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Medicine Notes Paediatrics Notes

Gastrointestinal Problems In Children Notes

Updated Gastrointestinal Problems In Children Notes

Paediatrics Notes

Paediatrics

Approximately 40 pages

An overview of the common paediatric conditions - from neonates to developmental delay and all the common childhood-specific illnesses organised by body system. Includes tips on history taking and examination along with investigations and management. Concise yet thorough enough for finals examinations. Colour coded including diagrams...

The following is a more accessible plain text extract of the PDF sample above, taken from our Paediatrics Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Gastrointestinal Problems in Children

Nutrition in childhood

  • Milk provides all the nutrients an infant needs for first 6 months of life

  • Newborn infants require 150ml/kg/day of fluid

  • Milk contains

    • Carbohydrate

    • Fat

    • Protein (casein, lactalbumin and lactoferrin)

    • Calcium

  • First colostrum is produced from breast – thin yellow milk, high in immunoglobulins

  • Breastmilk is deficient in vitamin K therefore all newborns offered Vit K at birth to prevent haemolytic disease of the newborn

Weaning starts around 6 months

Should not have cow’s milk until 1 year old

Start finger feeding at 7-9 months

At 9 months – eating mashed up adult food

Constipation

  • In normal children the frequency of bowel movements ranges from >2/day to none for several days

  • Infrequent bowel movements are common in exclusively breastfed babies

Constipation = passage of a hard, infrequent stools with painful defaecation

Soiling = faecal staining of the underwear and results from leakage of liquid stool around impacted faeces when a child is constipated. Often mistaken for diarrhea

Encoparesis = voluntary passage of a formed stool in inappropriate places (including underwear) by a child who is mature enough to be continent. Indicative of severe behavioral problems.

Causes of constipation – an overview

Acute causes Chronic causes

Fluid depletion

Caused by fever or hot weather

May require laxatives

Bowel obstruction

Rare and due to congenital gut malformations

Usually presents as an acute abdomen

May present as constipation with vomiting and abdominal pain

Functional constipation

Common, even more so in diabled children

Often stems from withholding from painful defeacation

May cause megacolon

Management includes laxative, bowel training and diet

Hirschprungs Disease

Onset in newborn period or infancy

Failure to thrive and abdo. Distension

Diagnosis by rectal biopsy

Examination

  • Review growth chart – Hirschprungs accompanied by FTT

  • Abdominal distension – hard, indentifiable faeces often palpated in RIF

  • Anorectal examination not usually indicated but will reveal hard stools/anal fissure may be found on inspection of anus

Investigation

  • Plain abdo xray – not normally required

    • May show enormous quantities of faeces in the colon

  • Rectal biopsy if ? hirschprungs disease

Functional constipation

  • Constipation often stems from painful passage of a hard stool, causing an anal fissure

  • Child withholds further stools to avoid pain

  • Water is reabsorbed from the colon – making the stools harder and more painful to pass

  • Becomes a self-perpetuating cycle

  • The restum becomes stretched and colonic dilatation may occur (megacolon)

Management of constipation

  • Evacuation of the bowel

    • Diet – in simple cases diet alone is effective

    • Laxatives

      • Osmotic e.g lactulose, movicol

      • Bowel stimulants e.g senna

    • Enemas – rarely required

    • Manual evacuation under GA – in severe cases

  • Maintenance

    • Stools should be kept soft by either diet or laxatives for 3-6 months

    • ...

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