GI problem in children

Question 1

What are some differential for a vomiting child?

Answer 1

• GORD
• Oesophagitis
• Peptic ulcer disease
• Food allergy/intolerance
• Neurological: raised ICP Eg. meningitis/brain tumour
• Metabolic: urea cycle defect, DKA
• Psychological
• Infection-UTI/LRTI
• Intestinal obstruction Eg. pyloric stenosis, malrotation, volvulus, duodenal atresia

Question 2

What are some signs of intestinal obstruction?

Answer 2

• Bilious vomit
• Severe abdo pain/cramps
• Feelings of fullness or swelling in abdomen
• Loud bowel sounds
• Flatulence
• Constipation

Question 3

What are some causes of bilious vomiting in children?

Answer 3

• Malrotation: midgut twist in clock wise direction
• Necrotising enterocolitis
• Duodenal atresia: narrowing of the duodenum

Question 4

How does GI malrotation happen?

Answer 4

It’s congenital and occurs if there is a disruption in the steps that the intestine takes to arrive at the correct position

Question 5

What is pyloric stenosis?

Answer 5

When the pyloris becomes narrow, restricting passage of food into the intestines

Treated with a pyloromyotomy

• Causes non-bilious projectile vomiting
• Onset: 3-8 weeks of age
• Symptoms: hungry after feeds, eight loss, olive mass, visible gastric , metabolic alkalosis, electrolyte derangement

Question 6

What is the management of Crohn’s disease?

Answer 6

• Nutritional rehab
• Azathioprine: immunosuppressant
• Methotrexate: Immunosuppressant
• Biologics
• 5-ASA (aminosalicylates): anti-dampen down inflammatory process

Question 7

What is the management of ulcerative colitis?

Answer 7

• 5-ASA (aminosalicylates): anti-dampen down inflammatory process
• Steroids
• Azathioprine: immunosuppressant
• Cyclosporin: immunosuppressant
• Biologics

Question 8

What are the symptoms of a Cow’s milk protein allergy?

Answer 8

Eczema, diarrhoea, constipation, vomiting, nappy rash, bloody stools, irritability, poor sleep, urticaria rash

Question 9

How is a Cow’s milk protein allergy diagnosed?

Answer 9

• Immediate food allergy-IgE RAST, skin prick test
• Delayed onset-exclusion followed by challenge

Prognosis-resolution-55% by 1 yr, 75% by 2 yrs, 87% by 3 yrs

Question 10

What are the causes of gastroenteritis in children?

Answer 10

Virus:
Rotavirus, norwalk-like, adenovirus, astrovirus, norovirus

Bacteria
Campylobacter, salmonella, shigella,E coli, C.difficile

Parasites
Giardia lamblia, cryptosporidium

Up to 50%-unknown cause

Question 11

What are some signs of severe dehydration?

Answer 11

• Abnormally sleepy/ lethargic
• Sunken eyes
• Drinking poorly
• Very low skin pinch

Question 12

What are some different type of laxatives?

Answer 12

Osmotic agents (lactulose, movicol* )

Stimulants (senna, bisacodyl, picosulfate, docusate)

Lubricants (mineral oil, liquid paraffin, docusate)

Bulking agents (fibre, bran, methylcellulose)