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Gastroenterology: Flashcards

1
Q

List 4 signs of dehydration:

A
  • Sunken fontanelle
  • Sunken eyes
  • Dry mouth and tongue
  • Slow capillary refill
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2
Q

How does plotting on a weight and height chart differ for preterm babies?

A

(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.

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3
Q

What is a centile on a growth chart?

A

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

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4
Q

What is GORD?

A

Immaturity of the lower oesophageal sphincter - abnormally relaxed

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5
Q

What can GORD cause?

A

Faltering growth (often due to vomiting).

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6
Q

Give 3 symptoms of GORD:

A
  • Vomiting
  • Irritability
  • Sleep disturbance
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7
Q

Give 2 complications of GORD:

A
  • Aspiration pneumonia

- Oesophageal-stricture

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8
Q

What is the diagnosis of GORD based on?

A

pH probe in oesophagus + stomach - indicated acid in the oesophagus for >4% of the day (dont often check though)

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9
Q

How is GORD managed?

A
  • 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
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10
Q

Give 3 medications that can be used in reflux disease:

A

1) Gaviscon/anteacid (calcium carbonate)
2) Ranitidine (H2 antagonist) Or Omeprazole (PPI)
3) Domperidone (prokinetic, ^ gastric emptying)

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11
Q

If GORD persists despite medication, what Rx can be done?

A

Fundoplication

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12
Q

What is gastroenteritis defined as?

A

Sudden change to >2 watery stools or 2 vomits. +/- fever/abdominal pain

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13
Q

What to vires commonly cause gastroenteritis? and 2 less common bacteria?

A 
Viral:
- Rotavirus
- Adenovirus
Bacterial:
- Salmonella
- Campylobacter
- Ecoli 0157
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14
Q

What is the normal course of gastroenteritis?

A
  • Usually self-limiting

- Sometimes admission is needed due to dehydration

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15
Q

What is the management of gastroenteritis?

A
  • 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
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16
Q

What is the most common cause of acute renal failure in children?

A

Haemolytic uraemic syndrome

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17
Q

What two parts make make up the amount of fluid that you give someone fro rehydration?

A

Maintenance + estimated deficit

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18
Q

What fluid is used to rehydrate with?

A

Isotonic solution - 0.9% saline

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19
Q

In Haemolytic uraemic syndrome (HUS), what two test should be performed and what will be seen on each?

A 
FBC:
- Low Hb
- Low platelets
Blood film:
- Fragmented red cells (schistocytes)
U+E:
- Acute kidney failure
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20
Q

Why are schistocytes present in HUS?

A

Fibrin meshs’ are present in arterioles, any RBC which pass through them are therefore shredded to produce fragmented RBC/ Schistocytes.

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21
Q

What organism typically causes the precipitation of HUS?

A

Ecoli 0157 - ‘shiga toxin’

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22
Q

How does the toxin responsible for HUS cause the symptoms?

A

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

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23
Q

What is the commonest surgical emergency of infancy?

A

Pyloric stenosis

24
Q

What is pyloric stenosis caused by and when examination feature would this produce?

A

Hypertrophy of the muscle of the gastric pylorus. Causes olive-shaped mass in the right upper quadrant.

25
Q

What are the features of pyloric stenosis and why?

A

Progressive projectile vomiting secondary to gastric outflow obstruction

26
Q

When does pyloric stenosis typically present?

A
  • 3-12 weeks of age

- Commoner in first-born males

27
Q

What is the investigation for pyloric stenosis?

A

Test feed:

1) observe feed
2) watch hyperperistalsis (abdo moving)
3) Palpate for pyloric mass
4) Witness projectile vomit!

28
Q

What would further investigation show in pyloric stenosis?

A
  • Capillary blood gas - metabolic alkalosis
  • US - thickened and lengthened pyloric muscle
  • U&Es - Dry baby (^sodium, urea, CK), low potassium and chloride
29
Q

What is the typical abnormality seen in blood gas analysis in pyloric stenosis?

A
  • Metabolic alkalosis
  • Hypokalaemic
  • Hypochloraemic
30
Q

What readings on blood gas analysis infer metabolic alkalosis?

A
  • Raised HCO3

- Raised Base excess (BE)

31
Q

Why metabolic alkalosis present in pyloric stenosis?

A

Due to continuous vomiting of NON-BILIOUS acid, depleting the body of its acid

32
Q

Why is there hypochloraemia in pyloric stenosis?

A

This is because H+ ions in the stomach bind due Cl- ions to produce HCl. This is then vomited = lost H+ and Cl- ions.

33
Q

Why is there hypokalaemia in pyloric stenosis?

A

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

34
Q

What is the management of pyloric stenosis?

A
  • Nil-by-mouth
  • NGT on free drainage
  • IV fluids and electrolyte resuscitation and maintenance
35
Q

What is the definitive Rx for pyloric stenosis?

A

Ramstedts pyloromyotomy - pyloric muscle is divided to open up gastric outlet

36
Q

What is it called when one part of the bowel telescopes into another?

A

Intussusception -Paediatric emergency

37
Q

What are the typical symptoms of intussusception?

A
  • Epigastric pain with screaming
  • Drawing up legs
  • Pallor
  • “redcurrant jelly stool”
38
Q

What typically precedes intussusception?

A

Viral illness - lymph node = lead point

39
Q

What might recurrent episodes of intussusception suggest?

A
  • Polyp

- Meckels Diverticulum

40
Q

What Ix should be performed to confirm intussusception?

A
  • AXR

- US

41
Q

What does intussusception cause?

A

Bowel obstruction:

  • Causes fluid shifts
  • Ischaemia

SURGERY REQUIRED

42
Q

What is the management of intussusception?

A

ABCD

Tx -

  • Air enema reduction OR
  • Surgery
43
Q

What is coeliacs disease caused by?

A

Autoimmune disease. Progressive flattening of small bowel mucosa = malabsoprion with steatorrhoea

44
Q

What can occur if Coeliacs isn’t diagnosed?

A
  • Faltering growth
  • Iron deficiency anaemia
  • Osteopenia
45
Q

What would you see on examination in someone with coeliacs disease?

A
  • Distended abdomen
  • Wasted buttocks with reduced muscle bulk
  • Pallor
  • Short stature
46
Q

What blood tests are performed in diagnosis of coeliacs disease?

A
  • Anti-tissue transglutaminase antibodies (TTG)
  • Anti-gliaden and anti-endomysial antibodies
  • Total IgA
47
Q

What results from blood tests confirms coeliacs?

A

Normal IgA and low TTG

48
Q

What features are seen on biopsy and where is this biopsy taken from?

A

Jejunal biopsy:

  • Subtotal villus atrophy
  • Crypt hypertrophy
  • Lymphocytic infiltrate
49
Q

What is Coeliacs disease associated with?

A
  • Downs
  • Hashimotos disease (hypothyroidism)
  • T1DM
  • Pernicious anaemia
50
Q

Which HLA is coeliacs associated with?

A

HLA B8

51
Q

What complications can coeliacs cause later in life?

A
  • Small bowel lymphoma
  • Carcinoma of bowel
  • Osteopenia
52
Q

What is the Rx for coeliacs?

A

Gluten free diet

53
Q

What type of anaemia is associated with iron deficiency anaemia?

A

Microcytic anaemia

54
Q

What is characterised by: a well child, growing normally and ‘carrot and pea’ diarrhoea?

A

Toddler diarrhoea (normal + settles down). Undigested food comes through.

55
Q

What conditional is associated with atopy?

A

Cows milk protein intolerance

56
Q

What are some presenting features of CMP intolerance?

A
  • Diarrhoea
  • Vomiting
  • GOR
  • Mouth ulcers
57
Q

What is the management of those with suspected CMP intolerance?

A
  • Formula fed

- Breast feeding: avoid soya and cows milk

Paeds (13 decks)

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