Dr. I. Lakshminarayana

Dehydration- How to assess Acute and Chronic abdominal pain Causes of vomiting and diarrhoea,

investigations and management Abdominal mass Feeding difficulties

Assess dehydration

Clinical dehydration

No dehydration

Suspected or confirmed shock

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

Give rapid intravenous infusion of 20 ml/kg 0.9% sodium chloride solutionGive an isotonic solution for fluid deficit

Viral- rotavirus, norovirus and adenovirus

Bacterial- salmonela, shigella, campylobacter, yersinia, E- Coli, Staph toxins.

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.

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

Investigations – Screening Total IGA and anti- Ttg

Biopsy – Showing villous atrophy Treatment- lifelong GFD, monitor growth.

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

Common Raised ICT Metabolic GORD Meningitis H High ammonia Gastroenteritis Tumours Organic acidemia UTI DKA

G.I Obstruction Pyloric stenosis Intessucception , Malrotation, Volvulus

Common Causes Constipation Colic Mesentric adenitis Appendicits UTI/Pyelonephritis

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

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

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

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

TeratomaKirk et al., 1981 Radiol. Clin. North Am., 19:527-545

Omphalocele Macroglossia Gigantism Exophthalmos Hypoglycemia

Beckwith-Wiedemann

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

Constipation – NICE guidelines on diagnosis and management

IBD diagnosis and treatment – BSPAGHN guideline

Obesity – covered in endocrinology