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Phase 3a - Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are some key clinical features of constipation?

A
  • Hard stool, difficulty passing, strain and painful abdominal pain
  • Rabbit dropping stools
  • Retentive posturing
  • Overflow soiling
  • Rectal bleeding associated with hard stools
  • Loss of sensation of necessity to open bowels
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2
Q

What is encopresis?

A

Faecal incontinence

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3
Q

Encopresis is not pathological until the age of 4, what are the rare causes of it?

A

Abuse, stress, learning disability, cerebral palsy, spina bifida.

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4
Q

What can be observed in encopresis?

A

Soiling of loose and smelly stools with hard stool remaining in the rectum.

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5
Q

What characterizes rectum desensitization?

A

Don’t open bowels when they need to and ignore sensation of a full rectum leading to retention, steadily increasing rectum stretch and further desensitization.

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6
Q

What lifestyle factors may contribute to constipation?

A
  • Low fiber diet
  • Poor fluid intake and dehydration
  • Sedentary lifestyle
  • Psychological problems - home or at school
  • Don’t open bowels when required
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7
Q

What secondary pathological problems may contribute to a child’s constipation?

A
  • Hypothyroid
  • Spinal cord lesions
  • Intestinal obstruction
  • Cystic fibrosis
  • Hirschsprung’s disease
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8
Q

Consider complications of paediatric constipation; what might they be?

A
  • Pain
  • Reduced sensation
  • Hemorrhoids
  • Anal fissure
  • Overflow and soiling
  • Psychological morbidity
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9
Q

What are 7 red flags to consider should a paediatric patient be constipation?

A
  1. Not passing meconium w/in 48 hrs of birth
  2. Neurological - lower limb
  3. Vomiting
  4. Ribbon stools
  5. Abnormal anus, lower back buttocks
  6. Failure to thrive
  7. Severe abdominal pain and bloating - obstruction or intussusception
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10
Q

Should a baby not pass meconium w/in 48 hrs of birth what are you thinking?

A

Hirschsprung’s disease or cystic fibrosis

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11
Q

What is the 1st line laxative prescribed for constipation?

A

Movicol (need to ween as bowel habits regulate)

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12
Q

What are 7 red flags to consider should a paediatric patient be constipation?

A
  1. Not passing meconium w/in 48 hrs of birth
  2. Neurological - lower limb
  3. Vomiting
  4. Ribbon stools
  5. Abnormal anus, lower back buttocks
  6. Failure to thrive
  7. Severe abdominal pain and bloating - obstruction or intussusception
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13
Q

What causes GORD in babies?

A

Immaturity of the lower oesophageal sphincter causing the stomach contents to easily reflux into the oesophagus.

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14
Q

A child is projectile/forceful vomiting their food, what would you consider this as a red flag for?

A

Pyloric stenosis
Intestinal obstruction

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14
Q

If a patient is unable to keep their food down, what would you consider?

A

Pyloric stenosis
Intestinal obstruction

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14
Q

A child has bile-stained vomit, what would you consider this as a red flag for?

A

Obstruction

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15
Q

A child presents with haematemesis or melaena, what would you consider this as a red flag for?

A

Ulcer
Oesophagitis
Varices

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15
Q

A child presents with abdominal distension, what would you consider this as a red flag for?

A

Intestine obstruction

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16
Q

A child presents with respiratory symptoms what may be causing these respiratory symptoms and they are red flags for?

A

Aspiration
Infection

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17
Q

A patient presents with blood in their stools, what is this a red flag for?

A

Infection
Cow milk protein allergy

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18
Q

A child presents with the red flags which would suggest an infection - what potential diagnoses can be made?

A

Pneumonia
UTI
Tonsillitis
Meningitis

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19
Q

A child presents with rash, angioedema and urticaria, what is a potential diagnosis?

A

Cow milk protein allergy

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20
Q

What are management options for a child with Sx of GORD?

A

Small, frequent meals, burp regularly
Don’t overfeed
Keep baby upright post feed

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20
Q

If GORD is problematic and conservative management is not successful what are management options?

A

Gaviscon, thicken their milk/formula, ranitidine, omeprazole

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20
Q

A child presents with reduced consciousness, bulging fontanelle and neuro signs, what are these red flags for?

A

Meningitis
Raised ICP

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21
Q

What may be offered in very severe cases of GORD?

A

Surgical fundoplication

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22
Q

What are the complications of Sandifer’s Syndrome?

A

Infantile spasms and seizures

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23
Q

What characterizes Sandifer’s Syndrome?

A

Brief abnormal movements associated with GORD in infants - features include torticollis and dystonia (back arching and unusual postures)

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24
Q

What is the difference between acute gastritis, enteritis and gastroenteritis?

A

Acute gastritis - stomach inflammation presenting with N/V

Enteritis - intestinal inflammation presenting with diarrhoea

Gastroenteritis - stomach to intestine inflammation presenting with N/V/diarrhoea

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25
Q

What are viral causes of gastroenteritis?

A

Rotavirus, norovirus (adenovirus rare)

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26
Q

Name bacterial causes of gastroenteritis?

A
  • Escherichia coli
  • Cambylobacter jejuni
  • Shigella
  • Salmonella
  • Bacillus cereus
  • S. aureus toxin
  • Giardiasis
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27
Q

How is E.coli spread?

A

Infected faeces, unwashed salad, contaminated water

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28
Q

What is the pathophysiology of E.coli (how does it cause the symptoms)?

A

Produces Siga toxin causing abdominal cramps, bloody diarrhoea, vomiting.

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29
Q

Which syndrome can E.coli causing gastroenteritis lead to?

A

Destroys blood cells and leads to haemolytic uraemic syndrome (HUS)

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30
Q

Why should antibiotics be avoided when treating gastroenteritis caused by E.coli?

A

Increase the risk of haemolytic uraemic syndrome (HUS)

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31
Q

What is the shape of campylobacter jejuni?

A

Gram negative curved or spiral shape

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32
Q

How is C.jejuni spread?

A

Raw, improper cooked poultry, untreated water, unpasteurized milk

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33
Q

What are the symptoms of gastroenteritis caused by c.jejuni?

A

Fever, diarrhoea and vomiting and abdominal cramp

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34
Q

How is gastroenteritis caused by C.jejuni treated?

A

Azithromycin and ciprofloxacin

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35
Q

How is shigella spread?

A

Faeces

36
Q

What are the symptoms of shigella caused by?

A

Bloody diarrhoea, abdominal cramps, fever

37
Q

What is the pathophysiological mechanism of Shigella causing gastroenteritis?

A

Shiga toxin causes HUS

38
Q

What antibiotics will treat Shigella?

A

Azithromycin, ciprofloxacin

39
Q

How is salmonella spread?

A

Raw eggs, poultry, food contaminated with infected faeces.

40
Q

What are the symptoms of gastroenteritis caused by salmonella?

A

Watery diarrhoea with mucus/blood, abdominal pain, vomiting

41
Q

What is the shape of bacillus cereus and how is it spread?

A

Gram +ve rod, fried rice left out at room temperature

42
Q

What are the Sx and their progression of bacillus cereus infection?

A

Abdominal cramp
Vomiting (5hr)
Diarrhoea (8hr)
Sx resolution after 24 hours

43
Q

The enterotoxins in s. aureus will cause gastroenteritis, what is there source and where will they cause infection?

A

On food; eggs, dairy, meat
Small intestine inflamed causing D/V, abdominal cramp, fever.

44
Q

How is giardiasis lamblia spread?

A

Cysts in stool contaminate food, water and are eaten thus infecting a new host (faecal-oral transmission)

45
Q

What are the Sx of giardiasis?

A

Chronic diarrhoea

46
Q

How is giardiasis diagnosed?

A

Stool microscopy

47
Q

What is the treatment of choice for giardiasis?

A

Metronidazole

48
Q

Which medication is not recommended in E.coli 0157 infection and Shigella or blood diarrhoea/high fever?

A

Metoclopramide

49
Q

What is the main aim and what can help a patient if this is not so straightforward in a gastroenteritis patient?

A

Stay hydrated
Dioralyte can be prescribed to help if tolerated

50
Q

What is the aetiology of intussusception?

A

Infant 6 months to 2 years (>boys)

51
Q

What is intussusception?

A

Bowel invaginated/telescopes into itself, folding inwards.
–> Thickens overall bowel size and narrows lumen at the folded area so palpable mass in abdomen
–> Faces passage obstructed

52
Q

What is the clinical presentation of intussusception?

A

RUQ palpable mass
Intestinal obstruction, vomiting
Severe, colicky abdominal pain
Pale, lethargic, unwell child
Redcurrant jelly stool

53
Q

What is the characteristic stool of intussusception?

A

Redcurrant jelly stool

54
Q

How is intussusception diagnosed?

A

Ultrasound scan, contrast enema

55
Q

What is the management of intussusception?

A

Therapeutic enema, surgical reduction/resection (bowel gangrenous or perforated)

56
Q

What is pyloric stenosis?

A

Hypertrophy of the pyloric sphincter causing pyloric narrowing and therefore preventing food passing into the stomach.

57
Q

Why does projectile vomiting result from pyloric stenosis?

A

Increasingly powerful peristaltic stomach contractions as food is attempted to be forced into the duodenum eject food out oesophagus
–> eventually projectile vomiting

58
Q

What is the typical presentation of a baby suffering pyloric stenosis?

A

Thin, pale and failing to thrive suffering projectile vomiting

59
Q

What is present on blood gas analysis in a baby suffering pyloric stenosis?

A
  • Hypo-chloric metabolic alkalosis
  • Vomiting HCl from the stomach
60
Q

How is pyloric stenosis diagnosed?

A

Abdominal USS to visualize thickened pylorus

61
Q

What is the management for pyloric stenosis?

A

Laparoscopic pyloromyotomy (Ramstedt’s operation) to widen canal

62
Q

What sign is present in Appendicitis?

A

Rovsing’s sign

63
Q

Clinical features of appendicitis?

A

Central move to RIF abdominal pain - McBurney’s point. N/V, guarding on abdominal palpation.

64
Q

What suggests appendix rupture?

A

Rebound tenderness, percussion tenderness.

65
Q

Management for appendix ruptured?

A

Appendicectomy by laparoscopic surgery

66
Q

What is the cow milk protein allergy?

A

Children <3 will have hypersensitivity to cow’s milk

67
Q

What are the symptoms of cow milk protein allergy?

A

Bloating, wind, abdominal pain, D/V
Allergic Sx (think the classic)

68
Q

Which IgE reaction will be quicker in cow milk protein allergy?

A

IgE - <2 hours
Non-IgE - slower over several days

69
Q

How is cow milk protein allergy diagnosed?

A

Skin prick test

70
Q

How is cow’s milk protein allergy treated?

A

Breast-feeding mother to avoid dairy. If formula milk then replace with special hydrolyzed formulas deigned for cow’s milk allergy

71
Q

What is coeliac disease?

A

Autoimmune disease causing atrophy of the intestinal villi in particular the jejunum

72
Q

Which genes are associated with coeliac disease?

A

HLA-DQ2 (90%), HLA-DQ8

73
Q

How coeliac disease present?

A

Failure to thrive, fatigue, WL
Anaemia secondary to Fe, B12, folate deficiency
Dermatitis herpatiformis
Neuro Sx: cerebellar ataxia, peripheral neuropathy, epilepsy

74
Q

What autoantibodies are present in coeliac disease?

A

Anti-TTG, EMA (endomysial antibodies), anti-DGP

75
Q

What is seen on endoscopy and intestinal biopsy in coeliac disease?

A

Crypt hypertrophy and villous atrophy

76
Q

What autoantibodies will be raised in coeliac disease?

A

Raised anti-TTG (1st choice)
Raised anti-EMA

77
Q

What are the three stage subtypes of coeliac disease?

A
  1. Partial villous atrophy (Stage 3a): Your intestinal villi are still there, but are smaller.
  2. Subtotal villous atrophy (Stage 3b): Your intestinal villi have shrunken significantly.
  3. Total villous atrophy (Stage 3c): Your intestinal lining is basically flat with no intestinal villi left.
78
Q

What are the 0-4 descriptions of the upper jejunal mucosal immunopathology?

A

0 - pre-infiltrative
1 - infiltrative
2 - infiltrative hyperplastic
3 - flat destructive
4 - atrophic hypoplastic

79
Q

What is the treatment for coeliac disease?

A

Lifelong gluten free diet

80
Q

What is coeliac disease associated with?

A

T1DM
Thyroid disease
AI hepatitis
Primary biliary cirrhosis
Sclerosing cholangitis

81
Q

What can be a key trigger of IBS in children?

A

Stress

82
Q

What is a common cause of toddler diarrhoea?

A

Underlying maturational delay in intestinal motility leading to intestinal hurry

83
Q

What is Meckel diverticulum?

A

2% of individuals will have the ileal remnant of vitello-intestinal duct (Meckel diverticulum) containing ectopic gastric mucosa or pancreatic tissue

84
Q

What is the treatment for Meckel diverticulum?

A

Surgical resection

85
Q

How do patients with Meckel diverticulum tend to present?

A

Asymptomatic, intussusception, volvulus around band, diverticulitis mimicking appendicitis

86
Q

What is the treatment for diaphragmatic hernia?

A

Large nasogastric tube then surgical repair

87
Q

Which ethnicity are umbilical hernias especially common within?

A

Afro-Caribbean infants

88
Q

How do diaphragmatic hernias tend to present?

A

Failure to respond to resus or respiratory distress

89
Q

How does one diagnose diaphragmatic hernia?

A

Chest and abdominal X-Ray

90
Q

What will cause inguinal hernias?

A

Patent processus vaginalis (on RHS commonly)

91
Q

How do babies with inguinal hernias present?

A

Intermittent swelling in groin or scrotum on crying/straining
Irreducible lump in the groin or scrotum of the infant
Unwell with irritability and vomiting

92
Q

How are inguinal hernias treated?

A

Opioid analgesia and sustained gentle compression then surgery

93
Q

If associated with what will prompt immediate operation for inguinal hernia?

A

Undescended testes

Phase 3a - Paediatrics (11 decks)

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