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Year 4 Paediatrics > Gastro > Flashcards

Gastro Flashcards

1
Q

Define Constipation

A

Decrease in frequency of bowel movements characterised by passage of stools which may be large and associated with straining/pain

Termed chronic if lasting more than 8 weeks

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2
Q

What is the normal Bowel Frequency in children?

A

<4 weeks - QTS
1y - BD
4y - Adult frequency (3 per day to 3 per week)

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3
Q

Name some causes of Constipation in children

A

Inadequate fluid/fibres
Psychosocial issues
Impaired mobility (Cerebral Palsy)
Neurodevelopmental (Downs)

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4
Q

Diagnosis of Constipation requires Atleast two of:

A

<3 complete stools a week
Hard large stool
Rabbit droppings
Overflow soiling

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5
Q

What is Retentive Posturing?

A

Straight legged
Tip toes
Arched back

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6
Q

Name three red flags for Constipation in children

A

Symptoms occurring from birth (?Hirschsprungs)
Abdominal Distension (?Hirschsprungs)
Ribbon stool pattern (?Anal Stenosis)

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7
Q

What suspected diagnoses with constipation would require a non urgent referral?

A

Coeliac
Hypothyroidism
CMPA

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8
Q

How is Constipation disimpacted?

A

Macrogol using escalating dose regimen (increasing dose until soft stools form)

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9
Q

Describe maintenance therapy in constipation

A

Movicol in escalating dose (normally half the dose required for disimpaction)

Can add Senna if required

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10
Q

What general advice should you give parents whose child is constipated?

A 
Scheduled toiletting
Bowel diary
Star chart
Adequate fibre and fluids
Don’t stop laxatives abruptly
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11
Q

Name four organic causes of Abdominal Pain

A

Constipation
Coeliac
Mesenteric Adenitis
Abdominal Migraine

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12
Q

Give three red flags in an Abdominal Pain presentation

A

Persistent vomit
Fever
Rectal bleeding

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13
Q

What initial investigations should be done in Abdominal Pain?

A

FBC, CRP, TTG, Urine Dipstick

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14
Q

Define Recurrent Abdominal Pain

A

Abdominal pain occurring Atleast four times a month, over Atleast two months which limits child’s activity and can’t be attributed to another cause
Believed to be due to dysregulation of visceral nerve pathways

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15
Q

How can recurrent abdominal pain be managed?

A

Encourage distraction and school

Peppermint Oil, Antispasmodics, Antidiarrhoeals

CBT

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16
Q

What are the different patterns of vomiting?

A

Acute (discrete episodes of moderate to high intensity)
Chronic (low grade daily pattern)
Cyclic (severe discrete episodes with pallor/lethargy/pain)

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17
Q

Give three causes of newborn vomiting

A

Pyloric Stenosis
Duodenal Atresia
Intestinal Malrotation

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18
Q

What diagnoses for vomiting would you consider after the newborn period?

A

GOR
Intussusception
Allergies

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19
Q

Give four Non GI causes of vomiting

A

Meningitis
Pyelonephritis
Migraines
Raised ICP

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20
Q

Give three causes of cyclical vomiting

A

Abdominal migraine
Cyclical vomiting syndrome
Intermittent obstruction

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21
Q

What features in a vomiting history could help differentiate the cause?

A

Bilious vs Non Bilious
Bloody vs Non Bloody
Projectile vs Non Projectile
Febrile vs Non Febrile

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22
Q

What investigations are required in acute vomiting?

A

Bloods
Stool Culture
AXR
Abdominal USS if projectile

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23
Q

What investigations are required in chronic vomiting?

A

H.Pylori testing
Coeliac AB screen
Urinalysis
?Imaging

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24
Q

What investigations are required in cyclical vomiting?

A

Serum Amylase
Serum Lipase
Serum Ammonia

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25
Q

Management of vomiting is supportive and treat underlying cause. What complications could occur?

A

Dehydration
Electrolyte Disturbance
Mallory Weiss

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26
Q

If no underlying organic cause for vomiting, what diagnosis should be considered?

A

Psychogenic

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27
Q

Define Diarrhoea

A

Change in consistency and frequency of stools, with enough loss of fluids and electrolytes to cause illness

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28
Q

Give 5 causes of Diarrhoea in children

A 
Infective Gastroenteritis 
Food Hypersensitivity 
Drugs (Antibiotics)
HSP
Intussusception
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29
Q

How would you manage mild to moderate diarrhoea?

A

No tests necessary

Replace fluids and electrolytes with oral glucose and electrolytes

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30
Q

How would you manage severe diarrhoea?

A

IV Fluids and electrolytes

Full range of bloods, ABG, Stool Culture, USS

Anti motility not recommended

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31
Q

What is Chronic Diarrhoea?

A

Diarrhoea persisting for more than 14 days

Can be due to reduced absorption (coeliac), osmotic (lactase deficiency), inflammatory (UC), or secretory (VIP secreting tumour)

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32
Q

What is Toddler’s Diarrhoea?

A

Occurring from 6 months to 5 years

Colicky intestinal pain, distension and undigested food

Managed with increased fibre and occasional loperamide

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33
Q

What stool tests could you do in chronic diarrhoea?

A 
Microscopy
Leukocytes
Fat
Culture
pH
Elastase
Calprotectin
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34
Q

Other than Stool, Blood and Radiological investigations, what else can be done in Chronic Diarrhoea?

A

H2 breath (Lactose Intolerance)
Biopsy (Coeliac/IBD)
Sweat (CF)

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35
Q

Coeliac is an autoimmune response to gluten. Describe the pathophysiology

A

Combination of immunological responses to an an environmental factor (gliadin) and genetic factors (HLA DQ2/DQ8)

Epithelial destruction and follows atrophy via antitissue transglutaminase and anti endomysial

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36
Q

Describe the classical presentation of Coeliac

A

Presenting at 9-24 months with features of malabsorption, failure to thrive, weight loss, loose stools

37
Q

Describe the atypical presentation of Coeliac

A 
Osteoporosis 
Peripheral Neuropathy
Anaemia
Dermatitis Herpetiformis
Dental Enamel Hypoplasia

Positive serology only

38
Q

What would the classic histology show in Coeliac?

A

Crypt Hyperplasia

Villous Atrophy

39
Q

Describe the latent presentation of Coeliac

A

Predisposing genes
Normal mucosa
Possible positive serology

40
Q

Describe the silent presentation of Coeliac

A

Damaged small intestine
Positive Serology
No symptoms

41
Q

How is suspected Coeliac investigated?

A

Patient has to be eating gluten at time and for Atleast 6 months before

Total IgA then tTG IgA

Duodenal biopsy if positive serology

42
Q

Describe the staging of Coeliac biopsy

A

0 - normal
1 - Increased intraepithelial lymphocytes
2 - Increased inflammatory cells and crypt hyperplasia
3 - all of the above plus mild to complete villous atrophy

43
Q

State four complications of Coeliac

A

Anaemia
Osteopenia
Osteoporosis
Malignancy

44
Q

Define GORD

A

Gastro-Oesophageal reflux is the passage of gastric contents into the oesophagus

Becomes known as GORD when it is symptomatic

45
Q

What is Posseting?

A

Reflux of contents beyond oesophagus, and can be normal in infants

Eg after feeding

46
Q

Why are children predisposed for reflux?

A

Reduced LOS tone
Short Oesophagus
Liquid diet
Significant periods recumbent

47
Q

Give three risk factors for GORD

A

Prematurity
Obesity
Hiatus Hernia

48
Q

How does GORD present?

A

Excess crying
Back arch
Chronic cough
Faltering growth

49
Q

What should you establish in a GORD history in relation to feeding?

A

Position and technique
Volume given (?over distension)
Frequency/Volume of vomits
Relationship to feeds

50
Q

GORD is a clinical diagnosis. Give three differentials

A

Pyloric Stenosis (Projectile)
Malrotation (Bile Stained)
CMPA (Blood in stool)

51
Q

How should you manage breast fed infants with GORD?

A

Alignate with water immediately post feed

52
Q

How should you manage formula fed infants with GORD?

A

1) Ensure not overfed (150ml/kg/d total)
2) Decrease feed volume and increase frequency
3) Use feed thickener
4) Stop thickener and add alignate

53
Q

If GORD doesn’t improve with alignates, what can be used?

A

PPI

H2 Antagonist

54
Q

The features of Crohns can be remembered by the mnemonic NESTS, describe this

A 
No blood or mucous
Entire GI tract
Skip Lesions
Terminal Ileum/Transmural
Smoking is a risk factor
55
Q

The features of UC can be remembered by the mnemonic CLOSE UP, describe this

A 
Continuous inflammation
Limited to colon/rectum
Only superficial mucosa
Smoking is protective
Excrete blood and mucous

Use Aminosalicyclates
PSC association

56
Q

Give four extraintestinal features of IBD

A

Clubbing
Erythema Nodosum
Pyoderma Gangrenosum
Iritis

57
Q

How is IBD investigated in children?

A

Faecal Calprotectin
OGD and colonoscopy with biopsy

AXR/Small Bowel MRI/CT for complications

58
Q

How is remission induced in Crohns?

A

First line - Oral Prednisolone/IV Hydrocortisone

Second Line - Azathioprine, Infliximab

59
Q

What is the maintenance treatment in Crohns?

A

Azathioprine/Mercaptopurine first line

Surgery for complications

60
Q

How is remission induced in UC?

A

Mild to Moderate - Aminosalicyclate first line, Prednisolone second line

Severe - IV Hydrocortisone or IV Ciclosporin

61
Q

What is the maintenance treatment for UC?

A

Aminosalicyclate or Azathioprine

Panprotocolectomy is curative (either Ileostomy or J Pouch)

62
Q

Describe the different types of viral hepatitis

A 
A- Faecal Oral
B - Blood Products, IVDU, Sex, Vertical
C - Same as above, mostly chronic
D - Coinfection for Hep B
E - Faecal Oeal
G - IV

(+ EBV,HIV, CMV)

63
Q

What are the non viral causes of Hepatitis?

A

Metabolic Disease (Wilson’s)
Autoimmune
Reye Syndrome

64
Q

What is Reye’s Syndrome?

A

Acute Encephalopathy associated with aspirin therapy and fatty liver infiltration

Nausea and vomiting, Hypoglycaemia, Abdo Pain

65
Q

Hepatitis can present in various ways in children. Describe some

A

Asymptomatic
Fulminant (Encephalopathy, Coagulopathy)

Fever, fatigue, anorexia, RUQ pain, jaundice

66
Q

Give five investigations for Hepatitis

A 
LFTs
Blood Glucose
Viral Serology
Serum Immunoglobulins 
Serum Copper
67
Q

Hepatitis is normally managed supportively with the avoidance of alcohol. How is Fulminant Hepatitis managed?

A

PICU

Liver Transplant

68
Q

Hepatitis is normally managed supportively with the avoidance of alcohol. How is Reyes Syndrome managed?

A

Maintain glucose >4mmol/l

Prevent sepsis

69
Q

Give four causes of CHRONIC hepatitis in Children

A

Chronic Hepatitis
NAFLD
A1 Antitrypsin
Biliary Atresia

70
Q

Biliary Atresia results in conjugated jaundice. How is it managed?

A

Kasai Portoenterostomy (attaching small intestine to liver opening)

71
Q

How could Chronic Hepatitis present in Children?

A

Jaundice
Pruritus
Anaemia
Developmental Delay

72
Q

What investigations could you do for Chronic Hepatitis that are different to those from Acute?

A

Sweat Test
A1 Antitrypsin Level
Serum/Urinary Copper
Liver Biopsy

73
Q

How is Autoimmune Hepatitis treated?

A

Prednisolone and Azathioprine

74
Q

How is Chronic Viral Hepatitis treated?

A

Interferon Alpha and Ribavirin

75
Q

How is Hepatitis due to Wilson’s disease treated?

A

Penicillamine

76
Q

Peptic Ulcers present similarly in children as adults. How could it be investigated?

A

Breath Test for H.Pylori

77
Q

How are Peptic Ulcers managed?

A

Omeprazole

If H.Pylori add Amoxicillin and Metronidazole

78
Q

Give five causes of Gastritis in Children

A 
H.Pylori
Irrational introduction of adult foods
Unbalanced food composition
Poor chewing 
Too Cold/Very Hot food
79
Q

Describe the pathophysiology of Gastritis

A

Some foods may cause formation of oedema cells and enhance acid synthesis

Inflammation and blood circulation to wall increases, altering nervous regulation (alters contractions)

80
Q

How would you investigate Gastritis in Children?

A

Full range of bloods
Faecal Culture and Analysis
H.Pylori

81
Q

How would you manage Gastritis in children?

A

Diet - mashed/puréed food without spices or additives, exclude roughage and carbonated drinks
PPIs
Antispasmodics

82
Q

What is the normal milk requirement in an infant?

A

150ml/kg/d

83
Q

Name four different types of formula milk

A

Cows Milk - early weeks are whey based, later weeks are casein based

Soya milk - now not recommended due to photo-oestrogens

Hydrolysed Cows Milk (CMPA)

Elemental Formula (Severe CMPA)

84
Q

When should solids be introduced to a child’s diet? What should the be?

A

Not recommended until 6 months

Baby rice, fruit and vegetables

No low fat products

Supplementary Vit ACD

85
Q

When should breast formula feeding be continued until?

A

1y

86
Q

Why should children avoid excess juices/fizzy drinks?

A

Cause of Toddler’s Diarrhoea

87
Q

How is Parenteral Nutrition given?

A

Via central or peripheral lines

88
Q

What are the two components of Parenteral Nutrition?

A

Lipid component (fat and fat soluble vitamins over 20h)

Aqueous component (Carbohydrate, protein, electrolytes, minerals over 24h)

Year 4 Paediatrics (15 decks)

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