Summary Final year MD notes - paediatric gastroenterology
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Course
Institution
Macquarie University (MQ
)
A collection suite of final paediatric MD notes to ace your penultimate and final year exams!
Look no further and save the stress of accessing multiple resources as this PDF collates and summarises information from several resources including but not limited to:
-Talley and O’Connor clinica...
Medical causes Surgical Causes Non-organic
GI cause Urology/Gynae Other GI cause Non-GI cause • Functional cause –
• Constipation • UTI - urethritis, • HSP • Appendicitis • Testicular no underlying
(common) cystitis, pyelonephritis torsion pathology (very
• DKA • Bowel obstruction
common in children
• Infantile colic • Mittleschirmz • Malignancy • Incarcerated • Ovarian torsion
> 5yo)
• Coeliac (ovulation pain) (neuroblastoma, hernia • Ectopic
• IBD • Dysmenorrhoea Wilm’s) • Malrotation /
(Period pain ) volvulus
• IBS
• PID • ISS
• Mesenteric adenitis
• STI • Hirschsprung
• Abdominal migraine
• Mesenteric
ischaemia
COMMON ABDO PAIN – Dx of Exclusion
RECURRENT abdo pain Abdominal migraine
Child presents w/ repeated non-organic/functional abdo pain episodes with NO Migraine lasting > 1hrs WITH central abdo pain
PP underlying cause
RF Stressful life events (?increased sensitivity & stimulation of visceral nerves in gut) Children > adults
Careful education + reassurance Careful education + reassurance
Ø Distraction techniques for pain Ø Acute Mx = Panadol + NSAID, + triptans + keep in dark
Ø Encourage sleep, regular meals, balanced diet, regular PA room
Mx Ø AVOID NSAIDs Ø Long-term Mx = Pizotifen (serotonin agonist),
propranolol, CCB
Ø Refer to school counsellor or child psychologist
*Slow weaning of pizotifen – prevent withdrawal Sx –
depression, anxiety, poor sleep and tremor
CONSTIPATION IN CHILDREN
Ø VERY common issue -- most is idiopathic or functional constipation (NO underlying cause)
Typical Sx RF DDx – organic Comp. Mx
• < 3x stools/week • Low fibre diet GI CAUSES: • Pain Educate + reassure – may
• Hard stools (difficult to pass) – rabbit • Inadequate hydration • Hirschsprung’s • Reduced sensation take months to resolve
droppings • Inactivity • Cystic fibrosis (meconium • Anal fissures • Correct reversible
• Straining ileus) cause
• Habitually not opening • Haemorrhoids
• Abdo pain ® ISS, SBO/LBO bowels ® • Bowel obstruction • High fibre diet +
• Faecal soiling adequate hydration
• Vomiting ® SBO/LBO, Hirsch desensitization of • Cow’s milk intolerance (overflow diarrhoea)
rectum ® feacal • Laxatives (e.g. Movicol
• No meconium ® Hirsch, CF • Anal stenosis / atresia • Psychosocial – osmotic laxatives)
impaction
• Ribbon stools ® anal stenosis morbidity
• Psychosocial issues
• Abnormal anus ® anal stenosis, sexual abuse, (e.g. home difficulties, OTHER: For psychosocial, idiopathic
IBD stresses) • Hypothyroidism cause
• Abnormal buttock OR lower limb FNDs® • SC lesion • Bowel diary
Spina bifida, SC lesion, sacral agenesis
• Sexual abuse • Reward for visit toilet
• FTT ® Coeliac, hypothyroidism, safeguarding
• Retentive posturing
• Overflow soiling – ENCOPARESIS (due to
faecal impaction) – loose smelly stool
• May be lose sensation to control bowels
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