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GI Flashcards

1
Q

What is the most common cause of vomiting in infancy?

A

GI reflux

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2
Q

What are some of the risk factors for GI reflux?

A

Preterm babies

Neurological disorders

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3
Q

What is the clinical presentation of GI reflux?

A
  • Typically develops <8wks with vomiting/regurgitation following feeds
  • Common in 1st year of life
  • Infants put on weight normally and are otherwise well
  • Nearly all resolve by 12months
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4
Q

Why does GI reflux arise?

A

-Common in 1st year of life due to functional immaturity of LOS leading to inappropriate relaxation

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5
Q

How might GI reflex present in babies?

A

May present with back-arching, tense, colours change with distress

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6
Q

What are the investigations in GI reflux?

A

Largely clinical diagnosis, maybe pH study

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7
Q

What is the tx in GI reflex in babies?

A
  • Parental reassurance
  • Is baby being overfed?
  • Hydrolysed milk (may stop vomiting if milk allergy) or Ranitidine (can continue to breastfeed)
  • Position 30 degree upright during feeding
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8
Q

How does gastroenteritis present?

A
  • Acute episode of vomiting followed by diarrhoea, fever.
  • If blood stained–> bacterial (notify PH)
  • Ask about travel hx and nocturnal diarrhoea
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9
Q

What is the main cause of gastroenteritis

A
  • Was Rotavirus but now vaccine

- Norovirus no1 in UK

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10
Q

What is the progression of gastroenteritis?

A

-Recovery of acute symptoms within 48hrs, diarrhoea may persist up to 2wks

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11
Q

What is a complication of gastroenteritis?

A

Secondary or acquired lactose intolerance due to inability to metabolise lactase. Should resolve within 2-3months.

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12
Q

What is the clinical presentation of toddler’s diarrhoea?

A
  • Benign, loose stools up to 12/day
  • M>F
  • Resolved by 5/6years
  • FBC to exclude coeliac
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13
Q

What is the tx of toddler’s diarrhoea?

A

Loperamide may help with toilet training

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14
Q

How does coeliac disease arise?

A
  • The gliadin fraction of gluten provokes an immunological response in the proximal small intestinal mucosa.
  • Villi become progressively shorter than absent, leaving a flat mucosa.
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15
Q

What are the gene associations in coeliac?

A

HLA-DQ2, HLA-DQ8

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16
Q

What is the clinical presentation of coeliac disease?

A

Profound malabsorption syndrome at 8-24months, failure to thrive, abdominal distension and buttox wasting abnormal stools and irritability.

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17
Q

How might coeliac disease present later?

A

Non-specifically with anaemia and growth failure

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18
Q

What is the investigation for coeliac?

A
  • IgA TTG

- If GF diet <2 years old, gluten challenge required later on

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19
Q

Why does constipation tend to arise in children?

A

Due to low fibre, high milk diet

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20
Q

What should you consider in a child presenting with constipation in the following age groups:

a) Babies
b) Older child

A

a) Anorectal abnormalities, Hirschprung’s disease, hypothyroidism and hypercalcaemia
b) Problems with toilet training/stress

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21
Q

What is seen o/e in a child with constipation

A
  • Distended abdomen, palpable faecal masses

- Generally one stool per day passed from age 3

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22
Q

What is the tx of constipation if faecal impaction?

A

1st line Movicol and electrolyte using an escalating dose regime.
2. Add stimulative laxative (lactulose) if Movicol does not lend to disimpaction after 2weeks.

23
Q

What is the tx of constipation- maintenance therapy?

A

1st line: Movicol paediatric plain
2. Add stimulate laxative (lactulose) if no response

Continue maintenance therapy for several weeks until bowel habit is established then slowly decrease dose.

24
Q

Should you use dietary tx alone as a 1st line tx for constipation in kids?

25
What is the clinical presentation of infant colic?
Persistent crying and screaming in a healthy baby, excess flatus several times a day, particularly at night.
26
What is the epidemiology of infant colic?
- Up to 40% babies - Occurs in first few weeks of life and resolves by about 4months - If severe and persistent: consider cow's milk allergy or reflux
27
What are some of the important GI problems to consider in babies?
``` Pyloric stenosis Intussusception Malrotation of the gut Hirschsprung's disease Biliary atresia ```
28
What is the epidemiology of pyloric stenosis?
- Typically presents in 2nd-4th weeks of life with vomiting, may present later up to 4months - M>F - Positive FHx - 1st borns more commonly affected
29
How does pyloric stenosis arise?
Caused by hypertrophy of the circular muscles of the pylorus
30
What are the clinical features of pyloric stenosis?
- 'Projectile' vomiting typically 30mins after a feed. - Constipation and diarrhoea may be present - Palpable mass in upper abdomen may be present - Hypochloraemia, hypokalaemia acidosis due to persistent vomiting
31
What are the investigations and tx of pyloric stenosis?
Diagnosis: USS Tx: Ramstedt pylomyotomy, NMB, IV rehydration.
32
How does intussusception arise?
Invagination of one portion of the bowel into the lumen of the adjacent bowel, typically ileo-caecal region.
33
What is the epidemiology of intussusception?
6-18 months old
34
What are the clinical features of intussusception?
- Paroxysmal abdominal colic pain during which the baby will draw up their knees and turn pale. - Vomiting - "red currant jelly" - "Sausage shaped mass" in RUQ
35
What is the investigation and tx of intussusception?
Investigation: USS, 'target like' mass Tx: air inflation under radiological control 1st line. If this fails or signs of peritonitis: surgery
36
How does malrotation of the gut arise?
Failure of the midgut to rotate during development
37
Dark mossy green vomit...
EMERGENCY | Malrotation of the gut
38
How does malrotation in the gut present: a) Infant b) Older child
Usually presents 3-7 days after birth a) Bile stained vomit b) GORD, vomiting, abdominal pain
39
What is the investigation and tx of malrotation of the gut?
- Upper Gi contrast study | - Tx: Ladd's procedure
40
Delayed passage of meconium >24hrs after birth?
Hirschsprung's disease
41
How does Hirschsprung's disease arise?
Absent ganglion cells in the anorectum
42
What is the epidemiology of Hirschsprung's disease?
M>F, increased risk in DS
43
What is the presentation of Hirschsprung's disease in babies vs older children?
Babies: delayed passage of meconium | Older children: constipation, abdominal distension
44
What are the investigations and tx of Hirschsprung's disease?
AXR: dilated bowel loops, absent rectal air Tx: excision or bypass of a-ganglionic intestine
45
What is the presentation, tx and complications of biliary atresia?
- Disrupted flow and excretion of bile - Jaundice >14 days, pale stools, dark urine - Urgent Kasai procedure (hepatoportoenterosctomy) best performed <8wks old. - Complications: liver cirrhosis, transplant
46
What is the main risk factor for NEC
Prematurity
47
What are the features and tx of NEC?
Early features: abdominal distension and bloody stools - Increased risk when empirical Abx given to infants >5 days - Tx: total gut rest, TPN, babies with perforations= laparotomy
48
When does a cow's milk allergy typically present?
In the first 3months of life in formula fed infants
49
What are the clinical features of a cow's milk allergy?
- Regurgitation and vomiting - Diarrhoea - Urticaria, atopic eczema - 'Colic' symptoms: irritability, crying - Wheeze, chronic cough
50
How is the diagnosis of cow's milk allergy made?
- Often clinical - Skin prick/patch testing - Total IgE + specific IgE (RAST) for cow's milk protein
51
What is the tx of cow's milk allergy if formula fed?
1st line: extensive hydrolysed formula milk (eHF) in mild-moderate symptoms
52
What is the tx of cow's milk allergy if breast fed?
Continue breast milk Eliminate cow's milk from maternal diet Use eHF milk when breast feeding stops, until 12months of age and at least for 6 months
53
When does cow's milk intolerance usually resolve?
By 1-2years old

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