Tackling Pediatric GIT pathologies Christopher Robbins (CPP Seminar, Reasing ‘6 March 2008 GIT presentation Most common S&S are: Vomiting Diarrhoea Constipation Abdominal pain Vorniting ‘Volume? Dribble or whole stomach Normal? Projectile? Repeated? Links to feeds or food? ‘@Blood or bile? Diarrhoea @Frequency?After each feed normal. ‘Consistency? Watery? Porridge? Undigested food? Colour? ‘@Blood/mucous? Constipation Days between stools? Consistency? Large stool/pellets ‘Pain? Straining? Withholding? Leakage of fluid? Bleeding Relaxed or stressed child? Abdominal pain Supporting tendemess? Site/radiation ‘Relation to food, stress, activity? Nature -colic, ache, acute, constant @Noctumal/day (organic/functional)Diagnosis ‘Note that the 5 common symptoms and signs indicate a potentially large Differential Diagnosis, Acute and chronic GIT Children present easily and often with acute GITs. Most are benign. ‘BUT, chronic presentations can have serious effects of nutritional ‘@Any diagnoses should be status and affect growth and considered carefully and only with development. an appropriate DD. Colic Colic Up to 30% babies have colic.(3x3x3) ‘Definitions disputed but long periods of excessive crying is suitable, esp nocturnal. Causes much debated and worth reflecting on: ~ frustrated communication with parents jjustment to their new world = sensitivity to gas in GIT. Colic usually benign but destructive; + Stresses parents + all deprived of sleep + child overfed in compensation (see later eating problems...) Acute appendicitis ‘Most common GIT emergency, but also often over- or underdiagnosed ‘Often starts umbilical, may not lateralise to RIF for 12-24 hrs and often not significant pain or tendemess until ischaemia and perforation. Perforation in 70% under 4 year oldsi! ‘Beware the indecisive herbalist. Mesenteric adenitis Abdominal pain, often associated with a respiratory infection, due to mesenteric lymph node involvement with peritoneal irritation with pain and tendernessNon-specific abdominal pain NSAP PU, GORD, gastritis ‘@More common in girs, esp 9-13 years old. ‘Often no tendemess or other signs. Can be stress related and pattems of pain before or after schoo! or related to bullying etc. ‘@Need careful history and DD to eliminate organic causes. Other causes abdominal pain @Liver/ gall bladder disease Constipation @Renal/cystitis Abdominal migraine (?) Abdominal migraine Aka periodic syndrome. Typical in children with bouts (2 hr) andominal pain, flushing, nausea and vom, often with family history, ‘Beware the confusion with the less exciting NSAP Constipation Never ignore as can become self perpetuating problem. ‘Causes variable:- ~ emotional = family stress - fear of defecation = TV}, school (new routines) = diet = rarely organic probs Causes constipation @Always seek cause BEFORE try stimulating laxatives Obstruction, encopesis, Hirschprungs, fibre deficit, avoidance etc. Treatment must follow cause. Diet and constipation Children (like elderly) eat small meals and few foods. Easy to be soft fibre deficient ‘Often fibre increase makes ‘wonder’ change: - soft means better transit - easy defecation - less pain, less avoidance,