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Med Finals - Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Red flags of abdominal pain

A

Persistent or bilious vomiting
Severe chronic diarrhoea
Fever
Rectal bleeding
Weight loss
Dysphagia
Night time pain
Abdominal tenderness

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2
Q

History of constipation

A

Less than 3 stools a week
Hard stool thats difficult to pass
Rabbit dropping stools
Straining and painful passage
Abdominal pain
Abnormal posture - retentive posturing
Rectal bleeding
Faecal impaction - overflow soiling
Incontinence of loose smelly stools
Hard stools palpable
Loss of the sensation of needing to open bowels

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3
Q

Red flags of constipation

A

Not passing meconium
Neurological signs
Vomiting
Ribbon stool
Abnormal anus
Abnormal lower back or buttocks
Failure to thrive
Acute severe abdominal pain and bloating

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4
Q

Management of constipation

A

Lifestyle management
Reverse contributing factors
Laxatives - movicol!
Encourage appropriate toilet behaviour

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5
Q

Define gastro oesophageal refulx disorder

A

Where contents of the stomach reflux through the lower oesophageal spincter into the oesophagus throat or mouth

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6
Q

Presentation of reflux

A

Normal after large feeds
Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Reluctance to feed
Pneumonia
Poor weight gain

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7
Q

Red flags of reflux

A

Not keeping anything down
Projectile or forceful vomiting
Bile stained
Haematemesis
Abdominal distension
Reduced consciousness, bulging fontanelle or neuro signs
Respiratory symptoms
Blood in stool
Signs of infection
Rash, angioedema
Apnoeas

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8
Q

Management of reflux

A

Small frequent meals
Burping regularly
Not overfeeding
Keep upright after feed

Gaviscon
Thickened milk
PPIs

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9
Q

Define pyloric stenosis

A

Hypertrophy and narrowing of the pylorus - preventing food traveling from the stomach to duodenum as normal

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10
Q

Presentation of pyloric stenosis

A

Failure to thrive
Projectile vomiting
Firm round mass in upper abdomen - large olive
Metabolic alkalosis - hypochloric

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11
Q

Management of pyloric stenosis

A

Abdominal ultra sound
Laparoscopic pyloromyotomy

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12
Q

Define gastroenteritis

A

Inflammation of the stomach leading to nausea vomiting and diarrhoea

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13
Q

Causative organism in gastroenteritis

A

Rotavirus
Norovirus

E. coli - shiga toxin
Campylobacter
Salmonella
Bacillus cereus

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14
Q

Management of gastroenteritis

A

Barrier nursing
Prevent dehydration

Anti-diarrhoeals - loperamide
Abx

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15
Q

Define coeliac disease

A

Autoimmune condition where exposure to gluten causes an immune reaction that creates inflammation in the small intestine

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16
Q

Presentation of coeliac disease

A

Failure to thrive
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia - iron, B12 or folate
Dermatitis herpetiformis
Neurological symptoms

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17
Q

Investigations in coeliac disease

A

Auto antibodies - anti-TTH, anti-EMA
Endoscopy and biopsy - crypt hypertrophy, villous atrophy

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18
Q

What conditions are associated with coeliac disease

A

Type 1 diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Down’s

19
Q

Management of coeliac disease

A

Life-long gluten free diet

20
Q

Define inflammatory bowel disease

A

Umbrella term for conditions causing chronic inflammation in the bowel

21
Q

Features of Crohns

A

Crows NESTS
No blood or mucus
Entire GI tract
Skip lesions
Terminal ileum
Smoking is a risk factor

22
Q

Features of ulcerative colitis

A

UC CLOSEUP
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa
Smoking protective
Excrete blood and mucis
Use aminosalicylates
Primary sclerosing cholangitis

23
Q

Presentation of IBD

A

Perfuse diarrhoea
Abdominal pain
Bleeding
Weight loss
Anaemia
Systemically unwell
Fevers
Malaise
Dehydration

24
Q

Extraintestinal manifestations of IBD

A

Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis and iritis
Inflammatory arthritis
Primary sclerosing cholangitis

25
Q

Investigations in IBD

A

Faecal calprotectin
Endoscopy
Imaging - CT

26
Q

Management of Crohns

A

Induce remission - steroids (azathioprine, mercaptopurine, infliximab)
Maintain remission - Azathioprine (methotrexate, infliximab)
Surgery -

27
Q

Management of ulcerative colitis

A

Inducing remission - mesalazine (corticosteroids, ciclosporin)
Maintaining remission - mesalazine, azathioprine, mercaptopurine
Surgery - ileostomy

28
Q

Define biliary atresia

A

A congenital condition where a section of the bile duct is either narrowed or absent - results in cholestasis and jaundice.

29
Q

Managment of biliary atresia

A

Kasai portoenterostomy

30
Q

Define intestinal obstruction

A

A physical obstruction preventing the flow of faeces through the bowel.

31
Q

Causes of intestinal obstrucction

A

Meconium ileus
Hirschsprung’s disease
Oesophageal atresia
Duodenal atresia
Intussusception
Imperforate anus
Malrotation
Strangulated hernia

32
Q

Presentation of bowel obstruction

A

Vomiting - bilious?
Abdo pain
Failure to pass stool or wind
Bowel sounds - absent or tinkling

33
Q

Define hirschsprungs disese

A

A congenital condition where the nerve cells of the myenteric plexus are absent in the distal bowel and rectum - Bowel looses its motility and stops passing food along its length
There is an absence of parasympathetic ganglion` cells

34
Q

Genetic associations with Hirschsprung’s disease

A

Down’s Neurofibromatosis
Waardenburg syndrome
MEN II

35
Q

Presentation of Hirschsprungs disease

A

Acute obstruction at birth or gradual development of symptoms
Delayed meconium passing
Chronic constipation
Abdominal pain
Vomiting
Poor weight gain and failure to thrive

36
Q

Investigation in Hirschsprung’s disease

A

Abdo xray
Rectal biopsy

37
Q

Management of Hirschsprung’s disease

A

Fluids
Manage obstruction
Surgical removal of affected bowel

38
Q

Define intussusception

A

Where a portion of bowel invaginates into itself - telescoping of the bowel.

39
Q

Associations with intussusception

A

Concurrent viral illness
Henoch-Schonlein purpuraa
Cystic fibrosis
Intestinal polyps
Meckel diverticulum

40
Q

Presentation of intussusception

A

Severe colicky pain
Pale lethargic unwell
Redcurrant jelly stool
Mass on palpation - sausage shapped
Vomiting
Obstruction

41
Q

Management of intussusception

A

Ultrasound
Therapeutic enemas - air or water
Surgical reduction

42
Q

Define appendicitis

A

Inflammation of the appendix

43
Q

PResentation of appendicitis

A

Central abdominal pain
Moves to right iliac fossa
Tenderness in McBurney’s point

Loss of appetitis
Nausea and vomiting
Rovsings signs - pain on palaption of left
Guarding
Rebound tenderness
Percussion tenderness

44
Q

Management of appendicitis

A

Appendicetomy
Laparoscopic exploration

Med Finals - Paediatrics (17 decks)

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