Gastrointestinal Flashcards
what is GORD?
gastroosphgeal reflux disease is when the stomach content is regurgitated back up the oseaphgus often causing pain.
symptoms of GORD
burning sensation stomach ache crying vomiting poor feeding irritable arching due to discomfort respiratory problems-aponea, cough, wheeze bloating heartburn increased salivation
common reason in infant
immature spinchter
milk based diet
forever lying down
how many resolve?
90% by one years of age
risk factors for gord
premature family history obesity hiatius hernia congenital diaphragm hernia repair or congenital oesophageal atresia neurodisability overfeeding
investigations
clinical based on history bloods-anaemia 24 ph monitoring barium meal if bile stained endosocpy manometry
management
lifestyle advice- sit up when feeding and after for abit ensure not overfeeding 150ml/kg/daily reassure this is normal 40% of babies add thickener to milk trial of gaviscon can consider PPI H2RA nissen fundoplication if no improvement
when would you consider a referral
haemetesis melena dysphagia no improvement after one years old faltered growth due to gord Pain needing ongoing therapy suspected diagnosis of sandifers syndrome
what is sandiier syndrome
gastro-oesophageal reflux disease + spastic torticollis +dystonic body movements
with or without hiatal hernia.
positioning of the head –> relief from abdominal discomfort caused by acid reflux (hypothesis)
what is gastroenteritis
sudden diarrhoea and vomiting
mostly caused by viral infection
resolves within a few days but care must be taken to prevent dehydration
whats notifable
food poisoning and dysentry
causes
viral-rotavirus, noravirus
bacterial-campylobacter, salmonella, shigella and ecoli
rf
poor hygeine
poor handling of meat/uncooked meat
immunocompromised
clinical features of gastroenteritis
diarrhoea vomiting fatigue abdopain febrile recently been on abx -c.ddiffle
what are red flags
signs of dehydration and shock
hypotension tachycardia reduced skin turgor sunken eyes altered responsiveness
investigations
mc and s if septicaemia ,blood, mucus, immunocompromised, recent travel ,> 7 days
FBC, UE, cup cultures
management
home management unless signs of shock do not give solid food continue on liquids avoid sugary and carbonated drinks give milk wash hands and do not share towels use ORS 48 hour symptom free before returning to school /nursery
do not give anti diarrhoeals
when are antibiotics given
if suspected septicaemia
salmonella in under 6 months, immunocompromised or malnourished
what is the definition of constipation
2 or more of the following over 8 week period or more:
pain on defectation
large tutti felt rectally or palpable from stomach
Megatron tutti blocking toilet
retentive posture or posture behaviour
more than 1 episode per week of fetal incontinence
less than 3 motions per week
presentation
straining pain dry anorexia reduced growth abdo distention involuntary soiling abnormal anal tone fresh rectal bleeding
causes
lack of fibre
lack of water
lack of exercise
poor colonic motility-fox in 55%
gi causes IBS, Coeliac, hypertensiitvty to food, Hirschsprung disease, anal disease, obstruction
non gi causes- hyeprcalcemia,
hypothyroidism, sexual abuse, opioids, diabetes inspidius
diagnosis
organic causes- coeliac antibody screen, tfts, calcium, biopsy, abdo xray
management
treat cause give fluids and fibre natural laxative-orange juice anal fissure 2% lidocaine ointment oral magnum citrate and magnum phosphate to clear bowels enemas manual evacuation in hospital
fecal softeners movicol
stimulant laxatives- Senna
what is appendicitis ?
the most common surgical emergency
peaks between 10-30 years of age
inflammation of the appendix
cause unknown
how does appendicitis present
signs and symptoms
umbilical generalised pain which moves to rif constant sharp pain loss of apetite nausea dysuria associated with anorexia rising pulse low grade fever guarding at mc burney point
what makes pain worse
movement
three signs
rosving- palpation in left iliac fossa causing pain in rif
psoas- hip flexed, pain
obturator-internal rotation of hip with stabilised ankle-pain
where is mc burney point
one-third of the distance from the anterior superior iliac spine to the umbilicus (navel
diagnosis of appendicitis
clinical diagnosis but bloods -neutrophilia, leucocytosis urinalysis protein abdominal and pelvic CT scan urinary pregnancy test in females
consider USS
scoring systems used of appendicitis
alvarado score of 7 for appendiectomy - 6 clinical features, 2 lab features
RIPASA
management of appendicitis
fluids
surgical appendiectomy
abx prophylaxis
thing to remember in appedicitis in children
may appear better temporarily if perforated
complications of appendicitis
peritonitis perforation infection abscess sepsis
differentials
ectopic pregnancy
crohns disease
UTI
mesenteric adentitis
8 features of Alvarado
abdominal pain that migrates to the right iliac fossa 1
Anorexia (loss of appetite) or ketones in the urine 1
Nausea or vomiting 1
Tenderness in the right iliac fossa 2
Signs
Rebound tenderness (Blumberg) 1
Fever of 37.3 °C or more 1
Laboratory
Leukocytosis > 10,000 2
Neutrophilia > 70%
what is coeliac disease
autoimmune mediated enteropathy on exposure to gluten in genetic predisposed individuals
who is coeliac more common in
females
50s and infancy
caucasians
key finding on bloods in coeliac
anaemia
symptoms of coeliac disease
steatthorea constipation diarrhoea bloating fatigue failure to thrive abdo distention flatulence vitamin D,E,K, A defieency , selenium due to malabsorption weight loss dermatitis herpeformis recurrent mouth ulcers
complications of coeliac disease
other autoimmune condition lymphoma anaemia osteoporosis infertility
diagnosis
bloods- anti TTG, EMA, IgA genetic tests HLADQ8 and 2 endoscopy biopsy marsh grading 0-4 check vitamin b12, d, exlude hypothyroidism osteoporosis screen
managing coeliac in paedds
followed up six to 12 months after diagnosis followed by a yearly check up after
annual an antibody blood test every year or less often. Another biopsy may be offered - not carried out routinely.
Children should also have their height and weight checked to monitor their growth and development.
gluten free diet
prevent nutritional/vitamin deficiencies with supplementation
what is Hirschsprung disease
the absence of ganglion cels from the mesenteric plexus as part of the large bowel
causing a narrow contracted segment
where in the bowel is Hirschsprung disease
extends from rectum to dilated colon
75% rectosigmoid but 10% can affect entire colon
presention of hirschsprung disease
when may it present late
neonatal period with intestinal obstruction - with meconium not passing within first 24-48 hours
bile stained vomiting
abdominal distention
if short segment of bowel is affected
if presents later, failure to thrive, constipation, overflow incontinencne
what do you need to be aware of when examining for Hirschsprung
rectal examination can temporarily relieve the symptoms as removal of finger causes watery stool and flatuence. this can delay diagnosis
diagnosis of Hirschsprung
abdo xray and enema-airless rectum and dilated bowel anaorectal mamometry suction rectal biopsy barium studies biopsy from rectum
what can Hirschsprung be associated with
down syndrome
endocrine neoplasias
a complication to be aware of
enterocolitis -12 % incidence can be life threatening
