Gastroenterology: Flashcards
List 4 signs of dehydration:
- Sunken fontanelle
- Sunken eyes
- Dry mouth and tongue
- Slow capillary refill
How does plotting on a weight and height chart differ for preterm babies?
(those 23-36 + 6 weeks) Plotted at corrected gestational age until 2 years old. Basically plot on a separate chart their height and weight until the EDD (40 weeks) and then from their EDD plot on the normal chart, basing the birth date as the EDD.
What is a centile on a growth chart?
If one is to take 100 boys (with the same birthday) and organise them in order of weight and then in order of height. Then each boy represents one centile
What is GORD?
Immaturity of the lower oesophageal sphincter - abnormally relaxed
What can GORD cause?
Faltering growth (often due to vomiting).
Give 3 symptoms of GORD:
- Vomiting
- Irritability
- Sleep disturbance
Give 2 complications of GORD:
- Aspiration pneumonia
- Oesophageal-stricture
What is the diagnosis of GORD based on?
pH probe in oesophagus + stomach - indicated acid in the oesophagus for >4% of the day (dont often check though)
How is GORD managed?
- Nurse upright whenever possible
- Small frequent feeds (babies stomach is about the size of a fist)
- Add gaviscon to feeds
- Self resolves by 12 months
Give 3 medications that can be used in reflux disease:
1) Gaviscon/anteacid (calcium carbonate)
2) Ranitidine (H2 antagonist) Or Omeprazole (PPI)
3) Domperidone (prokinetic, ^ gastric emptying)
If GORD persists despite medication, what Rx can be done?
Fundoplication
What is gastroenteritis defined as?
Sudden change to >2 watery stools or 2 vomits. +/- fever/abdominal pain
What to vires commonly cause gastroenteritis? and 2 less common bacteria?
Viral: - Rotavirus - Adenovirus Bacterial: - Salmonella - Campylobacter - Ecoli 0157
What is the normal course of gastroenteritis?
- Usually self-limiting
- Sometimes admission is needed due to dehydration
What is the management of gastroenteritis?
- Most managed at home with oral fluids e.g. dioralyte
- More serious = rehydration in hospital with NGT or IV fluids
- Stool samples can be sent to isolate organism
- Abx do not play a role in the Rx of viral gastroenteritis
What is the most common cause of acute renal failure in children?
Haemolytic uraemic syndrome
What two parts make make up the amount of fluid that you give someone fro rehydration?
Maintenance + estimated deficit
What fluid is used to rehydrate with?
Isotonic solution - 0.9% saline
In Haemolytic uraemic syndrome (HUS), what two test should be performed and what will be seen on each?
FBC: - Low Hb - Low platelets Blood film: - Fragmented red cells (schistocytes) U+E: - Acute kidney failure
Why are schistocytes present in HUS?
Fibrin meshs’ are present in arterioles, any RBC which pass through them are therefore shredded to produce fragmented RBC/ Schistocytes.
What organism typically causes the precipitation of HUS?
Ecoli 0157 - ‘shiga toxin’
How does the toxin responsible for HUS cause the symptoms?
1) It causes endothelial damage in the renal micro-vasculature.
2) This activated the coagulation cascade a microvascular thrombosis in kidneys
3) Platelet aggregation occurs = Consumption of platelets = thrombocytopenia
4) Fibrin/platelet mesh partially occludes kidney micro-vasculature = acute renal failure
5) Mesh shreds circulating RBC = Microangiopathic haemolytic anaemia = schistocytes and low Hb
What is the commonest surgical emergency of infancy?
Pyloric stenosis
What is pyloric stenosis caused by and when examination feature would this produce?
Hypertrophy of the muscle of the gastric pylorus. Causes olive-shaped mass in the right upper quadrant.
What are the features of pyloric stenosis and why?
Progressive projectile vomiting secondary to gastric outflow obstruction
When does pyloric stenosis typically present?
- 3-12 weeks of age
- Commoner in first-born males
What is the investigation for pyloric stenosis?
Test feed:
1) observe feed
2) watch hyperperistalsis (abdo moving)
3) Palpate for pyloric mass
4) Witness projectile vomit!
What would further investigation show in pyloric stenosis?
- Capillary blood gas - metabolic alkalosis
- US - thickened and lengthened pyloric muscle
- U&Es - Dry baby (^sodium, urea, CK), low potassium and chloride
What is the typical abnormality seen in blood gas analysis in pyloric stenosis?
- Metabolic alkalosis
- Hypokalaemic
- Hypochloraemic
What readings on blood gas analysis infer metabolic alkalosis?
- Raised HCO3
- Raised Base excess (BE)
Why metabolic alkalosis present in pyloric stenosis?
Due to continuous vomiting of NON-BILIOUS acid, depleting the body of its acid
Why is there hypochloraemia in pyloric stenosis?
This is because H+ ions in the stomach bind due Cl- ions to produce HCl. This is then vomited = lost H+ and Cl- ions.
Why is there hypokalaemia in pyloric stenosis?
This is due to dehydration. This activated the RAS which results in sodium retention. This in turn results in the loss of potassium in the urine
What is the management of pyloric stenosis?
- Nil-by-mouth
- NGT on free drainage
- IV fluids and electrolyte resuscitation and maintenance
What is the definitive Rx for pyloric stenosis?
Ramstedts pyloromyotomy - pyloric muscle is divided to open up gastric outlet
What is it called when one part of the bowel telescopes into another?
Intussusception -Paediatric emergency
What are the typical symptoms of intussusception?
- Epigastric pain with screaming
- Drawing up legs
- Pallor
- “redcurrant jelly stool”
What typically precedes intussusception?
Viral illness - lymph node = lead point
What might recurrent episodes of intussusception suggest?
- Polyp
- Meckels Diverticulum
What Ix should be performed to confirm intussusception?
- AXR
- US
What does intussusception cause?
Bowel obstruction:
- Causes fluid shifts
- Ischaemia
SURGERY REQUIRED
What is the management of intussusception?
ABCD
Tx -
- Air enema reduction OR
- Surgery
What is coeliacs disease caused by?
Autoimmune disease. Progressive flattening of small bowel mucosa = malabsoprion with steatorrhoea
What can occur if Coeliacs isn’t diagnosed?
- Faltering growth
- Iron deficiency anaemia
- Osteopenia
What would you see on examination in someone with coeliacs disease?
- Distended abdomen
- Wasted buttocks with reduced muscle bulk
- Pallor
- Short stature
What blood tests are performed in diagnosis of coeliacs disease?
- Anti-tissue transglutaminase antibodies (TTG)
- Anti-gliaden and anti-endomysial antibodies
- Total IgA
What results from blood tests confirms coeliacs?
Normal IgA and low TTG
What features are seen on biopsy and where is this biopsy taken from?
Jejunal biopsy:
- Subtotal villus atrophy
- Crypt hypertrophy
- Lymphocytic infiltrate
What is Coeliacs disease associated with?
- Downs
- Hashimotos disease (hypothyroidism)
- T1DM
- Pernicious anaemia
Which HLA is coeliacs associated with?
HLA B8
What complications can coeliacs cause later in life?
- Small bowel lymphoma
- Carcinoma of bowel
- Osteopenia
What is the Rx for coeliacs?
Gluten free diet
What type of anaemia is associated with iron deficiency anaemia?
Microcytic anaemia
What is characterised by: a well child, growing normally and ‘carrot and pea’ diarrhoea?
Toddler diarrhoea (normal + settles down). Undigested food comes through.
What conditional is associated with atopy?
Cows milk protein intolerance
What are some presenting features of CMP intolerance?
- Diarrhoea
- Vomiting
- GOR
- Mouth ulcers
What is the management of those with suspected CMP intolerance?
- Formula fed
- Breast feeding: avoid soya and cows milk
