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Leeds MBCHB Year 4 Peads > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

“Redcurrant jelly stools” dx

A

Intussusception

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2
Q

Persistent abdo pain and anaemia -> dx

A

Coeliacs or IBD

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3
Q

Raised focal calprotectin -> dx

A

IBD

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4
Q

Abdominal migraine presentation

A

central abdo pain LASTING LESS THAN 1 HOUR

Can have aura, photophobia or headaches

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5
Q

Management of abdominal migraine

A

Same as normal

Dark room, paracetamol, NSAIDs, sumatriptan

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6
Q

Prevention of abdominal migraines

A

Pizotifen - serotonin agonist

If stopped must be done slowly as causes depression

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7
Q

3 common (ish) secondary causes of constipation

A

Hypothyroidism, CF, Hirschsprungs disease

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8
Q

Term for feacal incontinence

A

Encopresis

Pathological at 4 years

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9
Q

“ribbon stool” dx

A

Anal stenosis

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10
Q

1st line management of constipation in kids

A

Movicol

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11
Q

Most common age for GORD in children

A

Under 1 years

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12
Q

Presentation of GORD in infants

A

Chronic cough, hoarse cry, reluctancy to feed, pneumonia, poor weight gain

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13
Q

Likely cause of “projectile vomiting”

A

Pyloric stenosis

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14
Q

Cause of “bile stained” vomiting

A

Internal obstruction

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15
Q

Likely cause of vomiting child with “blood in stools”

A

Cows milk allergy/ NEC

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16
Q

3 secondary causes of constipation

A

Hirschsprungs disease, CF, hypothyroidism

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17
Q

1st line management of GORD

2nd and 3rd

A

Advice/ thickened fluids
Gaviscon
Omeprazole

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18
Q

What is Sandifers syndrome

A

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

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19
Q

Cause of pyloric stenosis

A

Hypertrophy -> narrowing of pylorus

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20
Q

Other than projectile vomiting how else can pyloric stenosis present

A

Failure to thrive

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21
Q

What may be found on examination in pyloric stenosis

A

“olive” like mass in abdomen

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22
Q

Blood gas analysis in pyloric stenosis

A

Hypochloric metabolic alkalosis

HCl is removed from stomach

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23
Q

How to diagnoses pyloric stenosis

A

Abdo USS

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24
Q

Treatment for pyloric stenosis

A

Laparoscopic pyloromyotomy (Ramstedt’s operation)

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25
Q

2 most common causes of viral gastroenteritis

A

rotavirus and norovirus

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26
Q

What toxin does E Coli produce

A

Shiga

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27
Q

What can an E Coli 0157 infection lead to

A

Haemolytic uraemia syndrome (increased risk with ABX)

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28
Q

Child with abdominal cramps, bloody diarrhoea and vomitting

A

E coli 0157 infection (HUS)

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29
Q

Haemolytic uraemia syndrome triad:

A

Low platelets, low RBC and AKI

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30
Q

Most common cause of travellers diarrhoea and bacterial gastroenteritis

A

Campylobactor jejuni

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31
Q

Campylobacter jejuni gram stain

A

Negative

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32
Q

Abx for Campylobacter jejuni treatment

A

Azithromycin

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33
Q

Abdo cramping after eating left over rice

A

Bacillus Cereus gram positive

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34
Q

Bacillus Cereus incubation and recovery time

A

Vomiting within 5 hours, diarrhoea within 8

Resolves after 24 hours

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35
Q

Undercooked pork gram negative infection

A

Yersinia enterocolitica

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36
Q

Yersinia enterocolitica symptoms

A

Bloody diarrhoea, abdopain, fever and lymphadenopathy

Can mimic appendicitis (mesenteric lymphadenitis)

37
Q

Giardiasis treatment

A

Metronidazole

38
Q

Giardiasis symtoms

A

None or chronic diarrhoea

39
Q

How long off school do children need to remain after gastroenteritis

A

48 hours after symptoms resolve

40
Q

Post gastroenteritis complications

A

IBS, lactose intolerance, reactive arthritis, Guillian Barre

41
Q

Rash in coeliac disease

A

Dermatitis herpetiforms

42
Q

3 neuro symptoms in coeliac

A

Peripheral neuropathy, cerebellar ataxia, epilepsy

43
Q

What other condition is strongly associated with coeliacs

A

T1DM (test everyone)

[anaemia/ b12 deficiency]

44
Q

Most common genetic association with coeliac

A

HLA DQ2

45
Q

3 auto antibodies in coelias

A

TTG, EMAs, DGP

(test total IgA as TTG and DGP are IgA

46
Q

What two features will a coeliacs biopsy show

A

Crypt hypertrophy

Villous atrophy

47
Q

Acronym for Crohns

A

Crows Nest

No blood or mucus
Entire GI tract
Skip lesions
Terminal ileum most affected AND Transmural
Smoking is a risk factor
48
Q

Acronym for UC

A

UC - CLOSE UP

Continuous inflammation 
Limited to colon and rectum
Only superficial mucosa
Smoking is protective
Excrete blood and mucus

Use aminosalicylates
Psc

49
Q

Screening test for IBD

A

Faecal calprotectin

50
Q

Management of crohns to induce remission

A

1: Steroids
2: enteral nutrition (mix of amino acids and pro biome nutrients)

51
Q

Drugs used in crohns to maintain remission

A

Azothioprine or Mercaptopurine

52
Q

When would surgery be used in Crohns

A

When it only affects the distal ileum

53
Q

What does the drug choice in inducing remission depend on in UC

A

Mild to moderate: aminosalicytlale

Severe: steroids

54
Q

Drug used to maintain remission in UC

A

Aminosalicylate

55
Q

Two types of surgical choices in patients with UC

A

ileostomy

ileo anal anastomosis (j pouch)

56
Q

How does biliary atresia present

A

Persistent jaundice (lasting more than 14 days) in newborn

57
Q

Bilirubin analysis results in biliary atresia

A

High conjugated

As liver still working

58
Q

Management of biliary atresia

A

Surgery

Kasai portoenterostomy

59
Q

Can a patient with intestinal obstruction pass wind

A

No

60
Q

Vomiting type in obstruction

A

Green/ bilious

61
Q

Bowel sounds in obstruction

A

Tinkling/ high pitched

Absent later

62
Q

Initial investigation for ?obstruction

A

Abdominal xray

63
Q

What will an abdominal X-ray show in an obstructed patient

A

Dilated loops

Absence of air in rectum

64
Q

Treatment of obstruction

A

Drip and suck

NGT/rhyls

IV fluids

DO NOT GIVE METOCLOPRAMIDE

65
Q

Cause of Hirschsprung’s disease

A

Nerve cells of mesenteric plexus/ auerbachs plexus not present in bowel and rectum

No peristalsis

66
Q

Word meaning lack of plexus in Hirschsprung’s disease in whole colon

A

Total aganglionic

67
Q

4 condition Hirschsprung’s disease is associated with

A

T21
Neurofibromatosis
Waardenburg syndrome
MEN 2

68
Q

Presentation of Hirschsprung’s disease

A

Delay in passing meconium
Chronic constipation
Abdominal pain, distention, vomiting
Failure to thrive

69
Q

Main complication of Hirschsprung’s disease (other than constipation)

A

Hirschsprung’s associated entrocolitis

2-4 weeks after birth, fever, distention and sepsis which can lead to toxic megacolon and perforation

70
Q

How to diagnose Hirschsprung’s disease

A

Rectal biopsy

Can also do abdo X-ray to check for HAEC

71
Q

Definitive management of Hirschsprung’s disease

A

Removal of ganglionic bowel

72
Q

5 association with intussusception

A 
Concurrent viral illness
HSP
CF
Polyps
Meckel diverticulum
73
Q

Classic symptoms of intussusception

A

Redcurrant jelly stool
Sausage shaped mass in RUQ

Severe colicky abdominal pain

(viral illness proceeding)

74
Q

intussusception diagnosis is by?

A

USS or contract enema

75
Q

Management of intussusception

A

Therapeutic enemas to push bowel back

Surgical reduction

76
Q

4 complication of intussusception

A

Obstruction

Gangrenous bowel

Perforation

Death

77
Q

Peak age for appendicitis

A

10-20 years

78
Q

4 key appendicitis ddx

A

Ectopic pregnancy
Ovarian cysts (particularly with rupture and torsion)
Meckels diverticulum - malformation of distal ileum that can bleed, become inflamed and rupture
Mesenteric adenitis

79
Q

Rovsings sign

A

Palpation of LIF causes pain in RIF

80
Q

How is appendicitis dx made

A

Clinical history and raised inflmataory markers

CT can help
USS can exclude female pathology

81
Q

What is a appendix mass

A

Omentum sticks to inflamed appendix forming a mass

ABX and fluids

Remove later

82
Q

Management of appendicitis

A

laparoscopic appendicectomy

83
Q

What antibody mediates CMPA

A

IgE

But can be non IgE and occur over several days

84
Q

Usual age of presentation of CMPA

A

Under 1 year

85
Q

CMPA symptoms

A

Bloating, wind, abdominal pain, D&V

General allergic symptoms: rash, swelling, cough, sneezing

86
Q

When do most children outgrow CMPA

A

3 years

87
Q

Management and testing of CMPA

A

No testing available

STOP MUM CONSUMING DAIRY IF BREAST FEEDING
Hydrolysed cow milk

88
Q

Can breastfed babies get CMPA

A

YES

89
Q

When should children be weaned

A

6 months

If baby is high risk allergic, try allergens at 4 months

Leeds MBCHB Year 4 Peads (21 decks)

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