Gastrointestinal Flashcards
(165 cards)
1
Q
What types of vomiting can a child experience?
A
- Vomiting with Wretching
- Projectile vomiting
- Billous vomiting
- Effortless vomiting
2
Q
What is possetting?
A
Small amount of regurgitated milk which often accompanies expulsion of swallowed air
3
Q
How does possetting differ from regurgiation?
A
Regurgitation is larger volumes resulting in bigger volume losses
4
Q
Why is regurgitation important whereas possetting not?
A
Pssetting occurs in nearly all babies, whereas regurgitation could indicate the presence of GORD
5
Q
What are the phases of the vomiting reflex?
A
- Pre-ejection - Pallor, nausea, Tachycardia
- Ejection - Retch, Vomit
- Post-ejection - Weakness, shivering, lethargy
6
Q
What are the red flags in a vomiting child?
A
- Bilious vomiting
- Haematemesis
- Projectile vomiting
- Coughing after paroxysmal coughing
- Abdominal tenderness/pain on movement
- Abdominal distention
- Hepatospenomegaly
- Bloody stool
- Shock/severe dehydration
- Bulging fontanelle/seizures
- Faltering Growth
7
Q
What does bile stained vomit suggest?
A
Intestinal obstruction
8
Q
What would haematemesis suggest?
A
- Oesophagitis
- Peptic ulcer
- Oral/nasal bleeding
9
Q
What would projectile vomiting suggest?
A
Pyloric stenosis
10
Q
What would vomiting after paroxysmal coughing suggest?
A
Pertussis
11
Q
What would vomiting with abdominal tenderness/pain on movement suggest?
A
Surgical abdomen
12
Q
What would vomiting with abdominal distention suggest?
A
Intestinal obstruction
(incl. strangulated inguinal hernia)
13
Q
What would vomiting with hepatosplenomegaly suggest?
A
Chronic liver disease
14
Q
What would vomiting with blood in the stool suggest?
A
- Intussuception
- Gastroenteritis - salmonella or campylobacter
15
Q
What are possible causes of vomiting with severe dehydration/shock in a child?
A
- Pyloric stenosis
- Severe gastroenteritis
- Systemic infection - UTI, meningitis
- Diabetic ketoacidosis
16
Q
What would vomiting with seizures/bulging fontanelles suggest?
A
Raised ICP
17
Q
What would vomiting with faltering growth suggest?
A
- GORD
- Coeliac disease
- Other GI conditions - IBD etc
18
Q
What can cause vomiting in infants?
A
- Pyloric stenosis
- GORD
- Feeding problems
- Infection - gastroenteritis, respiratory, pertussis, UTI, Meningitis
- Dietary Protein Intolerance
- Intestinal obstruction
- Inborn metabolic problems
- Renal failure
- Congenital adrenal hyperplasia
19
Q
What can cause intestinal obstruction in infants?
A
- Pyloric stenosis
- Duodenal atresia
- Intussuception
- Malrotation
- Volvulus
- Strangulated inguinal hernia
- Hirschprungs disease
20
Q
What can cause vomiting in pre-school children?
A
- Gastroenteritis
- Infection - resp tract, otitis media, UTI, pertussis, meningitis
- Appendicitis
- Intestinal obstruction
- Raised ICP
- Coeliac disease
- Renal failure
- Inborn errors of metabolism
- Torsion of the testis
21
Q
What can cause intestinal obstruction in pre-school children?
A
- Intusucception
- Malrotation
- Volvulus
- Adhesions
- Foreign Body - bezoar
22
Q
What can cause vomiting in school age and adolescents?
A
- Gastroenteritis
- Infection - including pyelonephritis, speticaemia, meningitis
- Peptic ulcer/H. Pylori infection
- Appendicitis
- Migraine
- Raised ICP
- Coeliac disease
- Renal failure
- Diabetic ketoacidosis
- Alcohol/drugs
- Cyclical vomiting syndrome
- Bulimia/anorexia nervosa
- Pregnancy
- Torsion of the testicle
23
Q
What is GORD?
A
Gastro-oesophageal reflux
Involuntary passage of gastric contents into the oesophagus
24
Q
What can contribute to the developement of GORD in children?
A
- Relatively liquid diet
- Horizontal posture
- Short intra-abdominal oesophagus
25
What is the general progression of GORD in a child?
Normally resolves by 12 months - upright posture, mature lower oesophageal sphincter and solid diet
26
What are the complications of GORD?
* **Faltering growth**
* **Oesophagitis**
* **Recurrent aspiration -\> Pneumonia**
* **Dystonic neck posturing**
27
What groups of children is severe reflux more common in?
* **CP or other neurodevelopmental disorders**
* **Preterm infants**
* **Post surgery** - oesophageal atresia/diaphragmatic hernia
28
If you suspected GORD, how would you go about confirming diagnosis?
***_Usually clinically_*****_, or:_**
* **Video fluoroscopy**
* **Barium swallow**
* **Milk scan**
* **pH/impedence monitoring**
* **Endoscopy**
29
How can children with GORD present?
* **GI** - vomiting, haematemesis
* **General** - Faltering growth, feeding problems
* **Resp** - apnoea, wheeze, cough, chest infection
30
What should you consider as a differential diagnosis if a child is presenting with GORD like symptoms?
Cow's milk allergy
31
How would you approach managing a child with GORD?
**Determine complexity, then**
* **Feeding advise**
* Parental reassurance
* Feeding/post feeding position
* Adjust feeding volumes
* **Nutritional support**
* Thickener
* Pro-kinetic
* Acid suppression
32
In children with GORD which is unresponsive to conservative or medical treatment, what else can be done?
Nissen fundoplication
33
What would indicate the need for fundoplication in a child with GORD?
* **No response to treatment**
* **Oesophagitis**
* **Faltering growth**
* **Aspiration**
34
What is pyloric stenosis?
Hypertrophy of the pyloric sphincter causing gastric obstruction
35
What age does pyloric stenosis present?
4-12 weeks
36
What sex is more commonly affected by pyloric stenosis?
Boys (4:1)
37
What would suggest that a child had pyloric stenosis?
* **Projectile vomiting** - Non-billous, straight after feeding, no diarrhoea
* **Dehydration/Shock**
* **Weight loss**
* **Constipation** - from dehydration
38
What is the classical electrolyte disturbance seen in pyloric stenosis?
***_Hypokalaemic Hypochloraemic Metabolic Alkalosis_***
## Footnote
Vomiting -\> loss of hydrochloric acid (hydrogen and chloride ions) with the stomach contents. Severe vomiting -\> loss of potassium (hypokalaemia) and sodium (hyponatremia). The kidneys compensate for these losses by retaining sodium in the collecting ducts at the expense of hydrogen ions (sparing sodium/potassium pumps to prevent further loss of potassium), leading to metabolic alkalosis.
39
What would you see on examination if a child had pyloric stenosis?
* **Observe left-to-right LUQ peristalsis during feed**
* **Palpation of olive sized mass in RUQ**
40
What investigations would you do if you suspected a child had pyloric stenosis?
* **Bloods** - U&E's for electrolyte disturbance
* **Imaging** - US for thickened pylorus
41
How would you manage a child with pyloric stenosis?
1. **Fluid resus (0.45% saline, 5% dextrose + KCl)**
2. **NG tube** - if stomach is overinflated with air, also for post operative feeding
3. **Pyloromyotomy (Ramstedt's)**
42
What is intusucception?
Invagination of proximal bowel into distal segment (commonly ileum into caecum)
43
What is the most serious complication of intussusception?
Stetching and constriction of the mesentery -\> venous obstruction -\> engorgement and bleeding of mucosa -\> fluid loss, perforation -\> peritonitis, gut necrosis
44
What age does intussusception most commonly occur?
**3 months - 2 years**
Can occur at any age
45
How does intussusception present?
* **Paroxysmal Colic pain with** **episodic, painful crying** - pale, draws legs up
* **Vomiting**/**Not feeding**
* **Sausage shaped mass** - in abdomen; RF, transverse colon
* **Red current jelly stool** - late presentation
* **Abdominal distention**
* **Shock**
46
What is thought could be a cause of intussusception?
Viral infection of peyer's patch, which causes enlargement and forms a lead point
47
What is more likely to be a lead point in a child over 2 with intussusception?
* Meckel's diverticulum
* Polyp
48
How would you investigate for suspected intussusception?
US Scan - look for target sign
49
How would you treat intussusception?
* **Pneumostatic reduction (air enema)**
* **Laparascopic surgery**
50
When is surgery most likely to be required in managing intussusception?
Peritonitis or unsuccessful air enema
51
What is Meckel's Diverticulum?
Ileal remnent of the vitello-intestinal duct which contains ectopic gastric or pancreatic tissue
52
How does Meckel's diverticulum present?
**Asymptomatic**
or
**Severe rectal bleeding**
Can also present as intussusception, volvulus or diverticulitis
53
How would you treat Meckel's Diverticulum?
Surgical resection
54
What is the definition of chronic diarrhoea?
4 or more stools per day for more than 4 weeks
55
What is the definition of acute diarrhoea?
\< 1 week
56
What is the defintion of persistent diarrhoea?
2-4 weeks
57
What are the different types of diarrhoea?
* **Osmotic**
* **Secretory**
* **Inflammatory**
* **Altered motility**
58
How does osmotic diarrhoea occur?
Movement of water into the bowel to equilibrate osmotic gradients
Uually a feature of malabsorptive diarrhoea
59
How does secretory diarrhoea occur?
**Toxins switch on ion channels which in turn facilitate excessive water loss**
Classically associated with toxin production from Vibrio cholerae and enterotoxigenic Escherichia coli
60
How does inflammatory diarrhoea occur?
* **Malabsorption due to intestinal damage**
* **Secretory effect of cytokines**
* **Accelerated transit time in response to inflammation**
* **Protein exudate across inflamed epithelium**
61
What is a simple way to distinguish between secretory and osmotic diarrhoea?
**Fasting test** - if diarrhoea stops on fasting, then can assume it is osmotic
62
What is infant colic?
Common symptom complex which occurs in first few months of life and normally resolves by 4 months
Causes paroxysmal inconsolable crying often accompanied by drawing up of the knees and passage of excessive farts
63
What would you be thinking in a child that had persistent infant colic?
* **Cow's milk protein allergy**
* **GORD**
64
What is abdominal migraine?
Abdominal pain in addition to headaches
Can be associated with vomiting and facial pallor
65
What is recurrent abdominal pain definned as?
Pain sufficient to interupt normal daily activities and last at least ***_3 months_***
Pain is often periumbilical
A cause is identified in \<10% of cases
66
What gastrointestinal problems could cause recurrent abdominal pain?
* **IBD/IBS**
* **Constipation**
* **Non-ulcer dyspepsia**
* **Abdominal Migraine**
* **Gastritis/peptic ulceration**
* **Malrotation**
67
What gynaecological problems would you think of in a girl with recurrent abdominal pain?
* **Pregnancy**
* **Dysmennorhoea**
* **Ovarian cyst**
* **PID**
68
What urinary tract problems would you consider in a child with recurrent abdominal pain?
* **UTI**
* **PUJ obstruction**
69
What hepatobiliary problems would you consider in a child with recurrent abdominal pain?
* **Gallstones**
* **Hepatitis**
* **Pancreatitis**
70
What symtpoms or signs suggest an organic cause in recurrent abdominal pain?
* **Epigastric pain at night** - duodenal ulcer
* **Diarrhoea, Weight loss, growth failure, blood in stools** - IBD
* **Vomiting** - pancreatitis
* **Jaundice** - liver disease
* **Dysuria, 2o eneuresis** - UTI
* **Billous vomiting and abdominal distention** - Intussusception
71
What is the most common cause of gastroenteritis in the developed world??
Rotavirus
72
Besides rotavirus, what are other viral causes of gastroenteritis in children?
* **Adenovirus**
* **Norovirus**
* **Coronavirus**
73
Which more commoly cause of gastroenteritis, viruses or bacteria?
Viruses
74
What bacterial infections can cause gastroenteritis?
* **Campylobacter jejuni**
* **Shigella**
* **Salmonella**
* **E. Coli**
75
What are the common presenting symptoms in gastroenteritis in children?
* **Loose/watery stool**
* **Vomiting**
* **Abdominal pain**
* **Dehydration** - if profuse
76
What is the most serious complication of gastroenteritis?
Dehydration leading to shock
77
What types of children are at increaed risk of dehydration?
* **Infants**
* **\> 6 stools in last 24 hours**
* **3 or more vomits in last 24 hours**
* **Unable to tolerate fluids**
* **Malnourished**
78
What are the basal fluid requirements of children on a daily basis?
100-120ml/kg/day
79
Why are infants so at risk of dehydration?
* **Increased SA:volume ratio**
* **Higher fluid requirements**
* **Immature renal tubules**
80
What clincal red flags would indicate that a child is clinically dehydrated?
* **Decreased level of consiousness**
* **Dry mucous membranes**
* **Sunken eyes with no tears**
* **Decreased urine output**
* **Tachycardia/tachypnoea**
* **Reduced skin turgor**
81
What clinical features may you see in a child who is in hypovolaemic shock due to dehydration?
* **Decreased level of consiousness**
* **Decreased urine output**
* **Pale or mottled skin**
* **Cold extremities**
* **Grossly sunken eyes**
* **Dry mucous membranes**
* **Tachypnoea/tachycardia**
* **Weak pulses**
* **Slowed cap refill**
* **Hypotension**
82
What is isonatraemic dehydration?
When sodium and water loss are equal, meaning plasma sodium remains largely unchanged
83
What is hyponatraemic dehydration?
Greater loss of sodium, meaning that plasma sodium drops. This leads to shift of fluid from extra- to intra-cellular compartments.
If this occurs in the brain, brain volume increases -\> convulsions
Greater degree of shock per unit water loss due to reduction in extracellular volume
84
What can cause hyponatraemic dehydration?
Diarrhoea in a child where they drink water or hypotonic drink
85
What is hypernatraemic dehydration?
Water loss exceeds sodium loss, meaning that plasma sodium increases. This leads to a shift of fluid into the ECF. This means that signs of fluid depletion are less per unit fluid loss - less easy to see this form of dehydration clinically
86
Why is hypernatraemic dehydration dangerous?
Leads to cerebral shrinkage -\> jittery, increased muscle tone, hyperreflexia, altered consciousness, seizures and multiple cerebral haemorrhages
Transient hyperglycaemia also occurs
87
How would you investigate in a child with suspected gastroenteritis?
* **Normally no investigations** - based on clinical presentation
* **Stool culture** - septic, blood or immunocompromised
* **Bloods** - U&Es, creatinine, glucose
88
How would you treat a child who was dehydrated but showed no clincal signs of dehydration?
* **Continue breastfeeding**
* **Encourage fluid intake**
* **Discourage fruit juice and carbonated drinks**
* **Offer ORS if risk of dehydration**
89
How would you treat a child displaying clinical signs of dehydration?
* **ORT (50ml/kg over 4 hours) + small amount of maintenance fluid (with dioralyte)**
* **Continue breast feeding**
* **ORS via NG tube if intake poor**
* **IV fluids if clinically deteriorates**
90
How would you treat a child in clinical shock from dehydration caused by gastroenteritis?
**IV Fluid bolus** - 20ml/kg - Repeat until symptoms improve. If not, call for help
**If symptoms improve:**
* **IV therapy** - calculcate maintenance ( using values below), and add fluid deficit (100 ml/kg/day if shocked)
* First 10kg - 100ml/kg/day
* Second 10kg - 50 ml/kg/day
* \>20kg - 20ml/kg/day
91
How would you treat hypernatraemic dehydration?
\*\*Aim to reduce plasma sodium at rate of \<0.5 mmol/l per hour - may result in cerebral oedema and seizures if too quick
* **Isotonic solution**
* **Replace fluid deficit over 48 hrs**
92
What would you give a child once they had been rehydrated following dehydration caused by gastroenteritis?
ORS 5ml/kg for every large watery stool if still having symptoms
93
In a child who is being rehydrated, what nutritional considerations do you have to consider?
* **Continue breast feeds** - where possible
* **Encourage oral fluids but not solids**
* **Avoid carbonated drinks**
94
In a child who has been rehydrated, what nutritional considerations would you have to make?
* **Normal diet, milk and solids**
* **Avoid fruit juices and carbonated drinks until resolved**
95
What are red flag signs in a child with gastroenteritis?
* **Temperature**
* **Tachypnoea**
* **Altered consciousness**
* **Neck stiffness**
* **Blood in stool**
* **Bilious vomiting**
* **Severe or localised abdominal pain**
* **Abdominal distention**
96
What can happen following an episode of gastro-enteritis?
**Post-gastroenteritis syndrome**
Temporary intolerances (e.g. lactose)
97
What is important about nocturnal diarrhoea?
It is always pathological
98
How long does diarrhoea normally last?
5-7 days, resolves by 2 weeks
99
How long does vomiting normally last?
1-2 days, resolves 3 days
100
What are early signs of dehydration?
* **Thirst**
* **Sunken eyes**
* **Reduced skin turgor**
101
If a child has vomiting and diarrhoea, what would you want to rule out when taking history and examination, and considering what investigaitons to preform?
**Serious systemic infection** - sepsis, meningitis, UTI
102
Why do you give 100ml/kg/day for first 10kg, 50ml/k/day for 2nd 10kg, etc. instead of using the 4, 2, 1 formula?
To correct for fluid deficit from dehydration
103
For a child ***_in shock_*** from dehydration, how much extra fluid would you give in maintenance fluid to correct for fluid deficit?
100ml/kg
104
If a child is ***_not clinically shocked_*** from dehydration, how much extra fluid would you give in maintenance fluids within the first 24 hours to correct for fluid deficit?
50ml/kg
105
How would a child with a malabsorptive disorder present?
* **Abnormal stools**
* **Faltering growth**
* **Specific nutrient deficiency**
106
What is coeliac disease?
Enteropathy in which gliadin fraction of gluten molecule provokes a dmaaging immunological reaction in the proximal small intestine
Rate of migration of entrerocytes from crypts is massively increased but is insufficient for rate of cell loss at top of villi -\> villous atrophy
107
What is the prevalence of coeliac disease?
1/100
108
How does coeliac classically present?
* **Diarrhoea/steatorrhoea**
* **Anaemic**
* **Faltering growth**
* **Abdominal distention**
* **Arthralgia**
* **Buttock wasting**
* **General irritability/miserable**
109
What are risk factors for developing coeliac disease?
* **Type I diabetes**
* **Atuoimmune thyroid disease**
* **Down syndrome**
* **FH**
110
What skin manifestation can sometimes be seen with coeliac disease
Dermatitis herpatiformis
111
What genetic markers are associated with coeliac disease?
HLA-DQ3/DQ8
112
What investigations would you perform if you thought a child had coeliac disease?
**Bloods**
* **Anti-endomysial antibodies (EMA)**
* **IgA Anti-TTG (IgA-tTG)**
* **Total IgA** - if deficient -\> IgG anti-gliadin
**If bloods positive -\> Endoscopy and duodenal biopsy**
113
What would you see endoscopically in coeliac disease?
* **Scalloping**
* **Paucity of the folds**
* **Mosaic pattern of the mucosa**
* **Prominent submucosal blood vessels**
114
Histologically, what would indicate the presence of coeliac disease?
**Use Marsh criteria to stage;**
* **Villous atrophy**
* **Crypt cell hyperplasia**
* **Lymphocyte infiltration**
115
What is important to tell the patient when investigating for coeliac disease?
Keep eating moderate gluten diet
116
How would you manage a child diagnosed with coeliac?
* **Gluten free diet**
* **Consider pneumococcal vaccine**
* **Consult dietician**
117
What is an important complication to be aware of in coeliac disease?
Small bowel lymphoma
118
What other causes of malabsorption can occur in children besides coeliac disease?
* **CF**
* **Post-enteritis enteropathy**
* **Giardia**
* **Rotavirus**
* **Bacterial overgrowth**
* **Short bowel syndrome**
119
What parasites can cause gastro-enteritis?
* **Giardia**
* **Amoeba (Amoebiasis)**
120
What is toddler's diarrhoea?
Chronic, non-specific diarrhoea of varying consistency and explosiveness. Can sometimes have undigested food in it
Thought to be due to delay in maturation of intestinal motility
Most children grow out of it by age 5
121
What is defined as chronic constipation?
Infrequent passage of dry, hardened faeces often accompanied by straining and pain
122
What is regarded as normal for passage of stool in children?
* **Young -** 4/day
* **As they get older -** down to 2 per day
* Can be as few as 1 per week
123
What can cause constipation?
Often unclear and multifactorial, but can include;
* **Poor diet** - dehydration, Excessive milk, Low fibre
* **Intercurrent illness**
* **Medication**
* **Family history**
* **Psychological (secondary) -** Potty training/school toilet, stress
* **Organic** - hirschsprungs disease, hypothyroid, hypercalcaemia
124
What would you find on examination in a constipated child?
Palpable mass in well looking child
***_ONLY PAEDIATRIC SPECIALIST SHOULD PERFORM RECTAL EXAMINATION_***
125
What would constipation and failure to pass meconium within the first 24 hours suggest?
Hirschprung's disease
126
What can cause faltering growth and constipation in a child?
* **Hypothyroidism**
* **Coeliac disease**
* **Poor feeding**
* **Neglect**
* **Other causes**
127
What would gross abdominal distention with constipation indicate?
* **Hirschprungs disease**
* **Other forms of gastrointestinal dysmotility**
128
What would constiaption and abnormal lower limb deformity/neurology suggest as a cause of constipation?
Lumbosacral pathology
129
What would constipation with a sacral dimple above the natal cleft suggest?
Spina bifida
130
What would constipation with abnormal appearence/patency of the anus?
Abnormal anorectal anatomy
131
What would constipation iwth perianal bruising/multiple fissuers suggest?
Sexual abuse
132
What would consitpation with perianal fistulae/abscesses suggest?
Perianal Crohn's disease
133
What happens physiologically in long-standing constipation?
Rectum becomes overdistended, resulting in a loss in feeling the need to defecate. This can lead to dysfunction of the internal sphincter when the rectum contracts around the packed out contents -\> Overflow incontinence
134
How does constipation usually present?
* **Poor appetite**
* **Irritable**
* **Lack of energy**
* **Distended abdomen**
* **Witholding/straining**
135
How would you manage a child with constipation?
**Short term**
* **Laxatives**
**Long term**
* **Diet**
* Incerase fibre, veg, fluids, fruit
* Decrease milk
* **Behavioural/Psychological training**
136
What are the different types of laxatives that can be used for constipation?
* **Osmotic laxatives** (lactulose)
* **Stimulant laxatives** (senna, picolax)
* **Isotonic laxatives** (movicol) - stool softeners
137
What is faecal impaction?
***_Faeces gets stuck in the bowel_***
Faeces builds up, stretches rectum, and they lose the ability to sense faeces in the rectum -\> faeces from above impaction leaks round the side -\> soiling
138
In treating faecal impaction, how should you manage a child once they have been disimpacted?
Maintenance with stool softeners
139
If a child was constipated and had palpable faeces in their abdomen, how would you intially manage them?
**Movicol for 2 weeks**
140
If you were treating a child who was faecally impacted with movicol and there had been no spontaneous passage of stool, how would you proceed with their mangement?
Stimulant +/- osmotic laxatives
141
If you were treating a child who was faecally impacted and was on all 3 types of laxatives with no spontaneous stool produced, how would you manage?
**Enema or manual evacuation un GA**
142
What is cow's milk protein allergy?
Non-IgE mediated response to cow's milk protein
143
How does cow's milk protein allergy usually present?
* **Colicky symptoms**
* **Loose stool +/- musus/blood**
* **Faltering growth**
* **Vomiting**
144
How would you test for cow's milk protein allergy?
Remove milk from diet for 4 weeks - no other test
145
Once you had determined a child had cow's milk protein allergy, how would you proceed?
* **Remove all milk and wait until 1 year**
* **Re-introduce milk using milk ladder**
1. Hydrolysed milk/amino acid feeds
2. Cooked milk
3. Cheese/yoghurts
4. Milk
* **May need thickeners/acid suppression**
146
What are the approximate energy demands of a child while they are growing?
95-110 kcal/kg/day
147
How much protein do children need per day?
Protein 1.5-2g/kg/day protein
148
What vitamin are children at risk of becoming deficient in (esp. in scotland)?
Vitamin D
149
What are the benefits of breastfeeding?
* **Suckling/bonding**
* **‘Perfect’ nutrition for 6 months for most infants**
* **Tailor-made passive immunity (NB HIV)**
* **Development of infant’s active immunity**
* **Development of infant’s gut mucosa**
* **Reduced infection**
* **Almost no contaminants**
* **Antigen load minimal**
* **Cheap**
* **? Breast cancer**
150
How can children with Crohn's disease present?
* **Faltering growth/failure**
* **Abdominal pain**
* **Diarrhoea +/- blood and mucus**
* **Weight loss**
* **Fever/lethargy**
* **Pubertal delay**
* **Extra-intestinal manifestations**
151
What are extra-intestinal manifestations of Crohn's disease?
* **Oral lesions/perianal skin tags**
* **Arthralgia**
* **Erythema nodosum**
* **Uveitis**
152
How does Crohn's differ from UC?
* **More weight loss and growth failure**
* **Less diarrhoea and rectal bleeding**
* **Masses can sometimes be palpated in the abdomen**
153
How does UC differ from Crohn's clinically?
* **More diarrhoea and rectal bleeding**
* **Less weight loss and growth failure**
154
What similarities do Crohn's and UC display clinically?
* **Abdominal pain**
* **Arthritis**
* **Fever**
155
What is Crohn's disease?
Inflammatory bowel disease characterised by patchy segmental transmural chronic granulomatous inflammation which is associated with fissures, neuromuscular hypertrophy, strictures and fistula.
156
What is Ulcerative colitis?
Chronic remitting and relapsing inflammatory disease of the large intestine associated with the passage of blood, mucus and pus.
***_Only affects colon_** -* usually starts distally and works proximally
157
Where does Crohn's most commonly affect in the GI tract?
Distal ileum/proximal colon
158
If you suspected inflammatory bowel disease, what investigations would you perform?
**Bloods and biochemistry**
* **Full blood count** - Anaemia, Thrombocytosis
* **CRP & ESR** - raised
* **Low Albumin**
**Specific tests**
* **Stool calprotectin** - raised - important marker
**Imaging**
* **MRI** - Barium meal and follow-through (younger kids)
**Endoscopy/Colonoscopy**
159
How would you manage a child with IBD?
**Medical**
* Anti-inflammatory
* Immuno-suppressive - Steroids
* Biologicals (Infliximab)
**Nutritional**
* Immune modulation
* Nutritional supplementation - used more in children than adults
**Modulen IBD - 6 weeks - 75-80% response rate**
160
What histological findings would indicate crohn's disease?
Non-caseating epithelioid granulomata
161
What are the complications of IBD?
* **Inflammation**
* **Ulcers**
* **Abscess**
* **Fistulas**
162
How is remission induced in Crohn's?
Nutritional therapy - replaced with modular feeds
If that fails - ***_steroids_***
163
What is Hirschprungs Disease?
Abscence of myenteric and submucosal plexuses of parts of the large bowel -\> narrow, contracted segment of large bowel
75% of cases - confined to the rectosigmoid
10% - entire colon involved
164
How can Hirschprungs Disease present in the neonatal period?
* **Failure to pass meconium**
* **Intestinal obstruction**
* Abdominal distention
* Bilious Vomiting
* **Flatus**
165
How can hirschprungs disease present in childhood?
* **Chronic constipation**
* **Abdominal distention**
* **Growth Failure**
