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Paediatrics > Gastro > Flashcards

Gastro Flashcards

1
Q

What can diahorrea be a sign of?

A

Can be early sign of septic illness

Watery stools in breastfed babies are normal

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2
Q

What are the main causes of diahorrea in children?

A

Secretory:
-Increased secretion or decreased absorption e.g. Cholera, C. diff, e. coli
Osmotic:
-increased osmotic load in gut lumen
Motility disorders:
-Increased - thyrotoxicosis, Irritable bowel syndrome
-Decreased - pseudo-obstruction, intusucception
Inflammatory:
-Salmonella, shigella, rotavirus, UC/Crohns
-Coeliac disease
-Haemolytic ureamic syndrome

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3
Q

What are the causes of gastroenteritis in children?

A

Most commonly rotavirus

Can be norovirus, astrovirus or adenovirus

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4
Q

How is gastroenteritis treated?

A

Correct any dehyrdation with either oral or IV fluids in more severe cases
Oral rehydration therapy such as dioralyte
Continue breastfeeding
If ORT refused offer other fluids or consider giving it by NG tube
Reintroduce milk after 4hr of ORT or sooner if recovers and is hungry

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5
Q

What are the complications of gastroenteritis?

A

Dehydration
Malnutrition
Post-enteritis enteropathy reolves around 7wks

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6
Q

What investigations can be done for gastroenteritis?

A

Stools - look for bacteria, ova, cysts and parasites

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7
Q

What is Kwashiorkor?

A

This is the combination of signs resulting from poor protein intake
It causes diahorrea, anorexia, apathy, oedema, skin and hair depigmentation and distended abdomen
Need to re-educate child, family and politicians to graducally increase proteins and vitamins in diet

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8
Q

What is Marasmus?

A

This is a lack of calories and a discrepancy between height and weight associated with HIV
May require paraenteral nutrition
Even following treatment often have longterm growth abnormalities

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9
Q

What are the surgical causes of abdominal pain in children?

A

Appendicitis
Intususception - colicky pain with redcurrent jelly stools
Bowel obstruction - vomiting and constipation
Testicular torsion - sudden onset unilateral testicular pain, vomiting and nausea

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10
Q

What is the management of recurrent functional abdominal pain?

A

Distracting the child with other activities or interests
Encourage parents not to ask about the pain
Advice about sleep and reducing stress
Aim to address psychosocial triggers and exacerbating factors

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11
Q

What are the features of abdominal migraine?

A

Generalised abdo pain for more than an hour with normal examination
May have symptoms of normal migraine in conjunction

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12
Q

How can abdominal migraine be managed acutely and preventatively?

A

Acutely - dark room, NSAIDs, Sumitriptan

Preventative - Pizotifen - needs to be stopped gradually to prevent withdrawl

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13
Q

What is encopresis?

A

This is faecal incontinence after the age of 4 that is caused by chronic constipation - loose stools overflow causing soiling

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14
Q

What are the lifestyle factors that affect constipation?

A 
Habitually not opening the bowels
Low fibre diet
Poor fluid intake and dehydration
Sedentary lifestyle
Psychosocial problems such as a difficult home or school environment (always keep safeguarding in mind)
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15
Q

What are the red flags to look for in constipation?

A

Not passing meconium within 48 hours of birth (cystic fibrosis or Hirschsprung’s disease)
Neurological signs or symptoms, particularly in the lower limbs (cerebral palsy or spinal cord lesion)
Vomiting (intestinal obstruction or Hirschsprung’s disease)
Ribbon stool (anal stenosis)
Abnormal anus (anal stenosis, inflammatory bowel disease or sexual abuse)
Abnormal lower back or buttocks (spina bifida, spinal cord lesion or sacral agenesis)
Failure to thrive (coeliac disease, hypothyroidism or safeguarding)
Acute severe abdominal pain and bloating (obstruction or intussusception)

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16
Q

What is the management of constipation?

A

correct reversible causes, encourage high fibre and good hydration
Start laxatives (movicol 1st line)
Faecal impaction may require disimpation regime with high doses of laxitives at first
Encourage going to the toilet

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17
Q

What is normal in terms of reflux in babies?

A

Normal for babies to have reflux as long as they are growing normally
Due to immaturity of the lower gastro oesophageal junction
Most grow out of this by one year

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18
Q

What are some of the signs of problematic reflux in babies?

A

Chronic cough
Hoarse Cry
Reluctance to feed
Poor weight gain

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19
Q

What are some of the causes of vomiting in kids?

A 
Overfeeding
GORD
Pyloric stenosis
Gastroenteritis
Appendicitis
Infections e.g. tonsillitis
Intestinal obstruction
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20
Q

What are the red flags for vomiting?

A 
Not keeping down any feed
Projectile vomiting
Bile stained vomit (obstruction)
Haematemesis of melena
Abdo distension
Signs of infection
Rash
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21
Q

What is the management of GORD?

A 
General:
Small frequent meals
Burping regularly
Keeping baby upright after meals
More severe:
Gaviscon mixed feeds
Thickened milk
Omeprazole
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22
Q

What is sandifers syndrome?

A

Abnormal movements associated with GORD including torticollis and dystonia

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23
Q

How does pyloric stenosis present in babies? What does examination show?

A

Hungry baby that is thin, pale and failing to thrive
Have projectile vomiting
A firm round mass like a large olive in the upper abdomen, this is the hypertrophic pylorus

24
Q

What kind of blood gas will pyloric stenosis show?

A

Shows a hypochloric metabolic alkalosis due to all of the hydrochloric acid being vomited up

25
Q

What is the investigation and management of pyloric stenosis?

A

It is investigated with ultrasound and treated with a laproscopic pylomyotomy
This involves an incision into the smooth muscle to widen the canal

26
Q

What age does coeliac present?

A

Usually in early childhood but can present at any age

27
Q

What are the autoantibodies that develop in coeliac?

A

Anti ttg and anti endomysial (anti-EMA)
They target epithelial cells leading to inflammation
They rise and fall with disease activity

28
Q

What are the presenting features of coeliac?

A 
Can be asymptomatic
Failure to thrive
Diarrhoea
Fatigue
Weight loss
Anaemia
Dermatitis herpetiformis - itchy blistering rash on abdomen
29
Q

What are all patients with type 1 DM tested for?

A

Coeliac as commonly linked

30
Q

What are the features of crohns?

A 
Crows NESTS
No mucus in stool
Entire GI tract
Skip lesions
Transmural
Smoking is a risk factor
31
Q

What are the features of ulcerative colitis?

A 
U C CLOSEUP
Continous inflammation
Limited to colon and rectum
Only superficial mucosa
Smoking is protective
Excrete blood and mucus
Use aminosalicylates
Primary sclerosing cholangitis
32
Q

What are the extraintestinal manifestations of inflammatory bowel disease?

A 
Clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis and iritis
Inflammatory arthritis
Primary sclerosing cholangitis
33
Q

What investigations should be done for inflmmatory bowel disease?

A

Bloods for anaemia, infection, thyroid, CRP for active inflammation, kidney and liver function
Faecal calprotectin 90% sensitive and specific in adults
Endoscopy with biopsy gold standard
Imaging with ultrasound, CT and MRI for complications

34
Q

What is the management of Crohns?

A

Inducing remission:
-1st line steroids - oral pred or IV hydrocortisone
-Can add immunosupression e.g. azathioprine or methotrexate
Maintaining remission:
-1st line - azathioprine or mercaptopurine
-Alternatives - Methotrexate or infliximab
Surgical resection

35
Q

What is the management of UC?

A

Inducing remission:
Mild - aminosalicylates e.g. mesalazine oral or rectal
-2nd line pred
Severe - IV hydrocort or IV ciclosporin
Maintaining remission:
-Aminosalicylates or azathioprine
Surgery - removing colon and rectum (panprotocolectomy)

36
Q

What is biliary atresia?

A

It is a conginital narrowing or absence of the bile duct

This leads to cholestasis and prevention of excretion of conjugated bilirubin

37
Q

How does biliary atresia present in children?

A

It presents with persistent jaundice in a newborn.

It should be investigated after 2 weeks in term babies and 3 weeks in preterm babies

38
Q

What is the initial investigation for biliary atresia?

A

Look at conjugated and unconjugated bilirubin levels

There will be a high proportion of conjugated bilirubin as it is being conjugated but can’t be excreted

39
Q

What is the management of biliary atresia?

A

It is managed with a kosai procedure in which the biliary tree is attached directly to the GI tract
Most patients will require liver transplantation to fully resolve the problem

40
Q

What are the presenting features of intestinal obstruction?

A

Bilious vomiting with bright green bile and absolute constipation - no passage of wind or stools
high pitched bowel sounds can be heard then absent

41
Q

What are the causes of intestinal obstruction?

A 
Meconium ileus
Hirschsprungs disease
Oesophageal atresia
Duodenal atresia
Intussuception
Imperforate anus
Volvulus
stangulated hernia
42
Q

How is bowel obstruction diagnosed?

A

With an abdo xray showing dilated bowel loops and absence of air in the rectum

43
Q

What is the management of obstruction?

A

Keep them nil by mouth
Insert an NG tube to drain stomach and prevent further vomiting
Provide IV fluids to correct dehydration and electrolyte imbalances

44
Q

What is hirschsprungs disease?

A

Congenital absence of ganglion cells in the distal colon and rectum
This means the bowel does not relax and causes obstruction

45
Q

What conditions are associated with hirschsprungs?

A

Downs syndrome and neurofibromatosis

46
Q

How does hirschsprungs present?

A 
Severity and age varies in individuals
Delay in passing muconium >24hrs
Chronic constipation
Abdo pain and distension
Vomiting
Poor weight gain and failure to thrive
47
Q

What is hirschsprungs associated enterocolitis?

A

Inflammation and obstruction that occurs in 20% of hirschsprungs patients
Presents at 2-4weeks
Have fever, diarrhoea, distension and can have sepsis
Can lead to toxic megacolon and perforation
Requires urgent antibiotics and decompression

48
Q

How is hirschsprungs diagnosed?

A

Abdo x ray to show obstruction

Rectal biopsy shows absence of ganglionic cells

49
Q

What is the definitive management of hirschsprungs?

A

Surgical resection of aganglionic bowel section

50
Q

What is intususseption?

A

This is when the bowel telescopes into itself causing obstruction

51
Q

What age does intususseption tend to present?

A

In 6 months to 2 years

More common in boys

52
Q

What conditions is intususseption associated with?

A

Concurrent viral illness
Henloch scholein purpura
Cystic fibrosis
Meckel diverticulum

53
Q

What is the presentation of intususseption?

A

Present with obstruction
RUQ Sausage shaped mass in abdo
Redcurrent jelly stool
Vomiting

54
Q

What is the management of intususseption?

A

Therapeutic ememas with water or air to force bowel back into normal shape
Surgical reduction may be required if this does not work

55
Q

What is the peak age for appendicitis?

A

10-20 years

56
Q

What are the examination findings of appendicitis?

A

There is generalised tenderness that moves to the RIF

Tenderness at McBurney’s point, one third of the distance from ASIS to umbilicus

57
Q

How does cow’s milk protein allergy present?

A

Usually in the first few months
Diarrhoea after being fed with formula for a few months
Reflux

Paediatrics (11 decks)

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