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Medicine, Year 4, Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What are symptoms of Abdominal Migraine?

A 
Abdominal pain >1 hour
Nausea and vomiting
Headache
Photophobia
Aura
Pallor
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2
Q

What are treatments of Abdominal Migraine?

A

Low stimulus environment

Paracetamol, Ibuprofen, Sumatriptan

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3
Q

What drug is used to prevent Abdominal Migraines? What is the mechanism of action?

A

Pizotifen, serotonin agonist

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4
Q

What medication is first-line for constipation in children?

A

Movicol, osmotic laxative

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5
Q

What does a “ribbon stool” suggest?

A

Anal stenosis

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6
Q

What two conditions are associated with Meconium Ileus?

A

Cystic Fibrosis, Hirschprung’s disease

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7
Q

What ABG result would you expect in Pyloric Stenosis?

A

Hypochloraemic, Hypokalaemic metabolic alkalosis (with high bicarbonate levels)

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8
Q

What are the two associations with Pyloric stenosis?

A

Macrolide antibiotic use

Turner’s Syndrome

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9
Q

What is the typical history from a patient with Pyloric Stenosis? How is it diagnosed? How is it treated?

A

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)

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10
Q

What is the most common cause of obstruction in children?

A

Intussusception

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11
Q

What is the typical history from a patient with Intussusception?

A

Severe colicky abdominal pain, with a redcurrant jelly stool. RUQ sausage shaped mass, and patient will draw knees up to their chest

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12
Q

What age group does Intussusception occur in?

A

Aged 6 months to 2 years old

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13
Q

How is Intussusception diagnosed? What is the sign to look for?

A

By Abdominal Ultrasound: Target Bull’s eye lesion

By contrast Enema

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14
Q

How is Intussusception managed?

A
  • Therapeutic enema with air sufflation
  • Surgical reduction if enema fails
  • Surgical resection if bowel is gangrenous
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15
Q

What is Hirschprung’s Disease?

A

A congenital condition where parasympathetic ganglionic cells of the Meissners and Myenteric plexus are absent from the distal bowel and rectum which controls peristalsis

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16
Q

What are symptoms of Hirschprung’s Disease?

A

Failure to pass meconium within 48 hours, chronic constipation, FTT, abdominal pain, poor weight gain, vomiting

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17
Q

What two ways is Hirschprung’s Disease diagnosed?

A
  • Abdominal X-Ray

- Rectal suction biopsy of mucosa + submucosa

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18
Q

What is Hirschprung’s Disease associated with?

A

Down’s Syndrome
Neurofibromatosis
Waardenburg Syndrome
Men Type II

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19
Q

What is the definitive treatment for Hirschprung’s Disease?

A

Resection of aganglionic bowel, anorectal pull through

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20
Q

What is Oesophageal Atresia associated with?

A

VACTERL association, Polyhydramnios

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21
Q

What does VACTERL stand for?

A 
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal anomalies
Limb abnormalities
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22
Q

What is Oesophageal Atresia? When does it occur during development?

A

Where the oesophageal tube is interrupted, becoming a blind-end pouch. Occurs during Week 4 of development

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23
Q

What are symptoms of Oesophageal Atresia?

A

Increased oral secretions, regurgitation, choking, cyanotic spells

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24
Q

What is Duodenal Atresia associated with?

A

Down’s Syndrome, polyhydramnios

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25
Q

What is the main finding on AXR for Duodenal Atresia? How do we treat Duodenal Atresia?

A

Double bubble sign

Duodenoduodenostomy

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26
Q

What is the main symptom of Duodenal Atresia?

A

Bilous vomiting

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27
Q

What is the most common cause of Gastroenteritis in children?

A

Rotavirus

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28
Q

What are the features of Gastroenteritis?

A

Diarrhoea for 5-7 days, and vomiting for 1-2 days

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29
Q

What is the electrolyte abnormality associated with Gastroenteritis? What are symptoms of it?

A

Hypernatraemia

Jittery movements, drowsiness, coma, hypertonia, hyperreflexia, convulsions

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30
Q

What is Traveller’s Diarrhoea defined as? What is it caused by?

A

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

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31
Q

How do manage a child with Gastroenteritis?

A
  • 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
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32
Q

E. Coli producing Shiga toxin is associated with which condition?

A

Haemolytic Uraemic Syndrome

33
Q

Haemolytic Uraemic Syndrome is a triad of..?

A
  • Haemolytic anaemia
  • Acute kidney injury
  • Thrombocytopenia
34
Q

What is the incubation period of E. Coli?

A

12-48 hours

35
Q

What is the incubation period of Campylobacter jejuni? What is a complication of gastroenteritis cause by this bacteria? How is it treated?

A

48-72 hours
Guillin-Barre syndrome
Azithromycin, Ciprofloxacin

36
Q

What is the incubation period of Shigella?

A

48-72 hours

37
Q

What is the incubation period of Salmonella?

A

12-48 hours

38
Q

What is the incubation period of Giardiasis?

A

> 7 days

39
Q

What is the incubation period for Amoebiasis?

A

> 7 days

40
Q

What microbes have the longest incubation period?

A

Giardiasis and Amoebiasis

41
Q

What is the incubation period for Bacillus cereus?

A

1-6 hours for vomiting subtype

6-14 for diarrhoea subtype

42
Q

What is the incubation period for Staph aureus?

A

1-6 hours

43
Q

What is a complication of Yersinia Enterocolitica?

A

Lymphadenopathy -> Mesenteric Adenitis (mimics appendicitis)

44
Q

What are the symptoms / signs associated with Biliary Atresia?

A 
Jaundice
Dark urine, pale stools
Hepatopmegaly
Splenomegaly
Growth disturbances
45
Q

What test results might suggest Biliary Atresia?

A

Total Billirubin = Normal
Total Conjugated Billirubin = Increased
LFTs, Bile acids, Aminotransferases = May increase

46
Q

What is the surgical procedure for Biliary Atresia?

A

Kasai Portoenterostomy

47
Q

What is Mesenteric Adenitis caused by? How is it treated?

A

Yersinia Enterocolitica

No management required

48
Q

What are the symptoms of Necrotising Enterocolitis?

A

Poor feeding, bloody stools, abdominal distension

49
Q

What investigation is ordered for Necrotising Enterocolitis? What is seen?

A

Abdominal X-Ray
Dilated bowel loops, bowel wall oedema, pneumatosis intestinalis, portal venous gas, pneumoperitoneum, Rigler’s sign, Football sign

50
Q

How is a Malrotation treated?

A

Ladd’s procedure

51
Q

What is Malrotation?

A

Arrest of normal gut as it rotates around the Superior Mesenteric Artery

52
Q

What are the symptoms of Malrotation?

A

Billous vomiting, abdominal pain, abdominal distension, bloody stools

53
Q

How is Malrotation diagnosed? What may be present?

A

GI Contrast Study: Corkscrew sign

Ultrasound

54
Q

What are two differentials for Billous Vomiting?

A
  • Duodenal atresia

- Malrotation

55
Q

What is a sign on ultrasound might suggest a Volvulus?

A

Whirlpool sign

56
Q

What is Sandifer’s syndrome?

How does it resolve?

A

Gastro-oesophageal reflux
Torticolis + Dystonia

Will resolve once the reflux improves

57
Q

What is McBurney’s point?

A

One-third of the distance from the anterior superior iliac spine to the umbilicus

58
Q

What dermatological condition is associated with Coeliacs? What is it?

A

Dermatitis Herpetiformis

Itching, vesicular, blistering skin rash on abdomen and extensor surfaces

59
Q

What anaemias are associated with Coeliacs?

A

Iron, B12 and folate

Folate > B12 deficiency

60
Q

What is the first-line investigation for Coeliacs?

A

IgA-TTG

However must check for IgA deficiency, as it would give a false result if low

61
Q

What changes are observed on a Jejunal Biopsy in a patient with Coeliacs who has re-introduced gluten?

A
  • Villous atrophy
  • Crypt hyperplasia
  • Increase in intraepithelial lymphocytes
  • Lamina Propria infiltration with monocytes
62
Q

What is the name given to the classification of Coeliac Disease severity?

A

Marsh Classification

63
Q

What are complications of Coeliacs if untreated?

A 
Iron, B12, Folate deficiency
Hyposplenism
Osteoprosis, Osteomalacia
Lactose intolerance
EATL of small bowel
Oesophageal cancer (rare)
64
Q

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?

A

Refractory sprue

Treatment: Glucocorticoids, restriction of Soy

65
Q

What is the definitive management for Ulcerative Colitis?

A

Panproctocolectomy + Ileostomy / J-pouch

66
Q

What is the Truelove and Witts Criteria for Ulcerative Colitis?

A

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

67
Q

What is the difference in histology between Crohn’s and Ulcerative Colitis?

A

Crohn’s: Transmural (mucosa to serosa) + goblet cells + granulomas

Ulcerative Colitis: Mucosa to submucosa + crypt abscesses

68
Q

What are the radiological signs associated with Crohn’s Disease?

A

String sign, rose thorn ulcers, fistulae

69
Q

What are the radiological signs associated with Ulcerative Colitis?

A

Loss of haustrations, drainpipe colon

70
Q

Gallstones are more common in which IBD?

A

Crohn’s Disease

71
Q

Pseudopolyps are common in which IBD?

A

Ulcerative Colitis

72
Q

What is the first-line management for a Crohn’s patient to INDUCE remission during a flare-up?

A

Oral Prednisolone or IV Hydrocortisone

73
Q

What is the second-line management for a Crohn’s patient to INDUCE remission during a flare-up?

A 
Azathioprine
Mercaptopurine
Methotrexate
Infliximab
Adalimumab
74
Q

Smoking makes which IBD worse and which IBD better?

A

Smoking makes Crohn’s Disease worse

Smoking makes Ulcerative Colitis better

75
Q

What is the first-line management for a Crohn’s patient to MAINTAIN remission?

A

Azathioprine

Mercaptopurine

76
Q

What is the first-line management for a Ulcerative Colitis patient to INDUCE remission during a MILD/MODERATE flare-up?

What is second-line?

A

First-line:
Rectal Masalazine
(+ Oral Mesalazine)

Second-line:
Corticosteroids

77
Q

What is the first-line management for a Ulcerative Colitis patient to INDUCE remission during a SEVERE flare-up?

What is second-line?

A

First-line:
IV Corticosteroids

Second-line:
IV Ciclosporin

78
Q

What is the first-line management for a Ulcerative Colitis patient to MAINTAIN remission?

A

Aminosalicyclates
Azathioprine
Mercaptopurine

79
Q

Methotrexate is used in treatment regimes for which IDB?

A

Crohn’s Disease only

Medicine, Year 4, Paediatrics (16 decks)

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