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Paeds > Gastro > Flashcards

Gastro Flashcards

1
Q

Explain Posseting, Regurgitation and Vomiting

A

Posseting = small amounts of milk which accompany the return of swallowed air

Regurgitation = Larger, more frequent losses

Vomiting = forceful ejection of gastric contents

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2
Q

Causes of Vomiting in infants?

A

Gastro-oesophageal reflux

Feeding problems

Infection ( gastroenteritis, respiratory tract, whooping cough, urinary tract, meningitis)

Dietary protein intolerances

Intestinal obstruction ( pyloric stenosis, atresia, malrotation, volvulus, hirschsprung disease)

Inborn errors of metabolism

Congenital adrenal hyperplasia

Renal Failure

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3
Q

Causes of vomiting in Preschool children

A

Gastroenteritis

Infection ( resp tract, urinary tract, meningitis, whooping cough)

Appendicitis

Intestinal obstruction ( intussusception, malrotation, volvulus, adhesions, foreign body)

Raised ICP

Coeliac Disease

Renal Faiure

Inborn erros of metabolism

Torsion of testes

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4
Q

Causes of vomiting in school-age children?

A

gastroenteritis

infection ( consider pyelonephritis, septicaemia, meningitis)

peptic ulcer

appendicitis

migraine

raised ICP

coeliac disease

renal failure

diabetic ketoacidosis

alcohol/drugs

cyclical vomiting syndrome

bulimia/anorexia

pregnancy

torsion of the testes

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5
Q

What are the two most common causes of chronic vomiting in infants?

A

Gastro-oesophageal reflux

Feeding problems (force feeding/ overfeeding)

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6
Q

If vomiting in infants occurs with other symptoms such as fever, diarrhoea, runny nose or cough, what should be considered?

A

Gastroenteritis or Resp tract infection

but also consider UTI and Meningitis

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7
Q

What should be excluded if an infant is projectile vomiting around age 2-7 weeks?

What should be excluded if it is bile-stained? What further assessments should be done?

A

Pyloric Stenosis

Intestinal obstruction ( intussusception, malrotation and a strangulated inguinal hernia)

Assess for dehydration and shock

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8
Q

What is the cause of gastro-oesophageal reflux in infants?

A

Inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity

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9
Q

When does gastro-oesophageal reflux in infants normally resolve and why?

A

12 months

  1. maturation of the sphincter
  2. upright posture
  3. more solids in diet
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10
Q

What complications are associated with gatro-oesophageal reflux?

A
  1. Failure to thrive
  2. Oesophagitis
  3. Recurrent Pulmonary Aspiration (can lead to pneumonia, cough or wheeze)
  4. Dystonic neck posturing
  5. Apparent life-threathening events
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11
Q

Which infants are more likely to develop severe reflux?

A

Children with cerebral palsy

Preterm-infants (esp if they have bronchopulmonary dysplasia)

Following oesophageal atresia or diaphragmatic herna surgery

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12
Q

What investigations and management for gastro-oesophageal reflux?

A

Invest - nnormally clinical, however oesophageal pH monitoring can be used and endoscopy to idenitfy oesophagitis

Manage - parental assurance and thickening agents

  • if bad can use H2 receptor antagonists and PPIs
  • surgery considered in very bad cases
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13
Q

What happens as a consequence of severe vomiting due to pyloric stenosis?

A

hypochloraemic metabolic alkalosis

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14
Q

How can pyloric stenosis be diagnosed?

A

Examination - feed baby milk…..pyloric mass can be felt like an olive in the right upper quadrant

ultrasound examination also helpful

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15
Q

What must be done before a pyloromyotomy can be carried out?

A

Ensure that any fluid and electrolyte disturbances have been corrected

0.45% saline and 5% dextrose with potassium supplements

Then the pyloromyotomy procedure can be carried out

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16
Q

What can be some causes of sudden onset continuous crying in an infant?

A
  1. UTI
  2. Ear infection
  3. Fracture
  4. Torsion of Testis
  5. Meningitis
  6. Oesophagitis
  7. Coeliac disease
  8. Constipation
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17
Q

How does infant colic present?

A

Paroxysmal, inconsolable crying
drawing up of knees
excessive flatus

presents in 40% of babies and resolves by 4 months

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18
Q

If Infant Colic presents more severe and persistent that normal what could it be?

A
  1. Cow’s milk protein allergy

2. Gastro-oesophageal reflux

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19
Q

What are some less common causes of acute abdominal pain?

A
  1. lower lobe pneumonia may cause referred pain to abdomen
  2. primary peritonitis seen in patients with ascites (nephrotic syndrome/ liver disease)
  3. Can consider things such UTI and pyelonephritis
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20
Q

What is the commonest cause of childhood abdominal pain?

A

Acute Appendicitis

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21
Q

Symptoms of acute appendicitis?

A

anorexia

vomiting

abdo pain that starts centrally and moves towards right iliac fossa

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22
Q

Signs of acute appendicitis?

A

flushed face

oral fetor

low grade fever

abdo pain aggravated by movement

persistent tenderness with guarding in Mcburneys point

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23
Q

What is non-specific abdominal pain and mesenteric adenitis?

A

Abdominal pain which resolves in 24-48 hrs, often accompanied by an URTI and cervical lymphadenopathy

Identified during laparoscopy/laparotomy by large mesenteric nodes when the appendix is normal

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24
Q

What medical causes must be considered in older children and adolescents when presenting with abdominal pain?

A

Lower Lobe Pneumonia
Diabetic Ketoacidosis
Hepatitis
Pyelonephritis

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25
Q

When is intussusception in infants most common?

A

2-24 months

most common cause of intestinal obstruction

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26
Q

What are clinical features of intussusception?

A

paroxysmal, colicky pain with pallor, abdominal mass, redcurrant jelly stool

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27
Q

What imaging is used to diagnose intussusception? what would you see?

A

Abdominal X-Ray = distended small bowel and absence of gas in distal colon/rectum

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28
Q

Treatment options for intussusception?

A

IF there is NO peritonitis = rectal air insufflation and abdominal ultrasound to check response

If unsuccessful operative reduction

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29
Q

What is Meckel’s Diverticulum?

A

Ileal remnant of vitellointestinal duct

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30
Q

Anatomically how does malrotation occur?

A

If small bowel mesentery is not fixed at the duodenojejunal flexure or the ileocaecal region

31
Q

How does volvulus due to malrotation present?

A

blood in gastric aspirate or stool
bilious vomiting
abdo pain
tenderness

32
Q

What urgent investigation must be performed in any child presenting with bilious vomiting?

A

Upper GI contrast study

33
Q

What is recurrent abdominal pain?

A

recurrent pain, sufficient to interrupt normal activities that last atleast 3 months

affects 10% school-age children

normally pain occurs around umbillicus

34
Q

What investigations would you perform on a child presenting with recurrent abdominal pain?

A

Full Hx and Exam

  1. Perineum for anal fissures
  2. Check child’s growth
  3. Urine microscopy and culture (UTI)

4, Abdo USS (exclude gall stone and PUJ obstruction)

35
Q

What is long-term prognosis for recurrent abdominal pain?

A

50% will resolve rapidly

25% will take months to resolve

25% will develop migraine, IBS or functional dyspepsia in adulthood

36
Q

What is the most common cause of gastorenteritis in developed countries?

A

Rotavirus

also can be adenovirus, norovirus, calicivirus

37
Q

While less common, how would a bacterial form of gastroenteritis present? what is the most common organism?

A

Blood in the stool

Campylobacter Jejuni

other bacteria : cholera & enterotoxigenic E.coli

38
Q

What infections could be mistaken as gastroenteritis?

A

septicaemia, meningitis, resp. tract infection, otitis media, Hep. A, UTI

39
Q

What surgical disorders could be mistaken as gastroenteritis?

A

pyloric stenosis, intussusception, acute appendicitis, Hirschsprung

40
Q

What metabolic disorders could be mistaken as gastroenteritis?

A

diabetic ketoacidosis

41
Q

What groups of children are at increased risk of dehydration?

A
  1. under 6 months of age
  2. born with low birthweight
  3. vomited 3 or more times in last 24 hours
  4. if they cant tolerate extra fluids
  5. if they have malnutrition
42
Q

Why are infants at greater risk of dehydration?

A
  1. have greater surface area to weight ratio
  2. have higher basal fluid requiremnets
  3. immature renal tubular reabsorption
43
Q

When can dehydration be detected clinically?

A

> 5% loss of bodyweight

> 10% loss = SHOCK

44
Q

What is isonatraemic dehydration?

A

When losses of water are proportional to losses in sodium

45
Q

How does hyponatraemic dehydration occurs? What complications can be caused by it?

A

When in isonatraemic dehydration the infant consumes water or hypotonic solution, causing increase in water but not sodium

This leads to extracellular water moving into cells. In the brain this increases it’s volume causing convulsions

Extracellularly, this loss of water further compounds the effects of shock

46
Q

What causes hypernatraemic dehydration?

A

High insensible water loss ( high fever, hot dry environment,

Low-sodium diarrhoea

47
Q

What are signs of hypernatraemic dehydration?

A

depression of fontanelle

decreased tissue elasticity

sunken eyes

*hard to diagnose in fat babies

48
Q

What complications can arise from hypernatraemic dehydration?

A

Brain/cerebral shrinkage - jittery movements, increased muscle tone, hyperreflexia, seizures, small cerebral hemmorhage

Transient hyperglycemia in some babies

49
Q

What are red flag symptoms of clinical dehydration?

A

Appears unwell or deteriorating

Altered responsiveness (irritable, lethargic)

Sunken Eyes

Tachycardia

Tachypnoea

Reduced Skin Turgor

Also (reduced urine output, dry mucous membranes

50
Q

What investigations should be carried out for gastroenteritis?

A

Stool Culture
U&Es
if Abx taken take a blood culture

51
Q

What is management for a child who is clinically dehydrated?

A

Oral rehydration solution - fluid deficit replacement (50ml/kg) over 4 hours + maintenance fluids

IF keeps vomiting consider ORS by NG

52
Q

What is management for a child who is in shock?

A

IV therapy - 0.9% NaCl

If patient improves

Replace fluid deficit :

If initially shocked give 100ml/kg

If not shocked give 50ml/kg

53
Q

What is post-gastroenteritis syndrome?

A

Following gastroenteritis, introdcution of normal diet causes diarrhoea.

This is caused by lactose intolerance and diagnosed by a postive Clinitest, indicating non-absorbed sugar in the stool

To manage put them on ORS for 24 hrs then restart normal diet

54
Q

What are 3 indications of malabsorption?

A
  1. Abnormal Stools
  2. Failure to thrive (in most)
  3. Specific nutrient deficiencies
55
Q

What causes coeliac disease?

A

Gliadin component of Gluten

56
Q

How does coeliac disease present?

A

Classically - failure to thrive, abdominal distension, buttock wasting, general irritability

More commonly these days - mild, non-speccific GI symptoms, anaemia (iron/folate), growth failure

57
Q

What groups of children are at higher risk of coeliac disease?

A

Type 1 Diabetes
Autoimmune Thyroid
Down’s
1 degree relative with known disease

58
Q

How do you diagnose Coeliac disease?

A

Gold Standard - biopsy = muscosal changes seen ;
1. increased intraepithelial lymphocytes

  1. villous atrophy
  2. crypt hypertrophy
59
Q

What can help with toddler diarrhoea and what makes it worse?

A

fats can help

fruit juices high in non-absorbable sorbitol

60
Q

What to consider if a child has diarrhoea and one of the following?

a) failure to thrive
b) following gastroenteritis
c) following bowel resection
d) otherwise well

A

a) coeliac or cow’s milk protein allergy
b) post-gastroenteritis lactose intolerance
c) cholestatic liver disease, exocrine pancreatic dysfunction, malabsorption
d) toddler diarrhoea

61
Q

How does Crohn’s disease present?

A

Classically : abdominal, diarrhoea, weight loss

General : Fever, lethargy and weight loss

Extra-Intestinal : oral lesions, perianal skin tags, uveitis, arthralgia and erythema nodosum

62
Q

It adolescents what can the symptoms of Crohn’s normally be mistaken for?

A

psychological problems/ anorexia

63
Q

What would you use to diagnose Crohn’s and what would you expect to see?

A

Endoscopy - non-caseating epitheloid cell granulomata

in small bowel - narrowing, fissuring, muscosal irregularities and bowel wall thickening

64
Q

How would you treat Crohn’s?

A

To achieve remission - normal diet replaced with whole protein modular feeds

For long-term treatment - immunosuppresants (azathioprine, mercaptoprine or MTX)

anti-tumour necrosis factor agents (infliximab/adalimumab)

*overnight ng/gastromy feeds may be needed for growth correction

Surgery - needed to remove obstruction, fistulae and abscess formation

65
Q

How would Ulcerative Colitis present?

A

rectal bleeding, diarrhoea and colicky pain

weight loss and growth failure

extra-intestinal - erythema nodosum and arthritis

66
Q

Diagnosis of Ulcerative Colitis?

A

Endoscopy

mucosal inflammation, crypt damage and ulceration

67
Q

What form of UC is normally seen in children?

A

Pancolitis - 90% of children

in adults normally restricted to distal colon

68
Q

Treatment for UC?

A

Aminisalicylates

Systemic Steroids (azathioprine)

Surgery - Colectomy

69
Q

Why are regularly colonoscopic screenings required after diagnosis with UC?

A

adenocarcinoma risk

70
Q

What is Hirschsprung diseasE?

A

absence of ganglioncells from myenteric and submucosal plexus in part of the large bowel

71
Q

Which areas of the bowel are affected by Hirschsprung?

A

75% rectosigmoid

10% entire colon

72
Q

How does Hirschprung’s disease present?

A

In neonatal period - intestinal obstruction and failure to pass meconium, abdominal distension and bile-stained vomiting

In later childhood - chronic constipation, abdominal distension w/o soiling and growth failure

  • occasionally severe, life-threathening Hirschsprung enterocolitis sometimes due to clostridium difficile
73
Q

Diagnosis of Hirschsprung’s?

A

Rectal biopsy (absence of ganglion cells)

74
Q

Management of Hirschsprung’s?

A

Surgical - colostomy and anastomising normal innervated bowel

Paeds (13 decks)

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