3 - Paeds - Gastro - IBD Flashcards
% of patients that present in childhood/adolescence? results from?
CD vs UC - where?
25%
results from env triggers in genetically predisposed individual
CD - whole GIT
UC - just colon
CD-
Classical presentation (25%)?
General ill health features?
Extra-intestinal manifestations?
abdo pain, wt loss, diarrhoea
fever, lethargy, wt loss, growth failure, puberty delayed
oral lesions OR perianal skin tags, uveitis, arthralgia, erythema nodosum
CD-
may be mistaken for ? What confirms diagnosis?
mistaken for psych problems (delaying diagnosis)
confirmation -> raised infl markers (ESR, CRP, Platelets), IDA, low serum albumin
CD-
describe disease? where mostly? initially what? then?
transmural, focal (skip lesions), subacute/chronic inflam disease, mostly distal ileum/prox colon
initially acutely inflamed, thickened portions of bowel > strictures/fistula develop
CD-
imaging???
diagnosis by endoscopy/biopsy
upper GI endoscopy, ileocolonoscopy, and small bowel imaging required (narrowing fissures, mucosal irreg, thickening)
CD- MGMT - how to induce remission? if ineffective? how to maintain remission?
with nutritional therapy, 6-8wk whole protein modular feeds
if ineffective use systemic steroids
immunosuppressant medication (azathioprine, methotrexate)
CD- MGMT - if conventional trt fails? what else is normally needed? when is surgery indicated?
Anti-TNF-a’s (infliximab)
supplemental enteral nutrition to correct growth
surgery for complx -> obstruction, fistula, abscess, severe localised disease
UC- describe disease? 3 main presentation points? what Sx are less frequent than in CD? extra-intestinal manifestations?
recurrent inflam/ulcerating disease of colon mucosa
presents with rectal bleeding, diarrhoea, colicky pain
wt loss/growth failure less common
arthritis/erythema nodosum
UC- Diagnosis? must rule out what? why is small bowel imaging done?
endoscopy - confluent colitis from rectum proximally, 90% kids have pancolitis)
histology - mucosal inflam/cryptitis/ulceration
AFTER EXCLUSION OF INFECTION
small bowel imaging -> r/o extra colonic inflammation
UC- MGMT - mild? if disease confined to rectum/sigmoid? Aggressive/extensive?
aminosalicylates (mesalazine) for induction/maintenance
topical steroids
systemic steroids for acute exacerbations and immunomodulation eg azathioprine to maintain remission
UC- MGMT - severe fulminant disease? what if trt fails?
medical emergency, req trt with IV fluids and steroids
ciclosporin
UC- MGMT - when do surgery? what surgery?
UC gives increased risk of?
severe -> toxic megacolon/chronic poorly controlled disease -> colectomy with ileostomy/ileorectal pouch
increased risk of adenocarcinoma
