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Paediatric Gastroenterology Dr Shoana Quinn September 2009 Trinity College Dublin.

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Presentation on theme: "Paediatric Gastroenterology Dr Shoana Quinn September 2009 Trinity College Dublin."— Presentation transcript:

1 Paediatric Gastroenterology Dr Shoana Quinn September 2009 Trinity College Dublin

2 Paediatric Gastroenterology Recurrent Abdominal Pain of Childhood Recurrent Abdominal Pain of Childhood Constipation Constipation Gastroesophageal Reflux Gastroesophageal Reflux

3 Recurrent Abdominal Pain of Childhood Very Common Very Common Especially 7-14 years Especially 7-14 years Periumbilical Periumbilical Present all the time Present all the time Missing school Missing school Sensitive, perfectionistic children Sensitive, perfectionistic children

4 RAP Severe, doubled over Severe, doubled over Pallor Pallor Persistent for months Persistent for months Well in between episodes Well in between episodes No nocturnal symptoms No nocturnal symptoms Reassurance Reassurance Minimal Investigation Minimal Investigation

5 Constipation Very Common Very Common Hard, sore stools Hard, sore stools Frequency prior to toilet training is very variable Frequency prior to toilet training is very variable Withholding Withholding Faecal overload and overflow Faecal overload and overflow Perianal tears Perianal tears

6 History and Examination Withholding behaviour often mistaken for straining Withholding behaviour often mistaken for straining Bright red blood on stool or on wiping Bright red blood on stool or on wiping Children unaware of stool, not behavioural Children unaware of stool, not behavioural Faecal masses on palpation of abdomen Faecal masses on palpation of abdomen Perianal inspection. Rectal examination should never be performed in paediatrics Perianal inspection. Rectal examination should never be performed in paediatrics

7 Constipation treatment Child needs to gain confidence Child needs to gain confidence Get rid of hard impacted stool Get rid of hard impacted stool Soften stool adequately so not sore Soften stool adequately so not sore Regular toileting with foot support Regular toileting with foot support Continue treatment through toilet training as this is often a time of trouble. Continue treatment through toilet training as this is often a time of trouble. Star charts and reinforcement Star charts and reinforcement

8 Constipation treatment Bisacodyl (Dulcolax) for 3 days AM Bisacodyl (Dulcolax) for 3 days AM Liquid Paraffin at night Liquid Paraffin at night Lactulose if younger than 1 year Lactulose if younger than 1 year Movicol Movicol Suppositories should only be used as last resort Suppositories should only be used as last resort Diet in children not a big contribution, excess milk can cause constipation and iron deficiency Diet in children not a big contribution, excess milk can cause constipation and iron deficiency

9 Ddx Constipation Hirschsprung Disease aganglionosis in intramuscular and submucous plexuses of the bowel Hirschsprung Disease aganglionosis in intramuscular and submucous plexuses of the bowel Always involves anus and extends proximally Always involves anus and extends proximally Surgical treatment Surgical treatment Risk of enterocolitis Risk of enterocolitis

10 Gastroesophageal Reflux GOR a normal physiological event GOR a normal physiological event 50% children in first 3 months 50% children in first 3 months Fewer than 5% age 1 year Fewer than 5% age 1 year Well, thriving, happy child Well, thriving, happy child Happy to feed post vomit Happy to feed post vomit

11 GOR Clinical diagnosis Clinical diagnosis pH probe probably only useful investigation but need consistent operator and acidic refluxate pH probe probably only useful investigation but need consistent operator and acidic refluxate Barium studies are never appropriate Barium studies are never appropriate

12 Management of GOR Parental reassurance and centiles Parental reassurance and centiles Lie flat after a feed Lie flat after a feed Feed thickeners? Feed thickeners? No medications No medications

13 Gastrooesophageal Reflux Gastrooesophageal Reflux Disease Completely different condition Completely different condition Characterised by food refusal, haematemesis, irritability and failure to thrive Characterised by food refusal, haematemesis, irritability and failure to thrive Clinical diagnosis unless suspicion of obstruction Clinical diagnosis unless suspicion of obstruction Trial of PPI then endoscopy and biopsy Trial of PPI then endoscopy and biopsy Fundoplication vs longterm PPIs Fundoplication vs longterm PPIs


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