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gastro Flashcards

1
Q

What causes GORD

A

immaturity of oesophageal sphincter

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2
Q

Which pt is GORD most common in

A

Preterm
Cerebral palsy
hx of surgery

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3
Q

How do you diagnose GORD

A

Clinical picture

Also 24 hour pH monitoring

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4
Q

Mx of GORD

A

Reassure (begins early, can take a year to go away)
Review if:
Projectile vomiting, haematemesis, bile stained vom, FTT, persistent regurgitation beyond 1 year of life

If breast fed:
breast feeding assessment
alginate

If formula:
check right vol. is given
trial smaller more frequent feeds
trial thickened formula
alginate

Positional stuff:
keep baby upright

Medicine:
2-4 week trial of PPI or antihistamine in children who have 1 or more of :
unexplained feeding difficulty (choking), distressed behaviour, failure to thrive

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5
Q

Dx of pyloric stenosis

A

Symptoms:
vomiting which becomes worse –> projectile
hunger after vomiting (til they become so dehydrated that they don’t feed)

Mass in RUQ that feels like olive

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6
Q

What are people with pyloric stenosis at risk of

A

Hypochloraemic metabolic ALKALOSIS with low potassium and sodium

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7
Q

Mx pyloric stenosis

A 
IV rehydration (with 5% dextrose +0.45% saline) at 1.5x maintenance rate
Add potassium once output is up

Cure is Ramstedt pyloromyotomy

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8
Q

What is infant colic

A

excessive paroxysmal crying accompanied by drawing up of knees and passing excess flatus
common in first 4 months of life
if persistent –> CMP allergy

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9
Q

Mx for colic

A

Reassure that it often resolves around 6 months
If breastfeeding mum can benefit from hypoallergenic diet
If bottle fed check bottle size

Info: NHS choices
Strategies to soothe baby - white noise, holding

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10
Q

Signs + symptoms of appendicitis

A

Vomiting, anorexia, abdo pain

Pain aggravated by movement, fever, Guarding (may not get it if appendix is retrocaecal)

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11
Q

What is non-specific abdo pain

A

Pain that resolves within 24-48 hours
Often accompanied by cervical lymphadenopathy and URTI

These children can be diagnosed w/ mesenteric adenitis

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12
Q

Presentation of intussusception

A

PAROXYSMAL colicky abdo pain accompanied by pallor around the mouth
usually resolves but there may be some lethargy
child draws legs up
Redcurrant jelly stool
refusing feed
vomiting (bile stained)

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13
Q

What can cause intussusception

A

preceding viral illness (swollen peyer’s patches)

meckel’s diverticulum (most common place is ileum through ileo-caecal valve)

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14
Q

Complications of intussusception

A

Blocked venous flow, bleeding, inflammation, necrosis, perforation

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15
Q

Ix for intussusception

A

AXR - may show no air in large bowel

US - confirmatory test - target sign

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16
Q

Mx intussusception

A

ABCDE, IV fluids and NG aspiration may be needed
1.If no peritonitis - rectal air insufflation

  1. If clinically stable w/ no contraindications for contrast enema (peritonitis, perforation, hypovolaemia) + BSA clindamycin and gentamicin
  2. surgery

If recurrent Ix investigate for pathological lead point

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17
Q

How can Meckel’s diverticulum present

A 
Rectal bleeding and low Hb 
Can also present more acutely:
Meckel's diverticulitis (presents similarly to appendicitis)
intussusception
volvulus
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18
Q

Ix for Meckel’s

A

techentium scan

As meckel’s has gastric mucosa it takes technetium up

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19
Q

Mx for Meckel’s

A

Asymptomatic - nothing

Symptomatic - remove

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20
Q

2 presentations of malrotation

A

Obstruction - get bilious vomiting

Obstruction and vascular compromise

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21
Q

Mx of malrotation

A

vascular compromise - urgent laparotomy

Ladd procedure - divide Ladd bands and put bowel back in its place

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22
Q

Defintion of recurrent abdo pain

A

Pain that interrupts daily activities for up to 3 months

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23
Q

How does IBS present

A

(often precipitated by intra-abdominal infection)

non-specific abdo pain 
Complain of explosive stools
Bloating
constipation 
incomplete defecation

RULE OUT COELIAC’S

24
Q

What is IBS associated with

A

FHx, anxiety, mental health issues

25
Q

Mx of IBS

A

Lifestyle:
reduce stress
avoid caffeine
add fibre

Diarrhoea predominant:
lifestyly, antidiarrhoeals (give TCA +/- CBT if in pain)

Constipation predominant:
lifestyle, laxatives (give SSRI +/- CBT if in pain)

If both give combination of drugs

26
Q

When to suspect duodenal ulcers

A

Rare in kids

if pain wakes them up at night, back pain, 1st deg relative w/ peptic ulcer

27
Q

Mx of peptic ulcer

A

Trial PPI and do Ix

If suggestive of h.pylori - triple therapy (amox, clari, PPI)
If not do UGI endoscoopy - if this shows ulcer give PPI (or H2 antagonist 2nd line)
If this is negative then it’s functional dyspepsia

If bleeding: endoscopy +/- blood transfusion, PPI; then do surgery and embolisation

28
Q

How does eosinophilic oesophagitis present

A

difficulty swallowing, vomiting

29
Q

What is eosinophilic oesophagitis associated with

A

Atopic conditions

30
Q

Dx of eosinophilic oesophagitis

A

Trachealisation of oesophagus - give corticosteroids

31
Q

How does campylobacter gastroenteritis present

A

abdominal pain

32
Q

Features of shigella and salmonella infetcion

A

Dysenteric infection
blood and pus in stool
tenesmus
pain

33
Q

Features of cholera and enterotoxigenic e.coli

A

Profuse watery diarrhoea

34
Q

Mx of gastroenteritis

A

Consider admission
rehydrate
Advice on preventing spread

Tx dehydration
None - <10kg - 60-120ml, >10kg 120-240ml of oral rehydration solution per episode of vomiting (this is baseline

Mild (<5%) - 50mL of ORS/kg OVER 4 HOURS + the baseline
Moderate (5-10%) - 100ml/kg ORS over 4 hours + baseline
Severe (>10%) Emergency, admit + IV resusc w/ saline 20ml/kg every hour

NB - ABx rarely given

35
Q

maintenace fluid algorithm

A

0-10kg - 100ml/kg
10-20 - 50ml/kg
20+ - 20ml/kg

to be given over 24 hours

36
Q

How do you get isonatraemic + hyponatremic dehydration

A

Kids w/ diarrhoea drink water, they don’t replace sodium so water goes into intraceullular space
Brain expands – > seizures

37
Q

How do you get hypernatremic dehydration? What is the risk with correcting this?

A

Hot weather, low sodium diarrhoea
Water goes to intravscular so they look less dehydrated than they are
dangerous

Don’t corrct this too quickly as you can get too much water flowing into brain –> cerebral oedema

38
Q

Which part of bowel does coeliac affect

A

PROXIMAL SMALL INTESTINE

39
Q

Presentation of coeliac

A 
FTT
weight loss 
anaemia
bloating 
BUTTOCK WASTING
abdo distension
dermatitis herpetiformis
40
Q

Ix for coeliac

A

anti-tTG Ab
endomysial Ab
duodenal biopsy: CONFIRM DIAGNOSIS
Catch up of growth upon removing gluten also required to confirm dx

41
Q

Coeliac management

A

Remove gluten
dietician referral
calcium, iron vit d supplements (you get micronutrient def –> osteopenia)
annual review to check height weight and bloods

42
Q

Causes of nutrient malabsorption

A

cholestatic liver disease
short bowel syndrome Crohn’s (loss of terminal ileum)
exocrine pancreatic dysfunction

43
Q

How does crohn’s present

A

Fatigue
lethargy
bloody stool
can mimic anorexia

44
Q

Diagnostic features of Crohn’s

A

useful features:
Raised inf markers
low albumin
IDA

Diagnosis done by UGI
See narrowing, strictures, fistulae
hallmark - non-caseating epithelioid cell granuloma
Transmural inflammation

45
Q

What does crohn’s affect

A

Terminal ileum

46
Q

Mx of crohn’s

A

Polymeric diet (whole protein feeds) can send it into remission but it usually comes back
stop smoking
assess risk of osteoporosis
DO NOT RECEIVE LIVE VACCINES
Educate on recognisisng flare ups (weight loss)

for ileocaecal disease:
Mild - observation or budesonide or 5-ASA
moderate -
1. budesonide +/- 5-asa OR oral steroids
2. immunomodulator (azathioprine/methotrexate) + oral corticosteroid
3. biological therapy (infliximab) +/ oral steroid + azathioprine

Severe:
1.hospitalise + oral/IV corticosteroid
immunomodulator
2. biological therapy

47
Q

presentation of UC

A

rectal bleeding
colicky pain
diarrhoea

48
Q

Extraintestinal manifestations of UC

A

erythema nodosum

enteric arthritis

49
Q

Diagnosis of UC

A

Mucosal INF
Crypt destruction
ulceration

50
Q

Mx of UC

A

assess severity using paediatric ulcertaive colitis activity index
Mild - oral 5-ASA (can add steroids)
Moderate - oral pred, if good response give 5-ASA and taper, if not it’s steroid dependent disease
steroid dependent disease - infliximab, if inadequate think about surgery
Severe UC: medical emergency
High dose IV methylprednisolone
stop oral 5-ASA
Abx if bacteria

NB - 5-ASA used for maintaining remission (if this doesn’t work can add top 5-ASA or oral beclomethasone

51
Q

what can predispose to constipation

A

dehydration
anxiety
anal fissures

52
Q

Primary causes of constipation

A 
Hirschprung
Hypothyroidism 
rectal atresia
hypercalcaemia
coeliac's
53
Q

Red flags for constipation

A 
FTT
gross abdo distension
Failure to pass meconium 
neuro problems of lower limbs
sacral dimple (spina bifida)
54
Q

Mx of constipation

A 
Check for faecal impaction, if impacted:
disimpaction regime (osmotic laxative + lifestyle modification, may also need to add stimulant)

Start maintenance laxatives
dietary mod and osmotic laxative

behavioural interventions (scheduled toileting, bowel habit diary)
diet + lifestyl advice
secondary behaviour problems are common

55
Q

How does hirschprung’s disease present

A

No meconium
obstruction (with all these symptoms)
can also get hirschprung enterocolitis

in later life presents w/ constipation

56
Q

Diagnosis of hirschprung

A

absence of ganglion cells and acetylcolinesterase positive nerve trunks on full thickness suction biopsy

57
Q

Mx of hirschprung

A

Surgery (anorectal pullthrough)

paeds (19 decks)

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