Gastro-Enterology Flashcards by Martin Beattie

What are some indications for enteral nutrition?

1 - Disorders of sucking

2 - Prematurity

3 - Neurological problems

4 - Cystic fibrosis

5 - IBD

6 - GI Dysmotility

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Through which device is enteral feeding delivered?

Naso-gastric tube

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What are some complications of enteral feeding tubes?

1 - Infection

2 - Granulation

3 - Blockage

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What treatment sare available for chilhood IBD/Crohns?

1 - Modulen IBD - Nutrient drink

2 - Prednisolone - Steroid used to treat inflammatory conditions

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What are the complications of IBD?

Inflammation

Ulcers

Abscess

Fistulas

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What is measured in LFT’s?

1 - Bilirubin (total and direct and indirect)

2 - Alanine aminotransferase

3 - Aspartate aminotransferase

4 - Alkaline phosphatase

5 - Gamma glutamyl transferase

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Which components of LFT’s will be raised in biliary disease?

1 - Alkaline phosphatase

2 - Gamma Glutamyl Transferase

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Which components of LFT’s will be raised in hepatitis?

ALT/AST

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Which components of the LFT’s will be raised in biliary disease?

1 - Alkaline phosphotase

2 - Gamma Glutamyl Transferase

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What are the key tests to assess liver function?

1 - Coagulation (PT/APTT)

2 - Albumin

3 - Bilirubin

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What is the main clinical sign of paediatric liver disease?

Jaundice

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What is the long term complication of chronic liver disease?

Growth failure

Fat malabsorption

Pruritus

Pale stools

dark urine

bruising and petechiae

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At what levels of circulating bilirubin does jaundice become visible?

>40-50 umol

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What is the breakdown sequence of bilirubin?

1 - Mature RBC’s

2 - RBC’s broken down into haem

3 - Haem broken down into biliverdin

4 - Biliverdin becomes unconjugated bilirubin

5 - Unconjugated bilirubin becomes conjugated in liver

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Is unconjugated bilirubin water soluble or insoluble?

Water insoluble

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Is conjugated bilirubin water soluble or insoluble?

Water soluble

What type of bilirubin is associated with pre-hepatic jaundice?

Unconjugated bilirubin

What type of bilirubin is associated with post-hepatic jaundice?

Conjugated bilirubin

What type of bilirubin is associated with intra-hepatic jaundice?

Mixed

What are the 2 factors used to help make a diagnosis of the type of jaundice an infant has?

Understanding the metabolism of bilirubin

Age of infant

What are the causes of neonatal jaundice < 24hrs after birth?

Haemolysis

Sepsis

ALWAYS PATHOLOGICAL

What are the causes of jaundice between 24hrs and 2 weeks of life?

Physiological

Breast milk

Sepsis

Haemolysis

What are the causes of prolonged jaundice (i.e. > 2 weeks)?

Breast milk

Hypothyroidism

Hepatitis

Bilary atresia

What are the reasons for physiological jaundice in the newborn?

High turnover of RBC’s in the newborn

The liver hasn’t yet fully developed so cannot properly process the bilirubin

What type of bilirubin is associated with physiological jaundice?

Unconjugated

What type of bilirubin is associated with breast milk jaundice?

Unconjugated

What can be the causes of haemolysis in infants?

Rhesus disease G6PD Spherocytosis

Kernicterus is caused by which type of bilirubin and why?

Unconjugated bilirubin - it is fat soluble so can cross the BBB

What is the main mode of treatment for unconjugated jaundice?

Phototherapy with visible light

What are key points to remember when dealing with conjugated jaundice?

1) Conjugated jaundice is ALWAYS abnormal and requires further investigation 2) ALWAYS assess stool colour in infants with prolonged jaundice

What is the most important test when investigating a prolonged jaundice?

**Split bilirubin** - establish the ratio of conjugated-unconjugated bilirubin

What are key signs of biliary atresia?

1 - Conjugated jaundice 2 - Pale stools 3 - Dark urine

How is biliary atresia treated?

Kasai portoenterostomy

How should a suspected biliary atresia be investigated?

1 - Split bilirubin 2 - Stool colour 3 - USS 4 - Liver biopsy

What is the most common cause of neonatal hepatitis?

Alpha-1-antitrypsin deficiency