Gastroenterology Flashcards
What are symptoms of Abdominal Migraine?
Abdominal pain >1 hour Nausea and vomiting Headache Photophobia Aura Pallor
What are treatments of Abdominal Migraine?
Low stimulus environment
Paracetamol, Ibuprofen, Sumatriptan
What drug is used to prevent Abdominal Migraines? What is the mechanism of action?
Pizotifen, serotonin agonist
What medication is first-line for constipation in children?
Movicol, osmotic laxative
What does a “ribbon stool” suggest?
Anal stenosis
What two conditions are associated with Meconium Ileus?
Cystic Fibrosis, Hirschprung’s disease
What ABG result would you expect in Pyloric Stenosis?
Hypochloraemic, Hypokalaemic metabolic alkalosis (with high bicarbonate levels)
What are the two associations with Pyloric stenosis?
Macrolide antibiotic use
Turner’s Syndrome
What is the typical history from a patient with Pyloric Stenosis? How is it diagnosed? How is it treated?
Normal birth, but in first few weeks starts to project non-bilious vomit 30mins after feeding. Olive shaped mass palpable in RUQ, and observable peristalsis in abdomen
Diagnosed by abdominal ultrasound, which shows a thickened pylorus
Treated by a laparoscopic pyloromyotomy (Ramstedt operation)
What is the most common cause of obstruction in children?
Intussusception
What is the typical history from a patient with Intussusception?
Severe colicky abdominal pain, with a redcurrant jelly stool. RUQ sausage shaped mass, and patient will draw knees up to their chest
What age group does Intussusception occur in?
Aged 6 months to 2 years old
How is Intussusception diagnosed? What is the sign to look for?
By Abdominal Ultrasound: Target Bull’s eye lesion
By contrast Enema
How is Intussusception managed?
- Therapeutic enema with air sufflation
- Surgical reduction if enema fails
- Surgical resection if bowel is gangrenous
What is Hirschprung’s Disease?
A congenital condition where parasympathetic ganglionic cells of the Meissners and Myenteric plexus are absent from the distal bowel and rectum which controls peristalsis
What are symptoms of Hirschprung’s Disease?
Failure to pass meconium within 48 hours, chronic constipation, FTT, abdominal pain, poor weight gain, vomiting
What two ways is Hirschprung’s Disease diagnosed?
- Abdominal X-Ray
- Rectal suction biopsy of mucosa + submucosa
What is Hirschprung’s Disease associated with?
Down’s Syndrome
Neurofibromatosis
Waardenburg Syndrome
Men Type II
What is the definitive treatment for Hirschprung’s Disease?
Resection of aganglionic bowel, anorectal pull through
What is Oesophageal Atresia associated with?
VACTERL association, Polyhydramnios
What does VACTERL stand for?
Vertebral defects Anal atresia Cardiac defects Tracheo-Esophageal fistula Renal anomalies Limb abnormalities
What is Oesophageal Atresia? When does it occur during development?
Where the oesophageal tube is interrupted, becoming a blind-end pouch. Occurs during Week 4 of development
What are symptoms of Oesophageal Atresia?
Increased oral secretions, regurgitation, choking, cyanotic spells
What is Duodenal Atresia associated with?
Down’s Syndrome, polyhydramnios
What is the main finding on AXR for Duodenal Atresia? How do we treat Duodenal Atresia?
Double bubble sign
Duodenoduodenostomy
What is the main symptom of Duodenal Atresia?
Bilous vomiting
What is the most common cause of Gastroenteritis in children?
Rotavirus
What are the features of Gastroenteritis?
Diarrhoea for 5-7 days, and vomiting for 1-2 days
What is the electrolyte abnormality associated with Gastroenteritis? What are symptoms of it?
Hypernatraemia
Jittery movements, drowsiness, coma, hypertonia, hyperreflexia, convulsions
What is Traveller’s Diarrhoea defined as? What is it caused by?
3 loose stools or more in 24 hours, associated with fever, cramps, nausea, vomiting
Most commonly caused by E. Coli in developed world, but in Southeast Asia is caused by Campylobacter
How do manage a child with Gastroenteritis?
- Barrier nursing / infection control
- Stay off school 48 hours until symptoms improve
- Microscopy, culture, sensitivities on stool sample
- Fluid challenge: 20ml / kg 0.9% NaCl
- Rehydration solutions i.e. Dioralyte
E. Coli producing Shiga toxin is associated with which condition?
Haemolytic Uraemic Syndrome
Haemolytic Uraemic Syndrome is a triad of..?
- Haemolytic anaemia
- Acute kidney injury
- Thrombocytopenia
What is the incubation period of E. Coli?
12-48 hours
What is the incubation period of Campylobacter jejuni? What is a complication of gastroenteritis cause by this bacteria? How is it treated?
48-72 hours
Guillin-Barre syndrome
Azithromycin, Ciprofloxacin
What is the incubation period of Shigella?
48-72 hours
What is the incubation period of Salmonella?
12-48 hours
What is the incubation period of Giardiasis?
> 7 days
What is the incubation period for Amoebiasis?
> 7 days
What microbes have the longest incubation period?
Giardiasis and Amoebiasis
What is the incubation period for Bacillus cereus?
1-6 hours for vomiting subtype
6-14 for diarrhoea subtype
What is the incubation period for Staph aureus?
1-6 hours
What is a complication of Yersinia Enterocolitica?
Lymphadenopathy -> Mesenteric Adenitis (mimics appendicitis)
What are the symptoms / signs associated with Biliary Atresia?
Jaundice Dark urine, pale stools Hepatopmegaly Splenomegaly Growth disturbances
What test results might suggest Biliary Atresia?
Total Billirubin = Normal
Total Conjugated Billirubin = Increased
LFTs, Bile acids, Aminotransferases = May increase
What is the surgical procedure for Biliary Atresia?
Kasai Portoenterostomy
What is Mesenteric Adenitis caused by? How is it treated?
Yersinia Enterocolitica
No management required
What are the symptoms of Necrotising Enterocolitis?
Poor feeding, bloody stools, abdominal distension
What investigation is ordered for Necrotising Enterocolitis? What is seen?
Abdominal X-Ray
Dilated bowel loops, bowel wall oedema, pneumatosis intestinalis, portal venous gas, pneumoperitoneum, Rigler’s sign, Football sign
How is a Malrotation treated?
Ladd’s procedure
What is Malrotation?
Arrest of normal gut as it rotates around the Superior Mesenteric Artery
What are the symptoms of Malrotation?
Billous vomiting, abdominal pain, abdominal distension, bloody stools
How is Malrotation diagnosed? What may be present?
GI Contrast Study: Corkscrew sign
Ultrasound
What are two differentials for Billous Vomiting?
- Duodenal atresia
- Malrotation
What is a sign on ultrasound might suggest a Volvulus?
Whirlpool sign
What is Sandifer’s syndrome?
How does it resolve?
Gastro-oesophageal reflux
Torticolis + Dystonia
Will resolve once the reflux improves
What is McBurney’s point?
One-third of the distance from the anterior superior iliac spine to the umbilicus
What dermatological condition is associated with Coeliacs? What is it?
Dermatitis Herpetiformis
Itching, vesicular, blistering skin rash on abdomen and extensor surfaces
What anaemias are associated with Coeliacs?
Iron, B12 and folate
Folate > B12 deficiency
What is the first-line investigation for Coeliacs?
IgA-TTG
However must check for IgA deficiency, as it would give a false result if low
What changes are observed on a Jejunal Biopsy in a patient with Coeliacs who has re-introduced gluten?
- Villous atrophy
- Crypt hyperplasia
- Increase in intraepithelial lymphocytes
- Lamina Propria infiltration with monocytes
What is the name given to the classification of Coeliac Disease severity?
Marsh Classification
What are complications of Coeliacs if untreated?
Iron, B12, Folate deficiency Hyposplenism Osteoprosis, Osteomalacia Lactose intolerance EATL of small bowel Oesophageal cancer (rare)
What is the term referring to Coeliac’s Disease patients who have not responded well to 6-12 months of a Gluten free diet? What is the treatment?
Refractory sprue
Treatment: Glucocorticoids, restriction of Soy
What is the definitive management for Ulcerative Colitis?
Panproctocolectomy + Ileostomy / J-pouch
What is the Truelove and Witts Criteria for Ulcerative Colitis?
Mild: 4 or less stools with no systemic disturbance, normal CRP / ESR
Moderate: 4-6 stools with minimal systemic disturbance
Severe: 6 or more stools with blood, systemic disturbance
What is the difference in histology between Crohn’s and Ulcerative Colitis?
Crohn’s: Transmural (mucosa to serosa) + goblet cells + granulomas
Ulcerative Colitis: Mucosa to submucosa + crypt abscesses
What are the radiological signs associated with Crohn’s Disease?
String sign, rose thorn ulcers, fistulae
What are the radiological signs associated with Ulcerative Colitis?
Loss of haustrations, drainpipe colon
Gallstones are more common in which IBD?
Crohn’s Disease
Pseudopolyps are common in which IBD?
Ulcerative Colitis
What is the first-line management for a Crohn’s patient to INDUCE remission during a flare-up?
Oral Prednisolone or IV Hydrocortisone
What is the second-line management for a Crohn’s patient to INDUCE remission during a flare-up?
Azathioprine Mercaptopurine Methotrexate Infliximab Adalimumab
Smoking makes which IBD worse and which IBD better?
Smoking makes Crohn’s Disease worse
Smoking makes Ulcerative Colitis better
What is the first-line management for a Crohn’s patient to MAINTAIN remission?
Azathioprine
Mercaptopurine
What is the first-line management for a Ulcerative Colitis patient to INDUCE remission during a MILD/MODERATE flare-up?
What is second-line?
First-line:
Rectal Masalazine
(+ Oral Mesalazine)
Second-line:
Corticosteroids
What is the first-line management for a Ulcerative Colitis patient to INDUCE remission during a SEVERE flare-up?
What is second-line?
First-line:
IV Corticosteroids
Second-line:
IV Ciclosporin
What is the first-line management for a Ulcerative Colitis patient to MAINTAIN remission?
Aminosalicyclates
Azathioprine
Mercaptopurine
Methotrexate is used in treatment regimes for which IDB?
Crohn’s Disease only