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Year 4: Child Health > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is GOR?

A

the passage of gastric contents into the oesophagus and is normal in infants if it is asymptomatic.

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2
Q

What is GORD?

A

the passage of gastric contents into the oesophagus, it is the term used to describe this process in the presence of symptoms or complications from the reflux

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3
Q

What is coeliac disease?

A

A life long gluten-sensitive autoimmune disease of the small intestine.

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4
Q

What genetic components are linked to coeliac disease?

A

HLA-DQ2/DQ8

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5
Q

What signs on microscopic investigation can be seen in coeliac disease?

A

epithelial cell destruction and villous atrophy

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6
Q

Gluten protein is found in which types of cereal?

A

Wheat
Barley
Rye

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7
Q

Name some conditions related with coeliac disease.

A

Type 1 diabetes
Down syndrome
Turner syndrome
Other autoimmune diseases, such as thyroid disease, rheumatoid arthritis & Addison’s disease

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8
Q

Describe how a child with coeliac disease might present.

A

Most common presentation at 9-24 months of age with features of malabsorption, such as failure to thrive/ weight loss, loose stool, steatorrhea, anorexia, abdominal pain, abdominal distention, muscle waste. Child is often miserable with behavioral changes. Histology reveals crypt hyperplasia and villous atrophy.

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9
Q

Name some extra-intestinal symptoms in patients with coeliac disease.

A 
Dermatitis herpetiformis
Dental enamel hypoplasia
Osteoporosis
Delayed puberty
Short stature
Iron- deficient anaemia- resistant to oral Fe
Liver and biliary tract disease
Arthritis
Peripheral neuropathy, epilepsy, ataxia
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10
Q

What is tested for in the serology of suspected coeliac disease?

A

Test for total immunoglobulin A (IgA) and IgA tissue transglutaminase (tTG) as the first choice

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11
Q

If serology is positive for coeliac disease, what diagnostic test should be performed?

A

Endoscopic intestinal biopsy is necessary when the serology is positive

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12
Q

What is the gold standard test to diagnose a child with coeliac disease?

A

Duodenal biopsy

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13
Q

What cell mediated autoimmune response occurs in coeliac disease?

A

T cell mediated

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14
Q

Investigations for Coeliac disease will only be correct if the patient has been on a diet containing gluten for at least how long?

A

6 weeks

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15
Q

In cows milk protein allergy, what proteins produce an immune-mediated allergic response?

A

Casein and whey

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16
Q

How is CMPA classified?

A

IgE-mediated, non-IgE-mediated, and mixed.

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17
Q

Describe the pathophysiology of IgE mediated CMPA.

A

CD4+ TH2 cells stimulate B cells to produce IgE antibodies against cow’s milk protein which trigger the release of histamine and other cytokines from mast cells and basophils.

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18
Q

Describe the pathophysiology of Non IgE mediated CMPA.

A

T cell activation against CMP

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19
Q

How is CMPA managed?

A

An elimination diet is required for a least 6 months or until infant is 9-12 months old, with re-evaluation of the infant every 6 to 12 months to assess for tolerance to cow’s milk protein.

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20
Q

What formula can be used n infants with CMPA?

A

Extensively hydrolysed formula: cheaper, first-line formula made from cow’s milk but the casein and whey are broken down into smaller peptides which are less immunogenic. 90% of children with CMPA will respond to this.

Amino acid formula: more expensive, second-line formula for the 10% children who continue to have symptoms despite using hydrolysed formula or who have very severe symptoms.

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21
Q

How does gastroenteritis present?

A

Sudden onset diarrhoea with or without vomiting.

22
Q

What are the most common isolates of gastroenteritis?

A

Rotavirus

Campylobacter

23
Q

Which of the common isolates of gastroenteritis are vaccinated against in the National Vaccination Programme in the UK?

A

Rotavirus

24
Q

What should be discouraged in a child that is at risk of dehydration?

A

fruit juices and carbonated drinks

25
Q

What are he maintenance fluids required for a child that is 0-10kg?

A

100ml/kg/day

26
Q

What are he maintenance fluids required for a child that is 10-20kg?

A

1000ml+ 50ml/kg/day

27
Q

What are he maintenance fluids required for a child that is >20kg?

A

1500ml+ 20ml/kg/day

28
Q

What advise should a child be given following rehydration after an episode of gastroenteritis?

A
  • Avoid sharing towels
  • Do not return to school before 48hr
  • Do not swim for 2 weeks
29
Q

Name some complications of gastroenteritis.

A
  • Haemolytic uraemia sundrome
  • Reactive complications i.e. Reiter’s syndrome (urethritis, arthritis, uveitis)
  • Toxic megacolon
  • Secondary lactose intolernce
30
Q

Describe the bimodal peak age presentation of Crohn’s disease.

A

Between 15-30 and 60-80

31
Q

Where does Crohn’s disease commonly affect?

A

Distal ileum or proximal colon

32
Q

How is Crohn’s disease clinically characterised?

A

Transmural inflammation, deep ulcers and fissures (cobblestone appearance), skip lesions.

33
Q

Describe the microscopic appearance of Crohn’s disease.

A

Non-caseating granulomatous inflammation

34
Q

Describe the difference between Crohn’s and UC in relation to the site involvement.

A

Crohn’s: Entire GI tract

UC: Large bowel

35
Q

Describe the difference between Crohn’s and UC in relation to the inflammation.

A

Crohn’s: transmural

UC: mucosa only

36
Q

Describe the difference between Crohn’s and UC in relation to the microscopic changes.

A

Crohn’s: granulomatous (non-caseating)

UC: Crypt abscess formation, reduced goblet cells, non-granulomatous

37
Q

Describe the difference between Crohn’s and UC in relation to the macroscopic changes.

A

Crohn’s: Skip lesions, cobblestone appearance, fistula formation
UC: continuous inflammation (proximal from rectum), pseudopolyps, ulcers

38
Q

Name some risk factors of developing Crohn’s disease.

A
  • 20% family history
  • Smoking
  • White European descent
  • Appendectomy
39
Q

Describe how Crohn’s disease would present.

A

Episodic abdo pain, diarrhoea perhaps containing blood or mucus.

Systemic symptoms include malaise, anorexia, low-grade fever.

40
Q

Name the 3 types of imaging that can be utilised in the diagnosis of Crohn’s disease.

A
  1. Colonoscopy with biopsy
  2. CT - abdo/pelvis
  3. MRI
41
Q

Describe the medical management of remission of Crohn’s disease.

A
  • Fluid resuscitation
  • Nutritional support
  • Prophylactic heparin
  • Corticosteriod therapy
  • Immunosuppresent agents i.e. Azathioprine
42
Q

Describe the medical management of maintaining remission of Crohn’s disease.

A

Monotherapy i.e. Azathioprine
Biological agents i.e. infliximab
Smoking cessation

43
Q

Which investigation should be avoided during an acute flare of Crohn’s disease and why?

A

Colonoscopy - increased risk of perforation

44
Q

Describe the bimodal peak age presentation of UC.

A

15-25 years and 55-65 years

45
Q

Describe the prevention of UC.

A

Insidious onset with bloody stools (90% of cases). Often PR bleeding with mucus discharge

46
Q

What criteria can be used to grade UC?

A

Truelove and Witt

47
Q

What is the definitive diagnosis for uC?

A

Colonoscopy with biopsy

48
Q

Describe the AXR findings during UC.

A
  • Toxic megacolon
  • Mural thickening
  • Thumbprinting
  • Lead pipe colon
49
Q

Describe the medical management of remission of UC.

A
  • Fluid resuscitation
  • Nutritional support
  • Prophylactic heparin
  • Corticosteriod therapy
  • Immunosuppresent agents i.e. Azathioprine
50
Q

Describe the medical management of maintaining remission of UC.

A

Immunomodulators i.e. Mesalazine

51
Q

What is the cure for UC?

A

Total proctocolectomy

52
Q

Name some complications of UC.

A
  • Toxic megacolon
  • Colorectal carcinoma
  • Osteoporosis
  • Pouchitis

Year 4: Child Health (16 decks)

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