of constipation?
A
- Hard, painful stool
- Poor appetite
- Irritable
- Lack of energy
- Abdominal pain or distension
- Withholding or straining
- Diarrhoea
2
Q
Why can children become constipated?
A
- Poor diet: insufficient fluids and excessive milk
- Potty training/ school toilet
- Intercurrent illness
- Medications
- Family history
- Psychological
- Organic
3
Q
How can constipation be treated?
A
- Parent education
- Change in diet
- Reduce aversive factors
- Laxatives: osmotic laxatives (lactulose), stimulant laxatives (senna, picolax) and isotonic laxatives (movicol)
4
Q
What are the advantages and disadvantages of using laxatives for constipation?
A
- Advantages: non invasive and given by parents
- Disadvantages: non compliance and side effects
- Empty impacted rectum
5
Q
How does Crohn’s disease present in children?
A
- Weight loss
- Growth failure
- Abdominal pain
- Arthritis, mass, diarrhoea and rectal bleeding
6
Q
How does UC present?
A
- Diarrhoea
- Rectal bleeding
- Abdo pain
- Tend not to get as many systemic symptoms as Crohn’s
7
Q
What are you looking for on a history and examination in a child with suspected IBD?
A
- Intestinal symptoms
- Extra-intestinal manifestations (joint pain, red, painful, blurry eyes)
- Exclude infection
- FH
- Growth and sexual development
- Nutritional status
8
Q
Which investigations would you do in a child with suspected IBD?
A
- 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
9
Q
How is IBD managed in children?
A
- Induce and maintain remission
- Correct nutritional deficiencies
- Maintain normal growth and development
- Promote quality of life and normal psycho-social development
10
Q
Name the methods of treatment for IBD
A
- Medical: anti-inflammatories (5-ASA), immunosuppressants (steroids), thiopurines and biologics (infliximab)
- Nutritional: immune modulation and nutritional supplementation
- Surgical
11
Q
Name the stages of vomiting with retching
A
- Pre ejection: pallor, nausea and tachycardia
- Ejection: retch and vomit
- Post ejection
12
Q
Name the causes of stimulation of the vomiting centre
A
- Enteric pathogens
- Intestinal inflammation
- Metabolic derangement
- Infection
- Head injury
- Visual stimuli
- Middle ear stimuli
13
Q
How does pyloric stenosis present?
A
- Babies 4-12 weeks
- Projectile non-bilious vomiting
- Weight loss
- Dehydration +/-shock
- Metabolic alkalosis
- Hypochloraemia
- Hypokalaemia
14
Q
How can pyloric stenosis be managed?
A
- Fluid resus
- Surgery: Ramstedts pyloromyotomy
15
Q
What are the causes of bilious vomiting?
A
- Intestinal obstruction until proved otherwise
- Intestinal atresia
- Malrotation +/- volvulus
- Intussusception
- Ileus
- Crohn’s disease with strictures
