Gastro Flashcards
3 month old with increased irritability and intermittent arching and unusual neck postures. He born at term with no issues reported. He is frequently vomiting following feeds and has had one prev episode of pneumonia. What is an appropriate management?
GORD- gaviscon/omeprazole
Pneumonia- aspiration
5 year old is significantly smaller than his younger brother. No birth/pregnancy issues. He passes soft stool 2-3 times/day and non bloody diarrhoea. Abdomen is soft and non tender. Which is the most appropriate initial investigation?
TTG
Does coeliac present with diarrhoea or constipation in children?
can be both!
Three investigations for coeliac disease?
TTG and other autoantibodies (anti-EMA, IgA)
Biopsy
Resolution of symptoms with gluten free diet
Where might wasting be seen in children with coeliac disease?
buttocks
3 week old male projectile vomits after feeding. Child is exhibiting feeding cues and is quick to take bottle. On exam, there is a palpable mass in the right upper quadrant. What is the likely diagnosis?
pyloric stenosis
3 week old male projectile vomits after feeding. Child is exhibiting feeding cues and is quick to take bottle. On exam, there is a palpable mass in the right upper quadrant. What electrolyte abnormality will be seen?
Metabolic alkalosis
Hypokalaemia
Hypochloremia
Is there bile in vomit of child with pyloric stenosis?
no as food has not passed stomach and reached duodenum
Three differentials for jaundice in a baby?
breast milk jaundice, haemolysis, biliary atresia, physiological jaundice, hypothyroidism
21 day old breast fed is referred to a clinic with worsening jaundice. Mother reports pale chalky stools. Baby’s mother is rhesus negative and received anti-D during her pregnancy. What is the diagnosis?
biliary atresia
haemolysis arises in first 24 hours, breast milk and hypothyroidism don’t present with pale stools
What is the cause and treatment of physiological jaundice?
Liver not working as fast as blood is broken down, not an issue if bilirubin is stable and low. Phototherapy
11 year old boy with 3 month history of diarrhoea with intermittent blood, nocturnal stooling and weight loss. Stool microbio is negative. Faecal calprotectin 1800. Biopsy shows skip lesions and granulomas. Diagnosis?
crohn’s
One day old child has abdo distension and has not yet passed meconium. He has patent anus and is managing to suck on feeds. AXR there are dilated loops of bowel. Rectal exam is performed and explosive release of stool and air upon removal of the finger. What is the diagnosis?
Hirschprung’s= absence of parasympathetic ganglion cells in rectum
How to differentiate between meconium plug and hirschprung’s?
squirt sign= explosion of faeces after DRE. Present in Hirschprung’s
A 3 month old baby is brought by his mother with concerns that he arches his back during feeds and vomits frequently following them.
What is the most likely diagnosis?
GORD
A 6 week old infant presents with a 5 day history of fresh blood mixed with stool, noticed in their nappy on changing. She was born at term and had an uncomplicated delivery. She is formula fed and is thriving. Her mother has also taken her to the GP for dry skin. She appears well on examination, with no specific findings.
What is the most appropriate management?
Trial of hydrolysed formula
A previously well 6 month old baby is brought to ED with sudden onset paroxysmal screaming. His parents report him to draw his knees to his chest and become very pale, at the time of screaming. They state he has started passing bloody stools. What is the most likely diagnosis?
Intussusception
List three signs of on inspection you might find during paeds gastro exam
ulcers
stomatitis (sore mouth)
candidiasis
glossitis
Finger clubbing can be a sign on which diseases in children?
IBD, cystic fibrosis, coeliac disease, liver disease
Can you feel the spleen and kidneys in children?
kidneys are easily felt
splee is palpable in infants (notch appears later in childhood)
List three causes of hepatomegaly in children
Infection
Congestive cardiac failure
Tumours
Cystic fibrosis
Idiopathic
List three cases of splenomegaly?
Infection-malaria
haematological- sickle cell, hereditary spherocytosis
portal hypertension
neoplastic
thalassaemia
List three causes of hepatosplenomegaly
infection- EBV, CMV
portal hypertension
infiltration- leukaemia, lymphoma
haematological- thalassaemia
idiopathic
List two serious complications of GORD in newborns
apnoea
failure to thrive
aspiration pneumonia
What is the normal amount of feed in the first few months?
150ml/kg/day
List three causes of rectal bleeding in children
anal fissure
swallowed blood from epistaxis
gastroenteritis
hiatus hernia, peptic ulcer, meckel’s diverticulum
intussusception
IBD
What is intussusception?
bowel invaginates on itself which thickens the overall size of the bowel and narrows the lumen at the folded area, leading to a palpable mass in the abdomen and obstruction to the passage of faeces through the bowel.
In which age group does intussusception arise?
6 months to 2 years, most common in boys
List one condition that intussesception is associated with
Concurrent viral illness
Henoch-Schonlein purpura
Cystic fibrosis
Intestinal polyps
Meckel diverticulum
How does intussesception present?
severe colicky abdominal pain
pale lethargic child
bleeding in stool
vomiting
intestinal obstruction
right upper quadrant mass
Redcurrant jelly stool is indicative of which condition?
Look out for the “redcurrant jelly stool” in your exams as this indicates intussusception as a diagnosis.
A sausage shaped mass is detected on palpation. What is the likely diagnosis?
intussesception!!
What is the initial investigation for intussesception?
USS
1 year old child with viral upper respiratory tract infection develops severe abdo pain and vomiting with blood in stool. What is the likely diagnosis?
intussescption
List two complications of intussesception
obstruction
gangrenous bowel
perforation
death
List two risk factors for IBD
family history
family history autoimmune conditions- RA, thyroid disease
Name two causes of haematemesis in child
ulceration- peptic, hiatus hernia
bleeding disorders
swallowed blood- epistaxis, breastfeeding
acute gastritis, vomiting
Name a highly sensitive and specific test for coeliac disease
TTG-IgA
Name two histological features of coeliac disease
villous atrophy, crypt
hyperplasia, and increased intraepithelial lymphocytosis.
List two causes of acute diarrhoa
infection
staph toxin in food poisoning
response to infection- pneumonia
hirschprung’s, intussusception
Name two organisms that cause acute diarrhoea in children
e.coli, rotavirus, campylobacter
Name two causes of chronic dirrhoea
post infectious food tolerance- lactose
IBD
Coeliac, cystic- malabroption
constipation with overflow
Name two investigations for chronic diarrhoea
stool cultures
bloods
serum TTG
faecal calprotectin
peri anal inspection
List two medical causes of acute abdo pain
infection
constipation
HSP
acute nephritis
DKA
List two surgical causes of acute abdo pain in child
acute appendicitis
intussuception
volvulus
strangulated inguinal hernia
torsion of testes/ovary
List three red flags for abdominal pain
bilious/persistent vomiting
fever
severe chronic diarrhoea
rectal bleeding
weight loss
List three secondary causes of constipation
hirschprung’s
hypothyroidism
anal stenosis
intestinal obstruction
sexual abuse
cystic fibrosis
What is a cause of projectile vomiting in a child
pyloric stenosis
Which other condition must you test for is patient has coeliac disease?
T1D!! (remember OSCE station)
List two complications of coeliac disease
anaemia
osteoporosis
vitamin deficiency
small bowel adenocarcinoma
enteropathy associated T cell lymphoma
NHL
How to induce remission of crohn’s?
steroids +- immunosuppressants
How do induce remission of UC?
aminosalicylate e.g. msealazine
corticosteroids
How to maintain remission in UC?
mesalazine
azathioprine
How to maintain remission in crohn’s?
azathioprine
mercaptopurine
List three causes of intestinal obstruction in children
meconium ileus
hirschprung’s
dudodenal atresia
intussescption
volvulus
strangulated hernia
Two signs of obstruction on AXR?
dilated loops of bowel proximal to obstruction and collapsed loops of bowel distal to obstruction
absence of air in rectum
Name two conditions that Hirschprung’s disease is associated with
down’s syndrome
NF1
MEN 2
