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Phase 3a - Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

How does GORD presnt in children?

A

Babies:
* Chronic cough
* Hoarse cry
* Distress, crying or unsettled after feeding
* Reluctance to feed
* Pneumonia
* Poor weight gain

Children over 1 may experience similar sx to adults:
* Heartburn
* Acid regurg
* Retrosternal/epigastric pain
* Bloating
* Nocturnal cough

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2
Q

What are causes of vomiting in babies?

A
  • Overfeeding
  • GORD
  • Pyloric stenosis
  • Gastritis
  • Appendicitis
  • Infx i.e. UTI, tonsillitis or meningitis
  • Internal obstruction
  • Bulimia
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3
Q

Mx of GORD in babies?

A

Small, frequent meals
Burping regularly to help milk settle
Not over-feeding
Keep the baby upright after feeding (i.e. not lying flat)

If severe:
Mix gaviscon w/feeds
Thickened milk/formula
PPI e.g. omeprazole

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4
Q

What is pyloric stenosis?

A

When the muscle at base of stomach controllic gastric emptying into small intestine becomes hypertrophied. This leads to narrowing of gastric outlet leading to obstruction.

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5
Q

Sx of pyloric stenosis?

A
  • Projectile vomiting especially after feeds
  • Firm, round mass in upper abdo “feels like large olive” - especially during or after feeding
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6
Q

Complications of pyloric stenosis?

A
  • Metabolic alkalosis
  • Dehydration
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7
Q

Ix for pyloric stenosis?

A

Abdo USS - hypertrophic pyloric sphincter

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8
Q

Mx of pyloric sphincter?

A

Supportive: IV fluids
Surgical: pyloromyotomy procedure

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9
Q

What is gastroenteritis?

A

Acute gastritis = infl. of stomach
Enteritis = infl. of intestines
Acute gastritis + eneteritis = gastroenteritis = infl all way from stomach to intestines

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10
Q

Name some examples of viral and bacterial causes of gastroenteritis?

A

Viral:
* Rotavirus - MC
* Norovirus

Bacterial:
* Staph. Aureus
* Bacillus Cereus (grows on food not refrigerated immediately i.e. leftover fried rice)
* Campylobacter jejuni (travellers diarrhoea)
* E.coli
* Salmonella (raw eggs, poultry)
* Shigella (contaminated water, swimming pools)

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11
Q

Sx of gastroeneteritis?

A
  • N + V
  • Diarrhoea
  • Systemic sx - fever, malaise
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12
Q

Tx of gastroenteritis?

A

Abx:
* Salmonella and Shigella = Ciprofloxacin
* Campylobacter = erythromycin
* Cholera = tetracycline

Viral: self-limiting

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13
Q

Difference between crohn’s and ulcerative colitis?

A

Crohn’s (mnemonic - NESTS):
* N – No blood or mucus (less common in Crohns.)
* E – Entire GI tract
* S – “Skip lesions” on endoscopy
* T – Terminal ileum most affected and Transmural (full thickness) inflammation
* S – Smoking = RF (don’t set the nest on fire)

Ulcerative colitis (mnemonic - CLOSEUP):
* C – Continuous inflammation
* L – Limited to colon and rectum
* O – Only superficial mucosa affected
* S – Smoking is protective
* E – Excrete blood and mucus
* U – Use aminosalicylates
* P – Primary sclerosing cholangitis

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14
Q

Ix for IBD?

A
  • Faecal calprotectin
  • GS - Endoscopy (OGD and colonoscopy) with biopsy
  • Imaging i.e. USS, CT and MRI
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15
Q

Tx of Crohn’s?
Include - inducing remission and maintanence of remission

A

Inducing remission:
* 1st line - steroids (e.g. oral prednisolone or IV hydrocortisone)

Maintaining remission:
* 1st line - Azathioprine or Mercaptopurine

Surgery can be used to tx strictures + fistulas secondary to Crohn’s

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16
Q

Tx of ulcerative colitis?
Include inducing remission and maintaining remission

A

Inducing remission:
If mild/moderate -
* 1st line - aminosalicylate (e.g. mesalazine)
* 2nd line - corticosteroids (e.g. prednisolone)
**If severe - **
* 1st line - IV corticosteroids (e.g. hydrocortisone)
* 2nd line - IV ciclosporin

Maintaining remission:
* Aminosalicylate (e.g. mesalazine)
* Azathioprine
* Mercaptopurine

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17
Q

What is coeliac disease?

A

An autoimmune cdtn where exposure to gluten causes an immune reaction that creates inflammation in small intestine.

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18
Q

What are the 2 antibodies linked to coeliac’s?

A

Anti-tissue transglutaminase (anti-TTG) and anti-endomysial (anti-EMA)

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19
Q

Sx for coeliac’s?

A
  • Failure to thrive
  • Diarrhoea
  • Fatigue
  • Wgt loss
  • Mouth ulcers
  • Anaemia secondary to iron, B12 or folate deficiency
  • Dermatitis herpetiformis (itchy blistering skin rash that appears on abdomen)
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20
Q

What is the genetic association for coeliacs?

A

HLA-DQ2 gene (90%)

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21
Q

Ix for coeliacs?

A

Ix must be carried out whilst pt remains on diet containing gluten

Antibodies:
Raised anti-TTG antibodies (first choice)
Raised anti-endomysial antibodies

Endoscopy + biopy:
Crypt hypertrophy
Villous atrophy

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22
Q

Complications of untreated coeliac disease?

A

Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Enteropathy-associated T-cell lymphoma (EATL) of the intestine
Non-Hodgkin lymphoma (NHL)
Small bowel adenocarcinoma (rare)

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23
Q

Sx of appendicitis?

A
  • Central abdo pain that moves down to right iliac fossa
  • Palpation of abdo = tenderness at McBurney’s point (localised area 1/3 distance from ASIS to the umbilicus.
  • Loss of appetite
  • N+V
  • Gaurding on abdo palpation
  • Rebound and percussion tenderness - usually due to ruptured appendix
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24
Q

Ix for appendicits?

A

GS - CT abdo
DIagnostic laparoscopy

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25
Q

Tx of appendicitis?

A

Appendicectomy
or laparotomy (less risk compared to open surgery)

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26
Q

What are typical feautures of constipation?

A
  • Less than 3 stools per week
  • Hard stools
  • Rabbit dropping stools
  • Abdo pain
  • Retentive posturing
  • Hard stools possibly palpable in abdo
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27
Q

What is meant by the term ecopresis?

A

Faecal incontinence - chronic constipation where rectum becomes stretched and looses sensation. Large hard stools remain in rectum but loose stools are able to leak out causing soiling

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28
Q

Causes of constipation?

A
  • Low fibre diet
  • Poor fluid intake
  • Sedentary lifestyle

Secondary causes:
* Hirschsprung’s disease
* CF
* Hypothyroidism
* Sexual abuse
* Intestinal obstruction
* Anal stenosis
* Cows milk intolerance

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29
Q

Mx of constipation?

A
  • High fibre diet + good hydration
  • 1st line - movicol (laxative)
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30
Q

What is Hirschsprung’s disease?

A

A congenital cdtn where nerve cells of myenteric plexus are absent in distal bowel and rectum. The myenteric plexus is responsible for stimulating peristalsis of large bowel therefore, without this stimulation the bowel looses it’s motility and stops being able to pass food thus leading to chronic constipation.

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31
Q

What is the key pathophysiology in Hirschsprung’s disease?

A

Absence of parasympathetic ganglion cells.
The aganglionic section of colon does not relax causing it to become constricted leading to loss of movement of faeces + bowel obstruction

32
Q

What cdtns is Hirschsprung’s disease commonly associated with?

A

A fhx of Hirschsprung’s disease greatly increases risk.

Cdtns associated:
* Downs syndrome
* Neurofibromatosis
* Waardenburg syndrome (a genetic condition causing pale blue eyes, hearing loss and patches of white skin and hair)
* Multiple endocrine neoplasia type II

33
Q

Sx of Hirschsprung’s disease?

A

Delay in passing meconium (more than 24 hours)
Chronic constipation since birth
Abdominal pain and distention
Vomiting
Poor weight gain and failure to thrive

34
Q

What is Hirschsprung-associated enterocolitis (HAEC) + Mx?

A

Infl. + obstruction of intestine - life threatening. Typically presents within 2-4 wks of birth w/ fever, abdo distension and bloody diarrhoea. Can lead to toxic megacolon + bowel perforation.

Mx: Urgent abx, fluid resus + decompression of obstructed bowel.

35
Q

Ix + Mx of Hirschsprung’s disease?

A

Ix:
* Abdo xray
* Rectal suction biopsy GS - absent ganglionic cells

Mx:
* Surgical removal of the aganglionic section of bowel definitive tx
* If unwell - abx + fluid resus

36
Q

Causes of chronic diarrhoea?

A
  • Cows milk intolerance
  • Toddler diarrhoea
  • Coeliac
  • Gastroenteritis
37
Q

What is Meckel’s diverticulum?

A

Congenital abnormality of GI tract - originates from remnant of vitello-intestinal duct of embryo (usually disappears around 6 wks gestation).

Found on border of distal ileum + contains all 3 bowel wall layers.

38
Q

What are Meckel’s diverticulum ‘Rule of 2s’?

A
  • 2:1 male to female ratio
  • 2 inches long approx
  • 2 feet proximal to caecum
  • 2% population
39
Q

Sx of Meckel’s diverticulum?

A
  • Symptomless
  • Painless rectal bleeding
  • Abdo pain
  • Intussusception
  • Obstruction - can become entrapped in a hernia
  • Perforation by foreign body
40
Q

Ix + Mx of Meckel’s diverticulum?

A

Ix:
* CT scan

Mx:
* Surgical resection of the diverticulum

41
Q

What is cow’s milk protein allergy?

A

Hypersensitivity to the protein in cow’s milk. May be IgE mediated (rapid reaction to cow’s milk within 2 hrs of ingestion) or may be non-IgE mediated (reaction occurs slowly over couple of days)

Typically affects infants and children <3yrs.

42
Q

Sx of cow’s milk protein allergy?

A

GI sx:
* Bloating + wind
* Abdo pain
* Diarrhoea
* Vomiting

Allergic sx:
* Hives
* Angio-oedmea (facial swelling)
* Cough/wheeze
* Watery eyes
* Eczema

43
Q

Mx of cow’s milk protein allergy?

A
  • Breast feeding mothers avoid dairy products
  • Replace formula w/hydrolysed formulas

Most children will outgrow cow’s milk protein allergy by 3 yrs or earlier. Every 6mths or so, infants can be tried on first step of milk ladder.

44
Q

Difference between cow’s milk protein allergy and cow’s milk intolerance?

A

Cow’s milk intoleramce presents w/same GI sx but no allergic sx. Infants w/intolerance are also able to tolerate cow’s milk and continue to grow but will just suffer GI sx.

45
Q

What is biliary atresia?

A

When bile ducts in a newborn’s liver undergo progressive fibrosis + destruction. Leads to conjugagted hyperbilirubinaemia, liver failure and even death.

46
Q

Sx of biliary actesia?

A
  • Prolonged jaundice (beyond 14 days)
  • Biliary obstruction sx - dark urine, pale stools
47
Q

Ix for biliary atresia?

A
  • Bloods - raised conjugated bilirubin + deranged LFTs
  • Hepatic scintigraphy (Technetium-99m scan) - liver will take up istope but poor excretion will occur = destroyed bile ducts
  • Abdo USS
  • Cholangiography GS
48
Q

Mx of biliary atresia?

A

Hepatoportoenterostomy (Kasai procedure) - surgery that creates new pathway from liver to gut

49
Q

What are choledochal scysts (biliary cysts)?

A

Swellings in bile ducts which disrupt the normal flow of bile (which helps digest fats)

50
Q

Sx of choledeochal cyst?

A
  • Abdo pain (RUQ)
  • Jaundice (due to bile flow obstruction)
  • Fever (if there is infection i.e. cholangitis)
  • N+V
  • Pale stools + dark urine (due to bile not reaching the intestines)
  • Pruritus (itching) due to bile salts accumulating in the skin
51
Q

What is intussusception?

A

Invagination (telescoping) of a segment of the proximal bowel into distal bowel segment. (i.e. ileum passing into caecum through ileocaecal valve)

52
Q

RF for intussusception?

A
  • Viral infx - involving GI tract
  • Lymphoid hyperplasia - i.e. due to lymphoma
  • Meckel’s diverticulum
  • Polyps
  • CF
  • Rotavirus vax
53
Q

Sx of intussusception?

A
  • Paroxysmal, severe colicky pain
  • Lethary
  • Refusal of feeds
  • Vomiting - could be bile-stained
  • ‘Redcurrant jelly’ stool - blood stained mucus
  • Abdo distension + sausage shaped mass in abdo palpated
54
Q

Ix for intusussception?

A

Abdo USS - ‘target’ sign

55
Q

Tx of intussusception?

A
  • Initial - rectal air insufflation or contrast enema if child is stable
  • Otherwise, surgical reduction or surgical resecrtion if bowel becomes gangrenous
56
Q

What are MC types of hernia in young children?

A

Inguinal hernia (indirect - MC in children than direct)
Umbilical hernia

57
Q

What is indirect inguinal hernia?

A

Hernias that occur when the inguinal canal (the path of the descent of the testes into scrotum which occurs via the processus vaginalis during fetal development) doesn’t close properly. Allowing abdominal contents to herniate through.

58
Q

Sx of indirect inguinal hernia?

A
  • Groin swelling (as hernias may descend into scrotum and potentially strangulate)
  • Pain
  • Palpable mass that can be pushed back or reduces while lying
59
Q

Ix and Tx of indirect inguinal hernia?

A

Ix:
* Primarily clinical
* Imaging - ultrasonography

Tx:
* Surgical repair due to risk of strangulation - open or laparoscopic mesh repair

60
Q

What is umbilical hernia and how is it managed in children?

A

Occurs around the umbilicus due to a defect in the muscle around the umbilicus.

Resolve spontaneously without intervention.

61
Q

What is meant by failure to thrive and how does the NICE guidelines describe faltering growth in children?

A

Definition: Poor physical growth and development in a child

NICE guidelines:
* One or more centile spaces if their birthweight was below the 9th centile
* Two or more centile spaces if their birthweight was between the 9th and 91st centile
* Three or more centile spaces if their birthweight was above the 91st centile

62
Q

What are some causes of failure to thrive?

A
  • Inadequate nutritional intake
  • Difficulty feeding
  • Malabsorption
  • Increased energy requirements
  • Inability to process nutrition
63
Q

What are Ix for faltering growth?

A
  • Urine dipstick, for urinary tract infection
  • Coeliac screen (anti-TTG or anti-EMA antibodies)
64
Q

What are some causes of poor feeding/inadequate nutritional intake?

A
  • Maternal malabsorption if breastfeeding
  • Fe deficiency anaemia
  • Family or parental problems
  • Neglect
  • Availability of food (i.e. poverty)
  • Poor suck, for example due to cerebral palsy
  • Cleft lip or palate
  • Genetic conditions with an abnormal facial structure
  • Pyloric stenosis
65
Q

What are the sx of IBS?

A
  • Abdo pain
  • Bowel/stool habit abnormalities
  • Bloating
  • Worse after eating
  • Improved by opening bowels
  • Mucus in stools
66
Q

What is kwashiorkor?

A

Severe form of protein malnutrition. Characterised by the presence of bilateral pitting oedema in the absence of another medical cause of oedema.

Most often seen in sub-Saharan Africa and is rare in the developed world

67
Q

Causes of Kwashiorkor?

A
  • Protein deficiency
  • Poverty + food insecurity
  • Weaning
  • Infections
68
Q

Sx of kwashiorkor?

A
  • Bilateral pitting oedema
  • Distended abdomen
  • Hair changes - thin, brittle
  • Skin lesions
  • Growth failure
  • Diarrhoea
69
Q

Ix for kwashiorkor?

A

Bloods: albumin levels (blood protein) - low + electrolyte imbalances

70
Q

Tx of kwashiorkor?

A
  • Gradual refeeding - slowly reintroduced to avoid refeeding syndrome
  • Protein supplements
  • If infx - abx
71
Q

What is marasmus?

A

Severe form of malnutrition that primarily results from a deficiency in calories and energy, affecting both proteins and other essential nutrients.

Unlike kwashiorkor, which is characterized by protein deficiency, marasmus involves a total caloric deficiency.

72
Q

Sx of marasmus?

A
  • Wasting (severe wgt loss)
  • Stunted growth
  • Loss of muscle mass
  • No oedema unlike kwashiorkor
  • Emaciation (child’s skin may appear loose and wrinkled due to fat and muscle loss) - “monkey-like” appearance + hollow cheeks.
  • Weakness
73
Q

What is neonatal hepatitis syndrome?

A

Liver inflammation in newborns.

74
Q

What causes neonatal hepatitis?

A
  • Rubella
  • CMV
  • Hep virus A, B and C
  • Metabolic liver disorders - alpha-1 antitrypsin deficiency
75
Q

Sx of neonatal hepatitis?

A
  • Jaundice
  • Dark urine
  • Light stools
  • Abdomen swelling
  • Failure to grow
76
Q
A

Phase 3a - Paediatrics (14 decks)

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