Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Abdominal > Flashcards

Abdominal Flashcards

1
Q

Pain DDx

A

Vascular: GI bleed rare, HSP, intersussception
Infection / inflammatory: gastroenteritis common, UTI, hepatitis, IBD, LRTI, RULE OUT APPENDICITIS
Trauma: NAI
Autoimmune (rare)
Metabolic: DKA - CHECK BMs IN ALL CHILDREN WITH ABDO PAIN
Iatrogenic / idiopathic - self harm, constipation
Neoplasm
Congenital: Meckel’s diverticulum
Degenerative
Endocrine - DKA
Functional - IBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RISK OF DEHYDRATION?

A

STILL EATING AND DRINKING?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RF

A

Contact with anyone else with the same symptoms?
Foreign travel
Contact with farm animals
Change in what’s been eaten

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Recurrent abdo pain (common in children)

A

At least 1 episode per month for at least 3 consecutive months - severe enough to interfere with routine functioning

Use a positive diagnosis of a functional gut disorder - ROME III criteria may be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Red flags (to prompt consideration of further investigation)

A

Hx: age <5, systemic symptoms, nocturnal symptoms awaking the child from sleep, persistent RUQ / LUQ, chronic NSAID use, dysuria / haem / flank pain, FH of IBD / coeliac / peptic ulcer

Ex: growth deceleration, delayed puberty, jaundice, pallor, perianal disease, blood in stool

Investigations: raised WCC, raised inflammatory markers, anaemia, hypoalbuminaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Lactose intolerance

unlikely if blood in stools, weight loss

A

Can occur following an infective gastroenteritis
Usually temporary
Treated with a lactose exclusion for 6-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigations

A

Bloods: FBC, CRP, ESR, LFTs, coagulation screen, coeliac screen (IgA anti tissue transglutaminase)

Stools: MC&S, calprotectin (marker for gut damage, can be increased in polyps, infection…)

Further: AXR, OGD, colonoscopy, barium study (small bowel imaging), MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx

A

5-ASA drugs
Steroids
Immunosuppressive agents - steroid dependent / early relapse
anti-TNF antagonists - severe or refractory disease, failed immunosuppression
Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute bloody diarrhoea

A

PR > 100, Hb < 10, Alb < 30, BO > 10 x, fever, peritonism, increased WBC

Urgent ABX and stool culture

Dilated colon: urgent surgical input. IV steroids +/- infliximab / ciclosporin

Non dilated colon: urgent flexi sig, IV steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ROME III criteria

A

Recurrent abdo pain / discomfort 3 days per month in the last 3 months

Symptom onset > 6 months ago

Plus 2 of:
Improvement with defaecation
Onset associated with change in stool frequency
Onset associated with change in stool form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Passage of urine:

A

Number of wet nappies
As heavy as before?
How long since last wet nappy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Signs of dehydration in children

A 
Sunken fontanelle
Eyes sunken and tearless
Reduced level of consciousness
Reduced cap refill 
Dry mucous membranes
Tachypnoea 
Tachycardia, hypotension, peripheral vasoconstriction 
Reduced skin tugour
Sudden weight loss
Oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gastroenteritis Dx

A

The clinical diagnosis is based on sudden change in stool consistency to loose or watery stools and / or sudden onset of vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Blood in stool + diarrhoea / vomiting

A

Shigella
Campylobacter (most common cause of bacterial GE in UK - raw, uncooked meat)
Rotavirus
E.coli - associated with haemolytic uraemic syndrome
Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Intussusception

A

Peak presentation 3 months - 2 years
Hx: paroxysmal, severe colicky pain - draws legs up, pallor followed by lethargy
Refuse feed
Vomiting
Red currant jelly stool - blood and mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vomiting - red flags

A 
Blood
Bilous vomit - intestinal obstruction!
Projectile vomiting
Abdominal tenderness / distention 
Blood in stools
Bulging fontanelle
17
Q

Vomiting DDx

A 
Obstruction 
Infection - GE, UTI, meningitis, whooping cough
Pyloric stenosis
GORD
Coeliac
Intussusception .....
18
Q

Notification of Public Health England

A

Campylobacter
Giardia
Salmonella
E. coli

19
Q

Management

A

Fluid challenge with oral rehydration solution
Continue breast feeding / other milk feeds - reintroduce within 24 hours if stopped. Avoid juices and fizzy drinks
5-7 days, usually recovery by 2 weeks
Hand washing
48 hours off

20
Q

Safetynetting

A 
Unwell
Pale / mottled
Symptoms return / don't improve / worsen - vomiting should last no more than 3 days 
Decreased UO / wet nappies
Irritable / lethargic 
Cold extremities
21
Q

Infant feeding

A

Breast milk ideal for first 4-6 months
Solid food can be introduced ~ 6 months - rice, pureed fruit and vegetables ok. Avoid egg, wheat and fish < 6 m
Breast or formula feeds should be continued to 12 months when whole pasteurised cow’s milk can be introduced (unmodified not suitable)

22
Q

Risk of dehydration increased in

A

Children < 1 year, especially < 6 months
Low birth weight infants
> 5 loose stools and 2 episodes of vomiting in the last 24 hours
Not offered / able to tolerate supplementary fluid before presentation
Malnourished children

23
Q

Hypernatraemia dehydration features

A 
Jittery movements
Increased muscle tone 
Hyperreflexia 
Convulsions 
Drowsiness / coma
24
Q

Investigations

A

Stool microscopy and culture - recent travel abroad, diarrhoea not improving by day 7, suspected septicaemia, blood / mucus, immunocompromised

Blood culture - if starting abx

U&Es and glucose - dehydrated or starting IV fluids

25
Q

IV fluids

A

Indication - shock, red flag, persistent vomiting, hypoglycaemia

Shock: give bolus of 20 ml/kg of 0.9% NaCl (second bolus if persists)

When shock resolved give rehydration fluids

26
Q

Haemolytic Uraemic Syndrome

A

Generally seen in young children after diarrhoeal illness (classically E.coli). Other causes - pregnancy, HIV, SLE..
Triad of: acute progressive renal failure, microangiopathic haemolytic anaemia, thrombocytopaenia

Management: tx is supportive - fluids, blood transfusion, dialysis if required. Not usually role for abx. Plasma exchange in severe cases not associated with diarrhoea.

HTN long term complication

Paediatrics (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions