Gastroenterology Flashcards
1
Q
What is the presentation of gastro-oesophageal reflux disease
A
Due to regurgitation and Sequelae:
- nausea/ vomiting
- Poor weight gain/failure to thrive
Due to oesophagitis and sequelae:
- Dysphagia/ Peptic Stricture causing obstruction
- Distress after feeds/ irritability
- Anaemia/ Haematemesis
Respiratory Symptoms:
- Apnoea - from reflux causing spasms of vocal cords
- Aspiration Pneumonia,
- wheezing/Bronchospasm
- horseness/ coughing
Neurobehavioural:
- Infant spells (including seizure like events)
- Sandifers Syndrome (spasmic torso dystonia)
2
Q
What can cause GORD
A
LOS not matured yet
Overfeeding
3
Q
What increases the risk of GORD
A
Down Syndrome
Cerebal Palsy
4
Q
What tests can you do for GORD
A
Clinical Diagnosis
pH
Barium Swallow and meal
Endoscopy with biopsy - to distinguish between GORD and eosinophilic oesophagitis
5
Q
What is a differential for GORD
A
Eosinophilic Oesophagitis - allergic oesophagitis due to immune hypersensitivity to allergens in food and environment
same features as GORD and both present with eosinophils in the oesophagus
Only way to distinguish is biopsy - with GORD generally having less eosinophils and concentrated to distal end of oesophagus
Treat by removing cause e.g food allergy
or add Steroids if not sufficient
6
Q
What is the treatment for GORD
A
Conservative:
Reassurance and Avoid Overfeeding
Thicken/ Change Feeds
Think about how you are positioning baby whilst feeding
Medication:
1st line: Antacid (magnesium carbonate) + Sodium/Magnesium Alginate (gaviscon)
2nd line if that fails: PPI: Omeprazole or H2 Antagonist (ranitidine)
(add Metroclopramide if it is deemed as necessary)
Surgery:
Fundoplication
7
Q
What are the cause of Gastroenteritis in children
A
Viruses:
Rotavirus (most common)
Noravirus
Bacterial:
Toxins: Clostridium Dificille, Staph
Secretagogues: Cholera
Inflammatory: Salmonella, Campylobacter, Shigella (these ones cause bloody diarrhoea)
Parasitic:
Giarda
Others:
TB
HIV
8
Q
What is the presentation of Gastroenteritis
A
Diarrhoea +/- Bloody Stools if inflammatory
Fever +/- Vomiting
Abdominal Pain
Dehydration/ Reduced Consciousness
9
Q
What tests can you do for gastroenteritis and what is it key to examine for
A
- Clinical
- Assess Dehydration!!! (cap refill, pinch test)
- Stool Sample for Microbiology: Bacteria, Ova, Parasites
- Blood tests not necessary in simple gastroenteritis but measure serum electrolytes including glucose if:
- Severe dehydration
- S/S suggest electrolyte imbalance
- Altered Conscious state
- IV fluids required
10
Q
What is the prevention of gastroenteritis
A
Hygiene
Clean food and water
Education
Fly control
11
Q
What is the treatment of gastroenteritis
A
- If dehydrated: weigh and monitor dehydration and start oral rehydration therapy (ORT) (Dioralyte)
If child refusing ORT give via nasogastric tube
IV fluids for those in shock/ severe dehydration - Antibiotics - if bacterial complicated by septicaemia or systemic or if patient immunocomprimised
- Probiotics
- No anti-emetics/ anti-motility drugs
12
Q
When Should you perform a stool sample
A
suspect septicaemia
Blood or mucus in stool
Child is immunocompromised
13
Q
When may you consider performing a stool sample
A
Recently travelled abroad
Diarrhoea has not improved by day 7
Uncertain about diagnosis of Gastroenteritis
14
Q
What electrolyte imbalance could occur in severe dehydration from GE, how does it present and how should it be managed
A
Hypernatraemic Dehydration
- Unusual but serious
- Irritable with doughy skin
- Water shifts from intracellular to extracellular
- Rehydration should be slow
15
Q
What are 4 main potential causes of Diarrhoea
A
Allergic
Infective
Post - infective
Coeliac
16
Q
What other causes of diarrhoea should be considered
A
Inflammatory Bowel Disease Disaccharidase Deficiency Toddlers Diarrhoea Fabricated/ Induced IBS Other infections e.g otitis media, tonsillitis, UTI
17
Q
What is Acute Diarrhoea
A
Change in the consistency of stools (loose/watery) and/or
increase in the no. of evacuations (typically >3 in 24 hrs) with or without fever or vomiting which lasts 7 days to longer and not longer than 14 days
18
Q
What is Chronic Diarrhoea
A
Diarrhoea lasting longer than 2 weeks
19
Q
What can cause chronic Diarrhoea
A
Continued infection with first pathogen Infection with secondary pathogen Post Enteritis Syndrome Chronic non-specific diarrhoea Food Intolerance Malabsorption
20
Q
What is an example of a parasite that causes GE?
How long does it last?
How is it tested for?
How do you treat it?
A
Giardia - only 20% pick up rate on immediate stool examination
May last for years
Foreign travel not necessary
Test: Giardia stool ELISA kit
Treatment: Metronidazole
21
Q
How does post infective diarrhoea occur?
A
- Infection related mucosal disintegrity
- Immunological antigen exposure
- Mucosal (allergic) inflammation
- Secondary Disaccharidase deficiency
- Diarrhoea
22
Q
What is a common allergy in babies which leads to diarrhoea
A
Cows Milk Protein Allergy (CMPA)
23
Q
What type of allergy is cows milk allergy
A
IgE mediated - Immediate presentation
Non IgE mediated - Delayed can take upto 48hrs to appear
24
Q
What can non IgE presentation be sometimes misdiagnosed as
A
Lactose Intolerence
25
What systems does CMPA commonly effect
GI
Skin
Respiratory
26
What IgE mediated symptoms may you get in CMPA
GI:
- Angioedema of lips and tongue
- Oral Pruritis
- Nausea
- Colicky abdo pain
- D & V
Skin:
- Pruritis
- Erythema
- Acute uriticaria (Hives)
- Acute angioedema
Respiratory:
- URT: Sneezing, nasal itch, rhinnorhoea, congestion
- LRT: cough, chest tightness, wheezing, SOB
27
What non-IgE mediated symptoms may you get in CMPA
GI:
- GORD
- loose/frequent stools
- blood/mucus in stool
- abdo pain
- food refusal
- Constipation
- pallor/tiredness
- failure to thrive
- anaemia
Skin:
- Pruritis
- Erythema
- Atopic Eczema
Respiratory:
- lRT: cough, SOB, chest tightness, wheezing
28
How is CMPA diagnosed
Elimination diet
29
How is CMPA managed
Breastfeeding - mother must exclude cows milk from diet
Milld/Moderate - Hydrolysed Formulas
Severe - Amino Acid Based Formulas
30
When does lactase appear and when does it fall
Lactase appears late in foetal life and then falls after 3 yrs
31
When does lactose intolerance appear
Primary is rare
| Usually late onset (oriental background)
32
What symptoms may you get in lactose intolerance
```
Explosive Watery stools
Abdominal Distension
Flactulence
Audible Bowel Sounds
* No Systemic Symptoms
```
33
How can you distinguish between Lactose intolerance and Allergy
No systemic symptoms - bowel symptoms only
34
How do you diagnose Lactose intolerance
Elimination
| Lactose Hydrogen Breath Test
35
How do you treat Lactose intolerance
Lactose Restricted Diet
Lactose free formulas
Milkaid - lactase enzyme capsules
36
What other types of intolerances are there
Sucrose- isomaltase Deficiency - treat: Sucraid
| Fructose intolerance: Dietary management
37
What is the most common cause of persistent diarrhoea
Toddlers Diarrhoea - thought to be associated with high fluid, fibre and sugar and low fat
38
How does Toddlers Diarrhoea present
2 or more watery stools a day
Stools may be smelly and pale
Mild stomach pain my acompany
39
What differentiates Toddlers diarrhoea from more serious causes of diarrhoea
Absence of systemic Symptoms
| thriving Child
40
What diet can help Toddlers Diarrhoea
Low fruit, Low juice and high fat diet can help
41
What medication can help toddlers diarrhoea in severe cases
Loperamide
42
What is coeliac disease and when does it present
An autoimmune condition due to loss of immune tolerance to gliadin peptide antigens (component of gluten) in wheat, rye and barley
Infancy and adults in 5th decade
43
Which two human leucocyte antigen class 2 molecules have a strong association with coeliac disease
HLA DQ2 & DQ8
44
Which part of the gastrointestinal system does coeliac disease cause damage to
Proximal Small intestine
45
How does coeliac disease present
Systemic:
- Malabsorption
- Malnutrition
- Failure to thrive
- Weight loss
- Fatigue
- Anaemia
GI:
- Diarrhoea and Steatorrhoea
- Nausea
- Stomach pain
Skin:
- Dermatitis Herpitiformis
Joints:
- Arthalgia
Neurological:
- Peripheral Neuropathy
46
What investigations should be performed in coeliac disease
Serum Antibodies:
- IgA Tissue Transglutaminase
- IgA Endomysial Antibody
Endoscopy: of distal duodenal biopsy
FBC: may show anaemia
47
What are you going to see on Biopsy of someone with Coeliac Disease
- Crypt Hyperplasia
- Villous Atrophy
- Increased no. of intraepithelial lymphocytes
- Chronic inflammatory cells in lamina propria
48
What is the management of coeliac disease
Gluten Free diet (no wheat, rye or barley)
49
What other conditions is coeliac disease associated with
Hypothyroidism
| T1DM
50
What are further complications associated with coeliac disease
Overall increase in Cancer risk - especially GI cancer and small Bowel lymphoma
Osteopenia
Male Infertility
51
What are the two main types of inflammatory bowel disease
Crohns Disease
| Ulcerative Colitis
52
What are the pathological features of Crohns Disease
- Can occur anywhere from mouth to anus
- Discontinuous Involvement - patchy
- Can occur in all layers of the gut - mucosa, muscles and fat layers
53
What are the symptoms of Crohns Disease
```
Diarrhoea - bad smelling with blood
Abdo Pain
Weight loss
Fatigue
Fever
Vomiting
```
54
What are the signs of Chrons disease
Deep Ulcers and fissures in mucosa
Abdo Tenderness
Perianal Abscess
Anal Strictures
55
What systemic features do you get in Crohns Disease
Clubbing
Arthritis
Pyoderma gangrenosum
Conjunctivitis/ irisitis
56
What are the investigations of Crohns Disease
FBC: Anaemia, deficiency of iron, B12 or folate, raised ESR, CRP and platelets
LFT: albumin low in severe disease
Sigmoidoscopy and Colonoscopy
57
What histological features would you see on biopsy in Crohns
- Granulomas present in the subserosa
- Inflammation extends through all layers of bowel
- Increased in WBC are lymphocytes
58
What is the treatment of Crohn's
- Exclusive Enteral Nutrition (EEN) administered NG tubes 6-12 wks
- Corticosteroids (oral prednisolone) - IV hydrocortisone in severe disease
- Oral/Topical Aminosalicyclic Acid ( Oral 5 ASA)
- Immunomodulators (azathriopine used to maintain remission)
- Biologics - Anti TNF antibodies when resistant to corticosteroids/ immunosuppressents)
- Antibiotics
- Surgery - bowel resection
- Parenteral Nutrition
59
What are the complications of Crohns
Obstruction
Malabsorption
Perforation
60
What are the pathological features of Ulcerative Colitis
- Starts at rectum and only affects the colon
- Continuous Involvement - Spreads up colon
- Only mucosal involvement
- Ulcers, red mucosa which bleeds easily
61
What are the symptoms of Ulcerative Colitis
Diarrhoea - containing blood and mucus
Stomach Cramps
Systemic: Fever, Malaise, Weight Loss
Colon: Blood loss, toxic dilation, colorectal cancer
Joints: Arthritis, Alkylosing Spondylitis
Eyes: Conjunctivitis
Skin: erythema nodosum, pyoderma gangrenosum
Liver: Fatty liver, gallstones, hepatitis, cirrhosis
62
What tests would you do for Ulcerative Colitis
FBC, ESR and LFTs
Stool Sample to exclude infection
Colonoscopy
63
What histological features would you see on biopsy of Ulcerative Colitis
- Mucosal Inflammation
- No granuloma
- Increase WBC tend to br polymorphs
64
What is the treatment of Ulcerative Colitis
Mild/Moderate: Induction: Aminosalicyclates
Remission: Aminosalicyclates
Moderate/Severe: Induction: Corticosteroids
Remission: Immunomodulators e.g Azathioprine
65
What is the criteria for IBS
```
Abdo pain relieved by defaecation OR altered stool form or Frequency:
Plus 2 of the following
- Urgency/Straining
- Bloating
- Symptoms worsened by eating
- Mucus in the Stool
- Other symptoms e.g Nausea/ Lethargy
```
66
How is IBS managed
Healthy eating
Avoiding certain foods that trigger symptoms
FODMAP diet
67
What are some examples of rare congenital diarrhoea
Often autosomal recessive
- Microvillous Atrophy
- Autoimmune Enteropathy
- Tuftings Enteropathy
- Syndromic Diarrhoea
68
What conditions can cause too much energy to be used leading to failure to thrive
```
Congenital Heart Disease
Chronic Renal Failure
Chronic Respiratory Disease e.f CF
Chronic GI inflammation e.g IBD
Tumours
```
69
What are the consequences of persistent vomiting
```
Metabloic: Hypokalaemia, Alkalosis
Nutritional
Mechanical Injury: Mallory Weiss tears
Dental: erosions and caries
Oesophogeal stricture, Barretts, Anaemia
```
70
What is Appendicitis
Inflammation of the Appendix
71
How does Appendicitis pain clinically present
Classically begins as mid abdo pain (periumbilical) due tot visceral fibres in wall of appendix
As inflammation progresses and irritates parietal peritoneum - pain moves to RIF
72
What is the RIF pain in Appendicitis called
McBurneys Point - (2/3 along from umbilicus to R anterior superior iliac spine)
73
What other symptoms do you get in Appendicitis
- Anorexia
- Vomiting
- Tachycardia
- Fever
- Shallow Breaths
- Diarrhoea/ Constipation
74
What signs and special test would be seen in Appendicitis
- Guarding
- Rebound Tenderness
- Dunphys Sign: sharp pain when coughing
- Markles Sign: Pain in RIF dropping from heels to toes
75
What investigations should be performed in Appendicitis
Increased WCC, CRP and ESR
| US can help but CT more diagnostic
76
What are differentials for Appendicitis
```
Ectopic
Diverticulitis
UTI
Chrons
PID
```
77
What is the management of appendicitis
Appendicectomy followed by IV fluids and Abx (metronidazole + ceftriaxone)
78
What are complications of appendicitis
Perforation leading to localised abscess or generalised peritonitis
79
What is Pyloric Stenosis
Abnormally narrow opening from stomach into SI
80
What symptoms do you get in Pyloric Stenosis
```
Projectile vomiting - to end of bed
Vomit contains no bile
Vomits large quantity minutes after feeding
No Diarrhoea constipation more likely
Patient is anxious and hungry
Patient id malnourished and dehydrated
```
81
What are the signs of Pyloric Stenosis
Olive sized pyloric mass can be palpated during feeding in RUQ
Persistalis during a feed in LUQ (late presenting)
82
What would you find on investigation of Pyloric Stenosis
Urine Output - reduced
Hypochloraemia
Hypokalaemia
Metabolic Alkalosis
83
What imaging is used to diagnose Pyloric Stenosis
US
84
How is Pyloric Stenosis managed
Fluid and Electrolyte Replacement
| Ramstedts Pyloromyotomy
85
What is intussusception
Most common cause of intestinal obstruction where the ilium invaginate into the caecum
86
How do intussusception patients present
Intermittent abdo pain (colic) with drawing up of legs
Episodic intermittent inconsolable crying
Vomiting (green from bile)
Red Current Jelly Stool
Pale and floppy (shock) between pain
87
How is intussusception investigated
Exam: Sausage shaped mass on palpitation
US - target sign: consentric circles
X-ray: Distension of small bowel and no gas in large bowel
88
How is intussusception managed
Reduction by air enema
Reduction by laparoscopy if fails
Necrotic bowel removal
89
What is a volvulus
A twisted segment of bowel e.g sigmoid (always occurs in bowel with mesentery)
90
What is volvulus caused by
Congenital Anomoly of rotation of midgut
| linked to CF, Crohns, tumours
91
How does volvulus present
```
Severe and rapid obstruction
Sudden localised tenderness
Distension
Pain
Nausea/ Vomiting
```
92
How would volvulus be investigated
AXR: inverted U loop - looks like coffee bean
93
How is a volvulus managed
Non perforated: LADDS procedure
| Perforated: Resect/ Wash out and Abx to cover for sepsis
94
What can be causes of poor feeding in babies
```
It can be normal
Exceptions:
- Prematurity
- Babies of Diabetic Mothers - Hypoglcaemia
- Infection
- CHD
- Neurological e.g downs, Cerebal palsy
- Incorrect feeding technique
```
95
Why do hypoglycaemic babies feed poorly and what symptoms may present
Babies have difficulty co-ordinating feeding and breathing
- gagging
- turning blue
- choking
96
What types of feeding are there
- Breastfeeding ideal way
- NG tube
- Trophic Feeding
- Parental nutrition
97
What are NG tubes used for in poor feeding
when may you use a naso-jejunal?
Infants too ill or young to feed e.f resp distress
| If GORD a problem use naso - jejunal
98
What is trophic feeding
When would you use it
Feeding minute volumes to stimulate development of immature GI tract
Premature babies
99
When would you give parenteral nutrition
Post Op
Trauma
Oral nutriton poor e.g ill, low BW
Necrotizing Enterocolitis
100
How should you stop parenteral nutrition
In stages to prevent hypoglycaemia
101
What is Hirshspungs Disease
Congenital absence of ganglia in a segment of the colon causing paralysis of peristaltic movements
102
How does Hirshprungs Disease present
Functional GI obstruction
Constipation
Megacolon
103
What signs may you get in Hirshprungs Disease
Faeces may be felt in the abdomen
PR exam may reveal tight anal sphincter
Explosive discharge of gas and stools
104
What complications may you get in Hirshprungs disease
```
GI perforation
Bleeding
Ulcers
Enterocolitis - life threatening
Short gut syndrome after surgery
```
105
How is Hirshprungs disease diagnosed
Rectal Suction Biopsy of aganglionic bowel
106
How is Hirshprungs disease managed
Excision of Aganglionic Segment +/- Colostomy
107
What is congenital Diaphagmatic Hernia
AND
What is is associated with
```
Developmental defect in diaphragm allowing abdo contents to herniate into chest
Other congenital malformations:
- Neural tube defect
- Trisomy 18
- Chromosomal Deletions
```
108
What can congenital diaphragmatic hernia lead to
Impaired lung development - pulmonary hypoplasia and pulmonary HTN
109
How is congenital diaphragmatic hernia diagnosed
Pre-natal: US
| Post-natal: CXR
110
What are the signs of congenital diaphragmatic hernia
Difficult resuscitation at birth
Respiratory Distress
Bowel sounds in thorax
111
What is the treatment of congenital dighragmatic hernia
Prenatal: Consider fetal surgery - tracheal obstruction by balloon
Postnatal: Insert large bore NG tube
Try to keep all air out of gut
Surgery
112
What type of inguinal hernia presents in children
Indirect
113
How is an indirect inguinal hernia caused and who is at risk
Patent Processus Vaginalis (hasn't closed after birth)
| Premature infants!!!
114
What is a processus vaginalis
Passage which the descending testicles enter the the scrotum at near the end of pregnancy
115
How does an inguinal hernia present
A bulge lateral to pubic tubercle the crying due to abdo lining or bowel bulging through
116
What are the complications of inguinal henna
Incarceration - when contents of hernia become trapped causing strangulation
117
What symptoms may you get in strangulation from a hernia
Nausea/Vomiting, Fever and sharp severe pain
| Can lead to necrotic bowel - Immediate surgery
118
How are inguinal hernias managed
Laproscopic surgery with 6/2 rule
- under 6 weeks: 2 days
- under 6 months: 2 weeks
- under 6 years: 2 months
119
What is a hydrocele
A fluid filled sac due to a smaller patent processus vaginalis allowing only fluid though
- usually close within a year therefore no further action needed
120
What is the definition of colic
Rule of 3:
| Paroxysmal uncontrollable crying with pulling up of legs for >3 hrs per day, for >3 days a week for > 3 weeks
121
What can help colic
Movement: Rocking the baby
Letting baby finish first breast first: hind milk more fat and easier to digest
Breastfeeding: Low allergen diet and probiotics
122
What is constipation
Infrequent passage of stool associated with pain and difficulty, or delay in defecation
123
What is Encopresis
Involuntary faecal soiling or incontinence secondary to chronic constipation
124
What criteria is used to diagnose functional constipation
Rome III Criteria
125
What is in the Rome III Criteria
- Two or fewer stools per week
- At least one episode of faecal incontinence
- Stool Retention
- Painful/Hard bowel movements
- Presence of large faecal mass in rectum
- Large diameter stools that may block toilet
126
What is the pathogenies of functional constipation
1. Painful Defication
2. Voluntary Withholding
3. Prolonged faecal stasis causing reabsorption of fluid and increase in size and consistency
4. More pain back to 1.
127
What are red flags for Constipation
- Delayed passage of meconium
- Fever, vomiting, bloody diarrhoea
- Failure to thrive
- Tight empty rectum with presence of palpable abdominal faecal mass
- Abnormal neurological exam
128
What can cause constipation
```
Hirshprungs Disease
Anorectal Malformations
Diet
Poor fluid
Poor fibre
Anal fissure - fear
Coeliac Disease
Cystic Fibrosis
Spina Bifida
Hypothyroidism
Hypercalcaemia
Food Intolerance/allergy
Spinal tumours
```
129
What are the long term complications of constipation
Acquired Megacolon
Anal Fissures
Overflow incontinence
Behaviour Problems
130
What investigations should be performed for constipation
Usually non necessary but if organic cause suspected:
- TSH/ T4
- Serum Calcium
- Coeliac Panal
- Sweat Test
- AXR
- Anal manometry
- Rectal Biopsy
- Spinal imaging - neurological cause
131
How do you manage constipation
```
Conservative:
Education of normal bowel function
Diet/ Fluids and Exercise
Behavioural Advice
Toilet training advice
Simple Reward Schemes - remove guilt
```
```
Medications:
Stool softener: Lactulose
Bulking agent: Fybogel
Non Absorbed Laxative irrigate: Movicol
Stimulant: Senna, Duclolax
Enema
Anal Fissure: Anaesthetic Cream +/- GTN cream
```
132
What is the definition of failure to thrive
Failure to gain adequate weight or growth during infancy and childhood
133
What is faltering growth
A significant interruption in expected rate of growth of a child
an underlying causes must be considered
134
What is it important to consider in infants with failure to thrive
The parents height
Make allowance for prematurity until 18 maths
Non-organic as important as organic
135
What are the 4 key areas which lead to failure to thrive
Poor Intake
Malabsorption
Too much energy used up
Abnormal central control of growth/ appetite
136
What can cause abnormal central control of growth
GH
| Thyroid
137
What are important non-organic causes of failure to thrive
```
Poor parental understanding
Low income
Poor social support
Deliberate Starvation
Maternal Anorexia
Parental psychiatric illness
Emotional neglect
```
138
What investigations should be performed for diarrhoea
- Keep food diary
- Excess gas consider: Lactose Hydrogen Breath Test THEN Giarda Screening
- Consider decreasing juice and fruit
- Basic Screening test: IgA, CRP, ESR , FBC, LFTs, faecal elastase
- Stool sample: MC&S, viral serology
- Clotting, B12, Folate, Bone profile
- Endoscopy or Colonoscopy
- Sweat Test
139
What can cause hepatomegaly
Infections: CMV, Hep
Malignancy: leukaemia, lymphoma, neuroblastoma
Metabolic
140
What can Neonatal Hepatitis Syndrome be caused by
Viruses: CMV, Herpes
Metabolic Liver Disease
Genetic Disorders
Idiopathic
141
What symptoms may you get in Hepatitis
```
Jaundice
Hepatomegaly
Dark Urine
Pale stools
Pruritis
Easy Brusing
Infection
Ascites
Liver Failure
```
142
What investigations should be performed in hepatitis
US liver
Biopsy
LFTs
143
What is neuroblastoma and what age is it most commonly found in
Embryonal neoplasm - from sympathetic neuroblasts
Found in children under 5
Some forms regress, some very malignant
144
What are the signs of neuroblastoma
Abdominal swelling
| Pain and Discomfort
145
What are common metastatic sites of neuroblastoma
Lymph nodes
Scalp
Bones
Can cause DVTs
146
What investigations would you do in neuroblastoma
Catecholamines in urine
US and MRI for location/staging
mIBG scan
Biopsy
147
What is the treatment of Neuroblastoma
Surgery and Chemotherapy (Cyclophosphamide + Doxorubicin)
148
What is Biliary Atresia
Bile flow from liver to gallbladder is blocked leading to liver damage and cirrhosis
Cause unknown
appears 2wks - 2 mths of life
149
How does Biliary Atresia Present
Jaundice
Dark yellow urine
Pale Stools
Hepatosplenomegaly
150
How is Billary Atresia managed
Early intervention: Kasai Procedure
Late intervention: unlikely to be successful due to advanced liver damage therefore:
Liver Transplant!!
151
How is Billiary Atresia investigated
US
| Percutaneous Liver Biopsy
152
When should babies be referred with jaundice
Beyond 2 weeks
| preterm 3
153
What is Meckel Diverticulum
Distal Ileum contains remnants of gastric and pancreatic tissue
154
How does Meckel Diverticulum present
Gastric Acid Secretion:
causing GI pain and bleeding
Rectal Bleeding: melaenia
155
How id Meckel diagnosed
Radionucleotide test (Meckel Scan)
156
How is Meckel treated
Laproscopic Resection
157
What is Necrotising Enterocolitis
Inflammation of bowel due to intolerance of feeds and bacterial colonisation - leading to necrosis
158
Who is at risk of necrotising enterocolitis
Pre-term infants
159
What are the symptoms of necrotising enterocolitis
```
Billous vomiting (green)
Blood in stool
Abdominal distension and tenderness
Shock
DIC
Perforation
```
160
Why does perforation occur in necrotising entercolitis
Leaky wall caused by oedema - bacteria gets into gut wall causing perforation
161
How do you treat necrotising enterocolitis
ABCDE
Stop oral feeds
Give parenteral feeds
Give Abx e.g Cefotaxime + Vancomycin
162
How do you investigate necrotising enterocolitis
- X-ray: pneumonitis intestinalis
Riglers and Football sign
- Culture faeces
163
What is Kwashiorkor and what signs would you get
Due to decreased intake of protein and essential amino acid
| Signs: Poor growth, Diarrhoea, Apathy, Anorexia, Oedema, Skin/Hair depigmentation, distended abdomen
164
What is Marasmus, what is it associated with and what signs so you get
- Lack of calories and discrepancy between height and weight
- Associated with HIV
- Signs: distended abdomen, diarrhoea or constipation, infection, low albumin
