Gastroenterology Flashcards
5 causes of hepatomegaly
Infection: viral, bacterial, fugal, parasitic
Congestive cardiac failure
Infiltration: primary and secondary (e.g. neuroblastoma) tumours
Storage: Fat - cystic fibrosis, glycogen storage diseases
Idiopathic
5 causes of splenomegaly
Infecvtion: malaria Haematological: hereditary sphreocytosis, sickle cell Extramedullary haemopoesis: thalassaemia Portal Hypertension Neoplastic
5 causes of hepatosplenomegaly
Infection: EBV, CMV Portal Hypertension Infiltration: leukaemia, lymphoma Haematological e.g. thalassaemia Idiopathic
Facts about gastro-oesophageal refulx in paeds
Over 50% experience reflux int he first 3 months of life, >95% resolving by 1 year.
Vomiting and distress are the most usual symptoms. The most serious ones are: apnoea, failure to thrive, aspiration pneumonia.
Rule out over feeding (normal about 150ml/kg/day in first few months)
Diagnosis is usually through history
Significantly symptomatic who do not respond to therapy (antacids, trial of ranitidine, omeprazole) may have endoscopy
Top 6 causes of rectal bleeding
Local: anal fissure
Swallowed blood from epistaxis
Gastroenteritis (more likely bacterial)
Acid ulceration: hiatus hernia, peptic ulcer, Meckel’s diverticulum
Intussusception (late sign in approx 50% cases)
IBD
Top 5 risk factors for IBD
FHx of IBD
FHx of autoimune conditions - thyroid disease, rheumatoid arthritis
Parental smoking
Bottle feeding
Peri anal signs - 50% of paediatric Crohn;s patient will have diagnositc signs on inspection
Top 5 causes of haematemesis
After excluding colouring from drinks or food
Swallowed blood (from cracked nipple in breastfeeding neonate, to epistaxis in child)
Repeated vomiting, acute gastritis
Ulceration: hiatus hernia, drugs (aspirin, iron ingestion), peptic ulcer
Bleeding disorders
Very rarely oesophageal varices
5 facts about coeliac disease
May occur at any age but in infants failure to thrive usually from introduction of gluten, 6-9 months (when weaned) Stools: normal to pale and bulky Abdomen distended, buttocks wasted Tissue transglutaminae (TTG-IgA) test highly sensitive and sepcific with >10n TTG givign a diagnosis Duodenal mucosal biopsy is necessary in patients with a moderately elevated TTG. It will show typical histologicsal changes of villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytosis
5 causes of acute diarrhoea
Infection: rota and enterovirus, E coli, Salmonella, Camplyobacter
Staphyloccal toxin in food poisoning
Response to infection e.g. pneumonia
Starvation stools (watery, green mucous)
Surgical: intussusception, pelvic appendicitis, Hirschprung’s
5 causes of chronic diarrhoea
Toddler's diarrhoes Constipation with overflow Post infectious food intolerance (e.g. lactose) IBD Malabsorption e.g. CF, coeliac
Top 5 investigations for chronic diarrhoea
Stool - culture and sensitivity, c.diff toxin, virology Bloods - FBC, CRP, LFTs, ESR Serum TTG Faecal calprotrectin Peri anal inspection
5 medical causes of acute abdominal pain
Infection: gastroenteritis, mesenteric adenitis, lower lobe pneumonia, UTI, acute hepatitis
Constipation
Henoch-Schonlein purpura
Acute nephritis
Rare but important DKA, sickle cell crisis, iron/lead posioning
5 surgical causes of acute abdominal pain
Acute appendicitis Intussuception Volvulus Strangulated inguinal hernia Torsion of testis/ovary
Clinical assessment of dehydration
Dry mucous membranes Sunken fontanelle Depressed level of consciousness Sunken eyes (ask parents) Tachypnoea, Tachycardia prolonged capillary refill >2secs Decreased skin turgor (pinch some skin over chest/abdo, if it does not return almost immediately then skin turgor is abnormal) Weight loss Oliguria
