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Coeliac disease
This is T cell- mediated damage of the small bowel villi due to gluten exposure, causing malabsorption
– Gluten is found in wheat and grains and causes damage in the duodenum more than jejunum/ileum
– It is associated with HLA-DQ2 and -DQ8, and onset often presents in childhood and again at 50-60 years.
Symptoms:
– Diarrhoea + Bloating + Abdominal pain
– Malabsorption –> steatorrhea + weight loss
– Fatigue + failure to thrive
– Hyposplenism
-Anaemia –> iron, folate and Vit B12 deficient
– Osteoporosis + osteomalacia
Associated conditions:
– Dermatitis herpetiformis –> IgA deposition in dermis
– Autoimmune thyroid disease
– Type 1 diabetes
– Irritable Bowel Syndrome
– Lactose Intolerance
Diagnosis:
Patients must be on gluten diet for at least 6 weeks before test
1st line is to check tissue transglutaminase (TTG) IgA antibody + endomyseal antibody (IgA)
–> You must look at TTG and measure IgA levels, as if the patient is deficient in IgA then you get a false negative
–> If IgA deficient, repeat test for TTG with IgG isoform and also check HLA-DQ2 status
– If serology is positive –> duodenal biopsy:
–> shows villous atrophy + hyperplasia of the crypts + infiltration with lymphocytes
Management:
– Lifelong gluten free diet resolves symptoms
– Give pneumococcal vaccination every 5 years as patients display hyposplenism
– If untreated can lead to T cell lymphoma of the small intestine
Acute Appendicitis
This is the most common cause of abdominal surgery in people, which can occur at any age
– It occurs due to obstruction of the lumen commonly due to lymph hyperplasia (in children) or a feacolith (seen in adults)
– Gut organisms invade appendix wall after lumen obstruction leading to oedema, ischaemia and necrosis.
– The inflammation irritates visceral fibres initially but then causes localised peritoneal inflammation in the right iliac fossa.
Symptoms:
– Migrating Periumbilical pain –> right iliac fossa
– Mild fever (37.5-38ºC) and anorexia
– Infrequent Vomiting
– Constipation (but diarrhoea can also occur)
Signs:
– Rosving sign (palpating LIF caused pain in)
– Psoas sign (pain extending hip if retrocaecal appendix)
– Cope sign (pain on hip flexion if appendix closer to obturator internus)
Diagnosis:
– Raised inflammatory markers WCC and CRP combined with clinical history
– If diagnostic doubt then do ultrasound –> then CT if diagnosis still unclear
Management:
– Laparoscopic appendectomy + prophylactic IV antibiotics
Mesenteric adenitis
This refers to inflammation of the mesenteric lymph nodes, most often in response to infection.
– It is most commonly due to a viral URTI but can also rarely be due to bacterial infection
Symptoms:
– Diffuse abdominal pain (mimicking appendicitis)
– Nausea, vomiting, diarrhoea
– Non-localised abdominal tenderness
-Extra mesenteric lymphadenopathy
– Fever
Diagnosis:
It is a diagnosis of exclusion, but many are diagnosed during appendectomy
Management:
Reassurance (usually self-resolves)
Intussusception
This is a condition where the proximal segment of the bowel telescopes into the lumen of the adjacent distal bowel
– It most commonly involves the ileum passing into the caecum through the ICV
– Usually no underlying cause is found, but in children <2yrs, an identifiable lead point is more likely to be present (e.g., polyp, Meckel diverticulum)
Symptoms:
– Abdominal pain during which infant characteristically will pull their legs up to the chest area
– Vomiting (which can be green in colour due to bile)
– Blood-stained stool (red-currant jelly stool)
– Sausage-shaped mass in RUQ
– Can cause venous obstruction giving bowel necrosis and perforation
Diagnosis:
– Ultrasound is imaging of choice and shows a target-like mass
– Can also do CT scan if unclear
Management:
– 1st line is rectal air insufflation by radiologist
– If unsuccessful or bowel perforation –> surgery is required
Infantile Colic
This is a common condition which leads to spasms of infantile colic in the first few weeks of life, due to an unknown cause.
– It is defined as having episodes of crying >3 hours a day, for >3 days/week for at least 3 weeks
– Apart from this, however, the child will be completely healthy
Symptoms:
– Paroxysmal, inconsolable crying/screaming
– Drawing up of the knees
– Passive of excessive flatus
Diagnosis:
It is a diagnosis of exclusion once other more sinister causes have been ruled out
Management:
Reassure parents as the condition self-resolves by 6 months of age
