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Paeds > Gastro > Flashcards

Gastro Flashcards

1
Q

when should you breastfeed/formula feed until

A

6months

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2
Q

when should you start weaning

A

6 months

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3
Q

why is unmodified cows milk inappropriate

A

too much protein/electrolytes, deficient in iron, vitamins A,C,D

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4
Q

when can you give cows milk

A

after 12m

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5
Q

when to use specialised infants formula feed

A

cows milk protein allergy/intolerance, lactose intolerance, CF, intestinal resection

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6
Q

advantages of breastfeeding for baby

A

transfer IgA, lactoferrin and interferon reduces chance of gastroenteritis; lower chance atopy; good supply Fe and Ca; good supply protein and fat

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7
Q

advantages of breastfeeding for mother

A

reduced incidence breast cancer, improved relationship with baby

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8
Q

disadvantages of breastfeeding for baby

A

breast milk jaundice; transmission viruses/drugs; deficient in vitamin K; poor weaning practise

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9
Q

disadvantages of breastfeeding for mother

A

emotional, time consuming

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10
Q

what hormone is in the anterior pituitary

A

prolactin

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11
Q

what does prolactin do

A

stimulates milk reflex

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12
Q

what hormone is in the posterior pituitary

A

oxytocin

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13
Q

what does oxytocin do

A

contraction of myoepithelial cells in alveoli forcing milk into the larger ducts

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14
Q

bile stained vomit

A

intestinal obstruction

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15
Q

causes of haematemesis

A

oesophagitis, peptic ulceration, oral/nasal bleeding

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16
Q

projectile vomiting in first few weeks of life

A

pyloric stenosis

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17
Q

vomit at end of paroxysmal coughing

A

whooping cough (pertussis)

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18
Q

abdominal distension in vomiting

A

lower intestinal obstruction

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19
Q

hepatosplenomegaly

A

chronic liver disease, storage diseases

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20
Q

blood in stool in vomiting

A

gastroenteritis

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21
Q

bulging fontanelle or seizures in vomiting child

A

increased ICP

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22
Q

vomiting and failure to thrive

A

gastro oesophageal reflux, coeliac

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23
Q

what is Gastro oesophageal reflux

A

involuntary passage of gastric contents into oesophagus due to the lower oesophageal sphincter being inappropriately relaxed

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24
Q

why is GOR common in infants

A

fluid diet, horizontal posture, short intra abdominal length

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25
Q

presentation of GOR

A

recurrent regurgitation and vomiting, put on weight normally

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26
Q

complications of GOR

A

failure to thrive if severe vomiting, oesophagitis leading to haematemesis, pulmonary aspiration, apparent life threatening events, dystonic neck posturing

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27
Q

investigations in GOR

A

24h oesophageal PH monitoring (gold standard), 24h impedance monitoring, endoscopy and biopsy, contrast studies

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28
Q

management GOR

A

thickening agents added to feeds, position at 30 degree head prone after feeds, if more serious add ranitidine and PPIs (omeprazole), surgery last resort Nissen fundoplication

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29
Q

what is pyloric stenosis

A

hypertrophy of the pyloric muscle leading to gastric outlet obstruction

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30
Q

when does pyloric stenosis present

A

2-7 weeks

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31
Q

how does pyloric stenosis present

A

vomiting, hunger after vomiting, weight loss, hypochloraemic metabolic alkalosis with low Na and K

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32
Q

diagnosis pyloric stenosis

A

test feeds, waves of peristalsis, pyloric mass RUQ (feels like an olive), ultrasound

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33
Q

management

A

IV fluids to correct fluid and electrolytes, pyloromyotomy

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34
Q

recurrent abdominal pain how do they present

A

usually central pain (periumbilical) and otherwise well

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35
Q

RAP- what do you need to check

A

urine for UTI

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36
Q

RAP- gastro causes

A

IBS, abdominal migraine, constipation, non ulcer dyspepsia, gastritis and peptic ulceration

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37
Q

RAP- gynae causes

A

dysmenorrhoea, ovarian cysts, PID

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38
Q

RAP-psych causes

A

bullying, abuse, stress

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39
Q

RAP-hepato/biliary causes

A

hepatitis, gall stones, pancreatitis

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40
Q

RAP- urinary tract

A

UTI, pelvi-ureteric junction obstruction

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41
Q

symptoms in recurrent abdominal pain that suggest organic disease

A

epigastric pain at night, haematemesis, diarrhoea, weight loss, growth failure, vomiting (pancreatitis), jaundice, dysuria, bilious vomiting and distension

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42
Q

definition of recurrent abdominal pain

A

limiting activities lasting within 3 months

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43
Q

if suspect ulcer what do you do

A

PPI, eradication- amoxicillin + clarithromycin or metronidazole. if doesnt respond then functional dyspepsia

44
Q

causes of constipation- what to consider in babies

A

Hirschsprung, anorectal abnormalities, hypothyroid, hypercalcaemia

45
Q

causes constipation

A

not enough fibre and fluids, hypothyroid, hypercalcaemia, bowel disorder, stress, fear

46
Q

why does soiling occur

A

contraction of full rectum inhibits internal sphincter leading to overflow

47
Q

what is used in disimpaction regime

A

Movicol- polyethylene glycol + electrolytes which acts as a stool softener- escalating dose over 1-2 weeks until impaction resolves. if unsuccessful- use stimulant laxative

48
Q

last resort in constipation

A

enema or manual evacuation under anaesthetic

49
Q

what is Hirschsprungs

A

absence of gangluin cells from myenteric and submucosal plexuses in large bowel leading to narrow contracted segment

50
Q

what % of pts with hirsch affects entire bowel

A

10%, 75% are rectosigmoid

51
Q

presentation Hirschsprungs

A

neonatal- failure to pass meconium in first 24h of life, abdominal distension, vomiting
childhood- chronic constipation, abdominal distention, growth failure

52
Q

diagnosis Hirschsprung

A

suction rectum biopsy- absence of ganglion cells and presence of Ach +ve nerve trunks. barium studies

53
Q

management Hirschsprung

A

colostomy, anastomose normal bowel to anus

54
Q

what is coeliac

A

gliadin portion of gluten stimulates an immunological response

55
Q

what part of the bowel does coeliac affect

A

proximal small intestine mucosa

56
Q

what happens to the villi in coeliac

A

become shorter then absent

57
Q

classical presentation coeliac

A

malabsorption at 8-24m when wheat is introduced, failure to thrive, abnormal stools, irritable, buttock wasting, abdominal distention

58
Q

if coeliac presents later in childhood what does it present with

A

GI symptoms, anaemia, growth failure

59
Q

diagnosis coeliac

A

anti IgA TTG antibodies, anti endomysial antibodies, flat mucosa on jejunal biopsy

60
Q

complications coeliac

A

increased small bowel malignancy, associated with dermatitis herpetiformis

61
Q

management coeliac

A

remove wheat, rye, barley from diet

62
Q

what is the main cause of gastroenteritis

A

rotavirus

63
Q

if there is blood in the stool what is the cause of gastroenteritis

A

bacteria

64
Q

bacterial cause of gastroenteritis with severe pain

A

campylobacter jejuni (most common bacterial)

65
Q

bacterial cause gastroenteritis with dysenteric presentation (blood and pus)

A

shigella and salmonella

66
Q

bacterial cause gastroenteritis with profuse and dehydrating diarrhoea

A

e coli and cholera

67
Q

most serious complication of diarrhoea

A

dehydration leading to shock

68
Q

signs of dehydration

A

tachycardic, tachypnoeic, decreased urine output, dry mucous membranes, decreased skin turgor, sunken eyes

69
Q

signs of shock

A

lethargy, sunken fontanelle, dry mucous membranes, eyes sunken, tachypnoea, tachycardia, increased cap refill, weak peripheral pulses, decr tissue turgor, sudden weight loss, decr urine output, pale/mottled skin, hypotension, cold extremities

70
Q

how does hyponatraemic dehydration occur

A

drinking a lot of water so more Na lost than water

71
Q

what can hyponatraemic dehydration lead to

A

cerebral oedema and convulsions

72
Q

how does hypernatraemic dehydration occur

A

high water losses so more water lost than Na

73
Q

what can hypernatraemic dehydration lead to

A

jittery, increased muscle tone with hyperreflexia, altered conciousness, seizures, cerebral haem

74
Q

what is mild dehydration defined by and what is the management

A
75
Q

what is moderate dehydration defined by and what is the management

A

6-10% body weight loss. oral rehydration solution- 100ml/kg over 6h. if no improvement then IV rehydration

76
Q

what is severe dehydration defined by and what is the management

A

> 10% body weight loss. IV rehydration. bolus fluids if shocked- rapid infusion NaCl 0.9%.

77
Q

what can happen post gastroenteritis

A

can develop a temporary lactose intolerance- confirm by non absorbed sugar in stools- positive Clinitest result- return to ORS for 24h

78
Q

causes of chronic diarrhoea

A

coeliac, IBD, transient dietary protein intolerance, toddler diarrhoea

79
Q

features of transient dietary protein intolerance

A

diarrhoea +- vomiting with failure to thrive, eczema, acute colitis, migraine, occasional acute anaphylaxis

80
Q

which condition is IgE mediated- coeliac or transient dietary protein intolerance

A

transient dietary

81
Q

what is the most common food for transient dietary protein intolerance

A

cows milk protein

82
Q

differentiate transient dietary protein intolerance from coeliac

A

jejunal biopsy- patchy enteropathy with eosinophilsrather than flattened villi

83
Q

diagnosis transient dietary protein intolerance

A

most children have eosinophilia, positive RAST test, high IgE in plasma

84
Q

manage transient dietary protein intolerance

A

dietician, complete antigen exclusion, cows milk use hydrolysate based formula

85
Q

when do most children grow out of transient dietary protein intolerance

A

by 2 years

86
Q

what is toddler diarrhoea

A

chronic non specific diarrhoea- caused by functionally immature bowel leading to minor malabsorption

87
Q

features of toddler diarrhoea

A

stools varying consistency, presence of undigested vegetables, child well and thriving, no precipitating factors

88
Q

classical presentation of Crohns

A

25%- abdominal pain, weight loss, diarrhoea

89
Q

presentation of Crohns

A

growth failure, delayed puberty, abdominal pain, weight loss, diarrhoea, general ill health, extra intestinal manifestations- oral lesions, perianal fissures, uveitis, arthralgia, erythema nodosum

90
Q

where is the most common site affected in Crohns

A

distal ileum, proximal colon

91
Q

what happens to the bowel in Crohns

A

acutely inflamed, thickened bowel. strictures and fistulae form

92
Q

what is the histological in Crohns

A

non caseating epithelioid cell granulomata

93
Q

investigations in crohns

A

upper GI endoscopy, ileocolonoscopy, small bowel imaging

94
Q

how is remission induced in crohns

A

nutritional therapy- replace normal diet by whole protein modular feeds (polymeric diet), if not effective- steroids

95
Q

what drugs can be used in Crohns

A

steroids, immunosuppressants- azathioprine, methotrexate, anti tumour necrosis factor agents- infliximab, adalimumab.

96
Q

surgery necessary for what complications in Crohns

A

obstruction, fistulae, abscesses

97
Q

local symptoms of UC

A

rectal bleeding, colicky pain, diarrhoea

98
Q

systemic symptoms UC

A

weight loss, growth failure, arthritis, erythema nodosum

99
Q

what % of children in UC have pancolitis

A

90%

100
Q

diagnosis UC

A

biopsy, colonoscopy, crypt damage, ulceration

101
Q

treatment for mild UC

A

aminosalicylates- mesalazine, balsalazide. or topical steroids

102
Q

treatment for severe UC

A

systemic steroids

103
Q

complication of UC in severe fulminating disease

A

toxic megacolon- inflammation causes impaired gut motility leading to acute distension of the colon. increased abdominal pain and shock

104
Q

how is toxic megacolon treated in UC

A

emergency- ciclosporin, IV fluids, steroids. if not responsing- colectomy

105
Q

when is surgery implicated in UC

A

colectomy with ileostomy or ileorectal pouch in toxic megacolon or in chronic poorly controlled.

106
Q

what are you at increased risk of in UC

A

adenocarcinoma of colon in adults- regular screening after 10 years

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