Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

paediatrics > gastro > Flashcards

gastro Flashcards

1
Q

A 48 hour old neonate develops increasing abdominal distension. He had a normal delivery but has yet to pass any meconium. Following digital rectal examination liquid stool is released. Dx?

A

Hirschsprung’s disease May present either with features of bowel obstruction in the neonatal period or more insidiously during childhood. After the PR there may be an improvement in symptoms. Diagnosis is by full thickness rectal biopsy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A 7 month old girl presents with vomiting and diarrhoea. She is crying and drawing her legs up. There is a a sausage shaped mass in the abdomen. Dx?

A

Intussusception Sausage shaped mass (colon shaped) is common in intussusception. The other common sign is red jelly stool.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A 1 month old baby girl presents with bile stained vomiting. She has an exomphalos and a congenital diaphragmatic hernia. Dx?

A

Malrotation Exomphalos and diaphragmatic herniae are commonly associated with malrotation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

An 18 month old boy is brought to the emergency room by his parents. He was found in bed with a nappy filled with dark red blood. He is haemodynamically unstable and requires a blood transfusion. Prior to this episode he was well with no prior medical history. What is the most likely cause?

A

Meckels diverticulum the number one cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the causes of GI bleeding in children?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a Meckel’s diverticulum?

A

a congenital diverticulum of the small intestine

It is a remnant of the omphalomesenteric duct (also called the vitellointestinal duct) and contains ectopic ileal, gastric (risk peptic ulceration) or pancreatic mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the rule of 2s for Meckel’s diverticulum?

A
  • occurs in 2% of the population
  • is 2 feet from the ileocaecal valve
  • is 2 inches long
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how does a Meckel’s diverticulum present?

A

usually asymptomatic

  • abdominal pain mimicking appendicitis
  • rectal bleeding
    • Meckel’s diverticulum is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years
  • intestinal obstruction
    • secondary to an omphalomesenteric band (most commonly), volvulus and intussusception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how is a Meckel’s diverticulum managed?

A

removal if narrow neck or symptomatic.

Options are between wedge excision or formal small bowel resection and anastomosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the most common cause of vomiting in infancy?

A

gastro-oesophageal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the risk factors for developing gastro-oesophageal reflux?

A
  • preterm delivery
  • neurological disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how is gastro-oesophageal reflux managed?

A
  1. advise regarding position during feeds (30˚ head up)
  2. infants should sleep on their backs
  3. ensure not being overfed (as per their weight)
  4. trial of smaller and more frequent feeds
  5. trial of thickened formula / alginate therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

NICE do not recommend a PPI to treat overt regurgitation in infants and children occurring as an isolated sx. a trial of can be considered if 1 or more of the following apply:

A
  1. unexplained feeding difficulties (e.g. refusing feeds, gagging, choking)
  2. distressed behaviour
  3. faltering growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the complications of gastro-oesophageal reflux in children?

A
  • distress
  • faltering growth
  • aspiration
  • frequent otitis media
  • in older children: dental erosion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what can be considered if there a severe complications (e.g. faltering growth) and medical rx is ineffective for gastro-oesophageal reflux?

A

may consider fundoplication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is Hirschsprung’s disease caused by?

A

aganglionic segment of bowel due to a developmental failure of the parasympathetic Auerbach and Meissner plexuses

17
Q

what is Hirschsprung’s disease an important dDx for even though it is rare (1 in 5000 births)?

A

constipation

18
Q

what is the pathophysiology behind Hirschsprung’s disease?

A

parasympathetic neuroblasts fail to migrate from the neural crest to the distal colon → developmental failure of the parasymphatetic Auerbach and Meissner plexuses → uncoordinated peristalsis → functional obstruction

19
Q

what is Hirschsprung’s disease associated with?

A
  • male (3x more common)
  • Down’s syndrome
20
Q

what is a possible presentation of Hirschsprung’s disease in the neonatal period?

A

failure or delay to pass meconium

21
Q

what is a possible presentation of Hirschsprung’s disease in older children?

A
  • constipation
  • abdominal distension
22
Q

what are the ix done for Hirschsprung’s disease?

A
  • AXR
  • rectal biopsy: gold standard for dx
23
Q

how is Hirschsprung’s disease managed?

A
  • initially: rectal washout / bowel irrigation
  • definitive: surgery to affected segment of colon
24
Q

what is infantile colic?

A

a relatively common and benign set of sx seen in young infants

<3 months old, characterised by bouts of excessive crying and pulling up of the legs, often worse in the evening

occurs in 20% of infants, unkown cause

25
Q

how many % of children are affected with cow’s milk protein intolerance/allergy and when does it present?

A

3-6% of all children

presents in first 3 months of life in formula-fed infants, rarely seen in exclusively breastfed infants

26
Q

what kind of reactions are seen in cow’s milk protein intolerance/allergy?

A

both immediate (IgE related) and delayed (non-IgE mediated) reactions

CMPA for immediate

CMPI for mild-moderate delayed reactions

27
Q

what are the features of CMPI/CMPA?

A
  • regurgitation and vomiting
  • diarrhoea
  • urticaria, atopic eczema
  • ‘colic’ sx: irritability, crying
  • wheeze, chronic cough
  • rare: angioedema, anaphylaxis
28
Q

how is CMPI/CMPA investigated?

A
  • skin prick/patch testing
  • total IgE and specific IgE (RAST) for cow’s milk protein
29
Q

how is CMPI/CMPA diagnosed?

A

clinical (e.g. improvement with cow’s milk protein elimination)

30
Q

how are severe sx of CMPI/CMPA e.g. faltering growth managed?

A

refer to a paediatrician

31
Q

how is CMPI/CMPA managed if the child is formula-fed?

A

1st line for mild-moderate: extensive hydrolysed formula (eHF) milk

severe/no response to above: amino acid based formula (AAF)

32
Q

how is CMPI/CMPA managed if child is breastfed?

A
  • continue breastfeeding
  • eliminate cow’s milk protein from maternal diet, consider prescribing calcium supplements for breastfeeding mothers
  • use eHF milk when breastfeeding stops until 12 months of age and at least for 6 months
33
Q

what is the prognosis of CMPI?

A

usually resolves in most

  • children with IgE mediated intolerane: ~55% will be milk tolerant by age 5
  • children with non-IgE mediated intolerance: most children milk tolerant by 3 years

a challenge is often performed in hospital as anaphylaxis can occur

paediatrics (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions