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Paediatrics > Gastro > Flashcards

Gastro Flashcards

1
Q

Bile stained vomit

A

Intestinal obstruction after the Ampulla of Vater

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2
Q

Projectile vomiting in the first weeks of life

A

Pyloric stenosis

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3
Q

Blood in stool

A

Gastroenteritis - Camplyobacter/Salmonella

Intussusception (red current jelly)

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4
Q

Causes of vomiting in neonates

A

Overfeeding
Gastro-oesophageal reflux
Necrotising enterocolitis
Obstruction - pyloric stenosis, vulvulas, malrotation (bilious vom)

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5
Q

Causes of vomiting in infants

A

Gastroenteritis
Other infections - Pertussis, UTI, meningitis, otitis media.
Dietary intolerance.
Intestinal obstruction - pyloric stenosis, intussusception, duodenal atresia, Hirschsprung disease.
Congenital adrenal hyperplasia.

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6
Q

Causes of vomiting in children and adolescents.

A 
Gastroenteritis 
Infection - pyelonephritis, meningitis.
H.pylori and peptic ulcer.
Appendicitis
Raised ICP (tumour)
Diabetic ketoacidosis
Bulimia
Testicular torsion
Coeliac.
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7
Q

Duodenal atresia

A

Blind ending in oesophagus which can have connecting fistula to the trachea (tracheo-oesophageal fistula).
Diagnosis can be made antenatally = small for gestational age, polyhydramnios.
Postnatally = respiratory distress, choking, poor feeding, unable to swallow, increased secretions, aspiration.
Unable to pass catheter into stomach.
Immediate surgical repair!

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8
Q

Causes of small bowel obstruction in neonates

A

Duodenal or ileum atresia or stenosis
Malrotation and volvulus (can lead to necrosis)
Meconium ileus (associated with CF)
Meconium plug

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9
Q

Causes of large bowel obstruction in neonates

A

Hirschsprung disease

Rectal atresia

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10
Q

Hirschsprung disease pathology and clinical features

A

Absence of myenteric nerve ganglia in rectum and can extend up to colon.
More common in males.
Continuous contractions = obstruction, neonate won’t pass faeces.
S+S = constipation, abdo distension, megacolon, vomiting, explosive passage of stools and gas.

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11
Q

Investigations and management of Hirschsprung

A

Rectal suction biopsy

Surgical excision of aganglionic section and colostomy.

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12
Q

Complications of Hirschsprung

A

GI perforation, enterocolitis, short-gut syndrome after surgical correction.

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13
Q

Malrotation and volvulus

A

Unfixed mesentery during embryonic rotation of the small bowel. Ladd bands cross duodenum.
Bilious vomiting, Epigastric distension, Blood in stools - necrosis in mid gut.
Contrast imaging and radiography.
Surgical correction via Ladd’s procedure.

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14
Q

Risk factors for necrotising enterocolitis

A

Low birth weight, PREMATURITY, mucosal injury, enteral feeding and bacterial colonisation.

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15
Q

Clinical features of necrotising enterocolitis

A 
Abdo distension
Abdo tenderness
Blood PR
Visibile intestinal loops
Palpable abdo mass
Shock
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16
Q

Investigations for necrotising enterocolitis

A

Pneumatosis intestinalis on AXR - gas in gut wall.

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17
Q

Management of necrotising enterocolitis

A

Nil by mouth
Stool cultures
ABx = cefotaxime + vancomycin.
Surgery if perforated or necrotic bowel.

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18
Q

Normal feeding amount

A

150ml/kg/day

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19
Q

Non-pathological vomiting in baby

A

Posseting - regurgitation of milk with gas.

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20
Q

Pyloric stenosis epidemiology

A

More common in males. Presents in 2-7weeks of age

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21
Q

Pathology og pyloric stenosis

A

hypertrophy of pyloric sphincter, outlet obstruction from stomach.

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22
Q

Clinical features of pyloric stenosis

A

Projectile vomiting.
Visible gastric peristalsis.
Palpable abdo mass.
Dehydration from vomiting and weight loss.
Low chloride, sodium and potassium ions and metabolic acidosis due to vomiting.

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23
Q

Investigations for pyloric stenosis

A

Test feed - visible peristalsis from left to right, pyloric olive shaped mass on palpation of right upper quadrant, USS.

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24
Q

Management of pyloric stenosis

A

IV fluids and electrolytes to rehydrate

Surgical pyloromyotomy.

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25
Q

Children at risk of severe gastro-oesophageal reflux

A

Neurodevelopmental pathologies e.g. cerebral palsy.
Preterm babies
Post surgery for oesophageal atresia.

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26
Q

Factors which make babies more at risk of GORD

A

Fluid diet
Immature lower oesophageal sphincter.
Mostly horizontal posture.
Short intra-ado length of oesophagus.

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27
Q

Investigations for GORD

A

24hr pH monitoring of oesophagus.
24hr impedance monitoring
Endoscopy

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28
Q

Treatment for GORD

A

Education - more prone position with feed, thickening agents to feed.
Alginate therapy e.g. Gaviscon.
If occurring alone do not offer meds.
If sever/other symptoms - PPI e.g. omeprazole or H2 receptor antagonist e.g. ranitidine.

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29
Q

Cause of metabolic acidosis in children

A

Pyloric stenosis due to recurrent vomiting.

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30
Q

Surgical procedure for pyloric stenosis

A

pyloromyotomy

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31
Q

Surgical procedure for malrotation

A

Ladd procedure.

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32
Q

Differentials for abdo pain in neonates

A

Gastroenteritis
Mesenteric adenitis
Trauma/NAI
Intussusception

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33
Q

Differentials for abdo pain in infants

A 
Gastroenteritis
Constipation
UTI
Appendicitis
Mesenteric adenitis
Intussusception
Trauma
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34
Q

Differentials for abdo pain in children

A 
Gastroenteritis
Constipation
UTI
IBD
Appendicitis
Trauma
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35
Q

Differentials for abdo pain in teens

A 
Gastroenteritis
UTI
IBD
Gynae problem
Gallstones
Trauma
Mesenteric adenitis
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36
Q

Age of appendicitis

A

After 3yrs

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37
Q

Clinical features of acute appendicitis

A 
Anorexia
Vomiting
Abdo pain initially at at umbilicus then radiating to right iliac fossa. Aggravated by movement.
Low-grade fever
Tachycardia
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38
Q

Pathognomic feature of NEC

A

Peumatosis intestinal - gas in gut wall

39
Q

Local area for tenderness and guarding in appendicitis

A

MacBurney’s point in right iliac fossa.

40
Q

Even though appendicitis is rare in infants why is it risky?

A

Higher rate of perforation, less developed omentum.

41
Q

Management of appendicitis

A

Appendiectomy.

42
Q

Investigations for abdo pain

A 
URINE DIP
FBC, CRP
AXR
Renal imaging
USS
Barium studies.
43
Q

Intussusception pathogenesis

A

Small bowel telescopes and invaginates on itself. Gut tries to peristalsis itself, gets stuck, ischaemia and can lead to perforation. Mostly ileum passing into caecum at ileocaecal valve.

44
Q

Epidemiology of Intussusception

A

More common males. Any age but mostly 5-12months.

45
Q

Clinical features of intussusception

A 
Episodic.
Lethargy
Pallor
Inconsolable crying
Vomiting
Colic - leg drawing.
PR blood and red current jelly stool.
Palpable sausage mass.
46
Q

Investigations for intussusception

A

USS - doughnut sign/target with a crescent sign.
ABX - absent gas in distal bowel, distended small bowel, sausage shaped mass in lower right quadrant.
Enlargement of Peyer’s patches.

47
Q

Management of intussusception

A

Fluid resus
Air enema/air insufflation reduction
Surgical reduction

48
Q

Pathogenesis of Merkel’s diverticulum

A

Diverticulum of ileum from remnant vitello-intestinal duct. Contains ectopic gastric mucosa and pancreatic tissue.

49
Q

Rules of 2 with Merkel’s diverticulum

A

2% of population

2 inches long.

50
Q

Clinical features of Merkel’s diverticulum

A

Asymptomatic
PR bleeding (not bright red nor brown 😒)
Obstruction - intussusception, volvulus.
Pain mimicking appendicitis.

51
Q

Management of Merkel’s diverticulum

A

Surgical excision.

52
Q

Breastfed babies and stools

A

Breastfed babies can have non-patholgical diarrhoea.

53
Q

Kwashiorkor

A

Oedematous malnutrition.
Low protein and amino acids in diet
Common in children weaned late from breast milk onto a high-starch diet.
Clinical features = poor growth, diarrhoea, anorexia, depigmentation of hair and skin, distended abdo, oedema, angular stomatitis, abdo distension and hepatomegaly.
Bloods = Low glucose, low potassium, low magnesium, low haemoglobin, low albumin, low cholesterol.

54
Q

Marasmus

A

Low calorie intake and large discrepancy between weight for height (more than 3 SD below median), is less than 70%weight for height.
Clinical features = distended abdo, diarrhoea, infection esp HIV, reduced mid-arm circumference, lethargy, apathy.

55
Q

Common causative organism in developed countries for gastroenteritis

A

Rotavirus (now part of immunisation schedule)

Norovirus

56
Q

Common causative organism in less developed countries for gastroenteritis

A 
C.jejuni
E.coli
Shigella
Salmonella
Due to contaminated food and water
57
Q

Clinical features of gastrenteritis

A 
Diarrhoea - usually 3times in 24hrs.
Nausea
Sudden onset vomiting
Blood or mucus in stool
Fever
Malaise
Crampy abdo pain
Dehydration (complication rather than symptom)
58
Q

Investigations and management of gastroenteritis

A

Mostly clinical diagnosis with good history (e.g. contact with other sick people, foreign travel, exclusion of other diagnosis rash, bilious vomit, neck stiff)
Stool culture
Assess for shock or dehydration and rehydration with fluids and oral rehydration therapy via Dioralyte..

59
Q

Children at increased risk of dehydration when ill

A

Less than 1yr old.
Low birth weight infants
Passage of more than 5 loose stools in 24hrs
Vomiting twice in 24hrs
Unable to tolerate/accept supplementary fluids.
Refusing to breastfeed babies.
Signs of malnutrition.

60
Q

Clinical features in a dehydrated baby

A

Altered responsiveness - lethargy, irritable
Sunken eyes
Dry mucous membranes
TC
TP
Reduced skin turgor
Normal pulse, BP and cap refill. Unchanged skin colour. Warm peripheries

61
Q

Clinical features of a child in shock

A 
Hypotensive
Prolonged cap refill
Weak peripheral pulses
TC
TP
Cold extremities
Mottled, pale skin
Decreased level of consciousness.
62
Q

Causes of malnutrition

A

Inadequate intake - cleft palate, anorexia, neglect.
Inadequate retention or excessive calorie loss - vomiting.
Mal-absorption - Coeliac, CF, intolerance.
Failure to utilise nutrition - Hypothyroid, Turner’s.
Increase nutritional requirements - thyrotoxicosis, malignancy.

63
Q

Coeliac disease associated illness

A

Type 1 DM
Hypothyroid
(other autoimmune diseases)

64
Q

Pathology of coeliac disease

A

Autoimmune enteropathy. Gluten activates an abnormal mucosal response at the proximal small intestine.
Villious atrophy and chronic inflammation.

65
Q

Clinical features of coeliac disease

A 
Persistent symptoms.
Diarrhoea - offensive smell
Abdo bloating
Faltering growth/short stature
Failure to thrive
Weight loss
Anaemia and fatigue (low folate and ferritin)
Wasting of buttocks
Irritability
66
Q

Investigations and results for coeliac disease

A

Serology = IgA tTGA or IgA EMA
Small bowel biopsy = commonly duodenum, villous atrophy, crypt hyperplasia, lymphocytic cell infiltration in intra-epithelia and lamina propria inflammation.

67
Q

Management of coeliac disease

A

Gluten free diet

68
Q

IgA tTGA

A

IgA tissue transglutaminase antibody.

69
Q

EMA

A

Endomysial antibodies.

70
Q

2 types of inflammatory bowel disease

A

Crohn’s

Ulcerative colitis

71
Q

Pathogenesis of Crohn’s

A

Relapsing and remitting inflammation of the GI tract. Affects anywhere from mouth to anus but most commonly terminal ileum.
Areas affected = Skip lesions
Full thickness of mucosal wall is inflamed.

72
Q

Clinical features of IBD

A 
Diarrhoea
UC = blood and mucus in stool, faecal urgency,
Abdo pain and tenderness
Failure to thrive - esp in Crohn's
Weight loss
fatigue
Malaise
Anorexia
Fever
Systemic symptoms = oral lesions, arthralgia, erythema nodosum, conjunctivitis, uveitis, clubbing, ankylosing spondylitis.
73
Q

Pathogenesis of Ulcerative colitis

A

Relapsing and remitting inflammation of the mucosa in the rectum and colon (children mostly pancolitis).
inflammation formed from pseudo-polyps and hyperaemic mucosa.
Punctate ulcers can develop.

74
Q

Investigations for UC

A

Biopsy = crypt damage/loss, mucosal inflammation, ulceration.

75
Q

Management of UC

A

Mild = Aminosalicylates e.g. Mesalazine, topical steroids e.g. hydrocortisone.
Moderate = oral prednisone with tapering dose
Severe = IV hydration and electrolyte replacement, IV hydrocortisone, rectal steroids, exclude infection.
Relapse = Azathioprine
Surgical colectomy plus ileostomy.

76
Q

Management of Crohn’s

A

Replace diet with whole-protein modular diet.
Oral steroids tapering dose.
Relapse = azathioprine, infliximab.

77
Q

Complications of IBD

A

Bowel obstruction, toxic dilation = perforation, abscess formation, fistulae, colon cancer.

78
Q

Features of Toddler’s Diarrhoea

A

Able to see undigested food.
Thriving child
varying consistency of stools

79
Q

Differentials for diarrhoea in a child

A

Gastroenteritis
Coeliac disease (persistent, on solid foods, short growth)
CF (steatorrhoea, pulmonary symptoms)
Chronic constipation leading to overflow diarrhoea
Food intolerance
IBD

80
Q

Differentials for constipation in a child

A 
Hirschsprung (no faeces in 24hrs of life)
Hypothyroidism
Dehydration
Anal stenosis
Spina bifida
Sexual abuse.
81
Q

Loose stools after viral gastroenteritis

A

Transient post-infective lactose intolerance. Stools are green and frothy.

82
Q

Abdo mass, painless haematuria, flank pain, anorexia.

A

Wilm’s nephroblastoma.

83
Q

Common metastases for Wilm’s nephroblastaoma

A

Lung

84
Q

Pathophys of cow’s milk protein allergy

A

IgE or non IgE mediated allergy. Associated with other atopic diseases.

85
Q

Clinical features of cow’s milk protein allergy

A 
Colic pain
GORD
Vomiting
Blood and mucus stools
Faltering growth
Diarrhoea if IgE mediated. Constipation if non-IgE mediated.
Oedema of lips
86
Q

Components of cow’s milk which may initiate immune response

A

casein and whey fractions

87
Q

Management of cow’s milk protein allergy

A

IX =skin prick and/or specific IgE antibody blood test.
If breastfed = maternal exclusion of cow’s milk in diet.
Formula fed = use hypoallergenic infant formulas.

88
Q

Giardiasis

A

Diarrhoea. Cysts in stool and motile forms in jejunal juice.
Villus atrophy with IgA deficiency.
Metronidazole Rx

89
Q

Human interleukin antigens linked to coeliac

A

HLA DQ2 and DQ8

90
Q

Gluten sensitive rash

A

Dermatitis herpetiformis.

91
Q

Granulomas in UC and Crohns

A 
UC = uncommon non-caseating granulomas
Crohn's = common non-caseating granulomas
92
Q

Histology of Crohns

A 
Deep mucosal inflammation
Crypt abscess
Skip lesions of no inflammation
Non-caseating granulomas
Fistulas and sinus tracts
Lymphocytic infiltration
May have thickened wall
93
Q

Histology of UC

A 
Rectum and colon only
Superficial inflammation of mucosa
Rarely granulomas
Rarely lymphocytic infiltration
No bowel wall thickening
Continuous inflammation
'Cobblestoning'
Shortening of crypts
94
Q

Extra-GI symptoms of IBD

A 
Arthritis (Pauci-articular) esp CROHN'S.
Erythema nodosum
Aphthous ulcers
Episcleritis
Metabolic bone disease e.g. osteopenia

Paediatrics (16 decks)

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