Gastroenterology Flashcards
“Redcurrant jelly stools” dx
Intussusception
Persistent abdo pain and anaemia -> dx
Coeliacs or IBD
Raised focal calprotectin -> dx
IBD
Abdominal migraine presentation
central abdo pain LASTING LESS THAN 1 HOUR
Can have aura, photophobia or headaches
Management of abdominal migraine
Same as normal
Dark room, paracetamol, NSAIDs, sumatriptan
Prevention of abdominal migraines
Pizotifen - serotonin agonist
If stopped must be done slowly as causes depression
3 common (ish) secondary causes of constipation
Hypothyroidism, CF, Hirschsprungs disease
Term for feacal incontinence
Encopresis
Pathological at 4 years
“ribbon stool” dx
Anal stenosis
1st line management of constipation in kids
Movicol
Most common age for GORD in children
Under 1 years
Presentation of GORD in infants
Chronic cough, hoarse cry, reluctancy to feed, pneumonia, poor weight gain
Likely cause of “projectile vomiting”
Pyloric stenosis
Cause of “bile stained” vomiting
Internal obstruction
Likely cause of vomiting child with “blood in stools”
Cows milk allergy/ NEC
3 secondary causes of constipation
Hirschsprungs disease, CF, hypothyroidism
1st line management of GORD
2nd and 3rd
Advice/ thickened fluids
Gaviscon
Omeprazole
What is Sandifers syndrome
Abnormal movements associated with GORD
Torticollis (forceful neck muscle contraction causing neck twisting) and dystonia (abnormal twisting movements of back)
Improves when reflux is treated
Cause of pyloric stenosis
Hypertrophy -> narrowing of pylorus
Other than projectile vomiting how else can pyloric stenosis present
Failure to thrive
What may be found on examination in pyloric stenosis
“olive” like mass in abdomen
Blood gas analysis in pyloric stenosis
Hypochloric metabolic alkalosis
HCl is removed from stomach
How to diagnoses pyloric stenosis
Abdo USS
Treatment for pyloric stenosis
Laparoscopic pyloromyotomy (Ramstedt’s operation)
2 most common causes of viral gastroenteritis
rotavirus and norovirus
What toxin does E Coli produce
Shiga
What can an E Coli 0157 infection lead to
Haemolytic uraemia syndrome (increased risk with ABX)
Child with abdominal cramps, bloody diarrhoea and vomitting
E coli 0157 infection (HUS)
Haemolytic uraemia syndrome triad:
Low platelets, low RBC and AKI
Most common cause of travellers diarrhoea and bacterial gastroenteritis
Campylobactor jejuni
Campylobacter jejuni gram stain
Negative
Abx for Campylobacter jejuni treatment
Azithromycin
Abdo cramping after eating left over rice
Bacillus Cereus gram positive
Bacillus Cereus incubation and recovery time
Vomiting within 5 hours, diarrhoea within 8
Resolves after 24 hours
Undercooked pork gram negative infection
Yersinia enterocolitica
Yersinia enterocolitica symptoms
Bloody diarrhoea, abdopain, fever and lymphadenopathy
Can mimic appendicitis (mesenteric lymphadenitis)
Giardiasis treatment
Metronidazole
Giardiasis symtoms
None or chronic diarrhoea
How long off school do children need to remain after gastroenteritis
48 hours after symptoms resolve
Post gastroenteritis complications
IBS, lactose intolerance, reactive arthritis, Guillian Barre
Rash in coeliac disease
Dermatitis herpetiforms
3 neuro symptoms in coeliac
Peripheral neuropathy, cerebellar ataxia, epilepsy
What other condition is strongly associated with coeliacs
T1DM (test everyone)
[anaemia/ b12 deficiency]
Most common genetic association with coeliac
HLA DQ2
3 auto antibodies in coelias
TTG, EMAs, DGP
(test total IgA as TTG and DGP are IgA
What two features will a coeliacs biopsy show
Crypt hypertrophy
Villous atrophy
Acronym for Crohns
Crows Nest
No blood or mucus Entire GI tract Skip lesions Terminal ileum most affected AND Transmural Smoking is a risk factor
Acronym for UC
UC - CLOSE UP
Continuous inflammation Limited to colon and rectum Only superficial mucosa Smoking is protective Excrete blood and mucus
Use aminosalicylates
Psc
Screening test for IBD
Faecal calprotectin
Management of crohns to induce remission
1: Steroids
2: enteral nutrition (mix of amino acids and pro biome nutrients)
Drugs used in crohns to maintain remission
Azothioprine or Mercaptopurine
When would surgery be used in Crohns
When it only affects the distal ileum
What does the drug choice in inducing remission depend on in UC
Mild to moderate: aminosalicytlale
Severe: steroids
Drug used to maintain remission in UC
Aminosalicylate
Two types of surgical choices in patients with UC
ileostomy
ileo anal anastomosis (j pouch)
How does biliary atresia present
Persistent jaundice (lasting more than 14 days) in newborn
Bilirubin analysis results in biliary atresia
High conjugated
As liver still working
Management of biliary atresia
Surgery
Kasai portoenterostomy
Can a patient with intestinal obstruction pass wind
No
Vomiting type in obstruction
Green/ bilious
Bowel sounds in obstruction
Tinkling/ high pitched
Absent later
Initial investigation for ?obstruction
Abdominal xray
What will an abdominal X-ray show in an obstructed patient
Dilated loops
Absence of air in rectum
Treatment of obstruction
Drip and suck
NGT/rhyls
IV fluids
DO NOT GIVE METOCLOPRAMIDE
Cause of Hirschsprung’s disease
Nerve cells of mesenteric plexus/ auerbachs plexus not present in bowel and rectum
No peristalsis
Word meaning lack of plexus in Hirschsprung’s disease in whole colon
Total aganglionic
4 condition Hirschsprung’s disease is associated with
T21
Neurofibromatosis
Waardenburg syndrome
MEN 2
Presentation of Hirschsprung’s disease
Delay in passing meconium
Chronic constipation
Abdominal pain, distention, vomiting
Failure to thrive
Main complication of Hirschsprung’s disease (other than constipation)
Hirschsprung’s associated entrocolitis
2-4 weeks after birth, fever, distention and sepsis which can lead to toxic megacolon and perforation
How to diagnose Hirschsprung’s disease
Rectal biopsy
Can also do abdo X-ray to check for HAEC
Definitive management of Hirschsprung’s disease
Removal of ganglionic bowel
5 association with intussusception
Concurrent viral illness HSP CF Polyps Meckel diverticulum
Classic symptoms of intussusception
Redcurrant jelly stool
Sausage shaped mass in RUQ
Severe colicky abdominal pain
(viral illness proceeding)
intussusception diagnosis is by?
USS or contract enema
Management of intussusception
Therapeutic enemas to push bowel back
Surgical reduction
4 complication of intussusception
Obstruction
Gangrenous bowel
Perforation
Death
Peak age for appendicitis
10-20 years
4 key appendicitis ddx
Ectopic pregnancy
Ovarian cysts (particularly with rupture and torsion)
Meckels diverticulum - malformation of distal ileum that can bleed, become inflamed and rupture
Mesenteric adenitis
Rovsings sign
Palpation of LIF causes pain in RIF
How is appendicitis dx made
Clinical history and raised inflmataory markers
CT can help
USS can exclude female pathology
What is a appendix mass
Omentum sticks to inflamed appendix forming a mass
ABX and fluids
Remove later
Management of appendicitis
laparoscopic appendicectomy
What antibody mediates CMPA
IgE
But can be non IgE and occur over several days
Usual age of presentation of CMPA
Under 1 year
CMPA symptoms
Bloating, wind, abdominal pain, D&V
General allergic symptoms: rash, swelling, cough, sneezing
When do most children outgrow CMPA
3 years
Management and testing of CMPA
No testing available
STOP MUM CONSUMING DAIRY IF BREAST FEEDING
Hydrolysed cow milk
Can breastfed babies get CMPA
YES
When should children be weaned
6 months
If baby is high risk allergic, try allergens at 4 months
