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402 Paediatrics > Gastro > Flashcards

Gastro Flashcards

1
Q

How is abdominal pain present in babies?

A

Crying, drawing up of legs

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2
Q

With regard to abdominal pain in older children what are 3 important features in the history?

A

Pain lasting more than 4 hours
pain further away from umbilicus likely significant (except appendicitis)
Timing and character

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3
Q 
What is the significance of the following symptoms/signs associated with abdominal pain?
vomiting
stools
anorexia
dysuria
cough
A 
Vomiting - bilious suggests obstruction
stools - blood suggests inussusception in infact or IBD in older children
anorexia - normal appetite reassuring
dysuria - UTI
cough - pneumonia
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4
Q

What 4 conditions does a fever suggest in a child with abdominal pain?

A

Appendicitis
mesenteric adenitis
UTI
pneumonia

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5
Q

What 2 conditions does Jaundice suggest in a child with abdominal pain?

A

infectious hepatitis

biliary colic

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6
Q

3 useful investigation in a child with abdominal pain

A

FBC - neutrophilia
Urinalysis - nitrites/leucocytes/glucose
CRP

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7
Q

5 features of functional recurrent abdominal pain

A

pain usually periumbilical
no associated anorexia or change in bowel habits
thriving and no physical signs
fam history of recurrent abdominal pain/IBS
sources of stress/anxiety

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8
Q

It’s quite common for babies to vomit up small quantities of milk but what does projectile vomiting suggest, particularly if the baby is hungry afterwards?

A

Pyloric stenosis

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9
Q

What does vomiting after a feed suggest? 3

A

Overfeeding
gastro-oesophageal reflux
pyloric stenosis

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10
Q

What does early morning effortless vomiting indicate?

A

raised inter-cranial pressure

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11
Q

6 red flag features associated with vomiting?

A 
bilious vomiting
localised abdominal pain
persistent fever
altered consciousness/bulging fontanelle
petechial rash 
respiratory distress
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12
Q

What is the most common case of persistent loose stools in thriving pre-school child?

A

toddler diarrhoea

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13
Q

7 organic causes of constipation in children

A 
Coeliac disease
Food allergies (non-IgE)
bowel obstruction
Hirschsprung disease
CF
neuromuscular disorder
Hypothyroidism
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14
Q

6 red flags associated with constipation?

A 
Starts in first few weeks of life
Meconium passed >24hours
Abdominal distension of bilious vomiting
Faltering growth
delayed walking
child protection concerns
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15
Q

Management of constipation

A

High fibre and adequate fluid.

Laxatives may be needed - MOVICOL first line

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16
Q

What factors would suggest that a child is just constitutionally small?

A 
Small parents
low birth weight for gestational age
proportionally small
normal height and weight velocities
healthy
normal physical examination
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17
Q

In a child with faltering growth what factors must be considered of inadequate food intake is the suspected cause?

A

psychosocial deprevation
neglect
fabricated of induced illness

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18
Q

What is characterised by recurrent inconsolable crying, often accompanied by drawing up of the legs and occurs from 2 weeks to 4 months.

A

infantile colic

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19
Q

Aside from colic 6 other causes of recurrent inconsolable crying in an infant?

A 
Gastro-oesophageal reflux
cow's milk protein allergy
incarcerated hernia 
intussusception
otitis media
UTI
20
Q

What are the symptoms/signs associated with gastro-oesophageal reflux?

A

Vomiting
some abdominal discomfort indicated by back arching and crying after feeds
worse when lying down
feed aversion

21
Q

What is the typical management of gastro-oesophageal reflux in infants?

A

reassurance - 95% will resolve by 18 months

Thickening feeds might help

22
Q

Management of more severe gastro oesphageal reflux?

A

H2 antagonists
PPI
Domperidone

23
Q

When does pyloric stenosis usually present?

A

First 2-8 weeks of life

24
Q

5 Clinical features of pyloric stenosis?

A 
Persistent projectile non- bilios vomiting after feeds. 
Infant remains hungry after vomiting
Weight loss
Dehydration
Jaundice
25
Q

What is the investigation for pyloric stenosis?

A

Palpation of the hypertrophied pyloris during test feed

ultrasound

26
Q

What type of metabolic disturbance might develop as a result of pyloric stenosis and why?

A

Metabolic alkalosis

No gastric acid goes through so the kidneys retain hydrogen at expense of potassium.

27
Q

Pain localised to the right iliac fossa over a period of hours, which is worse on movement is indicative of what?

A

Acute appendicitis

28
Q

What are 5 common associated symptoms with acute appendicitis?

A 
anorexia
nausea
vomiting
diarrhoea
constipation
29
Q

What is Rovsing sign?

A

Palpation of the left iliac fossa causes pain in the right iliac fossa

30
Q

What condition is where one segment of the bowel telescopes into an adjacent distal part of the bowel.

A

Intussusception

31
Q

At what age is intussescption most common?

A

between 5 and 10 months

32
Q

Presenting triad of Intussusception

A

Paroxysmal colicky abdominal pain
Abdominal mass
Redcurrant jelly stool - (late sign)

33
Q

Management of Intussusception?

A

Surgical emergency - refer to surgery

34
Q

What is the main core of management for gastroenteritis?

A

Oral rehydration
Antibiotics rarely indicated except for specific bacterial infection
No role for anti diarrhoea meds

35
Q

4 clinical features of EITHER Crohns or ulcerative colitis?

A

abdominal pain
bloody diarrhoea with mucus
weight loss faltering growth

36
Q

If a patient is systemically unwell with malaise, tachycardia and fever is this more likely to be Crohns or UC?

A

Ulcerative colitis

37
Q

In a patient with aphthous ulceration and perianal disease is this more likely to be Crohns disease or ulcerative colitis?

A

Crohns

38
Q

How might IBD present in the eyes?

A

Anterior uvitis

episcleritis

39
Q

How might IBD present in the liver?

A

Gallstones
Cirrhosis
Fatty liver

40
Q

How might IBD affect the bones?

A

Osteoporosis
Arthritis
Spondylitis

41
Q

How might IBD present in terms of haematology?

A

Anaemia

Increased risk of thrombosis

42
Q

How might IBD present in the skin?

A

Erythema nodosum

Pyoderma gangrenosum

43
Q

For a patient with suspected IBD what investigations would you consider ordering other than endoscopy?

A

Faecal calprotectin - show inflammation
Stool sample - rule out bacterial infection
FBC - inflammation and anaemia

44
Q

Classical triad of coeliac disease presentation?

A

faltering growth
steatorrhoea
abdominal distension

45
Q

What is the first line investigation for coeliac disease?

A

IgA tissue transglutaminase

402 Paediatrics (4 decks)

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