GI System

1. GI System Dr. I. Lakshminarayana

2. Contents • Dehydration- How to assess • Acute and Chronic abdominal pain • Causes of vomiting and diarrhoea, investigations and management • Abdominal mass • Feeding difficulties

3. Dehydration

5. Management Assess dehydration Clinical dehydration No dehydration Suspected or confirmed shock Give rapid intravenous infusion of 20 ml/kg 0.9% sodium chloride solution Give an isotonic solution for fluid deficit Continue Breast feeding and other milk feeds. Encourage fluid intake. Give 50 ml/kg low osmolarity ORS Solution over 4 hours, plus ORS solution for maintenance. Consider NG feeding

6. Acute diarrhoea • Viral- rotavirus, norovirus and adenovirus • Bacterial- salmonela, shigella, campylobacter, yersinia, E- Coli, Staph toxins.

7. Chronic diarrhoea – Case study • Lasts > 3 weeks • 18 month old girl presents with chronic diarrhoea for 6 months, failure to thrive, anorexia, irritability and abdominal distension. She was tried on a milk free diet but her symptoms persisted.

9. Coeliac disease • Coeliac Disease (CD) is a reversible immune-mediated enteropathy caused by a permanent sensitivity to gluten in wheat, and related proteins in barley and rye, in genetically susceptible individuals

10. How do you manage this child? • Investigations – Screening Total IGA and anti- Ttg • Biopsy – Showing villous atrophy • Treatment- lifelong GFD, monitor growth.

11. Other causes of chronic diarrhoea 1)Food intolerance a) Cow’s milk protein intolerance (frequent regurgitation, vomiting, diarrhoea, blood in stools, atopic dermatitis) b) Carbohydrate intolerance- (primary and secondary lactose intolerance ) 2) Cystic fibrosis 3) Inflammatory bowel disease 4) Infection 5)Immunodefeciency

12. Causes of vomiting Common Raised ICT Metabolic GORD Meningitis H High ammonia Gastroenteritis Tumours Organic acidemia UTI DKA G.I Obstruction Pyloric stenosis Intessucception , Malrotation, Volvulus

13. Abdominal pain • Common Causes • Constipation • Colic • Mesentric adenitis • Appendicits • UTI/Pyelonephritis

14. Peritonitis- commonest cause is appendicitis Intessusception Abdominal mass Vomiting bile Torsion of testis

15. Chronic abdominal pain • Affects 10 % of children • More common in girls • Lasts longer than 3 months • Functional pain – insidious onset, periumblical, lasts 1-3 hours, no associated GI symptoms, headache common

16. Factors that suggest organic causes • Age <5 yrs • Constitutional symptoms- fever, weight loss • Disturbed sleep • Urinary symptoms • Family history of IBD • Occult or gross blood in stools • Abnormal screening blood tests

17. Renal 55% Wilms (& other) 25% Hydronephrosis 20% Cystic disease 5% Non Renal Retroperitoneal 23% Neuroblastoma 21% Teratoma 1% Other 1% Gastrointestinal 12% Appendiceal Abscess Lymphoma Hepatobiliary 6% Tumors Hepatoblastoma HCC Genital 4% Ovarian Cysts and Teratoma Abdominal Masses in Children Kirk et al., 1981 Radiol. Clin. North Am., 19:527-545

18. What is this syndrome? • Omphalocele • Macroglossia • Gigantism • Exophthalmos • Hypoglycemia • Beckwith-Wiedemann

19. Feeding problems in children • Total food refusal • Food selectivity by type • Food selectivity by texture • Liquid dependence • Bottle dependence • Inappropriate meal time behaviour • Excessive meal length • Packing food in mouth

20. What we haven’t covered • Constipation – NICE guidelines on diagnosis and management • IBD diagnosis and treatment – BSPAGHN guideline • Obesity – covered in endocrinology