Paediatric Gastroenterology Flashcards Preview

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Flashcards in Paediatric Gastroenterology Deck (23):
1

Moderate dehydration

6-9% body weight loss
Lethargic but irritable
Raised HR, normal BP
Sunken eyes and Fontainebleau
Oliguria usually obvious
Skin turgor 1-2 seconds

2

Severe dehydration

10% body weight loss
Infants: drowsy, limp, cold, sweaty, cyanotic limbs, comatose
Older children: apprehensive, cold, sweaty, cyanotic limbs
Rapid feeble pulse
Reduced BP
Sunken eyes and fontanelles
Skin turgor >2 seconds
Deep acidotic breathing

3

Management of dehydration

Mild:
Oral rehydration solution 45-90mmol/L Na + 90mmol/L glucose to facilitate
Oral or NG tube (if vomiting) over 4 hours

Severe:
IV therapy if circulatory insufficiency
Bolus 20mls/kg normal saline
Once normal perfusion restored, begin ORS

4

Contraindications for oral rehydration solution

Coma
Ileus
Intussusception
Perforated viscus
Malabsorption syndrome
Liver disease

5

IV fluid volume calculations

Maintenance fluids:
0-6m - 120-140mls/kg/day
>6m - first 10kg: 4mL/kg/day, next 10kg: 2ml/kg/day, subsequent >20kg: 1ml/kg/day

+deficit: estimate % dehydration x (BW x 10) in ml/day (divide by 24 for hourly rate)

Resuscitation fluids = normal saline, maintenance fluids = .45% saline + 5% glucose

6

Causes of gastroenteritis in paediatrics

Viral: rotavirus (50%), adenovirus (5-15%)
Bacterial: campylobacter (5-10%), salmonella, shigella, e. Coli
Parasitic: giardia, cryptosporidium

7

Differentials for chronic diarrhoea in a child

Toddler's diarrhoea
Coeliac disease
Giardiasis
Spurious/overflow diarrhoea
Inflammatory bowel disease
Cow's milk protein intolerance
Excessive ingestion of fluids
Amoeba

8

Red flags of chronic diarrhoea in a child

Blood in stool
Failure to thrive
Abnormal stool microscopy
- fat globules
- red cells
- White cells

9

Mild dehydration

Loss of less than 5% body weight
- dry mucous membranes
- decreased peripheral perfusion (slow cap refill)
- Thirsty
- Alert, restless

10

What is dermatitis herpetiformis

Coeliac disease

11

Causes of constipation in children

Functional (95% of healthy children older than 1y)
Cow's milk intolerance
Coeliac disease
CF
Lead poisoning
Intestinal obstruction
IN INFANTS:
- Hirschsprung disease
- Spinal dysraphism
- Sacral teratoma
- Infantile botulism

12

Define functional constipation for a child with developmental age 4y+

At least 2 of the following symptoms occurring for at least 2 months:
- 2 or fewer defecations per week
- at least one episode of foecal incontinence per week
- history of retentive posturing or excessive volitional stool retention (withholding)
- history of painful or hard bowel movements
- presence of large foecal mass in the rectum
- history of large-diameter stools that may obstruct the toilet

13

History of constipation suggestive of organic disease

Delayed passage of meconium
Fever, vomiting, diarrhoea
Rectal bleeding
Abdominal distenstion
Present from birth
Ribbon stools (very narrow diameter)
Urinary incontinence or bladder disease
Weight loss/Poor weight gain
Delayed growth
Extraintestinal symptoms (esp. neurological)
Congenital anomalies or syndrome associated with Hirschsprung disease
Family history of HD

14

When is antibiotic therapy indicated in paediatric gastroenteritis?

ALWAYS in shigella and giardia
LESS THAN 3M olds: salmonella and C. jejuni
Immunocompromised children
Systemically unwell children

15

Definition of coeliac disease

A small bowel disorder characterised by mucosal inflammation, villous atrophy and hyperplasia, which occur on exposure to dietary gluten and which demonstrate improvement following withdrawal of gluten from the diet

16

Prevalence of coeliac disease

1 in 70

17

Clinical features of coeliac disease in a child

Anorexia
Weight loss
Abdominal distension
chronic diarrhoea
Growth failure
Fatigue and pallor (iron deficiency)

18

Investigations if suspect coeliac disease

CBE (anaemia)
Iron studies
Autoantibodies (antigliadin, anti endomysial, anti tissue transglutaminase)
Small bowel biopsy: gold standard, must be performed while child still eating gluten, flattening of mucosal villi in small bowel

19

Management of coeliac dsiease

CELIAC
C: consultation with skilled dietician
E: education about the disease
L: lifelong adherence to gluten-free diet (wheat, rye, barley)
I: identification and treatment of nutritional deficiencies (Fe, folate, Ca, Vit D and B12)
A: access to an advocacy group
C: continuous long term follow up by multi-D team

20

How to monitor response to gluten free diet in a coeliac

Antibody testing 6m after beginning diet (tissue transglutaminase)
Gluten rechallenge

21

Causes of non response to gluten free diet in diagnosed coeliacs

Poor compliance or inadvertent gluten intake

22

Management of GORD in infants

Often difficult to manage, depends on severity and impact on infant:
- Posture: keep upright/head elevated 30deg after feeding
- Food thickening (Karicare, rice cereal, Gaviscon)
- Antacids: mylanta up to 0.5mL/kg (may cause constipation, use sparingly)
- Acid suppression: Ranitidine/omeprazole - 2 week trial of symptom improvement, discontinue if nil
Surgery: Fundoplication if very severe reflux (most commonly in children with CP + scoliosis, difficult flexibility and posture, recurrent aspiration pneumonia)

23

Clinical features of GORD in infants

Vomiting/regurgitation
Irritability