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Paediatric Gastroenterology

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Presentation on theme: "Paediatric Gastroenterology"— Presentation transcript:

1 Paediatric Gastroenterology
Dr Shoana Quinn September 2009 Trinity College Dublin

2 Paediatric Gastroenterology
Recurrent Abdominal Pain of Childhood Constipation Gastroesophageal Reflux

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

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

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

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

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

8 Constipation treatment
Bisacodyl (Dulcolax) for 3 days AM Liquid Paraffin at night Lactulose if younger than 1 year Movicol Suppositories should only be used as last resort 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 Always involves anus and extends proximally Surgical treatment Risk of enterocolitis

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

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

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

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

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