Gastroenterology Lecture Flashcards
(25 cards)
Differentials for vomitting after feeds
- GORD (if more than 4 months) otherwise GOR
- Cows milk protein intolerance
- Can be normal posseting +/- overfeeding (sphincter not strong)
Management of vomitting after feeds
- Observe feeds, get health visitor involved
- Trial of GOR advice - technique of bupring, smaller feeds, keeping upright after feeding
- Trial of CMP free
- GOR meds - eg PPI, milk thickener, gaviscon
Management of functional constipation
- Dietary advice inc fibre advice
- Good fluid intake
- Exercise
- Toilet training with encourgagement system (eg rewards)
Meds:
* Disimpaction regime (higher doses laxatives) - from home unless obstructive features
* Then maintenance regime
* Macrogol (osmotic laxatives) first line (eg Movicol), stimulant 2nd line
Red flags for constipation in children
- Not passing meconium within 48 hours of birth (cystic fibrosis or Hirschsprung’s disease)
- Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)
- Vomiting (intestinal obstruction or Hirschsprung’s disease)
- Ribbon stool (anal stenosis)
- Abnormal anus (infection, stenosis, inflammatory bowel disease or sexual abuse)
- Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)
- Failure to thrive (coeliac disease, hypothyroidism, cystic fibrosis or safeguarding issues)
- Acute severe abdominal pain and bloating (obstruction or intussusception)
3 important underlying causes of constipation in children
- Hirschprungs
- Spina bifida
- Cerebral palsy
How to test for Hirchsprungs
Rectal biopsy
Differentials for abdominal pain, failure to gain weight, pale loose stools
- Coeliac disease
- IBD
- Cystic fibrosis
- Overflow diarrhoea
- Poor diet and iron deficiency
- Other intolerance eg lactose
Coeliac disease is linked to which other AI disease
- Type 1 diabetes
- Thyroid disease
- Screened for coeliac disease if have these
Also Down syndrome is related
Where is gluten present? - which foods
Wheat
Barley
Rye
Testing for coeliac disease
- Total IgA level
- Anti-TTG - tissue transglutaminase
- Anti-EMA - endomysial
Then endoscopy + jejunal biopsy = crypt hyperplasia and villous atrophy
Complications of coeliac disease
- Nutritional deficiency
- Hyposplenism
- Anaemia
- Osteoporosis
- Cancer - small bowel lymphoma - enteropathy associated T cell lymphoma, NHL, small bowel adenocarcinoma
Differentials for high frequency diarrhoea including at night, pain when needing to open bowels for 6 weeks
- IBD
- IBS
- Giardia, C.diff, campylobacter, salmonella / other infection
IBD vs IBS
IBD:
* Unwell child - appear tired
* Maybe blood in stool
IBS:
* Seem well
Investigations for ?infection/IBD/IBS
- Stool microscopy and culture - need to check if fecal calprotectin is true (infection inflammation can cause false +ve)
- Fecal calprotectin - for IBD
- Bloods - FBC (?anaemia, high Plt for inflam), CRP (inflam), ESR, ferritin (inflammation)
- Colonoscopy + biopsy
- Upper GI endoscopy for ?Crohns
Management of IBD in children - broad
- Monitor growth
- Monitor pubertal development
- Monitor bone health - if using steroids
- Induction and maintenance regime
Acute management for UC
- IV steroids
Acute management for Chrohns
- Liquid diet enteral nutrition - for 8 weeks (esp if concerns re growth re steroids)
- Steroids (can sometimes add other immune drugs on top)
Maintenance for UC
- Aminosalicylates (e.g., oral or rectal mesalazine) first-line
- Azathioprine
- Mercaptopurine
Maintenance for Crohns
Azathioprine
Mercaptopurine
Functional gastrointestinal disease (FGID) - umbrella term for
- No underlying cause found - to do with gut-brain relationship eg:
- Abdominal migraine
- IBS
- Functional abdominal pain
- Functional dyspepsia - nausea no vomitting
What is important to check re GI symptoms and timing?
- Is there relationship with setting? eg does it happen at school?
Differentials for neonate with jaundice <24hrs
Always pathological (and if occurs after few weeks too)
* rhesus haemolytic disease
* ABO haemolytic disease
* hereditary spherocytosis
* glucose-6-phosphodehydrogenase
Jaundice cause day 2-14
- Usually normal - related to liver function, RBC fragility
Cause of jaundice after 14 days of birth
- Biliary atresia
- Hypothyroidism
- Galactosaemia
- Urinary tract infection
- Breast milk jaundice
- Prematurity
- Congenital infections
