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Paediatrics > Gastro-Enterology > Flashcards

Gastro-Enterology Flashcards

1
Q

What are some indications for enteral nutrition?

A

1 - Disorders of sucking

2 - Prematurity

3 - Neurological problems

4 - Cystic fibrosis

5 - IBD

6 - GI Dysmotility

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2
Q

Through which device is enteral feeding delivered?

A

Naso-gastric tube

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3
Q

What are some complications of enteral feeding tubes?

A

1 - Infection

2 - Granulation

3 - Blockage

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4
Q

What treatment sare available for chilhood IBD/Crohns?

A

1 - Modulen IBD - Nutrient drink

2 - Prednisolone - Steroid used to treat inflammatory conditions

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5
Q

What are the complications of IBD?

A

Inflammation

Ulcers

Abscess

Fistulas

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6
Q

What is measured in LFT’s?

A

1 - Bilirubin (total and direct and indirect)

2 - Alanine aminotransferase

3 - Aspartate aminotransferase

4 - Alkaline phosphatase

5 - Gamma glutamyl transferase

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7
Q

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

A

1 - Alkaline phosphatase

2 - Gamma Glutamyl Transferase

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8
Q

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

A

ALT/AST

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9
Q

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

A

1 - Alkaline phosphotase

2 - Gamma Glutamyl Transferase

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10
Q

What are the key tests to assess liver function?

A

1 - Coagulation (PT/APTT)

2 - Albumin

3 - Bilirubin

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11
Q

What is the main clinical sign of paediatric liver disease?

A

Jaundice

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12
Q

What is the long term complication of chronic liver disease?

A

Growth failure

Fat malabsorption

Pruritus

Pale stools

dark urine

bruising and petechiae

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13
Q

At what levels of circulating bilirubin does jaundice become visible?

A

>40-50 umol

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14
Q

What is the breakdown sequence of bilirubin?

A

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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15
Q

Is unconjugated bilirubin water soluble or insoluble?

A

Water insoluble

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16
Q

Is conjugated bilirubin water soluble or insoluble?

A

Water soluble

17
Q

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

A

Unconjugated bilirubin

18
Q

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

A

Conjugated bilirubin

19
Q

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

A

Mixed

20
Q

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

A

Understanding the metabolism of bilirubin

Age of infant

21
Q

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

A

Haemolysis

Sepsis

ALWAYS PATHOLOGICAL

22
Q

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

A

Physiological

Breast milk

Sepsis

Haemolysis

23
Q

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

A

Breast milk

Hypothyroidism

Hepatitis

Bilary atresia

24
Q

What are the reasons for physiological jaundice in the newborn?

A

High turnover of RBC’s in the newborn

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

25
Q

What type of bilirubin is associated with physiological jaundice?

A

Unconjugated

26
Q

What type of bilirubin is associated with breast milk jaundice?

A

Unconjugated

27
Q

What can be the causes of haemolysis in infants?

A

Rhesus disease

G6PD

Spherocytosis

28
Q

Kernicterus is caused by which type of bilirubin and why?

A

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

29
Q

What is the main mode of treatment for unconjugated jaundice?

A

Phototherapy with visible light

30
Q

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

A

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

31
Q

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

A

Split bilirubin - establish the ratio of conjugated-unconjugated bilirubin

32
Q

What are key signs of biliary atresia?

A

1 - Conjugated jaundice

2 - Pale stools

3 - Dark urine

33
Q

How is biliary atresia treated?

A

Kasai portoenterostomy

34
Q

How should a suspected biliary atresia be investigated?

A

1 - Split bilirubin

2 - Stool colour

3 - USS

4 - Liver biopsy

35
Q

What is the most common cause of neonatal hepatitis?

A

Alpha-1-antitrypsin deficiency

Paediatrics (25 decks)

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