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Child Health > Paediatric GI - Presentations > Flashcards

Paediatric GI - Presentations Flashcards

1
Q

How can vomiting episodes be described?

A

Acute - discreet episode
Chronic - low grade daily pattern associated with mild illness
Cyclical - discreet episodes + abdo pain. Child well in-between

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2
Q

What commonly causes children to vomit?

A

Gastroenteritis
Constipation
Appendicitis
Viral associated non specific vomiting

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3
Q

What commonly causes infants to vomit?

A

Intussusception
Pyloric stenosis
Malrotation/volvulus
Systemic infection

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4
Q

What is important to ask about in the history of vomiting?

A

Any blood or bile?
Projectile?
Duration?
Associated symptoms?

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5
Q

What does biliary vomit suggest?

A

Obstruction until proven otherwise

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6
Q

What does projectile vomiting indicate?

A

Pyloric stenosis

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7
Q

What do you assess on examination of a child who is vomiting?

A 
Signs of dehydration
Fever
Abdominal distention
Hernial orifices and genitalia
Cranial signs
Urinary signs
FB ingestion
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8
Q

How is vomiting managed?

A

Support with fluids if dehydrated

Find and treat cause

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9
Q

What complications are associated with vomiting?

A

Dehydration
Electrolyte disturbance
Mallory Weiss
Aspiration

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10
Q

What is diarrhoea?

A

Change in frequency and consistency of stool with enough fluid and electrolyte loss to cause illness

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11
Q

What most commonly causes diarrhoea?

A

Viral illness - self limiting

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12
Q

What symptoms raise suspicion of another cause to diarrhoea?

A 
Unwell child
Abdo tenderness and guarding
Shock
Jaundice
Reduced urine output
Bloody stool
Bilious vomit
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13
Q

What can cause bloody diarrhoea?

A

Infective - campylobacter, shigella, amoeba

Intussusception - est. 6-9 months

Haemolytic-uraemic syndrome

IBD

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14
Q

What are the viral causes of acute diarrhoea?

A

Rotavirus
Small round structured virus
Adenovirus

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15
Q

What are the bacterial causes of acute diarrhoea?

A 
E. Coli
Campylobacter spp.
Salmonella spp.
Shigella spp.
Vibrio cholerae
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16
Q

What are the protozoal causes of acute diarrhoea?

A

Giardia lamblia
Entamoeba histolytica
Cryptosporidium parvum

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17
Q

What sign would suggest gastroenteritis has a bacterial cause?

A

Temperature very high

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18
Q

What is vital when assessing a child with diarrhoea?

A

Assessing their hydration status

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19
Q

If a child is systemically unwell with diarrhoea, what would you consider?

A

UTI
RTI
Meningitis

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20
Q

What surgical causes can lead to acute diarrhoea?

A

Appendicitis

Volvulus

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21
Q

What other diagnoses would you consider if a child had acute diarrhoea?

A

CF
IBD
Overflow from constipation

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22
Q

How do you assess hydration status?

A 
Skin turgor
Mucus membranes
Urine output
Sunken Fontanelles
Heart rate - inc. with dehydration
Resp rate - inc. with dehydration
Cap refill
Appearance - alert, lethargic
Extremities - cool or warm
23
Q

When can diarrhoea be classified as chronic?

A

> 14 days

24
Q

What must be done if a child has chronic diarrhoea?

A

Full investigation into cause:
Culture
Bloods - anaemia? infection? U&E

Specialist tests:
Endomysial antibodies - coeliac
Sweat test - CF
Faecal calprotectin - IBD
Biopsy
25
Q

How is diarrhoea managed?

A

Supportive measurements - fluids, electrolytes

<6months - benefit to admitting
Continue breast feeding

26
Q

What is toddlers diarrhoea?

A

Well child with no failure to thrive with diarrhoea

Usually 2 yo

Possibly due to maturational delay in intestinal motility

27
Q

How does a child with toddlers diarrhoea present?

A

Undigested food
Flatus
Colicky intestinal pain

28
Q

What can you treat toddlers diarrhoea?

A

High fat
Give recommended amount of milk
Reduce fruit juice and sugary drinks

29
Q

How is constipation defined?

A

Infrequent (<3x/week) and painful defecation for more then 2 weeks

MUST BE DEVIATION FROM THE NORM

30
Q

What signs would indicate a child may be constipated?

A 
Palpable stool in abdomen
Withholding behaviours
Abdominal pain
Faecal incontinence
Distention
Anorexia
31
Q

When do organic causes for constipation occur?

A

Present in first few weeks of life

32
Q

What are some organic causes for constipation?

A 
Hirschprung's 
Anorectal malformation
Spinal cord problem
Hypothyroidism
Cow's milk allergy
Coeliac's
Neuromuscular disorders - cerebral palsy
33
Q

What red flags suggest an organic cause to constipation?

A 
Within first weeks of life
No meconium in 48hrs
Associated vomiting
Ribbon stool
Motor delay
34
Q

How commonly is constipation seen in children?

A

Very common in school aged children

35
Q

What is done for generalised constipation?

A

Disimpaction and Maintenance

36
Q

How are children with generalised constipation dis-impacted?

A

1 Osmotic agent - macrogol

2 Can add stimulant - Senna

3 Switch to osmotic laxative - lactulose

4 Give medication rectally

37
Q

What maintenance managed is used for generalised constipation?

A

Increase fluid and fibre
Bowel chart
Regular unhurried toileting
Reward for using toilet

38
Q

What questions would you ask about a child’s stools?

A

Frequency and consistency
Pain or blood on defecation?
Soiling?
History of delay passing meconium

39
Q

How do you infer abdominal pain in babies?

A

Screaming and drawing up of legs

40
Q

What features are important in the history of abdominal pain in children?

A

Duration - >4hr likely to be significant
Location - further from umbilicus likely to be significant
Nature
Associated symptoms

41
Q

What should you look for on examination of a child with abdominal pain?

A 
Fever
Jaundice
Rash
Resp tract
Hernial orifices
Genitalia
42
Q

What investigations would you carry out on a child with abdominal pain?

A 
Urinalysis
FBC
Stool sample
Sickling test? - if African/afro-caribbean
U&amp;E and glucose
Image - AXR/Ultrasound/CT
43
Q

What medical causes can lead to acute abdominal pain?

A 
Gastroenteritis
UTI
Constipation
IBD
Mesenteric lymphadenitis
Pancreatitis
44
Q

What surgical causes are associated with acute abdominal pain?

A

<1yo - Intussusception, Volvulus, Hernia, Hirschprung

Child - Appendicitis, Volvulus

Older child - Appendicitis, Ovary/testicular torsion

45
Q

What systemic causes can lead to acute abdominal pain?

A

DKA
HSP
Sickle cell disease
Lower lobe pneumonia

46
Q

When is abdominal pain classified as chronic/recurrent?

A

> = 4 a month for >= 2 months

Pain limit activities

47
Q

What is the pathophysiology of chronic abdominal pain?

A

Dysregulation of the visceral nerve paths lead to hyperalgesia

Commonly followed by acute GI inflammation

48
Q

What are the main risk factors for chronic abdo pain?

A 
Female
Obese
Stressed
Bullied
Parental anxiety
49
Q

What are the red flags associated with chronic abdo pain?

A 
Weight loss
PR bleed
Failure to thrive
Severe D&amp;V
Fever
Abnormal bowel sounds
50
Q

What would suggest chronic abdo pain is due to IBS?

A

Pain improve with defecation

Stool consistency change

Feel incomplete evacuation

51
Q

What would suggest chronic abdo pain is due to postprandial pain syndrome?

A

Fullness
Early satiety
Bloating and belching

52
Q

What would suggest chronic abdo pain is due to epigastric pain syndrome?

A

Epigastric burning

Not relieved by defecation or flatus

53
Q

What would suggest chronic abdo pain is due to abdominal migraine?

A

Intense periumbilical pain
Anorexia
N&V
Headache

54
Q

How is chronic abdo pain managed?

A 
Explain there is no likely cause
Investigate for causes
Explain symptoms
Stress coping strategies
Don't allow gains from pain - miss school
Peppermint oil, mebeverine, ranitidine

Child Health (30 decks)

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