Gastro and Nutrition Flashcards
Macroscopic and microscopic appearances in UC
Macroscopic;
- Continuous inflammation, ulcers, loss of haustra
Microscopic;
- Crypt abscesses, neutrophil infiltration
Macroscopic and microscopic appearances in Crohn’s
Macroscopic;
- Cobblestone mucosa, skip lesions, fistula
Microscopic;
- Transmural inflammation, granulomas
Rate of good weight gain in babies
15-20g/kg per day
At what point would you expect a baby to regain their birthweight?
2 weeks
HLA associations in coeliac disease
HLA DQ2 and DQ8
What other conditions are associated with coeliac disease?
T1DM
Thyroid disease
AI liver disease
Down syndrome
Turner syndrome
Where is a biopsy taken from to diagnose coeliac disease?
Duodenum (affects small bowel mucosa)
Serology tests for coeliac disease
IgA and IgA tTG
If IgA deficient will need IgG tTG +/- IgG EMA +/- HLA subtyping (DQ2 + DQ8)
If IgA tTG positive but <10 times upper limit will need biopsy to confirm diagnosis
Extra-GI manifestations of coeliac disease?
Dermatitis herpetiformis
Anaemia
Faltering growth
Osteoporosis
Dental enamel defects
Delayed puberty
Recurrent apthous stomatitis
Peripheral neuropathy secondary to B12 deficiency
Most common food allergies
Cow’s milk protein
Egg
Peanuts
Tree nuts
Fish
Shellfish
Soya
Wheat
These make up for >90% of allergies
Time span for IgE mediated reaction and non-IgE mediated reactions
IgE mediated reactions occur within minutes-2 hours from exposure
Non-IgE mediated reactions occur 2-72 hours following exposure
What % of children will grow out of food allergies (CMPA or egg) by the age of 5?
50%
What % of peanut allergies will persist into adulthood?
80%
What % of allergies present within the first year of life?
80%
What is the most common food allergy in infants <3 months
CMPA
What is the gold standard investigation to confirm GORD?
pH study
NOTE: GORD is typically a CLINICAL diagnosis and Ix rarely indicated. Should only be done if nil improvement with medical Mx, uncertainty regarding diagnosis or concerns r.e. anatomical abnormality for surgery
What percentage of infants experience GORD?
40%
What percentage of infants have resolution of GORD by 1 year?
90%
Risk factors for GORD in infancy
Neurodisability; e.g. Down Sx
Prematurity
Family history of GORD
Previous surgery for oesophageal atresia
What condition mimicks GORD?
CMPA
5 step ladder for managing GORD
1) lifestyle; smaller more frequent feeds, keep upright following feeds
2) Thickening agents or alginate therapy (gaviscon)
3) H2 receptor antagonists (ranitidine) or PPI (omeprazole)
4) Prokinetic agents (metoclopramide) - increase gastric emptying
5) Surgery (e.g. Nissen fundoplication)
Rule of 2’s for Meckel’s diverticulum
Presents <2 yrs of age
2% prevalence in general population
2 inches in length (5cm)
2ft from ileocaecal valve (60cm)
What is Meckel’s diverticulum a remnant of?
Vitellointestinal duct
What specific scan can be done to look for Meckel’s diverticulum?
Meckel’s scan; relies on uptake of Tc99m (radioisotope) by ectopic gastric mucosa
What specific scan can be done to look for a Meckel’s diverticulum?
Meckel’s scan; relies on uptake of TC99m (radioisotope) by ectopic gastric mucosa
How may a Meckel’s diverticulum present?
Painless PR bleeding (malaena or fresh blood)
Intussusception (abdo pain, bleeding, vomiting)
Bowel obstruction / volvulus
Diverticulitis (abdo pain and diarrhoea)
Incidental finding
Which is more common: UC or Crohns?
Crohns is twice as common as UC
Which type of IBD is smoking considered to be a protective factor?
UC
Most common age group to get rectal prolapse
<4 years of age
Most cases occur within first year of life
Causes of rectal prolapse
CF (10%)
Idiopathic
Increased abdominal pressure (chronic cough, toilet training, constipation)
Diarrhoeal disorders (malabsorption, infection)
Rectal polyps
Malnutrition
Child abuse (anal sex)
Management of rectal prolapse
Conservative;
- Dietary advice and laxatives to reduce straining
- Treat underlying causes
Surgery is occasionally required;
- Recurrent prolapses
- Resistant prolapse
- Ulceration
- Significant pain (usually painless)
Typical dystonic posturing seen in Sandifer syndrome
- Sudden deviation of the head and neck to one side and legs to the other side stretched out
- Back arches posteriorly
- Hyperextension of the spine
- Hyper-extendable hips
- Elbows flexed and held posteriorly
Cholestasis, heart murmur, butterfly vertebra
Alagille Sx
Causes of conjugated and unconjugated jaundice
Unconjugated = pre-hepatic
Conjugated = hepatic or post hepatic
Which enzyme conjugates bilirubin?
Bilirubin uridine diphosphate glucuronosyltransferase (UGT)
Conjugates bilirubin with glucuronic acid to make it water soluble
Most common causes of a conjugated jaundice
Idiopathic neonatal hepatitis
Viral hepatitis
Extrahepatic biliary atresia
Intrahepatic cholestasis syndrome (Alagille, alpha 1 antitrypsin)
Causes of Unconjugated jaundice
Pre-hepatic!
Haemolysis:
- Thalassaemia
- Sickle cell
- ABO/rhesus incompatibility
- HUS
- Spherocytosis
- Polycythaemia
Physiological / breast milk
Infection
Inherited disorders;
- Crigler-Najjar (sick baby)
- Gilbert (asymptomatic)
Causes of Conjugated jaundice
Hepatic or post-hepatic!
- Idiopathic neonatal hepatitis
- Viral hepatitis (Hep A/B, CMV, EBV, enterovirus)
- Extrahepatic biliary atresia
- Intrahepatic cholestasis syndrome (Alagille, alpha 1 antitrypsin)
- Bacterial sepsis
- Parasitic (malaria)
- Metabolic disorders (glycogen storage disease, Niemann-Pick, mitochondrial disorders)
- Biliary tree disorders (Caroli Sx)
- Hypothyroidism
- Cystic Fibrosis
At what blood bili level does Jaundice become visible?
80-100
Management of cholestatic liver disease
Ursodeoxycholic acid
Vitamins ADEK (fat soluble)
Sequelae of kernicterus
Athetoid cerebral palsy
High frequency hearing loss
Paralysis of upward gaze
Dental dysplasia
Learning disability
Risk factors for developing kernicterus
Serum bili >340 in a neonate >37 wks gestational age
Rapidly rising bili >8.5 per hr
Clinical features of bilirubin encephalopathy
Pathophysiology of kernicterus
High levels of unbound, lipid-soluble, conjugated bilirubin crossing the blood-brain barrier
