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Gastrointestinal - paeds Flashcards

(47 cards)

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1
Q

List some GI red flags in children + what the cause could be

A
  • projectile vomiting: pyloric stenosis or intestinal obstruction
  • not keeping any food down: pyloric stenosis or intestinal obstruction
  • bile stained vomit: intestinal obstruction
  • blood in stool: gastroenteritis or cows milk protein allergy
  • redcurrant jelly stool: intussusception
  • haematemesis or melaena: peptic ulcer, oesophagitis, varices
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2
Q

What is toddler’s diarrhoea?

A

A common cause of chronic diarrhoea in children between 1-5 years old
More common in boys
Caused by diet high in sugar, fluids and imbalance in fibre

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3
Q

Presentation of toddler’s diarrhoea

A

Chronic frequent loose or watery stools
Child seems well in themselves
Lacks additional symptoms.

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4
Q

Cause of toddler diarrhoea

A

High sugar diet
High fluid intake
Imbalance in fibre intake

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5
Q

Treatment of toddler’s diarrhoea

A

Fat, Fluid, Fruit Juice, Fibre
- fat: adding a small amount of high fat food at the end of a meal e.g. yoghurt, full fat milk
- fluid: >5-8 drinks a day can contribute so reduce fluid intake
- fruit juice: reduce sugary drink intake
- fibre: ensure child has balanced diet

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6
Q

Risk factors of GORD in children

A
  • preterm birth
  • family history
  • obesity
  • hiatus hernia
  • genetic conditions or neurodevelopmental disorders
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7
Q

Why do babies <1 have reflux?

A

Immaturity of the lower oesophageal sphincter

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8
Q

Presentation of problematic GORD in babies

A
  • chronic cough
  • hoarse cry
  • distress, crying or unsettled after feeding
  • reluctance to feed
  • pneumonia
  • poor weight gain
  • persisting after 1
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9
Q

Presentation of GORD in children >1

A

Similar to adults
- heartburn
- acid regurgitation
- retrosternal/epifastric pain
- bloating
- nocturnal cough

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10
Q

Management of paediatric GORD

A
  • small, frequent meals
  • burping regularly to help milk settle
  • not over feeding
  • thickened formula
  • keep baby upright after feeding
  • gaviscon mixed with feed if problematic
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11
Q

What is Sandifer’s syndrome?

A

A rare condition causing brief episodes of abnormal movements associated with GORD in infants

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12
Q

Key features of Sandifer’s syndrome

A
  • torticollis: forceful contraction of SCM causing neck twisting
  • dystonia: abnormal muscle contractions causing twisting movements, arching of back or unusual posture
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13
Q

What s Hirschsprung’s disease?

A
  • A congential disease where the parasympathetic ganglion cells of the myenteric plexus are absent in the distal bowel and rectum due to the cells not travelling all the way down the bowel
  • This causes constant constriction of the distal bowel and rectum > obstruction + distension in proximal bowel
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14
Q

Presentation of Hirschsprung’s disease

A
  • delay passing Meconium >24 hours
  • chronic constipation since birth
  • abdominal pain + distension
  • vomiting
  • poor weight gain + failure to thrive
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15
Q

What is Hirschsprung’s associated Enterocolitis?

A

Life threatening condition due to inflammation and obstruction of the bowel in neonates with Hirschsprung’s
Can cause toxic mega colon and bowel perforation

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16
Q

Presentation of Hirschsprung’s associated Enterocolitis?

A
  • presents 2-4 weeks after birth
  • fever
  • abdominal distinction
  • diarrhoea +/- blood
  • features of sepsis
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17
Q

Treatment of Hirschsprung’s associated Enterocolitis?

A
  • decompression of constricted bowel
  • Iv antibiotics
  • fluid resuscitation
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18
Q

Diagnosis of Hirschsprung’s disease

A

Rectal biopsy of the muscular layers
Showing absence of ganglionic cells

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19
Q

Treatment of Hirschsprung’s disease

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A

Surgical removal of the aganglionic section of the bowel

20
Q

Presentation of pyloric stenosis in babies

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A
  • presents in first dew weeks of life
  • hungry baby that is thin, pale + failing to thrive
  • projective vomiting
21
Q

Examination of pyloric stenosis in babies

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A
  • visible peristalsis after feeding
  • firm round mass palpable in upper abdomen - hypertrophic muscle of pylorus | ‘feels like a large olive’
22
Q

Blood gas of pyloric stenosis in babies

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A

hypochloric metabolic alkalosis
Due to vomiting of hydrochloric stomach acid

23
Q

Diagnosis of pyloric stenosis

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A

Abdominal USS

24
Q

Treatment of pyloric stenosis in babies

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A
  • Laparoscopic pyloromyotomy (Ramstedt’s operation)
  • incision made into the smooth muscle of the pylorus to widen the canal allowing food to pass
25
What is the most common cause of bowel construction in children?
Intussusception
26
What is intussusception?
When the bowel telescopes into itself Occurs in infants 6 months to 2 years Most common in boys
27
Presentation of intussusception
- severe, colicky abdominal pain - pale, lethargic + unwell child - **‘redcurrant jelly stool’** - sausages shaped mass in RUQ of abdomen - vomiting - intestinal obstruction
28
Diagnosis of intussusception
Abdominal USS Contrast enema
29
Associated conditions of intussusception
- **recent viral illness** - cystic fibrosis - intestinal polyps - Meckel’s diverticulum
30
Management of intussusception
- therapeutic enema - contrast, water or air - surgical reduction - surgical resection if complications occur
31
Complications of intussusception
- obstruction - bowel perforation - gangrenous bowel - death
32
Presentation of threadworms
- **seeings worms** in faeces or near to anus - **severe itching around anus** which is worse during the night (due to worms laying eggs) - **waking up during night due to itching** - severe itching in genital areas in girls
33
Investigations of threadworms
apply transparent adhesive tape to perianal skin in the morning + take to examine eggs
34
Treatment of threadworms
- single dose of antihelminitic *e.g. mebendazole* - if <6 months treat with hygiene measures - consider treating household contacts as highly transmissible - hygiene measures to clear the eggs - cut fingernails regularly, shower in morning to remove eggs, change bed sheets + night wear
35
What is functional constipation?
Idiopathic constipation - no significant underlying cause other than lifestyle factors
36
Secondary causes of constipation
- Hirschsprung’s disease - Cystic fibrosis - hypothyroidism - sexual abuse - intestinal obstruction - cows milk intolerance
37
Typical features that suggest constipation
- <3 stools a week - hard stools that are difficult to pass - rabbit dropping stool - abdominal pain - straining and painful passage - retentive posturing - rectal bleeding
38
Lifestyle factors that can contribute to constipation
- habitually not openingbowels - low fibre diet - poor fluid intake + dehydration - sedentary lifestyle - psychosocial problems *e.g. difficult home or school environment*
39
Outline desensitisation of the rectum
- often patients develop habit of not opening their bowels when they need to and ignoring the sensation of a full rectum - over time they loose the sensation of needing to open their bowels causing them to go to the toilet less - this causes retention of faeces > faecal impaction - overtime the rectum stretching more > further desensitisation
40
Management of functional constipation
- explain that treating constipation can be a prolonged process - correct reversible contributing factors - high fibre diet + good hydration - encourage + praise visiting the toilet - start laxatives - ***movicol/macrogol*** first line - disimpaction regimen if faecal impaction - ERIC website
41
What is absolute constipation?
When a patient is unable to pass stool or wind
42
Causes of intestinal obstruction in children
- meconium ileus - Hirschsprung’s disease - oesophageal atresia - duodenal atresia - intussusception - imperforate anus - volvulus - strangulated hernia
43
Presentation of intestinal obstruction
- persistent vomiting (my be bilious) - failure to pass stool or wind - abdominal pain + distortion - abnormal bowel sounds (tinkling or absent)
44
Management of intestinal obstruction in children
- emergency referral to paediatric surgical until - nil by mouth + inserting NG tube to drain stomach + stop vomiting - IV fluids - manage the underlying cause
45
Presentation of candida in paediatrics
- associated nappy rash - creases affected - pustular/papular satellite lesions - painful + itchy rash - possibly genital discharge
46
First line medication in constipation in paediatrics
Movicol/macrogol
47
Behavioural strategies to help manage constipation
- regular/scheduled toileting - make toilet visits active *e..g massaging gum in in clockwise circles, rocking back and forth* - sit on toilet with knees higher than hips - exercise - reward symptoms - addressing any fears about using the toilet

Paediatrics (6 decks)

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