Hafiz Usman Warraich Roll#C GI Disorders in Children

1. Hafiz UsmanWarraichRoll#CGI Disorders in Children Dr ShreedharPaudel 24/03/2009

2. Approach to a Child With Abdominal Pain • Acute abdominal pain Causes Surgical causes (children of ≤ 2 yrs age) -Malrotation -Intussusception -Necrotising enterocolitis -Incarcerated inguinal hernia -Volvulus -Appendicitis

3. Causes of Ac Abd Pain… • Medical causes (≤ 2 yrs age) • Gastroenteritis • UTI • Basal pneumonia • Hepatitis • Spontaneous bacterial peritonitis

4. Causes of Ac Abd Pain… • Surgical causes(children of ≥ 2 yrs age) • Appendicitis • Intestinal obstruction • Meckel’sdiverticulum • Peritonitis • Cholecystitis • Incarcerated inguinal hernia • Trauma

5. Causes of Ac Abd Pain… • Medical causes(children of ≥ 2 yrs age) • Worm infestation • Gastroenteritis • Hepatitis and liver abscess • UTI • Primary peritonitis • Pancreatitis • HSP • Ischemic bowel disease • Mesenteric lymphadenitis • Lead poisoning

6. Chronic & Recurrent Abdominal Pain • Recurrent or persistent bouts of abdominal pain that occurs over a minimum of 3 months. • Types:- Organic abdominal pain - Non organic abdominal pain

9. Treatment of functional abdominal pain • Organic causes should be excluded • Assurance of parents: absence of major illness • Child psychologists for management • Pain may be relieved by anticholinergic agents

10. Causes of chronic and recurrent abdominal pain • Children < 2yrs : -Colic- uncontrollable crying in a baby that has no known cause. - Malabsorption -Milk allergy -Rotational defects -Hirschprung disease -Esophagitis

11. Causes of chronic and recurrent abdominal pain • Children > 2years: -functional pain -constipation -giardiasis -intra-abdominal abscess -lead poisoning -pancreatitis -urolithiasis -intestinal parsites

12. Case 1 • 11 yrs old child with h/o abdominal pain for 2 mo—no associated symptoms --pain not localised What is the diagnosis?

13. Case 2 • 4 yrs male child, with --abdominal pain-4 days --nausea, vomiting, headache --Fever --Urine-dark --no diarrhoea --continuous pain What is the diagnosis?

14. Case 2 contd…. • Site of pain– Rt upper quadrant • Cough ???– to r/o basal pneumonia • Not functional pain coz fever present • D/D --Hepatitis—subclinical infective hepatitis—call after 3-4 days yellow sclera will be obvious. --Liver abscess

15. Case 3 • 18/12 yrs female child, --winter month --excessive crying and vomiting—severe abdominal pain suspected --mild fever 2 days back with running nose --stool 2-3 times a day with blood What are D/Ds?

16. Intussusception--important surgical condition missed with acute bacterial desentery.

17. Gastro-oesophageal reflux • Common—neonates and early infancy • 1st week of life incidence—85% • Declines to 6% by 2 months • Manifested as recurrent history of vomiting • Management --not required unless child looses weight and develops recurrent aspiration pneumonia --keep child upright after each feeding

18. Congenital Pyloric Stenosis • Manifests in neonatal period • More common in 1st born males • Projectile vomiting—2nd week after birth • Mass—firm and round palpable in the epigastrium with visible peristalsis L→R (as condition progresses) • If not treated early—dehydration with electrolyte imbalance

19. Congenital Pyloric Stenosis

20. Congenital Pyloric Stenosis contd… • Treatment: --Rammstedt’s operation- choice --feeding after few hours of operation --electrolyte, dehydration and alkalosis must be corrected before the operation

21. Intussusception • A portion of the alimentary tract is telescoped into a segment just caudal to it. • Frequently misdiagnosed as desentry in infancy and early childhood • Usually healthy children • Cases may coincide with outbreaks of adenoviral infections

22. Intussusceptioncontd…. • Clinical features: • Child around 1 yr of age presents with acute onset • Vomiting • Severe colicy abdominal pain • Episodic excessive crying • Attacks at varying interval of time • Followed by stool containing blood and mucus (Red currant jelly)

23. Intussusceptioncontd…. • Sausage-shaped mass lying transverse across the abdomen with features of acute abdominal obstruction • Rt iliac fossa may appear empty • DRE (digital rectal examination)—tip of intussusceptum

24. Intussusceptioncontd…. • Investigations: --USG abd-100% diagnostic for an expert eye --Barium enema X-Ray film—Claw sign ↓ Cupping (as obstructed by the intussusceptum) So pressure may reduce obstruction

26. Intussusceptioncontd…. • Treatment: --surgical emergency --treatment of shock and rehydration --if it’s of short duration hydrostatic pressure of barium enema may relieve intussusception but not so in ileoilialintussusception.

27. Intussusceptioncontd….

28. GI Allergy • Example– allergy to cow’s milk protein in the first few months of age • Clinical features may be • Diarrhea • Nausea • Vomiting • Abdominal pain

29. GI Allergy… • 3 main factors responsible are • Genetic predisposition • Allergen exposure • Contributory factors • Immunological defects • G I diseases • Infections • Non specific irritants

30. Management of GI Allergy • Find out the allergen • Avoid the exposure to allergen • Desensitization may be the last resort