GI Disorders Flashcards
What are some features of constipation in a child?
Infrequent passage of stool (usual range is 4 per day to 1 per week). Poor appetite Irritable Lack of energy Abdominal pain/distension Withholding or straining
What are some causes of constipation?
Poor diet - insufficient fluids, excessive milk.
Intercurrent illness
Medications - opiates, gaviscon
Family history
Psychological - not want to do it in public etc.
Anorectal malformations
Hypothyroidism
What is the cycle of constipation?
Holding in stool
Larger/harder stools form - water sucked out by bowel longer it stays there.
Painful bowel movement.
Stretching of back passage results in megarectum.
What is the treatment for constipation?
Reassure that it is not child’s fault.
Make stools never get hard again by re-training bowel.
Remove impaction - osmotic laxatives (lactulose, movicol), stimulant laxatives (Senna, picosulphate).
Treatment will last as long as constipation has been going on for.
What is the difference between inflammatory bowel disease in children compared to adults?
More extensive and worse in children.
Normal for children to get pancolitis in UC.
Rate of colectomy is higher than in adults.
Child with Crohn’s has more systemic symptoms but less obvious symptoms e.g. diarrhoea.
How does a child with Crohn’s commonly present?
Weight loss Abdominal pain Panenteric disease Systemic symptoms Extra intestinal manifestations - arthritis, uveitis, erythema nodosum, mouth ulcers, sore bottom.
What tests would you do for a child with suspected Crohn’s?
Inflammatory markers Serum albumin FBC Calprotectin Colonoscopy Endoscopy MRI
What are some features of Ulcerative colitis in children?
Calesocrypt abscesses
Don’t see as many systemic symptoms with UC than in Crohn’s.
MRI good to see small bowel inflammation.
What is the treatment for Crohn’s?
Nutritional therapy - liquid feed for 8 weeks (Modulin) to change microbiome.
Thiopurines 1st line to maintain remission.
Anti-TNF therapy if need to step up.
Steroids as last resort as they affect growth.
Surgery
What is the treatment for Ulcerative colitis?
5-ASAs 1st line and to maintain remission.
Thiopurines 2nd line to retain remission e.g azothiprine.
Anti-TNF for step up therapy.
Surgery
What are different types of vomiting that can occur in children?
Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting
What are the features of vomiting with retching?
Pallor Nausea Tachycardia Retching Vomit Weakness Shivering Lethargy
What can stimulate the vomiting centre in children?
Enteric pathogens Intestinal inflammation Metabolic derangement Infection Head injury Visual stimuli Middle ear stimuli
Very non-specific symptom!
What is visible gastric peristalsis?
Trying to push the food through the thickened pyloris. Can see the baby’s stomach moving.
What rules out pyloric stenosis?
Tinge of yellow/green in vomit then not pyloric stenosis.
why would pH be raised in pyloric stenosis?
Losing hydrochloric acid from stomach when vomiting.
What is the management of pyloric stenosis?
Fluid resuscitation -correct electrolyte imbalance.
Refer to surgeons: Ramstedts pyloromyotomy - small nick in muscle to allow food to pass through.
How does Pyloric stenosis present?
Babies 4-12weeks B>G Projectile non-bilious vomiting Weight loss Dehydration +/- shock Characteristic electrolyte disturbance - metabolic alkalosis, hypochloraemia, hypokalaemia.
What are some causes of Bilious vomiting?
Intestinal atresia Malrotation +/- volvulus Intussusception Ileus Crohn's disease with strictures
What investigations would you carry out for bilious vomiting?
Abdominal x-ray
Consider contrast meal
Surgical opinion re exploratory laparotomy.
What are some features of Effortless vomiting?
Almost always due to gastro-oesophageal reflux.
Self-limiting and resolves spontaneously in majority.
Few exception are cerebral palsy, progressive neurological problems, oesophageal atresia, generalised GI motility problem.
Usually starts at 2 weeks and gets worse 3-4 months. Gets better on solid foods and usually recovers fully by 18months.
How does Gastrooesophageal reflux present?
Vomiting Haematemesis Feeding problems Failure to thrive Apnoea Cough Wheeze Chest infections Sandifer's syndrome
What is Sandifer’s syndrome?
Spastic torticollis and dystonic body movements.
Nodding and rotation of head, neck extension, gurgling sounds, writhing movements of limbs, severe hypotonia.
What are some investigations for gastro-oesophageal reflux?
Video fluoroscopy Barium swallow pH study Oesophageal impedance monitoring- see how far travels up oesophagus. Endoscopy
