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CP2 PAEDS > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Why are children very vulnerable to adverse effects of poor nutrition?

A

Low nutritional stores
High nutritional demands for growth
Rapid neuronal development
Acute illness or surgery

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2
Q

NICE guidelines infant feeding (4)

A

Exclusive breast feeding 1st 6 months
1st breast feed within first few hrs of life
Skilled proffesionals available
Recommended breast feeding for 1st 12months. Wean after 6

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3
Q

Advantages of breast feeding (6)

A 
Decr GI infection 
Decr LRTI
Decr OME
Protective against NEC in prem babies
Decr incidence of obesity, DM, HTN
INcr relationship with mother
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4
Q

Complications breast feeding (8)

A 
Hard to measure intake
Harrd for >2 children births
Hard in pre-term babies
Hard to obtain sufficient milk 
Transmission - infection, drugs, nicotine/dx/alcohol
Breast milk jaundice
Vit K deficiency
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5
Q

Benefit of Colostrum

A

Incr proteinn + Immunoglobulin

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6
Q

Weaning off breast milk

A

Begin w/ purified foods
A few tsp when child is not hungry or tired
Gradually increased the no’

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7
Q

When can pasteurised cows milk been given on?

A

1 year

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8
Q

What is pasteurised milk deficient in?

A

VIt A,C,D

Iron

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9
Q

Who are specialised formulas used for? (3)

A

Cows milk allergy/intolerance
CF
Neonatal cholestatic liver disease

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10
Q

What is semi-hydrolysed milk used for?

A

Prophylactic use

Aim of reducing risk of cowsmilk protein allergy where there is FHx

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11
Q

Mild FTT on a growth chart

A

2 centiles

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12
Q

Severe FTT on a growth chart

A

3 centiles

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13
Q

Red flags FTT (3)

A

Decr wt + decr head length/head circumference
Developmental delay
Delayed puberty

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14
Q

Organic causes FTT (4)

A

Decr absorption - coeliac, CF, CMPA, post NEC
Catabolic state
Poor retention - vom, GORD
Cant use nutrients

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15
Q

Non-organic causes FTT (3)

A

Inadequate food
Psychosocial deprivation
Neglect

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16
Q

Mx FTT (3)

A

HV assess eating + provide support
Paeds dietician
SALT

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17
Q

What is PYMS

A

Paeds equivalent of MUST

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18
Q

Step 1 - PYMS

A

BMI

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19
Q

Step 2 - PYMS

A

Score % decr W

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20
Q

Step 3 - PYMS

A

Assess recent change in diet/nutrtional support incl reduced intake

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21
Q

Step 4 - PYMS

A

Note risk of being undernourishedduring hospital admission

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22
Q

Step 5 - PYMS

A

Use Mx guidelines +/or local policy to develop care plan

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23
Q

Causes of malnutrition (5)

A 
Poverty 
Neglect
Restrictive diets 
Illness 
ED
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24
Q

Consequences of malnutrition (4)

A

Impaired immunity
Delayed wound healing
Incr morbidity/mortality

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25
Q

What is Anthropometry

A

Skinfold thickness of triceps

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26
Q

Features of Marasmus (3)

A

Wasted appearance
Decr middle arm circumference
Incr skinfold thickness

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27
Q

Features of Kwashiokor (8)

A 
Generalised oedema 
Severe wasting 
Distended abdomen 
Hepatomegaly 
Angular stomatitis 
Diarrhoea 
Hypothermia 
Decr HR + BP
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28
Q

When does Kwashiokor occur?

A

After acute infection

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29
Q

What should an infant be eating @ 7-6m

A

Wider variety of foods, textures + tastes

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30
Q

What should an infant be eating @9-12months

A

3 meals a day + healthy snacks

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31
Q

What food groups should be avoided during weaning? (6)

A 
Salt 
sugar 
Honey
Shark, Marlin, Swordfish
Raw eggs 
Whole nuts
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32
Q

Overweight

A

> 91st centile

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33
Q

Obese

A

> 98th centile

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34
Q

Complications of being obese (9)

A 
Ortho - slipped upper femoral epiphysis, Blounts 
Headaches 
Hypoventilation syndrome/OSA
GB disease 
PCOS
T2DM 
HTN 
Asthma 
Incr Ca risk - endometrial, breast, colonic
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35
Q

What is over-feeding?

A

Consuming more milk than required for growth + energy

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36
Q

Signs of over-feeding (8)

A 
Incr W gain 
> 8 wet nappies /day 
Sloppy foul bowels
Extreme flatulence 
Belching 
Milk regurg 
Irritability 
Sleep disturbance
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37
Q

Freq of Stool’s 1st week of life

A

4/day

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38
Q

Freq of stool 1st year of life

A

2/day

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39
Q

Causes of normal constipation (3)

A

Dehydration
Problems w/ toilet training
Refusal/anxiety

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40
Q

Causes of constipation (medical) (7)

A 
Hirschprungs 
Anorectal abnormalities 
Hypothyroidism 
Hyerpcalcaemia 
Dehydration 
Anal fissure 
Anxiety/refusal
41
Q

Red Flag Sx constipation (8)

A 
Failure to pass meconium in 48hrs 
Constipation in first few w of life 
Ribbon stools 
FTT 
Gross abdo distension 
Abnorm L limb neurology/deformity 
Sacral dimple above natal cleft
Perianal bruising + fissures
42
Q

Mx simple constipation (4)

A

Mild laxatives
Incr fl intake
Encourage child to sit on loo after meal
Reward scheme

43
Q

Mx longstanding constipation (4)

A 
Disimpaction regime 
Movicol - osmotic 
Senna - stimulant 
Polyethylene glycol - maintenance 
Surgical if all above fails
44
Q

Encopresis

A

When toilet trained children soil their clothes

45
Q

What is the vast majority (80%) of Encopresis caused by?

A

Severe constipation + overflow

46
Q

Functional encopresis

A

Soiling with no evidence of constipation or impaction

47
Q

Causes of functional encopresis (5)

A 
Early in toilet training 
EMotional 
Lack self confidence/embarrassment 
Manipulate the surrounding enviro  
IBS
48
Q

Support available for soiling

A 
Address childs behavoir + sit on toilet 
Rewards
Tx underlying conditions 
Rx to paeds gastro 
Lots of info online + support
49
Q

What is Hirschprungs

A

Absence of ganglion cells in mesenteric plexus

50
Q

Appearance of bowel in Hirshprungs

A

Narrow contracted segment of bowel

51
Q

What % of Hirshprungs is confined to the recto-sigmoid

A

75%

52
Q

What % of Hirshprungs involves the entire colon

A

10%

53
Q

Who is more likely to get Hirshprungs?

A

Males

Downs syndrome

54
Q

PS Hirshprung’s in neonatal period

A

Intestinal obstructoin
No mec passed in 24hrs
Abdo distention
Bile stained vom

55
Q

PS Hirshprungs later in childhood

A

Chronic constipation
Abdo distention
Growth failure

56
Q

O/E Hirshprungs

A

Rectum = narrow

Removal finger –> gush of stool

57
Q

`Ix Hirshprungs

A

Suction rectal biopsy
Absence ganglion cells
Presence large ACH + nn trunks

58
Q

Mx Hisrchprungs

A

Surg = anorectal pull through

59
Q

Complications Hirshprungs

A

Enterocolitis

(mort = 10%0

60
Q

What is gastroenteritis

A

Inflammation of the stomach and intestines

61
Q

Causes GE (6)

A 
ROTAVIRUS
Norovirus 
Campy
Shigella 
Salmonella 
E coli
62
Q

RF GE (3)

A

ICC
Poor hygiene/sanitation
Poor food hygiene

63
Q

PS GE (3)

A

Sudden onset vom/diarrhoea
Febrile
Dehydrated

64
Q

Diagnostic indications GE

A 
Temp >< 38 
SOB 
RR
Altered consciousness 
Bulging fontanelle 
Rash
Blood/mucus stool 
Bilious vom 
Abdo pain
65
Q

When would you send a stool sample for GE?

A

If suspect sepsis

Or blood/mucus in stools

66
Q

General appearance: no dehydration vs dehydration vs shock

A

No - appears wells
Deh - appears unwell or deteriorating
Shock - appears unwell or deteriorating

67
Q

Conscious level - no dehydration vs dehydration vs shock

A

No - alert + responsive
Clinical dehydr - altered responsiveness
Shock - decr level of consciousness

68
Q

UO - no dehydration vs dehydration vs shock

A

No - normal
Dehydration - decreased
Shock - decreased

69
Q

Skin colour - no dehydration vs dehydration vs shock

A

No - norm
Dehydr - norm
shock - pale/mottled

70
Q

Extremitis no dehydration vs dehydration vs shock

A

No - warm
Dehydr - warm
Shock - cold

71
Q

Eyes - no dehydration vs dehydration vs shock

A

No - norm
Dehydr - sunken
Shock - grossly sunken

72
Q

Mucous membranes - no dehydration vs dehydration vs shock

A

No - moist
Dehydr - dry
Shock - dry

73
Q

Heart rate - no dehydration vs dehydration vs shock

A

No - norm
Dehydr - tachyC
Shock - tachyc

74
Q

Breathing - no dehydration vs dehydration vs shock

A

No - norm
Dehydr - tachypnoea
Shock - tachypnoea

75
Q

Peripheral pulses - no dehydration vs dehydration vs shock

A

No - norm
Dehydr - norm
Shock - weak

76
Q

CRT - no dehydration vs dehydration vs shock

A

No - norm
Dehydr - norm
Shock - prolonged

77
Q

Skin turgor - no dehydration vs dehydration vs shock

A

No - norm
Dehydr - reduced
Shock -reduced

78
Q

BP no dehydration vs dehydration vs shock

A

No - norm
Dehydr - Norm
Shock - HoTN

79
Q

Mx of GE w/ no dehydration

A

Continue br feeding
Encourage fl intake
Discouarage fruit/fizzy drinks
ORS as supplemental fl

80
Q

Mx of GE w/ Clinical dehydration

A

ORS - 50ml/kg over 4h + maintenance fl

81
Q

Mx of GE with shock

A

Rapid infusion 0.9% saline
100ml/kg 1st 10kg, then 50 for next 10 then 20
Continue breast feeding if possible
Monitoring U+E

82
Q

How long does diarrhoea last GE

A

stops by 2w

83
Q

How long does vomiting last GE

A

3 days

84
Q

What is post GE syndrome?

A

Watery discharge due to temporary lactose intolerance

85
Q

Mx post GE syndrome

A

ORT 24hrs

86
Q

UGI Sx CMPA (3)

A

Vomiting
Feed aversion
Pain

87
Q

Small intestine Sx CMPA

A

Diarrhoea
ABdo pain
FTT

88
Q

Why can CMPA occur in breast fed infants?

A

Because if mother ingests cows milk herself

89
Q

Mx CMPA

A

Limit CMP
Hydrolysed formula
After weaning intro cows milk 6-12m (challenge)

90
Q

What is the most common cause of persistent loose stools in pre-school children?

A

Toddlers diarrhoea

91
Q

Features of toddlers diarrhoea

A

Pale + foul smelling
Presence of undigested veggies
Child = well + thriving

92
Q

By what age does most of toddlers diarrhoea resovle by

A

5y

93
Q

What is GOR

A

Involuntary passage of gastric contents into oesophagus causing harm

94
Q

Causes of GOR (7)

A 
Inapprop relaxation LOS b/c functional immaturity 
Fluid diet + horizontal posture 
Hiatus hernia 
Incr gastric P 
gastric hypersecretion 
Allergy 
CNS disorders
95
Q

PS GOR

A 
Rec regurg/vom 
Choking 
Resp problems - cough, apnoea, wheeze, aspiration 
FTT
Heart burn
96
Q

Which conditions must you rule out for GOR? (5)

A 
Hiatus hernia 
GE
PS 
UTI
CMPA
97
Q

Mx GOR

A 
Positioning 
Thickened feeds 
Small/freq meals 
Avoid before sleep 
Avoid fatty foods/citrus 
Gaviscon/omeprazole/ 
Prokinetic - domperidone
98
Q

Surgical Mx GOR

A

NIssen fundoplication

99
Q

Complications of nissen fundoplication

A

Gas bloating syndrome

Dysphagia

CP2 PAEDS (18 decks)

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