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Flashcards in Abdominal pain II Deck (19):

What is the most common cause of gastroenteritis?



What is assessed in a patient suspected of gastroenteritis?

Assess for signs of dehydration and shock:
- Peripheral skin temperature
- Appearance of skin: Mottled or pale?
- HR: Tachycardia?
- Urine output: decreased?
- Alert and responsive? or drowsy?


What is the main sign of gastroenteritis?

Loose or watery stools for at least 3 times in 24 hours.


Which children is at a higher risk of dehydration?

- Children <1 year old, particularly < 6 months old
- Infants of low birthweight
- Children who vomited for more than twice in 24 hours
- Children who passed diarrhoeal stools for more than 5 times in 24 hours
- Signs of malnutrition


When will case of gastroenteritis be concerning?

Gastroenteritis is concerning/worrying if:
- child has not passed urine in the previous 12 hours
- child has not improved within 48 hours, or the overall condition is worsening
- Child is at high risk of dehydration
- Child has a history of premature birth or chronic medical conditions such as cardiac or renal disease.


What drinks are discouraged in children with gastroenteritis?

Discourage drinking of fruit juice and carbonated drinks.


What is the treatment for children with clinical signs of dehydration but can be managed at home?

Use Oral Rehydration Salt (ORS) solution to rehydrate:
Children <5 years old: give 50mL/kg body weight in addition to maintenance fluid
Children >5 years old: give 200mL of ORS solution after each loose stool

Avoid solid food until dehydration is corrected.


When is stool sample analysis required?

If there is blood or mucus in stools
If the child is immunocompromised.
If the child has a recent hospitalisation and/or is on antibiotics.


When is Coeliac disease usually presented? What are the signs?

Coeliac disease is usually presented in children before 2 years of age with failure to thrive, irritability, anorexia, vomiting and diarrhoea, abdominal distension and wasted muscles in the buttocks.


How are the stools like in Coeliac disease?

In Coeliac disease, the stools are pale and foul-smelling


What test is done to diagnose Coeliac disease?

Serology Test for presence of IgA tissue Transglutaminase antibodies and total IgA, or anti-endomysial antibodies as alternative screening.
Definitive diagnosis is made if there is subtotal villous atrophy on jejunal biopsy.


Coeliac disease is associated with which 2 other conditions?

Diabetes and Down's syndrome


What is the only effective treatment for Coeliac disease?

Avoid gluten in food, but rechallenge with gluten after 2 years when there may be full regeneration of the villi.


What are the signs and symptoms of Coeliac disease?

Unexplained GI symptoms like bloating, indigestion, diarrhoea and constipation.
Faltering growth in children
Iron, Vitamin B12 and folate deficiency.
Weight loss
Severe or persistent mouth ulcers


What is the management of Cow's milk protein intolerance?

Hydrolysed protein formula milk


What are the signs and symptoms of Cow's Milk Protein Intolerance?

Diarrhoea, that may be bloody
Urticaria rash (in IgE-mediated allergy)


How different are the onset of IgE-mediated and non-IgE mediated Cow's milk protein intolerance?

IgE-mediated onset is often acute (up to 2 hours after ingestion)
Non-IgE mediated onset is non-acute and generally delayed for 48 hours or 1 week after ingestion before symptoms are presented.


What is the skin reaction in Non-IgE-mediated Cow's milk protein intolerance?
What is the skin reaction in IgE-mediated Cow's milk protein intolerance?

Atopic eczema in Non-IgE mediated CMPI

Acute urticaria and/or acute angioedema in IgE-mediated CMPI


What are the complications of coeliac disease?

- Anaemia, such as iron deficiency anaemia
- Folate and vitamin B12 deficiency
- Osteoporosis due to malabsorption of calcium and/or vitamin D