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

Cystic fibrosis predominantly affects which ethnicity?

A

Caucasian

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

How is cystic fibrosis inherited?

A

Autosomal recessive

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

Which gene is affected in cystic fibrosis?

A

CFTR (cystic fibrosis transmembrane conductance regulator)

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

What is meconium ileus?

A

Failure to pass the first stool in neonates (usually passes within 24-48 hours)

CF is the most common cause

Bilious vomiting, abdominal distension, no meconium

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

What is the primary screening test for CF?

A

Immunoreactive trypsinogen (IRT; elevated) on a heel-prick blood

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

Why is immunoreactive trypsinogen elevated in CF?

A

IRT has not been converted to its active form due to impaired release of pancreatic enzymes

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

What test is used to confirm CF after abnormal IRT?

A

DNA assay to identify common CFTR mutations

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

What is the diagnostic criteria for CF?

A

Typical clinical manifestations of CF

AND

Evidence of CFTR dysfunction

Sweat chloride > 60 mmol/L on two occasions

OR

CFTR gene mutation

OR

Abnormal nasal potential difference test

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

What is the most important factor in CF prognosis?

A

Severity of pulmonary disease

Chronic respiratory infections and mucus plugging → irreversible bronchiectasis → progressive respiratory failure → death

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

Is physiological neonatal jaundice conjugated or unconjugated?

A

Unconjugated

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

When does physiological neonatal jaundice occur?

A

Between days 3-8 of life

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

Give 3 causes for physiological neonatal jaundice

A
  1. HbF replaced with HbA (haemolysis)
  2. Immature hepatic conjugation and elimation pathways → impaired metabolism
  3. Less bacteria in the GIT → less conversion of bilirubin to urobilin → less excretion of bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where is the vomiting (emetic centre)?

A

In the medulla

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

Which autonomic nerve mediates emesis?

A

Vagus

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

What electrolyte changes are seen in children with pyloric stenosis?

A

Metabolic acidosis (low H+, high HCO3- to compensate)

Low Cl-

Low K+

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

What surgical procedure is done for pyloric stenosis?

A

Pyloromyotomy

Incision is made through the pyloric sphincter and the lumen can bulge through this opening

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

What is the feed test in the context of suspected pyloric stenosis?

A

Shortly after eating, peristalsis may be visible

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

Which type of inguinal hernia involves protrusion of the bowel through the internal inguinal ring, external inguinal ring and into the scrotum?

A

Indirect inguinal hernia

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

Which type of inguinal hernia herniates lateral to the inferior epigastric artery?

A

Indirect

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

Which type of inguinal hernia herniates medial to the inferior epigastric artery?

A

Direct

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

Which type of inguinal hernia protrudes through the inguinal (Hesselbach’s) triangle?

A

Direct

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

Which type of inguinal hernia involves herniation through the external (superficial) inguinal ring only?

A

Direct

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

What is the best method of assessing dehydration?

A

% loss of body weight

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

What is the role of anti-diarrhoeal drugs in infants and children with gastroenteritis?

A

NO role - do not use

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

What is the role of anti-emetic drugs in infants and children with gastroenteritis?

A

Ondensetron may be used

Reduces vomiting

Improves intake of oral rehydration solutions

Reduces the need for IV fluids and hospitalisation

Can worsen diarrhoea

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

When is the peak incidence of intussusception?

A

3-12 months

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

What is this?

A

Target sign of intussusception

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

From what age/weight can ondansetron be used?

A

6 months/8kg

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

Acute abdominal pain with legs drawn up and with asymptomatic intervals is characteristic of which condition?

A

Intussusception

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

What is perferred treatment of intussusception?

A

Air enema

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

What investigations should be performed for intussusception?

A
  1. AXR (exclude perforation and obstruction)
  2. US
  3. Air enema (diagnostic and therapeutic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What pathogen is associated with reptiles?

A

Salmonella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Why do children with pyloric stenosis have high bicarbonate?

A

The kidneys reabsorb bicarboante to maintain fluid volume despite the metabolic alkalosis

If bicarbonate is loss, sodium follows, then water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is breastfeeding jaundice?

A

The persistence of physiologic jaundice beyond the first week of life

Exclusive breastmilk intake may increase intestinal absorption of bilirubin

35
Q

List 4 causes of neonatal conjugated hyperbilirubinaemia

A
  1. Hepatitis A/B
  2. Cystic fibrosis (decreased bilirubin excretion)
  3. Biliary atresia
  4. TORCH infections
  5. Choledochal cyst
  6. Dubin-Johnson syndrome
  7. Rotor syndrome
  8. Alpha-1-antitrypsin deficiency
36
Q

List 4 causes of neonatal unconjugated hyperbilirubinaemia

A
  1. Haemolytis disease of the newborn
  2. Spherocytosis
  3. Thalassemia
  4. G6PD deficiency
  5. Crigler-Najjar syndrome
  6. Glucuronyl transferase deficiency
  7. Hypothyroidism
  8. High GI obstruction
37
Q

What is kernicterus?

A

Chronic bilirubin encephalopathy

Rare complication of uncongugated hyperbilirubinaemia

Cerebral paresis, vertical gaze palsy, hearing impairment, athetosis (movement disorder)

38
Q

When might bilirubin be positive on urinalysis?

A

Failure of conjugated bilirubin to reach the intestines → bilirubin is not converted to urobilinogen

Biliary obstruction

Hepatic disease; hepatocellular disease, cirrhosis, hepatitis

39
Q

What might cause an elevated urobilinogen on urinalysis?

A

Conjugated hyperbilirubinaemia

Impaired hepatic reabsorption of urobilinogen; liver disease

Absent or decreased in obstructive jaundice

40
Q

What causes steatorrhoea?

A

Pancreatic e.g., chronic pancreatitis, CF

Malabsorption e.g., coeliac, giardiasis, Whipple’s disease, Crohn’s

Biliary e.g., PBC, PSC

41
Q

What are the two main diagnostic laboratory tests for coeliac disease?

A

IgA anti-tissue transglutaminase antibody

IgG deamidated gliadin peptide (test of choice for children < 2)

42
Q

Do perianal fistulae or abscesses suggest UC or CD?

A

Crohn’s disease

43
Q

What is the most common cause of acute abdomen in premature infants?

A

Necrotising enterocolitis

44
Q

What is the proposed pathophysiology of necrotising enterocolitis?

A

Mucosal damage and enteral feeding → bacterial growth → bowel necrosis/gangrene/perforation

45
Q

How is necrotizing enterocolitis diagnosed?

A

AXR

46
Q

What is this radiographic sign?

A

Pneumatosis intestinalis (necrotising enterocolitis)

Bubbles of gas within the wall of the intestine

“string of pearls” sign

47
Q

What is Dance’s sign?

A

RUQ mass (intussusception) with RLQ empty space (movement of cecum out of normal position)

48
Q

Which immunisation has been linked to intussusception?

A

Rotavirus

Intussusception more common following immunisation

49
Q

What often preceeds intusucception?

A

Viral infection

Enlarged lymph nodes can act as a lead point

50
Q

Which part of the GIT is affected by rotavirus?

A

Jejunum and duodenum

51
Q

What % of conjugated bilirubin as a proportion of total bilirubin suggests conjugated hyperbilirubinaemia?

A

20%

52
Q

What transcutaneous bilirubin (TcB) is an indication for serum bilirubin measurement?

A

> 250 micromol/L

53
Q

What are the potential side effects of phototherapy?

A

Overheating

Water loss from increased peripheral blood flow and diarrhoea (if present)

Diarrhoea from intestinal hypermotility

Ileus (preterm infants)

Rash

Retinal damage

‘bronzing’ of neonates with conjugated hyperbilirubinaemia

Temporary lactose intolerance

54
Q

What is defective in Crigler-Najjar syndrome?

A

UDP-glucuronosyltransferase activity

Liver enzyme responsible for conjugating bilirubin

55
Q

What is defective in Dubin-Johnson syndrome?

A

MRP2 transporter

Impaired movement of conjugated bilirubin from the hepatocyte to the bile canaliculi

56
Q

Which syndrome is most strongly associated with duodenal atresia?

A

Down syndrome

57
Q

What might cause bilious vomiting in a neonate?

A

Volvulus

Intestinal atresia

58
Q

What might cause haematemesis in infants?

A

Oesophageal varices (severe)

Mallory-Weiss tear

Erosive esophagitis or gastritis

Peptic ulcer

59
Q

What is the most common presentation of a Meckel diverticulum?

A

Painless rectal bleeding

60
Q

How does age at presentation affect the likelihood of Crohn’s disease vs ulcerative colitis?

A

< 8 - UC/Crohn’s, usually isolated colonic disease

> 8 - most likely Crohn’s disease

61
Q

What are the most useful indicators of possible IBD in a child with abdominal pain?

A

Diarrhoea

Growth failure

Pubertal delay

Weight loss

Rectal bleeding

Pallor/fatigue

Perianal skin tags/fistulae

Family history of IBD

62
Q

What are the classic features of abdominal pain from Crohn’s disease?

A

Localised in the RLQ

May be peritonitic

63
Q

Is hematochezia and the passage of mucus or pus characteristic of UC or CD?

A

Ulcerative colitis

64
Q

Are bowel obstructions characteristic of UC or CD?

A

CD

65
Q

Which antibodies are most commonly used to support an IBD diagnosis?

A

Perinuclear antineutrophil cytoplasmic antibodies (P-ANCA)

Anti-saccharomyces cerevisiae antibodies (ASCA)

66
Q

What is the usefulness of antibody tests in distinguishing CD and UC?

A

Perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) - weakly associated with CD

Anti-saccharomyces cerevisiae antibodies (ASCA) - weakly associed with UC

67
Q

Is transmural inflammation characteristic of CD or UC?

A

CD

68
Q

Are granulomas characteristic of CD or UC?

A

Crohn’s disease

69
Q

What is the prognosis for a congenital umbilical hernia?

A

90% spontaneously resolve by 5 years

70
Q

What is aphthous stomatitis?

A

Small, shallow, non-infectious and painful oral ulcers

“canker sores”

71
Q

Which nutritional deficiency is most strongly linked with aphthous stomatitis?

A

B12

Also folate and zinc

72
Q

Food poisoning from reheated rice and food kept warm but not hot is characteristically from which pathogen?

A

Bacillus cereus

73
Q

What exposure characteristically leads to Staphylococcus auerus food poisoning?

A

Inadequately refrigerated food (canned meats, mayonnaise/potato salad, custards)

74
Q

How is mesenteric adenitis diagnosed?

A

Ultrasound showing abdominal lymph nodes > 8mm

Small appendix must be demonstrated to rule out appendicitis

75
Q

What causes a congenital indirect inguinal hernia?

A

Failure of the processus vaginalis to obliterate

76
Q

What is encopresis?

A

Faecal incontinence in a child > 4 years old

At least 1 per month for 3 months

77
Q

What may cause encopresis?

A

Chronic constipation

Hirschsprung disease

Hypothyroidism

Hypercalcaemia

Spinal cord lesions

Anorectal malformations

Bowel obstruction

78
Q

What are the characteristics of the abdominal pain in HSP?

A

Colicky

+/- nausea and vomiting

+/- bloody stools or melena

79
Q

Where is the most common site of intussusception?

A

Ileocecal junction

80
Q

What causes current jelly stools in intussusception?

A

Sloughed mucosa following ischaemia

81
Q

What are the DDx for bilious vomiting in a neonate?

A

Midgut volvulus

Intestinal atresia (distal to empying of the bile duct)

Hirschsprung’s disease

82
Q

Where is the most common location of a Meckel’s diverticulum?

A

2 feet proximal to the ileocecal valve

83
Q

At what age can elective surgery for an unresolved umbilical hernia be performed?

A

5 years

  • High chance of self-resolution before this age*
  • 2-3 years if large or symptomatic*

Paediatrics (24 decks)

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