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Paediatrics > Feeding and GI > Flashcards

Feeding and GI Flashcards

1
Q

What is the pathogenesis of a megacolon secondary to constipation occuring in infants?

A

Acute episode - hard stool, pain, fissure
Learn pooing means pain
Withhold stool
Decreased rectal sensation - down regulated stretch receptors
Distended bowels and megacolon

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2
Q

Causes of faecal impaction/ megacolon?

A

Genetic predisposition - coeliac, CMP intolerance
neurological - spinal problems
anatomical - hirschsprungs
endocrine - hypothyroidism

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3
Q

When would you be suspicious of Hirschsprung’s disease? What is it>

A

Failure to pass meconium after 48 hours

Denervation of the distal colon

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4
Q

Symptoms of coeliac?

A

Failure to thrive
Anaemia
occasional diarrhoea
Bloating

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5
Q

Children with cows milk protein intolerance tend to present with what features?

A

Atopic features - hayfever, eczema, asthma
Uncomfortable at start of feed
Allergic medicated enterocolitis

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6
Q

How does hypothyroidism present in a baby?

A

Jaundice
constipation
skin colour changes
obesity

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7
Q

Questions to ask in a history of a child suffering constipation?

A 
Frequency
Consistency
Pain
School issues
Family issues
Any bed wetting
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8
Q

Describe the 7 stages of Bristol Stool Chart

A 
type 1 - hard nut like balls
type 2 - sausage with lumps
type 3 - sausage with cracks
type 4 - snake
type 5 - soft blobs with clear edges
type 6 - fluffy pieces ragged edges
Type 7 - water
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9
Q

On examination what would you look at on a child with constipation?

A

Perianal sensation
Any fissures?
Back
Palpate abdomen - any faecal masses especailly LIF and suprapubic

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10
Q

Advice do you give children who are chronically constipated?

A

Increase fibre intake
Increase fluid intake
Better toileting technique

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11
Q

How do you initially treat a child who is suffering faecal overload?

A

Enema - clear

Faecal softener, sitmulant - maintain

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12
Q

What is an antegrade colonic enema? ACE

A

Permanent fistula created to allow saline in to wash out colon

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13
Q

Name 3 types of stool softener

A

Lactulose
Movicol
Macrogols

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14
Q

Which stool softener is best used in children?

A

Movicol

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15
Q

Name 3 types of stimulants that are used to help constipation?

A

Senna
Ducosate
Sodium Picosulfate

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16
Q

Features of NSAP?

A

periumbilical, worse in day, headaches, stress/anxiety

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17
Q

3 types of NSAP?

A

Non-ulcer dyspepsia
Abdominal migraine
IBS

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18
Q

Presentation of Crohn’s disease?

A 
Intermittent fever
Mouth ulcers
perianal fissures
weight loss
blood in diarrhoea
abdominal pain
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19
Q

What do you always have to rule out on GI pain investigation

A

UTI

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20
Q

What investigations are performed to rule out coeliac and Crohn’s
One specific test for coeliac?

A

FBP, CRP, ESR, LFT, amylase

Anti-transglutaminase antibodies

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21
Q

What investigations can you perform on a child with abdominal pain?

A 
Urine dipstick
bloods - FBP, CRP, ESR, amylase, LFT, antitransglutaminase antibodies
USS of renal tracts
Barium meal
Endoscopy and H.Pylori breathe test
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22
Q

What can be given for abdominal migraine?

A

Pizotifen

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23
Q

Causes of vomiting in young children?

A 
GOR
feeding issues (overfeeding)
cows milk protein intolerance
obstruction - pyloric stenosis, more distal obstruction
Infections
IEM
Raised ICP
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24
Q

How and when does pyloric stenosis obstruction present in children?

A

Usually 4-8 weeks of life

Non-bilious

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25
Q

Causes of obstruction causing vomitting that occur distal down the GI tract?

A

Volvulus, intussusception, malrotation, atresia

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26
Q

How do IEM tend to present? which is the most common in children?

A

introduced to milk feeds - starts to vomit 2/3 days later
jaundice
hepatomegaly
poor weight gain

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27
Q

What feature alongside vomiting makes you worried about increase ICP?

A

Lethargy

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28
Q

7 causes of vomiting in children?

A 
GOR
Overfeeding
CMP intolerance
obstruction
raised ICP
Infection
IEM
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29
Q

How do you diagnose pyloric stenosis in a child? What will results show?

A

Venous pH and USS of the abdomen
Hypokalaemic hypochloraemic acidosis
Alkolotic blood

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30
Q

What type of acidosis is caused by pyloric stenosis?

A

Hypokalaemic hypochloraemic acidosis

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31
Q

Investigations into vomiting babies?

A

blood - FBC, UE, LFT, CRP, venous pH, USS, CT abdomen

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32
Q

What needs to be excluded in order to diagnose GOR?

A

Pyloric stenosis excluded

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33
Q

If a baby is well but has GOR, what 3 measures can be put given to improve symptoms?

A

Carobel to thicken feeds
Postural methods
Gaviscon

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34
Q

If a baby is in pain because of GOR, what 2 medications can be given?

A

Ranitidine

Omeprazole

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35
Q

What surgical treatment for GOR can be given to children with learning difficulties or autism?

A

Fundoplication

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36
Q

8 main causes for recurrent chronic diarrhoea in children?

A 
Toddler's diarrhoea
Cows milk protein intolerance
Coeliac
Pancreatic insufficiency
Primary or secondary disaccharidase deficiency (lactase)
immundeficiency 
Chronic infection
IBD
Gluten intolerance
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37
Q

Ages usually effected by Toddler’s diarrhoea?

A

18 months and 4-5 years of age

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38
Q

Which are the only 2 reasons for chronic diarrhoea in children that present with a thriving child?

A

Toddler’s diarrhoea

Cows milk protein intolerance

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39
Q

Presentation of cows milk protein intolerance?

A

Atopic features

Difficult to feed from the get go

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40
Q

Presentation of pancreatic insufficiency?

A

CF - recurrent chest infections, steatorrhoea, not thriving

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41
Q

Primary or secondary disaccharidase deficiency refers to what?

A

Lactose intolerance

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42
Q

What is the most common cause of secondary lactose intolerance?

A

Viral gastroenteritis which wipes out the small bowels ability to absorb for a few weeks

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43
Q

What does FBP exclude when investigating chronic diarrhoea in baby?

A

Crohns or Coeliac

44
Q

What does ESR/CRP exclude when investigating chronic diarrhoea in baby?

A

Infection

IBD

45
Q

What does LFT/albumin exclude when investigating chronic diarrhoea in baby?

A

liver cause

46
Q

What does stool culture look for specifically in chronic diarrhoea?

A

Giardiasis

47
Q

What does a stool pH look for in chronic diarrhoea ?

A

Acid stool with sugars indicative of lactose intolerance

48
Q

How do you exclude CF?

A

Sweat test

49
Q

Viruses most likely to cause acute diarrhoea in babies?

A

Rotavirus
SRSV, norwalk, winter vomiting
Adenovirus
Enterovirus

50
Q

5 bacteria that can cause acute diarrhoea? which can cause dysentry?

A 
Campylobacter
Salmonella
E.Coli
Shigella (dysentry)
Cholera
51
Q

3 main protozoa that can cause acute diarrhoea?

A

Crytosporidium
Giardiasis
Malaria

52
Q

Most likely cause of acute watery diarrhoea?

A

Rotavirus

53
Q

2 most likely cause of acute bloody diarrhoea?

A

Shigella and Campylobacter

54
Q

How do you manage acute diarrhoea in infant?

A

oral fluids/IV/ORS

Reintroduce milk and feeds quickly

55
Q

What does oral rehydration solution act on in the SI?

A

The sodium glucose co-transport pores and water by osmosis

56
Q

Signs that a child is 5% dehydrated or 10% dehydrated

A

sunken eyes/very sunken eyes
no tears
dry mucus membranes/very dry mucus membranes
drinks rampantly/ poor drinking (10%)
skin prick test goes back slowly/ very slowly

57
Q

What is RIglers Sign on X-ray and what is it indicative of?

A

Rigler’s sign is when you can see both sides of the intestine and stomach walls signifying pneumoperitoneum

58
Q

What patients are meconium ileus almost always contributed by?

A

CF

59
Q

what study can be performed to determine bowel transit time?

A

transit study/pellet study

60
Q

What is the study of choice for malrotation of the gut?

A

Fluoroscopy

61
Q

How much weight should i new born gain per week? how many calories?

A

200 grams

115 cal/kg/day

62
Q

Protein, calcium and iron requirements in first few months of life?

A 
protein = very high
calcium = steady throughout first year of life
iron = low (born with stores)
63
Q

Which minerals are good for wound healing?

A

zinc, copper, vitamin c, protein, energy

64
Q

How many months is it recommended a baby is breast fed for?

A

6 months

65
Q

Immune benefits of breast milk?

A 
immunological compounds
enzymes to improve digestions
antimicrobial elements
anti-inflam
hormone and GF
66
Q

What difference is breast milk in first 14 days of life?

A

Colostrum - rich in immunological compounds

67
Q

Immediate benefits of breast milk to the baby?

A

Reduces chances of necrotizing enterocolitis, acute otitis media, atopic conditions developing, RTI

68
Q

Benefits of breastfeeding to the mother?

A 
Reduces risk of breast and ovarian cancer
Delayed return of fertility
Reduces chances of developing T2DM
Reduced post menopausal hip fractures
Post partum weight loss
69
Q

2 examples of long chain polyunsaturated FAs and why breast milk is an important source?

A

Arachadonic acid and docosahexanoic acid

Babies cant produce themselves untill 4-6 months

70
Q

What are long chain polyunsaturated FAs used for?

A

CNS and retinal tissue

71
Q

What is the purpose of prebiotics in breast milk?

A

gut barrier
decolonises harmful bacteria
Immune system

72
Q

What 2 infections mean breastfeeding is contraindicated?

A

HIV

TB

73
Q

What conditions mean breast feeding is contraindicated for the baby?

A

IEM - galactossaemia, PKU

74
Q

Premature feeds contain what constituents for babies?

A 
more calories and protein
Calcium
Iron
Phosphate
Vitamin A
Copper
75
Q

What does partly hydrolysed formula contain and why?

A

Shorter chains less likely to cause allergic reaction

76
Q

AA based formulas used for who?

A

Multiple allergies and malabsorption in the gut

77
Q

Can you feed babies soya milk?

A

Not under 6 months

78
Q

Types of foods you can initially wean babies onto?

A

Puree fruit and vegetables, custard, potatoes, baby rice

79
Q

Second stage of weaning occurs at what age? what is food like? examples

A

7-9 months
minced and mashed
Weetabix, oats, cereal
toast, soft fruit, cooked veg

80
Q

Third stage of weaning occurs at what age?

A

10-12 months

no more bottle feeds

81
Q

When can gluten be introduced to a babies diet?

A

6 months

82
Q

When can shellfish be introduced to a babies diet?

A

6 months

83
Q

When can citrus fruits be introduced to a babies diet?

A

6 months

84
Q

When can eggs be introduced to a babies diet?

A

6 months (well cooked)

85
Q

When can processed foods be introduced to a babies diet?

A

12 months

86
Q

When can sugary foods be introduced to a babies diet?

A

12 months

87
Q

When can whole milk be introduced to a babies diet?

A

12 months

88
Q

When can honey be introduced to a babies diet?

A

12 months

89
Q

When can nuts be introduced to a babies diet?

A

12 months

90
Q

Causes of iron deficiency anaemia in children?

A

low birth weight
early use of cows milk
poor weaning diet
chronic disease

91
Q

What happens to children who have iron deficiency anaemia?

A

immune - prone to infection, general health
Coordination - locomotor skills, hand/eye
Behavioural
Physical wellbeing

92
Q

Overweight can be classified at what weight percentile?

A

over the 85th

93
Q

Obesity can be classified at what percentile?

A

over the 95th

94
Q

“nature” role in childhood obesity?

A

Low birth weight - programmed to retain calories

Parental gene influence

95
Q

Babies with Prader Willi Syndrome - initial presentation and as they develop?

A

Floppy baby
Difficult to feed initially
Gain appetite
Eat continuously

96
Q

What congenital conditions can cause obestiy in children?

A

Prader willi syndrome
Cohen
Cushing’s
Hypothyroidism

97
Q

Problems caused by childhood obestiy

A 
depression
dyslipidaemia
hypertension
SUFE
T2DM
sleep apnoea
Benign intracranial hypertension
98
Q

name a brand of oral rehydration solution?

A

Deoralyte

99
Q

What are the two important componenets of oral rehydration solution?

A

Glucose and salt

100
Q

When are IV fluids indicated in dehydration?

A

Persistent vomiting, still dehydrated despite ORS, in shock

101
Q

How much of a fluid bolus do you give in a child presenting with dehydration? How much dextrose IV?

A

20ml/kg 0.9% saline

2ml/kg 10% dextrose

102
Q

Hypopack is used to assess any underlying causes of hypoglycaemia. What 7 blood tests does it send off for?

A 
Insulin
AA
Lactate
GH
Cortisol
Serum glucose
Hydroxybutyrate
103
Q

Difference in the signs for 5 and 8% dehydration?

A 
5% = dry mucous membranes, decreased skin turgour, altered neuro, deep breathing
8% = Increased CRT over 2 seconds, cold and peripherally shut down, cold and clammy, circulatory collapse
104
Q

At what time period are fluid deficits replaced over?

A

48 hours

105
Q

What does MCADD invovle?

A

doesnt have medium chain acyl coA dehydrogenase and therefore cannot break down fats to be used in a fasting state, dependant on glucose

106
Q

Chance of having another baby with MCADD?

A

25% autosomal recessive

Paediatrics (20 decks)

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