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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)
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2
Q

What can cause GORD

A

LOS not matured yet

Overfeeding

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3
Q

What increases the risk of GORD

A

Down Syndrome

Cerebal Palsy

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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

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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

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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

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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

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8
Q

What is the presentation of Gastroenteritis

A

Diarrhoea +/- Bloody Stools if inflammatory
Fever +/- Vomiting
Abdominal Pain
Dehydration/ Reduced Consciousness

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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
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10
Q

What is the prevention of gastroenteritis

A

Hygiene
Clean food and water
Education
Fly control

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11
Q

What is the treatment of gastroenteritis

A
  1. 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
  2. Antibiotics - if bacterial complicated by septicaemia or systemic or if patient immunocomprimised
  3. Probiotics
  4. No anti-emetics/ anti-motility drugs
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12
Q

When Should you perform a stool sample

A

suspect septicaemia
Blood or mucus in stool
Child is immunocompromised

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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

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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
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15
Q

What are 4 main potential causes of Diarrhoea

A

Allergic
Infective
Post - infective
Coeliac

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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
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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

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18
Q

What is Chronic Diarrhoea

A

Diarrhoea lasting longer than 2 weeks

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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
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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

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21
Q

How does post infective diarrhoea occur?

A
  1. Infection related mucosal disintegrity
  2. Immunological antigen exposure
  3. Mucosal (allergic) inflammation
  4. Secondary Disaccharidase deficiency
  5. Diarrhoea
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22
Q

What is a common allergy in babies which leads to diarrhoea

A

Cows Milk Protein Allergy (CMPA)

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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

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24
Q

What can non IgE presentation be sometimes misdiagnosed as

A

Lactose Intolerence

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25
Q

What systems does CMPA commonly effect

A

GI
Skin
Respiratory

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26
Q

What IgE mediated symptoms may you get in CMPA

A

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
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27
Q

What non-IgE mediated symptoms may you get in CMPA

A

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

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28
Q

How is CMPA diagnosed

A

Elimination diet

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29
Q

How is CMPA managed

A

Breastfeeding - mother must exclude cows milk from diet
Milld/Moderate - Hydrolysed Formulas
Severe - Amino Acid Based Formulas

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30
Q

When does lactase appear and when does it fall

A

Lactase appears late in foetal life and then falls after 3 yrs

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31
Q

When does lactose intolerance appear

A

Primary is rare

Usually late onset (oriental background)

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32
Q

What symptoms may you get in lactose intolerance

A 
Explosive Watery stools
Abdominal Distension
Flactulence 
Audible Bowel Sounds 
* No Systemic Symptoms
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33
Q

How can you distinguish between Lactose intolerance and Allergy

A

No systemic symptoms - bowel symptoms only

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34
Q

How do you diagnose Lactose intolerance

A

Elimination

Lactose Hydrogen Breath Test

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35
Q

How do you treat Lactose intolerance

A

Lactose Restricted Diet
Lactose free formulas
Milkaid - lactase enzyme capsules

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36
Q

What other types of intolerances are there

A

Sucrose- isomaltase Deficiency - treat: Sucraid

Fructose intolerance: Dietary management

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37
Q

What is the most common cause of persistent diarrhoea

A

Toddlers Diarrhoea - thought to be associated with high fluid, fibre and sugar and low fat

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38
Q

How does Toddlers Diarrhoea present

A

2 or more watery stools a day
Stools may be smelly and pale
Mild stomach pain my acompany

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39
Q

What differentiates Toddlers diarrhoea from more serious causes of diarrhoea

A

Absence of systemic Symptoms

thriving Child

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40
Q

What diet can help Toddlers Diarrhoea

A

Low fruit, Low juice and high fat diet can help

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41
Q

What medication can help toddlers diarrhoea in severe cases

A

Loperamide

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42
Q

What is coeliac disease and when does it present

A

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

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43
Q

Which two human leucocyte antigen class 2 molecules have a strong association with coeliac disease

A

HLA DQ2 & DQ8

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44
Q

Which part of the gastrointestinal system does coeliac disease cause damage to

A

Proximal Small intestine

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45
Q

How does coeliac disease present

A

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

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46
Q

What investigations should be performed in coeliac disease

A

Serum Antibodies:

  • IgA Tissue Transglutaminase
  • IgA Endomysial Antibody

Endoscopy: of distal duodenal biopsy

FBC: may show anaemia

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47
Q

What are you going to see on Biopsy of someone with Coeliac Disease

A
  • Crypt Hyperplasia
  • Villous Atrophy
  • Increased no. of intraepithelial lymphocytes
  • Chronic inflammatory cells in lamina propria
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48
Q

What is the management of coeliac disease

A

Gluten Free diet (no wheat, rye or barley)

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49
Q

What other conditions is coeliac disease associated with

A

Hypothyroidism

T1DM

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50
Q

What are further complications associated with coeliac disease

A

Overall increase in Cancer risk - especially GI cancer and small Bowel lymphoma
Osteopenia
Male Infertility

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51
Q

What are the two main types of inflammatory bowel disease

A

Crohns Disease

Ulcerative Colitis

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52
Q

What are the pathological features of Crohns Disease

A
  • Can occur anywhere from mouth to anus
  • Discontinuous Involvement - patchy
  • Can occur in all layers of the gut - mucosa, muscles and fat layers
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53
Q

What are the symptoms of Crohns Disease

A 
Diarrhoea - bad smelling with blood 
Abdo Pain 
Weight loss
Fatigue 
Fever 
Vomiting
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54
Q

What are the signs of Chrons disease

A

Deep Ulcers and fissures in mucosa
Abdo Tenderness
Perianal Abscess
Anal Strictures

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55
Q

What systemic features do you get in Crohns Disease

A

Clubbing
Arthritis
Pyoderma gangrenosum
Conjunctivitis/ irisitis

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56
Q

What are the investigations of Crohns Disease

A

FBC: Anaemia, deficiency of iron, B12 or folate, raised ESR, CRP and platelets

LFT: albumin low in severe disease

Sigmoidoscopy and Colonoscopy

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57
Q

What histological features would you see on biopsy in Crohns

A
  • Granulomas present in the subserosa
  • Inflammation extends through all layers of bowel
  • Increased in WBC are lymphocytes
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58
Q

What is the treatment of Crohn’s

A
  • 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
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59
Q

What are the complications of Crohns

A

Obstruction
Malabsorption
Perforation

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60
Q

What are the pathological features of Ulcerative Colitis

A
  • Starts at rectum and only affects the colon
  • Continuous Involvement - Spreads up colon
  • Only mucosal involvement
  • Ulcers, red mucosa which bleeds easily
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61
Q

What are the symptoms of Ulcerative Colitis

A

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

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62
Q

What tests would you do for Ulcerative Colitis

A

FBC, ESR and LFTs
Stool Sample to exclude infection
Colonoscopy

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63
Q

What histological features would you see on biopsy of Ulcerative Colitis

A
  • Mucosal Inflammation
  • No granuloma
  • Increase WBC tend to br polymorphs
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64
Q

What is the treatment of Ulcerative Colitis

A

Mild/Moderate: Induction: Aminosalicyclates
Remission: Aminosalicyclates
Moderate/Severe: Induction: Corticosteroids
Remission: Immunomodulators e.g Azathioprine

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65
Q

What is the criteria for IBS

A 
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
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66
Q

How is IBS managed

A

Healthy eating
Avoiding certain foods that trigger symptoms
FODMAP diet

67
Q

What are some examples of rare congenital diarrhoea

A

Often autosomal recessive

  • Microvillous Atrophy
  • Autoimmune Enteropathy
  • Tuftings Enteropathy
  • Syndromic Diarrhoea
68
Q

What conditions can cause too much energy to be used leading to failure to thrive

A 
Congenital Heart Disease
Chronic Renal Failure 
Chronic Respiratory Disease e.f CF
Chronic GI inflammation e.g IBD
Tumours
69
Q

What are the consequences of persistent vomiting

A 
Metabloic: Hypokalaemia, Alkalosis
Nutritional
Mechanical Injury: Mallory Weiss tears 
Dental: erosions and caries 
Oesophogeal stricture, Barretts, Anaemia
70
Q

What is Appendicitis

A

Inflammation of the Appendix

71
Q

How does Appendicitis pain clinically present

A

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
Q

What is the RIF pain in Appendicitis called

A

McBurneys Point - (2/3 along from umbilicus to R anterior superior iliac spine)

73
Q

What other symptoms do you get in Appendicitis

A
  • Anorexia
  • Vomiting
  • Tachycardia
  • Fever
  • Shallow Breaths
  • Diarrhoea/ Constipation
74
Q

What signs and special test would be seen in Appendicitis

A
  • Guarding
  • Rebound Tenderness
  • Dunphys Sign: sharp pain when coughing
  • Markles Sign: Pain in RIF dropping from heels to toes
75
Q

What investigations should be performed in Appendicitis

A

Increased WCC, CRP and ESR

US can help but CT more diagnostic

76
Q

What are differentials for Appendicitis

A 
Ectopic
Diverticulitis 
UTI
Chrons 
PID
77
Q

What is the management of appendicitis

A

Appendicectomy followed by IV fluids and Abx (metronidazole + ceftriaxone)

78
Q

What are complications of appendicitis

A

Perforation leading to localised abscess or generalised peritonitis

79
Q

What is Pyloric Stenosis

A

Abnormally narrow opening from stomach into SI

80
Q

What symptoms do you get in Pyloric Stenosis

A 
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
Q

What are the signs of Pyloric Stenosis

A

Olive sized pyloric mass can be palpated during feeding in RUQ
Persistalis during a feed in LUQ (late presenting)

82
Q

What would you find on investigation of Pyloric Stenosis

A

Urine Output - reduced
Hypochloraemia
Hypokalaemia
Metabolic Alkalosis

83
Q

What imaging is used to diagnose Pyloric Stenosis

A

US

84
Q

How is Pyloric Stenosis managed

A

Fluid and Electrolyte Replacement

Ramstedts Pyloromyotomy

85
Q

What is intussusception

A

Most common cause of intestinal obstruction where the ilium invaginate into the caecum

86
Q

How do intussusception patients present

A

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
Q

How is intussusception investigated

A

Exam: Sausage shaped mass on palpitation
US - target sign: consentric circles
X-ray: Distension of small bowel and no gas in large bowel

88
Q

How is intussusception managed

A

Reduction by air enema
Reduction by laparoscopy if fails
Necrotic bowel removal

89
Q

What is a volvulus

A

A twisted segment of bowel e.g sigmoid (always occurs in bowel with mesentery)

90
Q

What is volvulus caused by

A

Congenital Anomoly of rotation of midgut

linked to CF, Crohns, tumours

91
Q

How does volvulus present

A 
Severe and rapid obstruction
Sudden localised tenderness 
Distension 
Pain 
Nausea/ Vomiting
92
Q

How would volvulus be investigated

A

AXR: inverted U loop - looks like coffee bean

93
Q

How is a volvulus managed

A

Non perforated: LADDS procedure

Perforated: Resect/ Wash out and Abx to cover for sepsis

94
Q

What can be causes of poor feeding in babies

A 
It can be normal 
Exceptions:
- Prematurity 
- Babies of Diabetic Mothers - Hypoglcaemia 
- Infection
- CHD
- Neurological e.g downs, Cerebal palsy 
- Incorrect feeding technique
95
Q

Why do hypoglycaemic babies feed poorly and what symptoms may present

A

Babies have difficulty co-ordinating feeding and breathing

  • gagging
  • turning blue
  • choking
96
Q

What types of feeding are there

A
  • Breastfeeding ideal way
  • NG tube
  • Trophic Feeding
  • Parental nutrition
97
Q

What are NG tubes used for in poor feeding

when may you use a naso-jejunal?

A

Infants too ill or young to feed e.f resp distress

If GORD a problem use naso - jejunal

98
Q

What is trophic feeding

When would you use it

A

Feeding minute volumes to stimulate development of immature GI tract
Premature babies

99
Q

When would you give parenteral nutrition

A

Post Op
Trauma
Oral nutriton poor e.g ill, low BW
Necrotizing Enterocolitis

100
Q

How should you stop parenteral nutrition

A

In stages to prevent hypoglycaemia

101
Q

What is Hirshspungs Disease

A

Congenital absence of ganglia in a segment of the colon causing paralysis of peristaltic movements

102
Q

How does Hirshprungs Disease present

A

Functional GI obstruction
Constipation
Megacolon

103
Q

What signs may you get in Hirshprungs Disease

A

Faeces may be felt in the abdomen
PR exam may reveal tight anal sphincter
Explosive discharge of gas and stools

104
Q

What complications may you get in Hirshprungs disease

A 
GI perforation
Bleeding 
Ulcers 
Enterocolitis - life threatening
Short gut syndrome after surgery
105
Q

How is Hirshprungs disease diagnosed

A

Rectal Suction Biopsy of aganglionic bowel

106
Q

How is Hirshprungs disease managed

A

Excision of Aganglionic Segment +/- Colostomy

107
Q

What is congenital Diaphagmatic Hernia
AND
What is is associated with

A 
Developmental defect in diaphragm allowing abdo contents to herniate into chest 
Other congenital malformations:
- Neural tube defect 
- Trisomy 18
- Chromosomal Deletions
108
Q

What can congenital diaphragmatic hernia lead to

A

Impaired lung development - pulmonary hypoplasia and pulmonary HTN

109
Q

How is congenital diaphragmatic hernia diagnosed

A

Pre-natal: US

Post-natal: CXR

110
Q

What are the signs of congenital diaphragmatic hernia

A

Difficult resuscitation at birth
Respiratory Distress
Bowel sounds in thorax

111
Q

What is the treatment of congenital dighragmatic hernia

A

Prenatal: Consider fetal surgery - tracheal obstruction by balloon
Postnatal: Insert large bore NG tube
Try to keep all air out of gut
Surgery

112
Q

What type of inguinal hernia presents in children

A

Indirect

113
Q

How is an indirect inguinal hernia caused and who is at risk

A

Patent Processus Vaginalis (hasn’t closed after birth)

Premature infants!!!

114
Q

What is a processus vaginalis

A

Passage which the descending testicles enter the the scrotum at near the end of pregnancy

115
Q

How does an inguinal hernia present

A

A bulge lateral to pubic tubercle the crying due to abdo lining or bowel bulging through

116
Q

What are the complications of inguinal henna

A

Incarceration - when contents of hernia become trapped causing strangulation

117
Q

What symptoms may you get in strangulation from a hernia

A

Nausea/Vomiting, Fever and sharp severe pain

Can lead to necrotic bowel - Immediate surgery

118
Q

How are inguinal hernias managed

A

Laproscopic surgery with 6/2 rule

  • under 6 weeks: 2 days
  • under 6 months: 2 weeks
  • under 6 years: 2 months
119
Q

What is a hydrocele

A

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
Q

What is the definition of colic

A

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
Q

What can help colic

A

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
Q

What is constipation

A

Infrequent passage of stool associated with pain and difficulty, or delay in defecation

123
Q

What is Encopresis

A

Involuntary faecal soiling or incontinence secondary to chronic constipation

124
Q

What criteria is used to diagnose functional constipation

A

Rome III Criteria

125
Q

What is in the Rome III Criteria

A
  • 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
Q

What is the pathogenies of functional constipation

A
  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
Q

What are red flags for Constipation

A
  • 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
Q

What can cause constipation

A 
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
Q

What are the long term complications of constipation

A

Acquired Megacolon
Anal Fissures
Overflow incontinence
Behaviour Problems

130
Q

What investigations should be performed for constipation

A

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
Q

How do you manage constipation

A 
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
Q

What is the definition of failure to thrive

A

Failure to gain adequate weight or growth during infancy and childhood

133
Q

What is faltering growth

A

A significant interruption in expected rate of growth of a child
an underlying causes must be considered

134
Q

What is it important to consider in infants with failure to thrive

A

The parents height
Make allowance for prematurity until 18 maths
Non-organic as important as organic

135
Q

What are the 4 key areas which lead to failure to thrive

A

Poor Intake
Malabsorption
Too much energy used up
Abnormal central control of growth/ appetite

136
Q

What can cause abnormal central control of growth

A

GH

Thyroid

137
Q

What are important non-organic causes of failure to thrive

A 
Poor parental understanding 
Low income 
Poor social support 
Deliberate Starvation
Maternal Anorexia 
Parental psychiatric illness
Emotional neglect
138
Q

What investigations should be performed for diarrhoea

A
  • 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
Q

What can cause hepatomegaly

A

Infections: CMV, Hep
Malignancy: leukaemia, lymphoma, neuroblastoma
Metabolic

140
Q

What can Neonatal Hepatitis Syndrome be caused by

A

Viruses: CMV, Herpes
Metabolic Liver Disease
Genetic Disorders
Idiopathic

141
Q

What symptoms may you get in Hepatitis

A 
Jaundice
Hepatomegaly 
Dark Urine 
Pale stools
Pruritis 
Easy Brusing 
Infection 
Ascites 
Liver Failure
142
Q

What investigations should be performed in hepatitis

A

US liver
Biopsy
LFTs

143
Q

What is neuroblastoma and what age is it most commonly found in

A

Embryonal neoplasm - from sympathetic neuroblasts
Found in children under 5
Some forms regress, some very malignant

144
Q

What are the signs of neuroblastoma

A

Abdominal swelling

Pain and Discomfort

145
Q

What are common metastatic sites of neuroblastoma

A

Lymph nodes
Scalp
Bones
Can cause DVTs

146
Q

What investigations would you do in neuroblastoma

A

Catecholamines in urine
US and MRI for location/staging
mIBG scan
Biopsy

147
Q

What is the treatment of Neuroblastoma

A

Surgery and Chemotherapy (Cyclophosphamide + Doxorubicin)

148
Q

What is Biliary Atresia

A

Bile flow from liver to gallbladder is blocked leading to liver damage and cirrhosis
Cause unknown
appears 2wks - 2 mths of life

149
Q

How does Biliary Atresia Present

A

Jaundice
Dark yellow urine
Pale Stools
Hepatosplenomegaly

150
Q

How is Billary Atresia managed

A

Early intervention: Kasai Procedure
Late intervention: unlikely to be successful due to advanced liver damage therefore:
Liver Transplant!!

151
Q

How is Billiary Atresia investigated

A

US

Percutaneous Liver Biopsy

152
Q

When should babies be referred with jaundice

A

Beyond 2 weeks

preterm 3

153
Q

What is Meckel Diverticulum

A

Distal Ileum contains remnants of gastric and pancreatic tissue

154
Q

How does Meckel Diverticulum present

A

Gastric Acid Secretion:
causing GI pain and bleeding
Rectal Bleeding: melaenia

155
Q

How id Meckel diagnosed

A

Radionucleotide test (Meckel Scan)

156
Q

How is Meckel treated

A

Laproscopic Resection

157
Q

What is Necrotising Enterocolitis

A

Inflammation of bowel due to intolerance of feeds and bacterial colonisation - leading to necrosis

158
Q

Who is at risk of necrotising enterocolitis

A

Pre-term infants

159
Q

What are the symptoms of necrotising enterocolitis

A 
Billous vomiting (green)
Blood in stool
Abdominal distension and tenderness
Shock 
DIC
Perforation
160
Q

Why does perforation occur in necrotising entercolitis

A

Leaky wall caused by oedema - bacteria gets into gut wall causing perforation

161
Q

How do you treat necrotising enterocolitis

A

ABCDE
Stop oral feeds
Give parenteral feeds
Give Abx e.g Cefotaxime + Vancomycin

162
Q

How do you investigate necrotising enterocolitis

A
  • X-ray: pneumonitis intestinalis
    Riglers and Football sign
  • Culture faeces
163
Q

What is Kwashiorkor and what signs would you get

A

Due to decreased intake of protein and essential amino acid

Signs: Poor growth, Diarrhoea, Apathy, Anorexia, Oedema, Skin/Hair depigmentation, distended abdomen

164
Q

What is Marasmus, what is it associated with and what signs so you get

A
  • Lack of calories and discrepancy between height and weight
  • Associated with HIV
  • Signs: distended abdomen, diarrhoea or constipation, infection, low albumin

Paediatrics (13 decks)

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