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Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Why are infants more prone to GORD

A

Immature involuntary relaxation of the lower oesophageal sphincter
lying on back
Liquid diet

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2
Q

What are the clinical signs of GORD

A

distress post feeding
vomiting and posseting
poor weight gain

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3
Q

What are the complications of GORD

A 
	due to regurgitation and sequelae:
	poor weight gain
	nausea, vomiting
	due to oesophagitis and sequelae:
	chest/ epigastric pain
	irritability/ feeding problems
	anaemia/ haematemesis
	dysphagia/ peptic stricture causing obstruction
	Respiratory symptoms:	
	aspiration pneumonia (recurrent or chronic)
	bronchospasm/ wheezing (intractable asthma)
	apnoea/ cyanotic episodes/ ALTEs
	cough/ stridor/ hoarseness/ hiccoughs
	Neurobehavioural:
	Infant “spells” (including seizure-like events)
	Sandifer’s syndrome`
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4
Q

What investigations could you do for GORD

A

Mainly clinical diagnosis
24 hour oesophageal pH monitoring
barium studies
endoscopy

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5
Q

How would you treat GORD

A 
reassure that 95% will go by the age of 18 months 
prescribe thickners (gaviscon and thick and easy) for feeds, H2 antagonists/PPIs
prokinetic drugs like domperidone
surgery may be required - Nissen fundoplication
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6
Q

What is pyloric stenosis

A

thickening of the pyloric muscle causing gastric outlet obstruction. presents between 2-7 weeks

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7
Q

What are the clinical features of pyloric stenosis

A

Non bilious Vomiting, which increases in frequency and
forcefulness over time, ultimately becoming
projectile
• Hunger after vomiting until dehydration leads to
loss of interest in feeding
• Weight loss if presentation is delayed.

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8
Q

What is the classic metabolic sign of pyloric stenosis

A

Hypochloraemic hypokalaemic metabolic alkalosis. This is due to loss of acidic gastric acid contents and the kidneys retaining hydrogen ions at the expense of potassium

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9
Q

How would you diagnose pyloric stenosis

A

Test feed with milk - look for gastric peristalsis, look for pyloric mass that looks like an olive in RUQ.
abdominal USS if in doubt.
Check U&Es for hypercholraemic metabolic alkalosis

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10
Q

how do you treat pyloric stenosis

A

correct fluid balance and electrolyte disturbance.

Ramstedt pyloromyotomy surgical procedure

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11
Q

What are the causes of gastroenteritis

A

rotavirus - most common
noravirus
astrovirus

Shigella
e.coli
campylobacter jejuni
cholera - vibro cholerae 
typhoid - salmonella typhi
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12
Q

What are non infective cause of diarrhorea

A 
pyloric stenosis
intussusception
acute appendicitis 
necrotising enterocolitis
short gut syndrome
hirschsprung disease 
diabetic ketoacidosis
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13
Q

clinical signs of gastroenteritis

A

Sudden change to loose watery stool and vomiting.
other members of family may have had similar
dehydration
bloody stool
usually preceeded by a viral illness
abdominal pain
fever indicates bacterial cause

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14
Q

What investigations would you perform for gastroenteritis

A

U&Es, plasma urea, glucose, electrolytes

stool culture if stool is bloody or child is septic or immunocompromised.

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15
Q

How would you manage gastroenteritis

A

Oral rehydration therapy/ fluids

antibiotics if bacterial

NO LOPERAMIDE

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16
Q

What is constipation

A

less than 1 stool a day in infants

and less than 3 stools a day in school children

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17
Q

Causes of constipation

A 
hirschsprungs disease
hypothyroidism
coeliac disease
spina bifida 
abnormal anorectal anatomy
sexual abuse
toilet training 
stress
diet
perianal crohns disease 
hypercalcaemia
dehydration
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18
Q

clinical features of constipation

A 
pain
distended abdomen
overflow diarrhoea
pr bleeding
anorexia
fear of toilet
straining
loss of the feeling the need to defecate - often before overflow diarrhoea
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19
Q

Management of constipation

A
  1. diet and habit change
  2. Macrogol laxative (type of osmotic laxative) - e.g. movicol (polyethene glycol)
  3. stimulant laxative - senna +/- lactulose
  4. enema or manual evacutation

polyethene glycol for maintenance

20
Q

What is appendicitis

A

inflammation from the appendix usually following obstruction (faecolith)

21
Q

How to Dx appendicitis

A

abdominal USS
FBC and CRP
X ray
pregnancy test

22
Q

Treatment of appendicitis

A

appendectomy

IV antibiotics

23
Q

How would you treat an inguinal hernia

A

opioid analgesia and gentle compression - then referral to surgery

BUT if nonreducible then emergency referral to surgery due to risk of strangulation

24
Q

How would you manage a crohns flare in children

A

Remission is induced with nutritional therapy, when
the normal diet is replaced by whole protein modular
feeds (polymeric diet) for 6–8 weeks. This is effective
in 75% of cases. Systemic steroids are required if
ineffective.

budesonide
azathioprine
then biologics 
long term enteral nutrition
surgery
25
Q

Definition of failure to thrive

A

failure to gain adequate weight or achieve adequate growth during infancy or early childhood’
• Fall across 2 centiles on growth chart

26
Q

What is marasmus

A

Undernutrition plus discrepancy between height and weight (more than 3 SD below the median). Caused by lack of all nutrition. standard deviations below the median, Oedema is
not present. Skinfold thickness and mid-arm circumference are markedly reduced, and affected children are often withdrawn and apathetic.
corresponding to <70% weight for height, and a
wasted, wizened appearance.

27
Q

What is kwashiorkor

A

Another manifestation of severe protein malnutrition, not necessarily lack of overall nutrition.
There is generalised oedema as well as severe wasting.
Because of the oedema, the weight may not be as severely reduced. In addition, there may be:
• a ‘flaky-paint’ skin rash with hyperkeratosis
(thickened skin) and desquamation
• a distended abdomen and enlarged liver (usually
due to fatty infiltration)
• angular stomatitis
• hair which is sparse and depigmented
• diarrhoea, hypothermia, bradycardia and hypotension

28
Q

What is hirschsprungs disease

A

Absence of ganglion cells in the myenteric and submucosal plexuses in part of the large bowel

29
Q

Risk factors for hirschsprung disease

A

downs syndrome
meconium ileus
male
family history

30
Q

Clinical features of hirschsprung disease

A

usually intestinal obstruction in
the newborn period following delay in passing
meconium. In later childhood – profound
chronic constipation, abdominal distension and
growth failure

31
Q

Diagnosis and management of hirschsprung disease

A

barium enema and Xray showing contracted narrow section of bowel

Suction rectal biopsy

treatment - colostomy then anastomosing normally innervated bowel

32
Q

What is intersussception

A

telescoping of the bowel

33
Q

How does intussusception present

A

paroxysmal, colicky pain, legs drawn up
with pallor, sausage shaped abdominal mass, redcurrant jelly
stool

34
Q

How is intussusception diagnosed

A

abdominal USS Abdominal x ray

35
Q

How is intussusception treated

A

Reduction is attempted by rectal air insufflation
unless peritonitis is present
• Surgery is required if reduction with air is
unsuccessful or for peritonitis.

36
Q

What is meckel diverticulum

A

An ileal remnant of
the vitello-intestinal duct, a Meckel diverticulum,
which contains ectopic gastric mucosa or pancreatic
tissue.

37
Q

How does meckel diverticulum present

A

Generally asymptomatic, but may present with
bleeding (which may be life-threatening),
intussusception, volvulus or diverticulitis.

38
Q

How do you diagnose meckel diverticulum

A

A technetium scan will demonstrate increased uptake by

ectopic gastric mucosa in 70% of cases

39
Q

How do you treat meckel diverticulum

A

surgical resection

40
Q

What is infant colic

A

Paroxysmal, inconsolable crying or screaming
often accompanied by drawing up of the knees and passage of excessive flatus takes place several times a
day, particularly in the evening. Occurs <4 months

41
Q

How is infant colic managed

A

The condition is benign but it is very frustrating and worrying for parents and may precipitate non-accidental injury in infants already at risk.
Support and reassurance should be given.
If severe and persistent, it may be due to a cow’s milk protein allergy or gastro-oesophageal reflux and an empirical 2-week trial of a whey hydrolysate formula followed by a trial of anti-reflux treatment may be considered.

42
Q

What is the most appropriate way to confirm a diagnosis of pyloric stenosis

A

test feed. NG tube and aspiration to empty the stomach, small feed of dioralyte, examiners fingers placed just below the liver edge. palpable olive mass = stenosed pylorus

43
Q

What would indicate cows milk intolerance

A

abdominal pain
chronic vomiting
eczema
flatulence, bloody stool, diarrhoea/constipation

44
Q

What investigations are needed for cows milk intolerance

A

skin prick or specific IgE antibody testing

45
Q

How is cows milk intolerance managed

A

cows milk elimination diet, hypoallogenic infant formula, mother to avoid cows milk

Paediatrics (10 decks)

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