Upper and Lower GI - Part 2 Flashcards
What is constipation?
Infrequent passage of stool
Normal range of frequency differs
Depends on age and diet
What are the other signs and symptoms with constipation?
Poor appetite, irritable, lack of energy, abdominal pain or distention and withholding/ straining
Diarrhoea
Why do children become constipated?
Social - poor diet, potty training and excessive milk
Physical - intercurrent illness and medication (Gaviscon and opiates)
Physiological
Organic
What is the vicious cycle in constipation?
Pain or anal fissure - withholding of stool - constipation - large hard stool - continues
What is the treatment of constipation - social?
Dietary - increased fibre, fruit, veg, fluids and decrease milk
What is the treatments for phycological factors of constipation?
Reduce aversive factors - make going to the toilet more pleasant
Soften stool and remove pain
Reward good behaviour
What are the treatment of constipation?
Soften stool and stimulate defaecation - osmotic laxatives (lactulose), stimulant laxatives (senna and picosulphate) and isotonic laxatives (Movicol and laxido)
What are the advantages and disadvantages of laxatives?
Non-invasive and given by parents
Non-compliance and side effects - crampy tummy ache
What are the effects of mega-rectum?
Pressure on urethra and bladder - leading to UTIs and urinary retention
Soiling
What is the treatment of severe constipation?
Empty impacted rectum, empty colon, maintain regular stool passage, slow weaning off treatment and ensure compliance
What are the presenting features of Chron’s disease and UC?
Diarrhoea + rectal bleeding (more in UC), abdominal pain, fever, weight loss + growth failure in Chron’s, arthritis and mass in Chron’s
What signs are seen in Chron’s disease and UC?
Erythema nodosum in Chron’s more commonly
Oral changes - rolled edge ulcers in Chron’s
Perianal changes - elephant ear tags
What are the investigations for Chron’s disease and UC?
FBC, ESR, anaemia, thrombocytosis, stool calprotectin, raised CRP and low albumin
No stool pathogens - microbiology
What are the differences in adult and paediatric IBD prevalence?
More unclassified IBDU in paediatrics
More Chron’s seen in paediatrics
More males present in paediatrics
Children - UC have pancolitis and Chron’s have ileocolonic + upper GI/ pan-enteric
What are the definitive investigations for IBD?
Radiology in Chron’s - MRI and barium meal
Endoscopy - colonoscopy and upper GI endoscopy
Mucosal biopsy, capsule enteroscopy and enteroscopy
What could be seen in UC on colonoscopy?
Crypt abscesses
Contact bleeding
Mucus/ pus seen
What could be seen on colonoscopy for Chron’s disease?
Serpiginous ulcers
What are the aims of treatment in IBD?
Induce and maintain remission
Correct nutritional deficiencies
Maintain normal growth and development
What are the methods of treatment for IBD?
Anti-inflammatory, immunosuppressive and biologics (Infliximab)
Nutritional - immune modulation and nutritional supplementation
Surgical
What is the bottom up treatment for Chron’s disease?
Polymeric diet or oral prednisolone
Steroid sparing agents azathioprine/ 6MP or methotrexate
Biologicals - Infliximab and adalimumab
Surgery
