Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Blood in vomit

A

Oesophagitis, peptic ulceration, oral/nasal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Projectile vomiting in first few weeks of life

A

Pyloric stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Vomiting at the end of paroxysmal coughing

A

Whooping cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Abdominal distension

A

Intestinal obstruction, including strangulated inguinal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Blood in stool

A

Intussusception or gastroenteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Failure to thrive

A

GORD, coeliac disease and other chronic GIT conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is posseting?

A

Is the return of small amounts of milk with the return of swallowed air - occurs in nearly all babies from time to time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What sort of infections can be associated with vomiting in infants

A

Gastroenteritis but also with UTI and CNS infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When does GORD usually resolve by?

A

Usually resolves spontaneously by 12 months of age - due to maturation of lower oesophageal sphincter, assumption of upright posture and more solids in diet (liquid diet, lying down and immature sphincter are reasons for GORD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications of GORD

A

Failure to thrive
Oesophagitis
Recurrent pulmonary aspiration
Dystonic neck posturing (sandifer syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of uncomplicated GORD

A

Adding inert thickening agents to feeds and positioning in head up 30degree position after feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of more severe GORD

A

Acid suppression with h2 receptor antagonists (ranitidine) or proton pump inhibitors (omeprazole)
Surgery if don’t respond to medication or have oesophageal stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is pyloric stenosis

A

Hypertrophy of pyloric muscle causing gastric outlet obstruction
Presents between 2-7 weeks of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which infants is pyloric stenosis more common in

A

More common in boys 4:1

Particularly in first borns and may have a family history especially on maternal side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Type of vomiting in pyloric stenosis

A

Increases in frequency and forcefulness over time until it becomes projectile
Hunger after vomiting until dehydration causes loss of interest in eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Diagnosis of pyloric stenosis

A

Feed test - gastric peralstasis wave moving across abdomen and pyloric mass (like olive) usually palpable in RUQ - ultrasound can be helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of pyloric stenosis

A

IV fluids to correct any fluid and electrolyte imbalance

Treatment by pyloromyotomy - Ramsteadt - division of muscle - quick recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Green vomit in child

A

Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is colic?

A

Paroxysmal, inconsolable crying or screaming often accompanied by drawing up of the knees and passage of flatus several times a day - particularly in the evening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Incidence and period of colic

A

Occurs in first few weeks of life and resolved by 4 months of life and occurs in up to 40% of babies
Benign condition but can be worrying for parents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can severe and persistent colic be due to?

A

Milk protein allergy or GORD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Causes of acute abdomen pain? x8

A

Appendicitis , hernia, hip joints and testes need to be checked
Lower lobe pneumonia
Primary peritonitis with nephrotic syndrome or liver disease
DKA
UTI and acute pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In what age is acute appendicitis uncommon in?

A

Uncommon in children under 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Symptoms of acute appendicitis? x3

A

Anorexia
Vomiting (usually only a few times)
Abdominal pain, initially central and colicky and then localising to RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Signs in acute appendicitis?

A

Flushed face with oral fetor
Low grade fever
Abdominal pain aggravated by movement
Persistent tenderness with guarding in RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why does diagnosis of acute appendicitis need to be made quickly in preschool children?

A

Perforation may be rapid - omentum is less developed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What might be identified in urine of acute appendicitis

A

White blood cells or organisms as inflamed appendix may be adjacent to ureter or bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is intusseception?

A

Invagination of proximal bowel into a distal segment - most commonly the ileum passes into the caecum through the ileocaecal valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

At what age does intusseception commonly occur?

A

May occur at any age but peak age is between 3 months and 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Most serious complication of intusseception

A

Constriction of mesentery therefore venous obstruction and engorgement, bleeding from mucosa, fluid loss and bowel necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Presentation of intusseception

A

Paroxysmal, severe colicky pain and pallor - pale during pain - especially around mouth. May refuse feeds, may vomit
Sausage shaped mass palpable in abdomen
Abdominal distension and shock

32
Q

Type of stool in intusseception

A

Characteristic red currant jelly stool comprising blood stained mucus - tends to occur later in illness
May be first seen on PR

33
Q

Management of intusseception

A

Rectal air infusion normally enough (once child has been fluid resuscitated)
Ultrasound good to confirm diagnosis and see effect of treatment
Surgery if air infusion doesn’t work

34
Q

Cause of volvulus in infant

A

Malrotation of small bowel in fetal life, mesentery not fixed properly and predisposed to volvulus - causes obstruction

35
Q

When does malrotation usually present

A

First 1-3 days of life from Ladd bands obstructing

36
Q

What is abdominal migraine?

A

Migraine associated with abdominal pain - midline abdominal pain with vomiting and facial pallor
Usually family history of migraine

37
Q

Possible causes of recurrent abdominal pain x2

A

Irritable bowel syndrome

Gastritis - including being caused by h.pylori (urea breath test)

38
Q

Most common virus causing gastroenteritis in children

A

Rotavirus - now a successful vaccine been introduced

39
Q

What sort of gastroenteritis is caused by E. coli and cholera?

A

Profuse, rapidly dehydrating diarrhoea

40
Q

Which surgical disorders can mimic gastroenteritis x5

A

Pyloric stenosis, intusseception, appendicitis, necrotising enterocolitis, Hirschsprung disease

41
Q

What systemic infections can mimic gastroenteritis

A

Septicaemia and meningitis

42
Q

Which local infections can mimic pyloric stenosis

A

Respiratory tract infection, otitis media, hep A, UTI

43
Q

Most serious complication of gastroenteritis

A

Dehydration leading to shock

44
Q

Signs of dehydration

A 
Weight loss (5-10% is clinical dehydration)
Depressed fontanelle
Pale or mottled skin
Reduced urine output
Cold extremities
Pli cutanee 
Prolonged cap refill time 
Dry mucous membranes
Sunken and tearless eyes 
Tachycardia and weak peripheral pulses 
Hypotension
45
Q

What is hyponatraemic dehydration?

A

Normally with dehydration sodium and water loss is equal - but if fluid loss is replaced with water then sodium is less than water and causes shift of water from extra cellular to intracellular - increase brain volume causes convulsions

Also more shock

46
Q

What is not useful in gastroenteritis

A

Anti diarrhoeal drugs because they prolong excretion of bacteria and are ineffective

47
Q

Management of gastroenteritis without clinical dehydration ( >5% of body weight)

A

Prevent dehydration with good fluid intake and oral rehydration solution

48
Q

Management of gastroenteritis if clinical dehydration but without shock

A

Oral rehydration solution
Continue normal fluid intake aka breastfeeding and give fluid deficit replacement over 4 hours (50ml/kg)
If dehydration continues consider IV fluids with 0.9% sodium chloride solution with 5% glucose - 50ml/kg if not shocked

49
Q

Management of gastroenteritis if dehydrated and shocked

A

Fluid infusion
100ml/kg (10% of body weight)
0.9% sodium chloride solution with glucose

50
Q

What should be avoided in dehydration with gastroenteritis

A

Fruit juices and carbonated drinks

51
Q

What can sometimes occur after recovery from gastroenteritis

A

Temporary lactose intolerance with watery diarrhoea on returning to normal diet

52
Q

Presentation of malabsorption x3

A 
Abnormal stools (smelly and can't flush down toilet) 
Failure to thrive 
Nutrient deficiencies
53
Q

Presentation of coeliac disease

A

Classical presentation is profound malabsorption syndrome at 8-24 months when wheat/gluten products are introduced - failure to thrive, abdominal distension, wasting of buttocks and abnormal stools
But now children present later in childhood - nonspecific gastrointestinal symptoms and anaemia (iron/folate deficiency) and growth failure

54
Q

Tests for coeliac disease

A

IgA tissue transglutaminase antibodies and endomysial antibodies
Small intestine biopsy showing villus changes

55
Q

What is toddler diarrhoea?

A

Non specific diarrhoea of varying consistency in preschool children
Thrive well
Probably due to maturational delay in bowel
Usually grow out by age 5
Diet needs a good amount of fat, not too much juice/squash and a normal about of fibre in diet

56
Q

Crohn and UC from normal notes

A

Yup

57
Q

Presentation of Crohn and UC in children

A

Crohn just generally unwell and failure to thrive but without gastrointestinal symptoms - can mimic anorexia nervosa
UC - rectal bleeding, diarrhoea and colicky pain - may also get failure to thrive but not as much as with crohns

58
Q

What can long standing constipation in children cause

A

Can cause distension of rectum and then overflow involuntary soiling - need disimpaction regime with stool softeners etc and rectum will go back to normal after this
Must be followed by maintenance treatment
Fluid and fibre can help

59
Q

General constipation in children

A

Children stool patterns vary as much as adults therefore parents reporting “constipation” is often not a problem

60
Q

What is Hirschsprung disease?

A

Absence of ganglion cells from the myenteric and submucosal plexuses of part of large bowel causes a narrow constricted segment - extends from rectum, usually just affecting recto sigmoid colon - but can stretch further - causes obstruction and failure to pass meconium in first 24 hours of life

61
Q

Signs of Hirschsprung

A

Abdominal distension and bile stained vomit
Failure to pass meconium
Rectal examination may reveal narrow segment
And removal of finger may lead to gush of liquid stool and flatus

62
Q

How does Hirschsprung present in later childhood

A

Profound chronic constipation, abdominal distension and growth failure - usually without soiling

63
Q

Diagnosis of Hirschsprung disease

A

Suction rectal biopsy - showing absence of ganglion cells, presence of large acetylcholinesterase positive nerve trunks

64
Q

Management of Hirschsprung disease

A

Surgical - usually initial colostomy followed by anastomosing normal innervated bowel to anus

65
Q

How make diagnosis of appendicitis

A

USS may help - but regular clinical review every few hours is best as appendicitis is a progressive condition
USS shows thickened, non-compressible appendix with increased blood flow

66
Q

Management of appendicitis

A

If guarding already (perforation) then IV antibiotics and fluid resus before appendicetomy
If there is a mass palpable and no signs of peritonitis then can do IV antibiotics and conservative management - perform appendicetomy later on

67
Q

Diagnosis of intussusception

A

Xray will show distended small bowel and absence of gas in the distal colon or rectum
Abdominal US may help confirm diagnosis and check response to treatment

68
Q

Complication and urgent management of intussusception

A

Shock - therefore fluid resus is needed - due to pooling of fluid in the gut which may lead to hypovolaemic shock

69
Q

Treatment of Crohns x3

A

Steroids and diet modification to induce remission
Immunosuppressants (azathioprine, mercaptopurine or methotrexate) to maintain remission
Anti-TNF (infliximab and adalimumab) if these fail

70
Q

How does UC in children differ from it in adults?

A

90% have pancolitis as opposed to adults where it is normally confined to distal colon

71
Q

Treatment of UC

A

Mild - aminosalicylates (balsalazide and mesalazine), more aggressive = systemic steroids for acute exacerbations and immunomodulatory therapy (azathioprine) to maintain remission

72
Q

Leading cause of death in premature infants (bowel stuff)

A

Necrotising enterocolitis

73
Q

Symptoms of necrotising enterocolitis (early and more advanced)

A

Early - feeding intolerance, abdominal distension and bloody stools
Quickly progress to abdominal discolouration, perforation and peritonitis

74
Q

X ray signs in necrotising enterocolitis

A

Dilated bowel loops, bowel wall oedema, pneumatosis intestinalis (intramural gas) portal venous gas, air inside and outside bowel wall (Rigler sign), air outlining the falciform ligament (football sign)

75
Q

Management of necrotising enterocolitis

A

IV fluids, TPN and IV antibiotics for 10-14 days to rest bowel

Paediatrics (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions