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PAEDS SC1 > Gastro > Flashcards

Gastro Flashcards

1
Q

Dx pyloric stenosis

A

Abdo US– hypertrophy of sphincter

Barium- string sign, pyloric beak

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2
Q

Tx pyloric stenosis

A
  1. Fluid and electrolytes

2. Pyloromyotomy- Ramstedt (old), lapro

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3
Q

PC meckels

A

Incidental

Acute intermittent rectal bleeding

OB V I

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4
Q

Dx Meckels

A

Tc 99– ectopic gastric mucosa

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5
Q

Tx Meckels

A

Surgical excision– if it’s bleeding from surrounding ulceration

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6
Q

Associated with pyloric stenosis

A

M-E-T

Maternal history

Erythromycin

TEF

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7
Q

Associated with hirschsprungs

A

DOWNS

MEN 2

WAARDENBERG syndrome

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8
Q

PC hirschsprungs

A

Failure to pass meconium

FTT
billious vomiting

Abdo distension

Empty vault on DRE

Explosive stool discharge

Abnormal sphincter tone

Chronic constipation if older kid

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9
Q

Dx Hirschsprungs

A
  1. Barium enema
  2. PFA
  3. Anorectal manometry
    - failure of internal sphincter to relax
  4. Rectal suction bx
    - absence Meissner and Auerbach
    - hypertrophied nerve endings with AChE stain
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10
Q

Tx hirschsprungs

A

TWO STEPS:

  1. Diverting colostomy
  2. Definitive pull through
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11
Q

MCC bowel obstruction in first two years of life

A

Intussusception

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12
Q

Risk factors intussusception

A

Polyp
Lymphoma

Rotavirus
Adenovirus
Parasites

HSP
CF
Celiac
Meckels

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13
Q

PC intussusception

A

SUDDEN COLICKY abdo pain

Sausage mass in RUQ

Vomiting

Currant jelly stools (later)

Absence bowel RLQ

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14
Q

MC site intussusception

A

Ileocecal

Proximal into distal

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15
Q

Dx intussusception

A
  1. PFA- obstruction, perforation, mass

2. US- target sign

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16
Q

Tx intussusception

A
  1. Volume and electrolytes and CBC
  2. NG tube decompression
  3. Air contrast barium enema- insuffulation
    - diagnostic> therapeutic
  4. Surgery- reduction and resection of gangrenous bowel
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17
Q

Sites of malrotation

A

DJ

IC

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18
Q

PC malrotation and volvulus

A

FIRST MONTH of life
- bilious vomiting

Cramps abdo pain
Distension
Bloody / mucus diarrhea

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19
Q

Dx malrotation and volvulus

A
  1. AXR- bird beak and air fluid levels
  2. Abnormal lig of treitz
  3. US
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20
Q

Tx malrotation and volvulus

A
  1. NG tube decompression
  2. IV fluids
  3. Sx repair ER– gastric volvulus
  4. Sx repair or endoscopy – intestinal volvulus
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21
Q

PC NEC

A

Preme

First few days of life

Feeding intolerance

Bloody stools

Delayed gastric emptying

Abdo distension

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22
Q

Dx NEC

A
  1. LABS
  2. PFA
    Dilation/ portal venous has/ free air/ pneumatosis intestinalis
  3. US
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23
Q

Tx NEC

A

Supportive

Surgery – ileostomy with mucus fistula

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24
Q

PC pyloric stenosis

A

Little boy
3 weeks old, becomes projectile vomiting non bilious

Palpable olive like mass = visible peristalsis

HINGRY – malnourished and dehydrated

HypoK hypoCl met alkalosis

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25
Q

CB jaundice

A
  1. Extra hepatic- Bili atresia, choledochal cysts
  2. Intra hepatic
    - IEM: tyrosinemia, AAT, galactosemia
    - neonatal hepatitis
    - TPN cholestasis
  3. Dubin Johnson
  4. Rotor
  5. TORCH
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26
Q

UCB jaundice

A

Physiologic

  • increase Hct, enterohepatic circulation
  • decrease rbc life span, gluc transferase
  • patent ductus venous
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27
Q

UCB pathological

A
  • BREAST milk
  • Criggler
  • Gilbert’s
  • increase enterohepatic
  • sepsis
  • haemolysis
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28
Q

BREAST milk jaundice

A

Steroids and Esterfied Fatty acids

  • inhibit conjugation
  • activate enterohepatic circulation
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29
Q

Definition jaundice levels

A

> 5mg/dL

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30
Q

NB Hx points jaundice

A
  • diet
  • drug exposure intrauterine
  • familial Hb / rbc problems
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31
Q

Exam jaundice

A
  1. Hb
    - pallor
    - EHA- HM
    - bruising- Petechiae, cephalohematoma
  2. Hepatic/ GI
    - abdo distension
    - delayed MEC passage
    - light stools dark urine
  3. Infection signs
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32
Q

Dx jaundice

A 
1. BLOOD
smears
DCT
Bili levels 
Blood typing
  1. LIVER
    US, HIDA
  2. Levels and IEM
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33
Q

Tx jaundice

A
  1. Underlying
  2. UCB
    - photo tx
    - exchange transfusion
  3. Phenobarbital
    - Gilbert’s
    - type 2 gluc transferase def
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34
Q

SE’s photo tx

A

Decrease intestinal motility
Dehydration, hyperthermia
Decrease maternal time
Retinal damage

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35
Q

SE’s exchange transfusion

A 
Death
Thrombocytopenia
NEC
PCT
GvHd
Infection 
Electro
36
Q

Jaundice

A

Haemolysis - UCB

Congenital infection- CB

37
Q

Jaundice 24hrs- 2 weeks

A 
Physiologic
BREAST milk
Jaundice 
Haemolysis
Infection
Criggler
Bruising
Pgcythemia
38
Q

Jaundice > 2 weeks

A

CB

  • bile duct obs
  • neonatal hepatitis

ICB

  • physio or breast
  • infection
  • hypothyroidism
  • HA
  • high GIT obstruction
39
Q

Kasai procedure

A

hepato-porto-enterostomy

40
Q

MCC OLT in paeds

A

biliary atresia

41
Q

Choledochal cysts definition

A

= extrahepatic biliary tree cysts

42
Q

PC choledochal cysts

A 
25%= IFNANTS= CHOLESTASIS
Older kids:
- jaundice
- abdo pain
- abdo mass
- cholangitis
43
Q

Dx biliary atresia

A
  1. fasting US
  2. HIDA/ TIBIDA
  3. liver bx
  4. liver lapro
44
Q

Dx choledochal cysts

A
  1. US

2. Radionucleide scan

45
Q

Dx of AAT deficiency

A

ANTENATAL

  • levels of AAT
  • phenotype
46
Q

Prognosis of AAT

A 
50%= good
50%= OLT
47
Q

Dx of galactosemia

A
  1. reducing sugar in urine

2. enzyme in RBC

48
Q

Tx of galactosemia

A

galactose free diet= protective to liver

STILL…

  • developmental delay and
  • OVARIAN FAILURE
49
Q

In born errors of bile acid synthesis

A

increase in cholenoic acid bile acids

NORMAL GGT

50
Q

PC inborn errors of bile acid synthesis

A

CHOLESTASIS

51
Q

PC progressive familial intrahepatic cholestasis

A
  • jaundice
  • itching
  • diarrhoea with FTT
  • rickets / CLD
52
Q

Progressive familial intrahepatic cholestasis

A

RECESSIVE– bile acid transporter problem

DECREASE GGT

53
Q

Dx of inborn errors of bile acid synthesis

A

Mass spectrometry

54
Q

Tx of inborn errors of bile acid synthesis

A

Ursofalk= ursodeoxycholic acid

55
Q

Biopsy of neonatal hepatitis syndromes

A

NON-specific,

GIANT CELL hepatitis

56
Q

4 complications of acute liver failure

A

Cerebral edema
Haemorrhage
Pancreatitis
Sepsis

57
Q

2 things a/w reyes

A

Aspirin

Medium Chain Acyl dehydrogenase deficiency

58
Q

Liver work up

A
  • bilirubin
  • transaminases
  • ALP
  • coagulation screen
  • plasma ammonia
  • acid base balance
  • blood glucose
  • EEG
  • CT
59
Q

Tx acute liver failure

A
  • IV dextrose
  • antibiotics and antifungals
  • coag: FFP, vit K, H2 ant, PPI’s
  • OLT
  • cerebral edema: mannitol and fluid restriction
60
Q

poor prognosis acute liver failure

A

shrinking liver
increase bilirubin with decrease transaminases
worsening coagulopathy
coma

61
Q

fibropolycystic kidney disease

A

= liver disease a/w ADPCKD and ARPCKD

62
Q

causes of chronic liver disease in kids

A
  1. chronic infection
  2. autoimmune hepatitis
  3. wilsons disease
  4. CF
  5. fibropolycystic liver disease
  6. alpha 1 AT
  7. neonatal liver disease
  8. bile duct lesions
  9. NAFLD
63
Q

diagnosis of cirrhosis

A

transaminases
ALP
bilirubin
PT

64
Q

Tx cirrhosis

A
  1. nutrition
  2. pruritus
  3. encephalopathy
  4. OLT
65
Q

nutrition cirrhosis

A

ADEK
high protein/ carbs/ long chain FA’s
NG
TPN

66
Q

pruritus cirrhosis

A 
loose clothes
emollients
cholestyramine
phenobarbitol
ursodeoxycholic acid
67
Q

encephalopathy cirrhosis tx

A

protein restriction
lactulose
rifaxamin

68
Q

OLT cirrhosis indications

A

FTT
severe complications despite tx
poor QoL
severe malnutrition

69
Q

6 RED FLAG SIGNS OF SHOCK/DEHYDRATION

A
  1. eyes shrunken and tearless
  2. decreased skin turgor
  3. tachypnea
  4. tachycardia
  5. irritable/lethargic
  6. deteriorating
70
Q

risk factors for dehydration

A
  • low BW or 6 stools past 24hrs
  • vomit 3x/1 day
  • unable to tolerate XS fluids
  • malnutrition
71
Q

prevention of dehydration

A

breast/formula
increase fluids
ORS

72
Q

clinical dehydration

A 
ORS****
breast/formula
normal fluids
------> IV: 0.9% saline if vomiting
\+ IV vit K
\+ breast
73
Q

SHOCK

A

IV 0.9% NaCl and PICU

74
Q

after rehydration mgmt

A

reintroduce solids
hygiene

NO carbonated drinks
NO fruit juices
NO school until 48hours after last episode

75
Q

Clinitest

A

presence of non-absorptive sugar in stools
—> return to ORS 24hrs……then reintroduce normal diet

for post-gastroenteritis syndrome
— give TPN until mucosa recovered

76
Q

Toddler diarrhear= Chronic Nonspecific Diarrhea treatment

A 
4F's
Fibre
Fluids
Fat (35-40%)
Fruit juice XS AVOID
77
Q

Gluten free diet— avoid….

A 
BROW
Barley
Rye
Oats
Wheat
78
Q

Rome 3 criteria for constipation

A

> 1 fecal incont toilet/week

79
Q

risk factors for hemorrhagic disease of the newborn

A

perinatal asphyxia
maternal anticonvulsants
breast fed
preme

80
Q

risk factors for haemolytic disease of newborn

A

miscarriage
abortion
amnionitis
bleeding during pregnancy previous

81
Q

when do babies present with hemorrhagic disease of newborn

A

day 2-4

weeks 1-8

82
Q

Kleihauer test

A

checking for fetal Hb in maternal blood

[anaemia]

83
Q

4 ways to protect from jaundice in newborn

A
  1. RhoGAM
  2. feeding
  3. breast
  4. metaloporphyrins: inhibit haemoxygenase
84
Q

drugs causing acute liver failure

A

paracetamol
halothane
INH
amantia phalloides

85
Q

phenobarbitol in treatment of jaundice

A

type 2 glucuronysl transferase def

gilberts syndrome

PAEDS SC1 (13 decks)

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