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1 Paediatrics > Gastro > Flashcards

Gastro Flashcards

1
Q

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?

A

GORD- gaviscon/omeprazole

Pneumonia- aspiration

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2
Q

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?

A

TTG

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3
Q

Does coeliac present with diarrhoea or constipation in children?

A

can be both!

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4
Q

Three investigations for coeliac disease?

A

TTG and other autoantibodies (anti-EMA, IgA)
Biopsy
Resolution of symptoms with gluten free diet

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5
Q

Where might wasting be seen in children with coeliac disease?

A

buttocks

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6
Q

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?

A

pyloric stenosis

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7
Q

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?

A

Metabolic alkalosis
Hypokalaemia
Hypochloremia

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8
Q

Is there bile in vomit of child with pyloric stenosis?

A

no as food has not passed stomach and reached duodenum

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9
Q

Three differentials for jaundice in a baby?

A

breast milk jaundice, haemolysis, biliary atresia, physiological jaundice, hypothyroidism

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10
Q

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?

A

biliary atresia

haemolysis arises in first 24 hours, breast milk and hypothyroidism don’t present with pale stools

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11
Q

What is the cause and treatment of physiological jaundice?

A

Liver not working as fast as blood is broken down, not an issue if bilirubin is stable and low. Phototherapy

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12
Q

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?

A

crohn’s

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13
Q

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?

A

Hirschprung’s= absence of parasympathetic ganglion cells in rectum

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14
Q

How to differentiate between meconium plug and hirschprung’s?

A

squirt sign= explosion of faeces after DRE. Present in Hirschprung’s

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15
Q

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?

A

GORD

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16
Q

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?

A

Trial of hydrolysed formula

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17
Q

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?

A

Intussusception

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18
Q

List three signs of on inspection you might find during paeds gastro exam

A

ulcers
stomatitis (sore mouth)
candidiasis
glossitis

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19
Q

Finger clubbing can be a sign on which diseases in children?

A

IBD, cystic fibrosis, coeliac disease, liver disease

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20
Q

Can you feel the spleen and kidneys in children?

A

kidneys are easily felt
splee is palpable in infants (notch appears later in childhood)

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21
Q

List three causes of hepatomegaly in children

A

Infection
Congestive cardiac failure
Tumours
Cystic fibrosis
Idiopathic

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22
Q

List three cases of splenomegaly?

A

Infection-malaria
haematological- sickle cell, hereditary spherocytosis
portal hypertension
neoplastic
thalassaemia

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23
Q

List three causes of hepatosplenomegaly

A

infection- EBV, CMV
portal hypertension
infiltration- leukaemia, lymphoma
haematological- thalassaemia
idiopathic

24
Q

List two serious complications of GORD in newborns

A

apnoea
failure to thrive
aspiration pneumonia

25
Q

What is the normal amount of feed in the first few months?

A

150ml/kg/day

26
Q

List three causes of rectal bleeding in children

A

anal fissure
swallowed blood from epistaxis
gastroenteritis
hiatus hernia, peptic ulcer, meckel’s diverticulum
intussusception
IBD

27
Q

What is intussusception?

A

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.

28
Q

In which age group does intussusception arise?

A

6 months to 2 years, most common in boys

29
Q

List one condition that intussesception is associated with

A

Concurrent viral illness
Henoch-Schonlein purpura
Cystic fibrosis
Intestinal polyps
Meckel diverticulum

30
Q

How does intussesception present?

A

severe colicky abdominal pain
pale lethargic child
bleeding in stool
vomiting
intestinal obstruction
right upper quadrant mass

31
Q

Redcurrant jelly stool is indicative of which condition?

A

Look out for the “redcurrant jelly stool” in your exams as this indicates intussusception as a diagnosis.

32
Q

A sausage shaped mass is detected on palpation. What is the likely diagnosis?

A

intussesception!!

33
Q

What is the initial investigation for intussesception?

A

USS

34
Q

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?

A

intussescption

35
Q

List two complications of intussesception

A

obstruction
gangrenous bowel
perforation
death

36
Q

List two risk factors for IBD

A

family history
family history autoimmune conditions- RA, thyroid disease

37
Q

Name two causes of haematemesis in child

A

ulceration- peptic, hiatus hernia
bleeding disorders
swallowed blood- epistaxis, breastfeeding
acute gastritis, vomiting

38
Q

Name a highly sensitive and specific test for coeliac disease

A

TTG-IgA

39
Q

Name two histological features of coeliac disease

A

villous atrophy, crypt
hyperplasia, and increased intraepithelial lymphocytosis.

40
Q

List two causes of acute diarrhoa

A

infection
staph toxin in food poisoning
response to infection- pneumonia
hirschprung’s, intussusception

41
Q

Name two organisms that cause acute diarrhoea in children

A

e.coli, rotavirus, campylobacter

42
Q

Name two causes of chronic dirrhoea

A

post infectious food tolerance- lactose
IBD
Coeliac, cystic- malabroption
constipation with overflow

43
Q

Name two investigations for chronic diarrhoea

A

stool cultures
bloods
serum TTG
faecal calprotectin
peri anal inspection

44
Q

List two medical causes of acute abdo pain

A

infection
constipation
HSP
acute nephritis
DKA

45
Q

List two surgical causes of acute abdo pain in child

A

acute appendicitis
intussuception
volvulus
strangulated inguinal hernia
torsion of testes/ovary

46
Q

List three red flags for abdominal pain

A

bilious/persistent vomiting
fever
severe chronic diarrhoea
rectal bleeding
weight loss

47
Q

List three secondary causes of constipation

A

hirschprung’s
hypothyroidism
anal stenosis
intestinal obstruction
sexual abuse
cystic fibrosis

48
Q

What is a cause of projectile vomiting in a child

A

pyloric stenosis

49
Q

Which other condition must you test for is patient has coeliac disease?

A

T1D!! (remember OSCE station)

50
Q

List two complications of coeliac disease

A

anaemia
osteoporosis
vitamin deficiency
small bowel adenocarcinoma
enteropathy associated T cell lymphoma
NHL

51
Q

How to induce remission of crohn’s?

A

steroids +- immunosuppressants

52
Q

How do induce remission of UC?

A

aminosalicylate e.g. msealazine
corticosteroids

53
Q

How to maintain remission in UC?

A

mesalazine
azathioprine

54
Q

How to maintain remission in crohn’s?

A

azathioprine
mercaptopurine

55
Q

List three causes of intestinal obstruction in children

A

meconium ileus
hirschprung’s
dudodenal atresia
intussescption
volvulus
strangulated hernia

56
Q

Two signs of obstruction on AXR?

A

dilated loops of bowel proximal to obstruction and collapsed loops of bowel distal to obstruction

absence of air in rectum

57
Q

Name two conditions that Hirschprung’s disease is associated with

A

down’s syndrome
NF1
MEN 2

1 Paediatrics (19 decks)

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