Gastroenterology Flashcards
Red flags of vomiting
What are the red flags of vomiting in children what are they assoicated with?
- Bile stained vomit
- Haematemesis
- Projectile vomiting, in first few weeks of life
- Vomiting at the end of paroxysmal coughing
- Abdominal tenderness/Abdo pain on movement
- Abdominal distension
- Hepatosplenomeglay
- Blood in the stool
- Severe dehydration, shock
- Bulging frontanelle or seizures
- Failure to thrive
Haematemesis: can also be oesophageal variceal bleeding.
Hepatosplenomegaly: can also be due to inborn error of metabolism
Normal stool patterns
What are the normal stool patterns for:
- 0 to 4 months (breast and bottle fed)
- 4 months to 1 year
- After 1 year
Investigations to consider
What are the main investigations, indications and expected findings in Acute Diarrhoea?
Diarrhoea Diagnosis clues
What are the ages, stool features, pain (?), fits (?), vomiting (?), high fever (?) and typical season for:
- Rotavius
- Shigella
- E.Coli
- Salmonella
- Campylobacter
Acute Diarrhoea
What are the common causes of Acute Diarrhoea?
Chronic Diarrhoea
What are the common causes of Chronic Diarrhoea?
Blood, stool and other investigations
What are the key blood, stool and other investigation, their findings and significance?
Causes of Vomiting
What are the main causes of vomiting in Infants, Preschool children and school age children?
Gastroenteritis
What is the ateiology, symptoms, complications and investigations of Gastroenteritis?
Ateiology:
- There are 3 main causes:
- Viral
- Bacterial
- Protazoan: Giardia and Cryptosporidium
Investigations:
- Usually none reqired
Treatment:
- Clincal Dehydration: Give ORS often and in small amounts
Gastroenteritis
What is the management of Gastroenteritis?
Short hand version:
- No clincal dehydration = Feed more/ORS
- Clincal Dehydration = ORS 50ml/kg over 4 hours & maintenance fluids
- Shock = IV Bolus 20ml/kg
- If still in shock > PICU
- If shock resolves > IV Saline 100ml/kg over 4 hours & maintenance fluids
Maintenance fluids = (100ml/kg/24hrs for 1st 10 kg), (50ml/kg/24hrs for 2nd 10 kg), (20ml/kg/24hrs up to 50kg)
Gastroenteritis
Outline the features of: No clinical dehydration, Clinical Dehydration and Shock including:
- General appearnace
- Concious level
- Urine output
- Skin colour
- Extermities
- Eyes
- Mucous membranes
- HR
- Breathing
- Peripheral pulses
- Capilliary refil time
- Skin Turgour
- BP
Appendicitis
Outline the symptoms, ateiology, complications, investigastions and management of Appendicitis
Symptoms:
- Abdo pain: initially central, then RIF
- Oral fetor = unpleasant odour from mouth
- Gaurding: particularly in the RIF, McBernie’s point
Investigstions:
- USS: also can identify abscess, abdominal mass or perforation
Management:
- Complicated (perforation, abdo mass or abcess) or uncomplicated
Pyloric Stenosis:
Outline the symptoms, ateiology, complications, investigations and management of Pyloric stenosis
Molrotation/Volvus
Outline the symptoms, ateiology, complications, differentials, investigations and management of Molrotation/Volvus
Mesenteric Adenitis
Outline the symptoms, ateiology, complications, differentials, investigations and management of Mesenteric Adenitis
Urinary Tract Infection
Outline the symptoms, ateiology, complications and differentials of Urinary Tract Infection
Urinary Tract Infection
Outline the investigations and management of Urinary Tract Infection
Recurrent Abdominal Pain
Outline the symptoms, ateiology, complications, differentials, investigations and prognosis of Recurrent Abdominal Pain
Definition:
Defined as pain sufficient to interrupt normal activiteis for more than 3 months
Aetiology:
Lots of different causes, can be psychosomatic, stress, constipation
Investigations:
- History and Exam (exam perineum for anal fissures) and ask about stress
- Growth chart
- Urine microscopy and culture: manditory since UTI can present with just Abdo pain
- Abdo Ultrasound: good for galls stones and suspected urinary obstruction
- Coeliac antibodies and TFTs: any other investigations need a clinical indication to do
Prognosis:
- 1/2 of cases resolve quickly
- 1/4 resolve in a few months
- 1/4 long term issues: such as abdominal migraine, IBS or functional dyspepsia
Recurrent Abdominal Pain
Outline the symptoms, investigations and management for non resolving recurrent abdominal pain, including:
- Abdominal Migraine
- IBS
- Peptic Ulceration
- Nodular Antral Gastritis
- Functional Dyspepsia
- Eosinophilic Oesophagitis
Abdominal Migraine:
Symptoms: Associated withe headaches, long periods that are fine then 12 to 48 hours of non specific abdo pain
Management: Migraine medication (sumatriptan)
IBS:
Classic IBS presentation, psychogeneic. Often assocaited with Coeliac which is why its tested for.
Peptic Ulceration:
(casued by H.Pylori)
Symtpoms: Uncommonin children, should be considered when they have epigastric pain, waking them up in the night and radiates to the back.
Investigations: Stool antigen for H.Pyloti
Management:
- PPI (Omeprazole) if Peptic ulceration is suspected
- If H.Pylori is suspected, give Amoxicillin and Metronidazole or Clarithromycin
Nodular Antral Gastritis:
Symptoms: Associaed with abdo pain and nausea
Investigations:
- Gastric antral biopsy: H.Pylori produces Urease that is detected on biopsy
- Stool antigen for H.Pylori
- 13 C breath test: (given 13 C labelled Urea by mouth)
Management: Same as Peptic Ulercation
Functional Dyspepsia:
If treatment fails then do an endoscopy, if it is normal they have Functional Dyspepsia. Very similar to IBS. May benefit from a Hypoallergenic diet.
Eosinophilic oesophagitis:
Inflammatory condition, often presents with “food being stuck in the chest”. Associated with Asthma and Eczema.
Investigations: Endoscopy, showing macroscopic linear furrows and trachalization of the oesphagus.
Management: Corticosteriods in the form of fluticasone or viscous badesonide.
Possible causes of Abdominal Pain
What are the possible causes of recurrent abdominal pain?
Constipation in Children:
What are the NICE guidelines on diagnosing constipation in Children for those under and over 1 year?
Include:
- Stool pattern
- Symptoms associated with defecation
- History
Constipation in Children:
What are the possible causes of constipation in Children?
Constipation in Children:
What is the management of constipation in Children?
General points:
- Faeces are palpable = faecal impaction
- Stools passing spontaneously = disimpaciton
- Don’t use dietary changes as first line alone, but make sure the child is well hydrated
- Maintenance Therapy: First line is Movicol Paediatric plain. Continue for several weeks until symptoms have subsided.
Constipation in Children:
What are the red flags of constipation? What do they indicate?
Include:
- Timing
- Passage of Maeconium
- Stool Pattern
- Growth
- Neuro
- Abdomen
- Diet
- Other
- Failure to pass meconium > Hirschprung disease
- FTT > Hypothyroidism, Coeliac disease, other
- Ribbon stools > blood is never good, IBD, UC, Crohn’s
- Lower limb deformity > Lumbosacral pathology
- Abdominal distension > Inestinal obstruction
- Evidence of maltreatment > safegaurding
