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Gastroenterology Flashcards

1
Q

What foods should be avoided if weaning <6m?

A

Wheat
Fish
Eggs
Food high in: salt/sugar/honey (risk of botulism)

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2
Q

What is mild Failure to Thrive classed as? + severe?

A 
Mild = cross 2 centile lines
Severe = cross 3 centile lines
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3
Q

List some non-organic (env/psych) causes of Failure to Thrive (5)
What % of cases are due to non-organic causes?

A 
Feeding probs/lack of food
Low socioeconomic status/maternal education
Abuse
Poor bond with child
Maternal depression

> 95% due to non-organic causes

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4
Q

List some organic causes of Failure to Thrive (6)

A 
Impaired suck/swallow (cleft)
Impaired retention (vom, severe GORD)

Malabsorption (Coeliac, CF, CMP, NEC, Short gut, Cholestatic liver disease)

Chronic illness (Crohn’s, CF Chronic renal failure, liver disease)

Failure to utilise nutrients (IUGR, Premature, Down’s Infection, metabolic disorders)

High requirements (thyrotoxicosis, congenital heart, malignancy, chronic infection)

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5
Q

What things should be asked about in Failure to Thrive (5)

A 
Detailed Hx + food diary
Social Hx probs
Feeding probs
Symptoms (Vom, Diarrhoea)
Illness
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6
Q

What Ix can be done in Failure to Thrive (7)

A 
FBC
Urinalysis + culture
U&amp;E + creatinine
LFTs + TFTs
Coeliac screen
Sweat test
Prealbumin (nutritional marker)
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7
Q

When is hosp admission in failure to thrive indicated? (3)

A

<6m
Severe FTT
Requiring active refeeding

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8
Q

What is the outcome like for FTT with non-organic cause?

A

Non-organic / continued underrating → lasting deficit

If due to developmental impairment → short term

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9
Q

When might acute constipation be caused by?

How is it managed?

A

e.g. febrile illness

Self-limiting / mild laxatives + extra fluid

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10
Q

What is a complication of long term constipation?

A

Rectum can over distend → lose feeling to defacate → involuntary soiling

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11
Q

What are some common causes of constipation? (6)

A

Dehyration
Reduced fluid intake
Anal fissure → pain

In older, related to:
Toilet training
Unpleasant toilets
Stress

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12
Q

What are the red flag symptoms for constipation?

A 
Failure to pass meconium in 1st 24hrs
Abdo distension
Failure to Thrive
Bruising/Fissures (abuse)
Abnormal lower limb neurology (lumbosacral pathology)
Sacral dimple (spina bifida occulta)
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13
Q

How is constipation managed if faeces are not palpable?

+ if palpable?

A

→ Balanced diet + fluids + mild laxatives

→ Mild laxatives (movicol)
If spontaneous stools: maintain balanced diet + fluids
If not → stimulant laxatives (senna) ± osmotic laxative (lactulose)
Still unsuccessful: enema (± sedation)/ manual evacuation

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14
Q

What types of milk are recommended + for how long?

A

Breast/formula recorded for 12m (wean after 6m)

+ pasteurised cow’s milk may be given after 12m

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15
Q

What may specialised formulas be used for? (5)

A 
Cow's milk protein (CMP) allergy/intol 
Lactose intol
CF
Neonatal cholestatic liver disease
After intestinal resection
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16
Q

Why should soya milk not be used in <6m?

A

High aluminium content + phytoestrogens

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17
Q

What are the different types of hydrolysed formula milks + when are they used?

A

Partially hydrolysed (longer peptide chains):
Used for CMP prophylaxis (reduces risk allergy where FH)
Not suitable when have allergy (adverse reaction)

Extensively hydrolysed: for those with CMP allergy (amino acid formula - not v tasty)

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18
Q

What are the features of CMP enteropathy (12)

A

Cutaneous:
Urticaria
Atopic + contact dermatitis
Angioedema

GI:
N+D+V
Constipation
Colic + colitis
Transient enteropathies
Resp/ENT:
Asthma/wheeze
Otitis media
Rhinoconjunctivitis
Laryngeal oedema
Anaphylaxis
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19
Q

Describe the symptom latency (which Sx + when) of CMP enteropathy

A

Immediate → rash + resp probs
Hrs → GI
24hrs → cough/wheeze

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20
Q

What Ix can be done into CMP allergy? (3)

A

Hx - FH atopy common
Skin prick test for CMP
IgE (specific for CMP) blood test

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21
Q

How is CMP allergy managed?

A

If breast fed:
Eliminate CMP + eggs from mum’s diet + req Ca supplements

If formula-fed: change to amino acid formula

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22
Q

What types of food allergies are common in infants?

+ in older children

A

Infants: milk, eggs, peanuts
Older: peanuts, tree nuts, fish/shellfish

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23
Q

How may IgE mediated + non-IgE mediated food allergies present differently?

A

IgE mediated (T1HS): allergy symps
Urticaria / Facial swelling / Anaphylaxis
10-15mins after ingestion

Non-IgE mediated (T2HS): = intolerance
GI symps (N+D+V + abdo pain + FTT) / Colic / Eczema
Sometimes present w. bloody stools in 1st wks life
Hrs after ingestion

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24
Q

How are food allergies/intolerances Dx?

A

Skin prick test
Specific IgE blood tests
Poss need intestinal biopsy to support Dx
Gold standrd: oral food challenge (double blind placebo)

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25
Q

How are food allergies/intolerances managed?

A

Avoid allergen food completely
Plan/training in case of incident

For mild (no cardioresp Sx) → oral antihistamines
For severe → epipen
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26
Q

What is functional encoperesis / how does it occur?

What are the RFs (4)

A

Retain stools to prevent pain
→ lose more water in colon → more painful
→ colon distension → loss of defacate sensation
→ rectal sphincter distends → stools force way out

No toilet training
Toilet phobia
Manipulative soiling
IBS

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27
Q

List some support sources for child soiling/encoporesis (4)

A

GP
Many referred to paed gastroenterologists
Psychological / parental help
Online info / Encoporesis support groups

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28
Q

What is soiling/encopresis defined as?

A

Child >4 (previously toilet trained) soiling self w/wo constipation/overflow

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29
Q

What is the incidence/prevalence of gastroenteritis in children in UK? + commonest causative pathogen?

A

10% of <5s

Rotavirus

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30
Q

How does gastroenteritis generally present?

What are the main RFs (ask in Hx) (3)

A

Sudden stool change → loose/watery
OR
Onset of vomiting

Recent contact with acute D+V
Exposure to known source
Recent travel abroad

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31
Q

What symptoms may make you think of an alternative Dx to gastroenteritis (8)

A 
Temp >38 ( in <3m) or >39 (in >3m)
SOB/Tachypnoea
Severe abdo pain 
Abdo distension /rebound tenderness
Blood/mucus in stools
Bilious vomiting
Meningism signs (stiff neck/ fontanelle/ purpuric rash)
Altered consciousness
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32
Q

What situations are Ix done in gastroenteritis?

A

Stool sample

  • if blood/mucus
  • if immunocompromised
  • if suspect sepsis

Microbiology:

  • recent travel
  • diarrhoea not improved in 7d
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33
Q

What is mesenteric adenitis? What is it caused by?

A

Inflamed lymph glands in abdo
Common cause of abdo pain in <16s

Usually viral - self-resolves

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34
Q

What are the features of mesenteric adenitis? (4)

A

Abdo pain - central/RIF
Nausea + diarrhoea
Fever + malaise
Preceding sore throat/ coryzal symptoms

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35
Q

What are the DDx of mesenteric adenitis (2) + poss Ix (4)

A

Ectopic preg
Appendicitis

Bloods (CRP/ESR)
Preg
Poss PR
Occasionally laparotomy

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36
Q

What is the incidence + age onset of colic?

A

40% babies

Occurs in 1st weeks of live + resolves by 4m

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37
Q

What are the features of colic?

A

Paroxysmal
Inconsolable crying
Excessive flatulence (esp in evenings)
Often accompanied with drawing up the knees

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38
Q

What may severe / persistent colic be due to? (2)

A

→ May be due to CMP allergy / reflux

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39
Q

How is infantile colic managed? (3)

A

Support + reassurance
Gripe water recommended (unproven benefit)

If suspect CMP: 2wk trial of hydrolysed formula
→ Then trial anti-reflux Tx

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40
Q

How much of food intake is used in growth in infants/children?

A

at 4m → 30% intake for growth

at 1yr → 5%

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41
Q

What are some S+S of overfeeding (3)

A

Increased GI reflux
Obesity
Lactose overload (cramps, gas, crying, watery stools)

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42
Q

List some of the features of clinical dehydration (14) + of which of these indicate shock (5/13)

A

Tachycardia
Tachypnoea

Hypotension (indicates shock)
Weak periph pulses (shock)
Cold peripheries (shock)
Pale/mottled skin (shock)
Prolonged CRT (shock)

Reduced skin turgor
Dry mucous membs
Sunken eyes
Sunken fontanelle

Reduced urine output
Sudden wt loss
Altered responsiveness (loss consciousness = shock)

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43
Q

What are the RFs for dehydration in (7)

A 
<1yr (esp <6m)
Low birth weight infants
6+ diarrhoeas in 24hrs
3+ vomits in 24hrs
Signs malnutrition
Stopped breastfeeding during illness
Unable to have fluids before presentation
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44
Q

What factors would make you suspect hypernatraemia (3)

A

Jittery / convulsions
Increased tone / hyperreflexia
Drowsiness/coma

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45
Q

What management measures should be taken (4) if assessed for dehydration + confirm NOT dehydrated

A

Continue breast
Encourage fluid intake
Discourage fruit juices/ carbonated
Use ORS

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46
Q

How is clinical dehydration (not shock) initially managed?

A

Fluid deficit replacement (50ml/kg) over 4hrs

Continue breast
Use ORS small/often
If poor intake use ORS+ other fluids
If vomiting: consider NG

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47
Q

How is severe dehydration/shock initially managed?

A

0.9% saline ± 5% dextrose:
Fluid deficit replacement:
100ml/kg if initially shocked
50ml/kg if later shocked)

Maintenance fluids:
100ml/kg/day for first 10kg
50ml/kg/day for next 10kg
20ml/kg/day for remainder kg (or 4:2:1 per hour)

Continue breast if poss

Monitor U&Es / creatinine / glucose

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48
Q

What is the management after rehydration (following dehydration/shock) (4)

A

Full strength milk / Reintroduce usual solids
Avoid fruit juices/carbonated
Advise parents on good hygiene
No return to school until 48hrs after last episode

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49
Q

What drugs are NOT routinely given in dehydration?

A

Abx

Anti-diarrhoeals

50
Q

In what cases of dehydration would Abx be given? (3)

A

Suspect sepsis
Immunocompromised
Bacterial infection (salmonella/ C.diff)

51
Q

What is post-gastroenteritis syndrome

+ how is it managed?

A

Introducing normal diet after
→ watery diarrhoea + temporary lactose intolerance

Confirmed with +ve ‘Clinitest’ result (presence of non-absorbed sugar in stools)

Use ORS 24hrs / continue reintro normal diet

52
Q

Why is GORD so common in infants?

A

Functional immaturity of lower oesophageal sphincter
Fluid diet
Horizontal posture
Short intra-abdo length of oesophagus

53
Q

What are the features of GORD? (4)

A

Recurrent regurgitation / vomiting
Post-feed
Regurgitate 1/3rd-1/2 of food
Putting wt on normally + otherwise well

CLINICAL DX OF REFLUX

54
Q

When are Ix indicated for GORD? (3)

What Ix may this include? (4)

A

Atypical Hx
Failed Tx response
Complications:
Aspiration / ALTEs / FTT / Dystonic neck / Oesophagitis

24hr pH oesophageal monitoring
24hr impedance monitoring (freq/food-related onset)
Endoscopy + biopsy
Contrast studies

55
Q

How is reflux managed in uncomplicated cases? (4)
in more severe cases?
if failure to respond to treatment?

A

Parental reassurance
Adding inert thickeners to feeds
30degree head-up position after feeds
Feeding smaller amounts more often

In signif: H2R antag (ranitidine) / Domperidone / PPI

If failure to respond Tx: consider DDx CMP allergy

56
Q

When/what surgical management can be done in reflux?

A

If complications/ unresponsive to intense medical Tx / oesophageal strictures

Nissen fundoplication (abdo/laparoscopic)

57
Q

What are the complications that can occur from reflux? (7)

A

FTT (from severe vomiting)
Oesophagitis (haematemesis/ Fe defc anaemia/ heartburn/ feeding discomfort)
Dystonic neck posture
Aspiration (pneumonia/ cough/wheeze/ apnoea)
ALTEs
SIDS (rare)
Barrett’s oesophagus (rare)

58
Q

Describe the conjugation process of bilirubin

A

Hb + haem prot breakdown → unconj bilirubin // albumin

Normally conj in liver + excreted in bile (dark urine/stools)

XS conj → albumin saturated → unconj crosses BBB
→ Basal ganglia damage (kernicterus)

59
Q

In infants, what might alter bilirubin resorption in the gut?

A

Reduced milk intake → increased bilirubin resorption

60
Q

List some causes of jaundice from unconj bilirubin (6)

A 
Breast milk jaundice
Haemolytic anaemia
Hypothyroidism
Infection
High GI obstrn
Crigler-Najjar syndrome (bilirubin metab disorder)
61
Q

List some causes of jaundice from conj bilirubin (3)

A

Bile duct obstrn (choledochal cyst)
Intrahepatic biliary hypoplasia (atresia)
Neonatal hepatitis syndrome:
(CF / a1-antitrypsin defc / congenital inf / inborn error)

62
Q

What % of newborns get physiological jaundice?

Why does it occur

A

> 50%
Shorter RBC lifespan + RBC breakdown
Liver bilirubin metabolism less efficient in 1st few days life

63
Q

What are the features of physiological jaundice of the newborn? (4)

A

Jaundiced sclera/gums/skin
Dark urine + pale stools (= unconj; water soluble)
Hepatomegaly
Poor wt gain

64
Q

What Ix can be done for jaundice?

A

If visible jaundice → transcutaneous bilirubinometer
(unless <24hrs old / <35/40) → if over 250 → test serum

Measure/6hrs whilst on Tx until sub-threshold/stable

65
Q

What are the features of kernicterus? (4)

A

Lethargy / irritability
Poor feeding
Increased muscle tone
Arched back

66
Q

What are the complications of kernicterus? (3)

A

Choreoathetoid (dyskinetic) cerebral palsy
Learning difficulties
Sensorineural deafness

67
Q

List the possible causes for neonatal jaundice if <24hrs (5)
if 2d-2wks (4)
if >2wks (>3wks preterm) (4)

A 
<24hrs:
Haemolytic disorders (Rh, ABO, spherocytosis, G6PD)
Congenital infection
IUGR
Hepatosplenomegaly
ITP
2d-2wks:
Physiological jaundice of newborn
Breast milk jaundice
Infection
Dehydration
>2-3wks:
Breast milk jaundice
Infection
Congenital hypothyroidism
Biliary atresia (conj)
68
Q

How is neonatal jaundice managed if bilirubin not extremely high?

+ if dangerously high

A 
Single phototherapy (w. breaks/feeds/hydration)
→ If falls then stop // If not then continuous (no interrupt)
→ If falls then single

Exchange transfusion with donor blood (2x circ vol)
Check levels /2hrs
→ then continuous phototherapy

69
Q

What is the incidence of biliary atresia?

What may it progress too if no surgical intervention?

A

1 in 14,000

can → chronic liver failure + death

70
Q

What are the features of biliary atresia?

A

FTT (normal birth wt)
Jaundice (conj - dark urine/pale stools (post-meconium))
Hepatosplenomegaly (portal HT → spleno)
Bruising

71
Q

What Ix may be done into biliary atresia? (4)

A

LFTs useless

Fasting abdo USS
Radioisotope scan w. TIBIDA (shows liver uptake/ no excr)
Liver biopsy (NB overlap features w. neonatal hepatitis)
Dx by laparotomy

72
Q

What is the surgical treatment for biliary atresia?

A

Use jejunum loop + join onto porta hepatis

73
Q

What is Coeliac disease?

What is its incidence in Europe?

A

Gluten → damaging immune response in proximal SI mucosa

1 in 3000

74
Q

What is the classical presentation of Coeliac disease? (6)

A 
8-24m
Failure to thrive
Abdo distension
Buttock wasting
Abnormal stools
Irritability
75
Q

How may Coeliac disease present in older children? (5)

A 
Failure to Thrive / unexpected wt loss
Prolonged fatigue
Persistent/unexplained GI symps (D+V)
Recurrent abdo pain
Unexplained Fe defc anaemia
76
Q

How is Coeliac disease investigated?

A

If on gluten diet AND S/s or Associated conditions
→ serological tests

If been off gluten, must have 1+ gluten meal /day/6wks
→ Serological tests

IgA -ve → check IgA defc / exclude DDx / poss biopsy
IgA +ve → intestinal biopsy (Dx)

77
Q

How is Coeliac disease managed?

A

Gluten free diet for life

UNLESS <2y/o → gluten challenge later in life

78
Q

Which tissue/site of the bowel is affected in Crohn’s

A

Transmurual IBD
Commonly affecting distal ileum/ prox colon
Inflamm/thickening → strictures + fistulae

79
Q

How may Crohn’s disease present in children?

What are the possible presenting features (7)

A

Older children
Lethargy + malaise (not necessarily with GI symps)

Abdo pain
Diarrhoea
Fever
Growth failure
Wt loss
Delayed puberty
80
Q

What are the extra-systemic manifestations of Crohn’s? (FACE U POO)

A 
Fe defc anaemia
Arthralgia
Clubbing
Erythema nodosum
Uveitis
Perianal skin tags
Oral lesions
Osteoporosis
81
Q

How is Crohn’s Dx?

A

Endoscopy/biopsy - non-caseating granulomata

AXR - small bowel irregs/fissures/narrowing

82
Q

Describe the management of Crohn’s (5)

A

Nutritionally (whole prot feeds every 6-8wks)
→ effective in 75%

Ineffective → systemic steroids
+ immunosuppressants (prevent relapse)

Steroids ineffective → MABS

Longterm enteral supplement (overnight NG/gastrostomy)
→ to correct growth failure

Surgery: if severe localised unresponsive / complications

83
Q

Which tissue of the bowel is affected in UC?

A

Colon mucosa

84
Q

What are the features of UC (4)

A

Rectal bleeding
Diarrhoea
Colicky pain
Growth failure (not as bad as Crohn’s)

85
Q

What are the extra-systemic manifestations of UC (MADAME UC)

A 
Mouth ulcers
Ank spon
DVT
Arthralgia (sero -ve)
M: erytheMa nodusuM
Episcleritis

Uveitis
Clubbing

86
Q

How is UC Dx?

A

Endoscopy/Biopsy
AND
Exclusion of gastroenteritis

87
Q

How is UC in children different to adults?

A

Adults usually confined to distal rectum

Children: 90% have pancolitis

88
Q

Describe the management of UC (5)

A

Aminosalicylates (for mild) → remission/maintenance

Extensive/exac → systemic steroids + immunosupps

Confined to rectum/sigmoid → topical steroids

Fulminant = emergency (risk toxic mega/ bad chronic)
→ IV steroids/fluids
→ colectomy/ileostomy + ileorectal pouch

Bowel cancer screening 10yrs post-Dx

89
Q

Describe the features of functional/recurrent abdo pain (4)

A

Characteristically periumbilical
Child otherwise well
Interrupts normal activities
Lasts >3m

90
Q

List the usual causes of functional/recurrent abdo pain (4)

A

IBS**
Abdo migraine
Functional dyspepsia
Stress/anxiety related

91
Q

What must the Ex/basic Ix include in a child presenting with functional/recurrent abdo pain (4)

A

Assess growth
Abdo palpation (exclude gall stones / PUJ obstrn)
Inspect perineum (anal fissures)
Urine MC+S (UTI DDx)

92
Q

How is functional/recurrent abdo pain discussed with the parents?

A

Reassure parents (10% school aged children)
Explain that aim to find any serious cause without unnecessary Ix
Explain diff b/wn serious/dangerous
(serious = signify time out of school, not dangerous)

93
Q

What causes IBS?

A

Altered GI motility + abnormal sensation
Often post-GI infection / FH
Also psychosocial factors (stress + anxiety)

94
Q

What are the symptoms of IBS (ABCEF)

A 
Abdo pain: worse before/relieved by defacating
Bloating
Constipation (b/wn normal/loose)
Explosive/loose/mucousy stools
Feeling of incomplete defacation
95
Q

What are some causes of gastritis / peptic ulcer in children? (3)

A

H.Pylori (usually silent/asymp infection in children)
Infection
Pernicious anaemia
Bile reflux

96
Q

List the symptoms of gastritis in children (3)

A

Nausea
Vomiting
Abdo pain (frequent complaints)

97
Q

List the symptoms of peptic ulcers in children (3)

A

Gnawing/burning in epigastrium
Pain relieved by eating/antacids/milk
Bleeding → haematemesis/malaena

98
Q

How is H.Pylori / gastritis / peptic ulcer managed?

A 
Triple therapy (H.Pylori): amoxi + metro/clarithro + PPI
Lifestyle factors (for older children): 
avoid irritant foods / alc / smoking / NSAIDs
99
Q

What are the features of Toddler Diarrhoea? (4)

A

Vary in consistency (well formed → loose/explosive)
Often contain undigested vegetables
Paler + smellier than usual
Well + thriving

100
Q

What advice can be given to parents in terms of managing Toddler Diarrhoea?

A

Investigations not usually necessary as v v common
Can relieve a bit by ensuring enough fat/fibre in diet
Maintain hydration

101
Q

What reassuring info can be given to parents regarding Toddler Diarrhoea

A

Due to gut motility immaturity
NOT malabsorption
Other more serious diseases (Coeliac/ Gastroenteritis/ Lactose intol/ malabsorption) would not be well/thriving

102
Q

How does Malabsorption manifest? (3)

A

Abnormal stools
Failure to thrive
Specific nutrient defc

103
Q

List the diff types of malabsorption syndromes (8)

A

Coeliac
Food allergy/intolerance

Exocrine panc dysfunc
Cholestatic liver disease / Biliary atresia → fat/fat-sols
Short bowel syndrome (congenital/NEC)
Loss of terminal ileum → defective Bile/B12 absorption

Lymphatic leakage/obstrn
Small-intestinal mucosal disease (Coeliac, enzyme defects e.g. lactase post-GI, transporter defects)

104
Q

How is malabsorption investigated?

A 
Dietician review (may just be poor calorific intake)
Stool sample (pH-carb/bile acids/prots/infection)
Urinalysis (transporter defects)
Various bloods/endoscopy/biopsy (dep on what DDx)
105
Q

What are some causes/RFs of malnutrition in MEDCs/UK (7)

A 
Chronic illness - esp at risk:
Preterm
Congenital heart disease
IBD/Chronic GI conditions
Malignancy
Renal failure
Cerebral palsy

Eating disorders

106
Q

How is malnutrition assessed?

A

Food diary
Nutritional status index e.g. BMI/ tricep skin fold thickness/ mid-upper arm circumf
Biochem/immunological tests (less important)

107
Q

What are the complications of malnutrition? (3)

A

Multi-system disorder
Impaired immunity / wound healing
Permanent delay in intellectual development

108
Q

What diff types (2) of nutritional support can be given in malnutrition + when is each used?

A

Enteral - when digestive tract functioning
(safe + maintains gut func)
Via NG/gastrostomy - continuous feeds overnight

Parenteral - exclusively/or as adjunct
Cannula (short term)/ central venous (long-term)

109
Q

Describe the MUST tool for malnutrition (5 steps)

A 
Step 1: BMI
Step 2: % unplanned wt loss
Step 3: acute disease effect
Step 4: add scores from steps 1-3 
→ gives overall risk malnutrition
Step 5: use guidelines/local policy to make care plan
110
Q

What are some diff measurement indexes of assessing nutritional status? (3)

A

Wt for ht (BMI) - acute malnutrition/wasting
Severe = 3SDs (<70%) below median

MUAC (mid-upper arm circumference)
Severe = <115mm

Ht for age - chronic malnutrition/stunting

111
Q

Define + describe the 2 diff types of severe protein-energy malnutrition

A

Marasmus - no oedema
Severe low BMI / MUAC / skin fold thickness (wasting)

Kwashiorkor - generalised oedema/severe wasting
Wt loss not as severe due to oedema

112
Q

What are the features of Kwashiorkor (9)

A 
Flaky rash/ hyperkeratosis
Dry/brittle hair
Angular stomatitis
Diarrhoea
Abdomen distension
Enlarged liver
Hypotension/Bradycardia
Hypothermia
Low plasma albumin/Mg/K/glucose
113
Q

When might you see Kwashiorkor in UK/MEDCs? (2)

A

When not weaned off breast until 12m (high-starch diet)

After acute inter-current infection e.g. measles/gastroenteritis

114
Q

What are the features of viral hepatitis (5 common + 2 less common)
What will be seen on LFTS?

A 
Lethargy
Abdo pain / tenderness
Nausea
Vomiting
Hepatomegaly

Jaundice (only 50%)
Splenomegaly

Transaminases v elevated + Coag normal

115
Q

How is HepA transmitted?
What is the prognosis of its progression to chronic liver disease?
How Dx?
How treated/managed?

A

Faecal-oral

Does not progress to chronic liver disease

IgM Antibodies confirm Dx
Self-resolves + Contact prophylaxis

116
Q

How is HepB transmitted
What is the prognosis of its progression to chronic liver disease?
How Dx?
How treated/managed?

A

Viral: perinatally/sexually/blood

> 90% become chronic carriers (+10% → cirrhosis)

Anti-HBc (acute infection) + HBsAg (ongoing/carriers)
Maternal +ve → babies need Ig Vx (5% req further dose)

117
Q

How is HepB transmitted

What is the prognosis of its progression to chronic liver disease?

A

Viral: mainly blood (IVDUs)/ vertical (risk if HIV)

Most → chronic carriers (20-25%→ cirrhosis/carcinoma)

118
Q

What are some symptoms of acute liver failure? (5)

A

Jaundice
Coagulopathy
Encephalopathy*
Hypoglycaemia + electrolye disturbances*

*Irritability / confusion / aggression

119
Q

What is the commonest type of parasite infection in children?
What other types of parasitic infection may be seen? (2)

A

Worms

Giardia lambia
Cryptosporidium

120
Q

How does parasitic infection of worms present?

How must it be treated

A

Usually asymp
Anal/vaginal itching
Esp at night

Treat whole household: hygiene/ mebendazole/piperazine

121
Q

How does giardia lambia transmit?

What are the features (5)

A

Faecal-oral

Travellers diarrhoea >10d
Nausea
Abdo pain
Anorexia / wt loss / FTT
Dehydration
122
Q

How does cryptosporidium transmit?

What are the features (3)

A

From animals/ infected indivs (nursery/food/water)

Low grade fever
Malaise
Sudden onset watery diarrhoea

Child Health (14 decks)

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