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HD 2 > GI Disorders in Childhood > Flashcards

GI Disorders in Childhood Flashcards

1
Q

What are the causes of chronic diarrhoea in childhood? (6)

A 
Enteropathy (coeliac, CMPI)
Pancreatic Insufficiency
Lactase Deficiency
IBD - weight loss, abdominal pain, tiredness, rectal bleeding
Constipation (overflow soiling)
CF (malabsorption)
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2
Q

What causes abdominal pain? (4)

A

Constipation
Functional/RAP/Irritable Bowel Syndrome (IBS)
Duodenal ulcer/H. Pylori
IBD

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3
Q

What causes chronic vomiting? (3)

A

GORD
Intestinal Obstruction
Duodenal ulcer

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4
Q

What are some reasons for failure to thrive and weight loss? (2)

A

Coeliac

CF

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5
Q

What causes rectal bleeding? (4)

A

IBD (Crohns or Ulcerative colitis)
Fissures/haemarrhoids
Polyps/Polyposis syndromes
Infection (Bacterial)

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6
Q

What is the mean intestinal transit time in young children?

A

33 hours

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7
Q

85% of 1-4 year olds pass stools ____ a day.

A

Once or twice

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8
Q

How are functional GI disorders diagnosed/defined?

A

Criteria fulfilled at least once per week for at least 2 months before diagnosis.

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9
Q

What are the main categories of functional GI disorders?

A

Vomiting, abdominal pain, functional diarrhoea, disorders of defecation

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10
Q

Define constipation.

A

Infrequent, hard stools (or difficulty/delay in defecation leading to distress).
Passing less than 3 stools per week OR if they have painful bowel movements and stool retention in spite of passing stools more than 3 times per week.

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11
Q

Define soiling.

A

Escape of stool into the underclothes

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12
Q

Define encopresis.

A

The passage of normal stools in abnormal places

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13
Q

How many % of visits to paediatric practice are due to constipation? How many % presenting to a paediatric GI clinic?

A

3%

25%

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14
Q

How does constipation present? (6)

A 
Diarrhoea/soiling
Infrequent bowel movements 
Painful bowel movements
Palpable rectal abdominal mass
Acute abdominal pain 
Recurrent urinary tract infections
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15
Q

What are the types of causes of constipation?

A

Functional

Organic

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16
Q

What are the organic causes of constipation? (4)

A

Hirschsprung’s
Hypothyroidism
Neurologic
Anal stenosis

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17
Q

What suggests an organic cause of constipation?

A 
History of constipation in neonatal period
Delayed passage of meconium
Failure to thrive 
Distended abdomen
Abnormal anus
Sacral dimples
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18
Q

What is noticed on PR exam for Hirschsprung’s?

A

Empty rectum

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19
Q

How is constipation diagnosed by examination?

A

Palpable rocks in the abdomen, hard faeces on PR exam, and anal tone patulous

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20
Q

How is constipation diagnosed by investigation?

A

Transit time is measured by marker studies
TSH/Calcium
Rectal suction biopsy
Anorectal manometry

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21
Q

How is constipation treated?

A

Initial clear out - high dose laxatives/lavage
Maintenance treatment
One softener, one stimulant

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22
Q

What are the different types of laxatives? (5)

A

Stool bulk formers, osmotic laxatives, stool softeners, stimulants, specific 5HT4 receptor antagonists.

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23
Q

How do stool bulk formers work? Give some examples.

A

They increase stool bulk by drawing water around their fibres. This requires adequate fluid intake. E.g. fibre supplements, sterculia.

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24
Q

How do osmotic laxatives work? Give some examples.

A

They draw water into the intestinal lumen. They may cause dehydration and electrolyte abnormalities. E.g. lactulose, magnesium.

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25
Q

How do stool softeners work? Give an example.

A

These are retained in the stool, they ease passage. E.g. liquid paraffin.

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26
Q

How do stimulants work? Give some examples.

A

They stimulate mucosal entero-endocrine cells which stimulate motility and fluid secretion, e.g. senna, dantron.

27
Q

How do specific 5HT4 receptor antagonists work? Give an example.

A

They stimulate motility, e.g. tergaserod.

28
Q

What is the difference between GOR and vomiting?

A

GOR - passive regurgitation of gastric/duodenal contents into oesophagus.

Vomiting involves active contraction.

29
Q

How does GOR differ from GORD?

A

In GORD, there is objective damage (e.g. oesophagitis) and subjective severe symptoms (vomiting/heartburn etc).

30
Q

How many % of babies age 1-3 months have GOR? What about at 12 months?

A

50%

5%

31
Q

What are the ‘red flags’ for GORD? (4)

A

Haematemesis
Failure to thrive
Sandifers syndrome (back arching in infants)
Aspiration Pneumonia

32
Q

How is GORD investigated? (4)

A

pH Study(records acid reflux, pH <4)
Impedance (measures both acid and non-acid reflux)
Barium swallow/ meal
Upper GI Endoscopy

33
Q

What is the principle of impedance study?

A

Change of electrical impedance during passage of a bolus - there is a decrease of impedance during passage of a bolus with high conductivity (e.g. most liquids).

34
Q

How is GOR treated?

A 
Positioning
Thickening of feeds
H2 antagonists and proton pump inhibitors
Promotility agents (e.g domperidone)
Jejunostomy feeds
Nissen’s fundoplication
35
Q

Eosinophilic oesophagitis - what is the history?

A

Treatment resistant symptoms of GORD
History of food sticking
History of atopy

36
Q

How is eosinophilic oesophagitis treated?

A

Dietary (food exclusions, pragmatic trials)
Oral budesonide
Monteleukast

37
Q

What is recurrent abdominal pain?

A

1 episode of pain per month for 3 months, sufficient to interfere with routine functioning.

38
Q

Is recurrent abdominal pain more common in boys or girls?

A

Girls

39
Q

How many % of recurrent abdominal pain is organic?

A

33%

40
Q

How many % of school children are affected by recurrent abdominal pain?

A

10-15%

41
Q

Where is functional RAP felt?

A

Midline, poorly localised

42
Q

Where is organic RAP felt?

A

Away from umbilicus or referred

43
Q

What overlaps with RAP?

A

Migraine
Irritable bowel syndrome
Non ulcer dyspepsia

44
Q

How many % of those with RAP get complete resolution? How many % continue to adulthood?

A

50 %

25 %

45
Q

Define gastritis.

A

Inflammation of the gastric mucosa

46
Q

What causes gastritis?

A

H. pylori infection

NSAIDs

47
Q

How does gastritis present?

A

Vomiting, abdominal pain, haematemesis/melaena, anemia

48
Q

How is H pylori infection diagnosed?

A

Endoscopy (Clo Test and histology)
Stool antigen
C13 Breath Test (rarely used now)

49
Q

What does H pylori convert urea to?

A

It uses urease to convert urea to carbon dioxide and NH3 (ammonia).

50
Q

What is the Clo test?

A

It turns pink if it is positive for urease (pH rises above 6) and yellow if it is negative.

51
Q

How is HP treated?

A

2 weeks - Amoxycillin, clarithromycin

6 weeks - H2 antagonists/proton pump inhibitors

52
Q

What causes painless rectal bleeding in toddlers?

A

Juvenile polyps

53
Q

Rectal bleeding differential diagnoses.

A 
Constipation
Bacterial infections
Inflammatory bowel disease
Polyps
Worms
54
Q

What two conditions compose IBD?

A

Crohn’s and ulcerative collitis

55
Q

What is Crohn’s disease?

A

Mouth to anus, patchy disease ‘skip lesions’
Transmural inflammation
Granulomas

56
Q

What is UC?

A

Only rectum/colon
Continuous disease (starting from rectum)
Mucosal inflammation

57
Q

How does Crohn’s disease present?

A 
Abdominal pain
Weight loss
Diarrhoea
Growth failure/pubertal delay
Raised ESR/CRP/low albumin/Hb
Other presentations - fever, clubbing, PR bleeding, arthropathy, oral ulcers, abdominal mass..
58
Q

How does UC present?

A

Chronic bloody diarrhoea
Abdominal pain
Weight Loss
Other presentations - sclerosing cholangitis, erythema nodosum, arthropathy

59
Q

How is IBD diagnosed?

A

Endoscopy + Biopsies
MRI Abdo
Radiolabelled white cell scans

60
Q

How is remission induced in IBD?

A

Exclusive enteral nutrition (only Crohn’s)
Steroids
5-ASA
Biologicals e.g. Anti-TNF (Infliximab)

61
Q

How is remission maintained in IBD?

A

5-AS
Immunosuppressants e.g. azathioprine
Biologicals (infliximab, adalimumab)

62
Q

How is 5-ASA delivered?

A

pH dependent coat which dissolves in pH > 7
Microgranules encased ethyl cellulose coat
Once daily dosing

63
Q

What is the surgical treatment for IBD?

A

UC: Colectomy (curative)

Crohn’s: Depends on disease localisation, likely to need further surgery in future

HD 2 (25 decks)

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