Gastro Flashcards
What are the features of abdominal migraine and how is the acute attack treated/ how are they prevented?
Central abdo pain lasting >1hr
N&V, anorexia, pallor, headache, photophobia, aura
Acute treatment
-Quiet dark room
-Paracetamol
-Ibuprofen
-Sumatriptan
Preventative measures
Pizotifen (serotonin agonist) - main one used - withdraw it slowly
Propanolol
Cyproheptadine (antihistamine)
Flunarazine (CCB)
What are the features of constipation
Less than 3 stools per week
Hard stools/ rabbit dropping
Straining/ painful
Abdo pain
Retentive posturing
Rectal bleeding
Faecal impaction- overflow soiling
Loss of sensation of needing to go
What is encopresis
Faecal incontinence- not pathological until 4 yrs old
Sign of chronic constipation- loose stools leak out
Rarer causes of encopresis
-Spina bifida
-Hirschpring’s disease
-Cerebral palsy
-Learning disability
-Stress/ abuse
What are some red flags relating to constipation in children
-Not passing meconium within 48 hrs birth - CF/ Hirschsprung’s disease
-Neuro signs in lower limbs- cerebral palsy/ spinal cord lesion
-Vomiting- obstruction/ hirschsprung’s
-Ribbon stool- anal stenosis
-Abnormal anus- anal stenosis, IBD, abuse
-Abnormal lower back/ buttocks- spina bifida, spinal cord lesion, sacral agenesis
-Failure to thrive- Coeliac, hypothyroid
-Severe abdo pain/ bloating- obstruction/ intussusception
What is the management of constipation in children
- Correct any reversible factors- high fibre diet and good hydration
- Start laxatives (Movicol)
- Faecal impaction may need a disimpaction regime- high doses of laxatives given first
- Encourage toilet visits, bowel diary, star charts etc
What are the features and management of GORD in children
In babies oesophageal sphincter is immature so stomach contents easily reflux- improves with growth
Chronic cough, hoarse cry, distress/ crying/ unsettled, reluctance to feed, pneumonia, poor weight gain
Management
Small frequent meals, burping regularly to settle milk, don’t overfeed, keep baby upright after feeds
If more severe
Gaviscon mixed with feeds
Thickened milk/ formula (anti reflux formula)
PPIs
Surgical fundoplication if very severe but this is rare
What is Sandifer’s syndrome
Brief episodes of abnormal movements due to GORD in infants
Torticollis- neck twisting
Dystonia- arching back, unusual postures and twisting movements
What are the features and management of pyloric stenosis
Thickening of the pyloric sphincter and narrowing of the pylorus- stops food from travelling from stomach to duodenum
Projectile vomiting
-First few weeks of life- thin baby, pale, failure to thrive
-Can see abdomen peristalsis and a firm mass in upper abdomen
Blood gas will show- Hypochloric metabolic alkalosis- the baby is vomiting hydrochloric acid from the stomach
Diagnosis
Made with abdo USS
Treatment- laparoscopic pyloromyotomy- widening pylorus
What are the most common causes of viral gastroenteritis
Rotavirus
Norovirus
What are the distinct features associated with E.Coli
Haemolytic uraemia syndrome
(Don’t use abx as this will increase risk of this)
Infected faeces, unwashed salads, contaminated water
What are the distinct features of campylobacter jejuni
Travellers diarrhoea - most common type
Raw or poorly cooked poultry
Untreated water
Unpasteurised milk
Incubation period 2-5 days- symptoms resolve in 3-6
Abdo cramps, diarrhoea with blood, vomiting, Fever
Abx- Azithromycin and ciprofloxacin
What are the distinct features of shigella
Faeces contaminating drinking water, swimming pools and food
Incubation period 1-2 days symptoms resolve in approx 1 week
Haemolytic uraemia syndrome
Bloody diarrhoea, cramps abdo pain, fever
Azithromycin and ciprofloxacin can be given if severe
What are the distinct features of salmonella
Eating raw eggs/ poultry, contaminated food with infected animal faeces
12hrs to 3 days incubation period
Watery diaggoea with mucus/ blood
Abdo pain, voomiting
Antibiotics only if severe and do culture/ sensitivities first
What are the distinct features of bacillus cereus
Fried rice left out
Food not put in fridge after cooking
Abdo cramping and vomiting within 5 hrs of ingestion
Watery diarrhoea
Symptoms resolve in 24 hrs
What are the distinct features of yersinia entercolitica
Undercooked/ raw pork / urine and faeces of rabbits and rats
Usually affects children- watery bloody diarrhoea, abdo pain, fever, lymphadenopathy
Incubation 4-7 days and illness can last 3 weeks
Older children get right sided abdo pain- mesenteric lhymadenitis
What are the distinct features of staphylococcus aureus toxin
Eggs, dairy and meat
Diarrhoea, perfuse vomiting, abdo cramps, fever
Symptoms start and settle within 12-24 hrs
What are the distinct features of Giardiasis
Faecal oral transmission
May not cause symptoms or may cause chronic diarrhoea
Treatment with metronidazole after stool microscopy
What are the features and management of coeliac disease
Anti-TTG and Anti-EMA antibodies
Anti-DPG
Test for IgA antibodies- IgA deficiency- they have the condition but antibody test won’t show up as coeliac
Jejunal villous atrophy
* Link with type 1 diabetes*
Failure to thrive, weight loss, diarrhoea, fatigue, mouth ulcers, anaemia- iron B12 and folate deficiency, dermatitis herpetiformis
HLA-DQ2 gene
Diagnosis - must still have gluten in diet
Total IgA and TTG and EMA antibodies
Endoscopy and intestinal biopsy
Lifelong gluten free diet
What are the features/ Management of Crohn’s disease
Crows NESTS
No blood or mucus
Entire GI tract
Skip lesions
Terminal ileum most affected and Transmural (full thickness inflam)
Smoking is a risk factor
Inducing remission
Steroids- Oral prednisone/ IV hydrocortisone
If doesn’t work add one of Azathioprine, mercaptopurine, methotrexate, infliximab
Maintaining remission
1st Azathioprine or Mercaptopurine
Others: Methotrexate, infliximab, adalimumab
Surgery- when disease only affects the distal ileum
What are the features/ management of ulcerative colitis
CLOSEUP - UC
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa affected
Smoking is protective
Excrete blood and mucus
Use aminosalicylates
Primary sclerosis cholangitis
Inducing remission
Mild/ moderate : Aminosalicylate (mesalazine oral or rectal)
Steroids (pred)
Severe: IV steroids
2nd line IV ciclosporin
Maintaining remission
Aminosalicylate (mesalazine)
Azathioprine
Mercaptopurine
UC only affects colon and rectum so can remove these and leave patient with an ileostomy or a J-pouch
How do you test for IBD in children
Faecal calprotectin
Endoscopy- OGD and colonoscopy- gold standard
Monitor growth and pubertal development especially since they are often on steroids etc
What are the features of biliary atresia
A section of the bile duct is narrow/ missing
Cholestasis- bile can’t be transported from the liver to the bowel
Conjugated bilirubin can’t be excreted in bile
Presents just after birth- jaundice- high conjugated bilirubin
Suspect in persistent jaundice lasting more than 14 days in babies or 21 days in premies
Investigate conjugated and unconjugated bilirubin
High levels of conjugated bilirubin will show that the liver can process bilirubin for excretion but excretion is not happening due to flow of bile
Management
Kasai portoenterostomy- attach small intestine to liver opening to clear conjugated bilirubin
Will probably need a full liver transplant
What are the features and management of intestinal obstruction
Causes
Meconium ileus, Hirschsprung’s disease, oesophageal atresia, duodenal atresia, intussusception, imperforate anus, malrotation of intestines with a volvulus, strangulated hernia
Presentation
Persistent vomiting, billows
Abdo pain and distension
Failure to pass stols/ wind
Abnormal bowel stools- high pitched/ tinkly
Abdo X-ray- dilated bowel loops- absence of air in rectum
Management
NBM, NG tube, IV fluids and surgery
What are the features of Hirschsprung’s disease and how is it managed?
nerve cells of myenteric plexus are absent in bowel and rectum - absence of parasympathetic ganglion cells at the end of the colon- can happen to the entire colon
Loss of peristalsis of the large bowel
Aganglionic section of the colon does not relax and becomes constricted - bowel obstruction proximal to this
Genetic association between
Down’s syndrome
Neurofibromatosis
Waardenburg syndrome (pale blue eyes, patches of white skin and hair, hearing loss)
MEN 2
Presentation
Delay in passing meconium
Chronic constipation since birth
Abdo pain and distension
Vomiting
Poor weight gain
Surgical removal of the aganglionic section of bowel
Rectal biopsy to show lack of ganglionic cells
What are the features of Hischsprung-associated enterocolitis
Inflam and obstruction of the intestine
2-4 weeks of birth - fever, abdo distension, bloody diarrhoea, sepsis
Can lead to toxic megacolon
Urgent abx, fluid resus and decompression
Management
Ando x-ray
Rectal biopsy - absence of ganglionic cells
What are the features and management of intussusception
Bowel telescopes into itself (folds inwards)
Narrows lumen- palpable mass in abdomen and obstruction - 6 months to 2 years
More common in boys
Associated with n
Viral illness, henoch Schonlein purpura, Cystic fibrosis, intestinal polyps, Meckel’s diverticulum
Presentation
Severe, colicky abdo pain
Pale lethargic unwell
Redcurrant jelly stool
RUQ mass- sausage shaped
Vomiting
Intestinal obstruction
Management
USS / contrast enema for diagnosis
Therapeutic enemas- used to reduce intussusception
Surgical reduction
