Gastroenterology Flashcards

Question

How is appendicitis managed in children? | What are the complications?

Answer 1

Need appendicectomy. If <10yrs need to be under paediatric surgeon. >10yrs can be under adult surgeons provided there is a paediatric unit. ``` Post surgery complications include- Bleeding Infection Pain Scars Damage to surrounding organs Removal of normal appendix VTE ```

Answer 2

Part of the bowel telescopes/invaginates into another part of bowel. This makes the bowel wall appear thicker and the lumen more narrow so stool will not be able to pass through the bowel. Common in 6 months to 2yrs old. ``` Presentation- Redcurrent jelly like stool Non specific colicky abdominal pain RUQ sausage shaped mass (stool) Vomiting Intestinal obstruction May have had a recent viral infection I.e. URTI ```

Answer 3

``` Concurrent viral infection Henoch Cystic fibrosis Intestinal polyps Meckels diveritculum ```

Answer 4

Investigate with USS or contrast enema. Management- Need to reduce intussusception. Either therapeutic enema I.e. water, contrast or air is forced up the colon to force the bowel to move out of itself. If this fails then surgical repositioning. If the blood supply is compromised and leads to gangrenous bowel, or there is a bowel perforation then need surgical resection.

Answer 5

Bowel perforation Bowel gangrenous Death Bowel obstruction

Answer 6

Normal bowel has myenteric plexus, which controls the peristalsis. During normal development the parasympathetic cells travel distally down the GI tract. In Hirschsprung’s these parasympathetic cells don’t travel completely down and so part of the colon and rectum are left without parasympathetic innervation. If the entire colon is affected this is total colonic aganglionosis. Bowel without parasympathetic cannot relax therefore in a state of constriction. Stool can’t get past, and so proximal to this constriction get stool collection and bowel dilation.

Answer 7

Usually stand alone. Strong FHx. Can be associated with Downs, neurofibromatosis and MEN II.

Answer 8

Some neonates born with bowel obstruction. ``` Features- Don’t pass meconium within first 24-48hrs Vomiting Distended abdomen Chronic constipation since birth Poor growth and failure to thrive ```

Answer 9

Diagnosed with a rectal biopsy- will show absence of ganglionic cells. Can also use and X-ray to look for obstruction or features of HAEC Manage with bowel resection. Will go on to live normal lives but have life long bowel function disturbances and some may have incontinence issues.

Answer 10

Hirschsprung’s associate enterocolitis. Inflammation of the bowel, in a pt with Hirschsprung’s. This leads to fever, abdominal distension, diarrhoea (often bloody) and sepsis features. This can lead to toxic mega colon and perforation. Investigate with X-ray. Manage with fluids, Abx, decompression surgery.

Answer 11

Abdominal distension Abdominal pain Vomiting Absolute constipation Also hear tinkling bowel sounds early on which become absent later

Answer 12

``` Hirschsprung’s Intussusception Oesophageal atresia Meconium ileus Imperforate anus ```

Answer 13

Investigated with an AXR- dilated loops of bowel proximal to the obstruction, collapsed loops of bowel distal to the obstruction. Absence of air in the rectum. Manage by paediatric surgical unit admission. Suck and drip- insert NG tube to ‘suck out’ from the bowel, give IV fluids.

Answer 14

Bile duct is either narrowed partially or completely; the bile can not be excreted out of the liver. Usually conjugated bilirubin from the liver is excreted in the bile, so this leads to a build up of conjugated bilirubin.

Answer 15

Suspect if >14 days jaundice in term baby or >21 days jaundice in premature baby. Measure the proportion of conjugated bilirubin compared to unconjugated. Higher conjugated suggests biliary atresia. Management is surgery. Kasai portoenterostomy- take part of the small intestine and insert it onto the liver where the bile duct would usually attached. It is effective but many patients will go on to need full liver transplant.

Answer 16

``` Clubbing Episcleritis and iritis Inflammatory arthritis Erythema nodusum Pyoderma gangrenosum ``` UC- ascending cholangitis (check LFTs)

Answer 17

FBC (anaemia, thrombocytosis as a sign of inflammation), LFTs (albumin as nutrition marker, AC), CRP, TFTs, U+Es. Faecal calprotectin. Gold standard is an OGD and colonoscopy in children to get the most information. Can further image with USS, CT or MRI

Answer 18

Inducing remission- First line is by a full liquid diet for minimum of 6 wks to reverse the acute flare. This is the best method and should always be trialled before steroids. 2nd line by a long way is steroids I.e. IV hydrocortisone or oral prednisolone. 3rd line would be immunosuppressants I.e. azathioprine. Maintaining remission- Azathioprine Methotrexate Mercaptopurine Surgery to manage strictures and fistulas. Since Crohns contains skip lesions, surgical resection is only effective if the distal ileum alone is affected.

Answer 19

Inducing remission- First line is mesalazine (aminosalicylate) Second line is corticosteroid. In more severe disease first line is corticosteroid, second line is IV ciclosporin. Maintaining remission- Mesalazine Azathioprine Surgery- Can remove the entire rectum and colon- create an ileostomy or j-bag for the stool to leave. J bag involves using the ileum to act as a rectum.

Answer 20

Exposure to gluten causes inflammation of the small intestine, particularly the jejune. This leads to villous atrophy and crypt hypertrophy. The antibodies involved are IgA antibodies Anti-TTG and Anti-EMA. Thought HLA-DHQ 2 gene (mainly) and DHQ-8 are also involved. ``` Associated with- T1DM Thyroid disease Autoimmune hepatitis Down’s syndrome ```

Answer 21

``` Asymptomatic Or Fatigue Wt loss Mouth ulcers Failure to thrive (young children) Diarrhoea Anaemia due to deficiency or iron, B12 or folate Dermatitis herpatiformis ``` Rarely can get neurological features- Cerebellar ataxia Peripheral neuropathy Epilepsy

Answer 22

Need to still be on a gluten diet. Test total IgA levels. Test with anti-TTG, anti-EMA and HLA type. Anti-TTG and anti-EMA are IgA; some patients can have IgA deficiency so will have negative coeliacs test even though they are positive. Test for the IgG levels of these antibodies. Can also conduct endoscopy with biopsy. ALWAYS TEST PATIENTS DIAGNOSED WITH T1DM EVEN IF THEY DON’T HAVE SYMPTOMS.

Answer 23

Gluten free diet life long.

Answer 24

``` Anaemia Vitamin deficiency Osteoporosis Ulcerative jejunitis Non Hodgkin lymphoma ```

Answer 25

Inflammation of the stomach and intestines leading to nausea, vomiting and diarrhoea. Will self resolve. Need to ensure patient is not dehydrated. Encourage oral fluids, but if not tolerated and dehydrated then IV fluids. Anti diarrhoeal and antibiotics are not indicated. Child should not go school fro 48hrs, on wards should be isolated. Commonly caused by virus- contagious.

Answer 26

Lactose intolerance IBS GBS Reactive arthritis