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Y5 Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

What is possetting?

A

throwing up small amounts of milk together with a burp (swallowed air)

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2
Q

What is regurgitation

A

larger, more frequent losses

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3
Q

what is vomiting

A

forceful ejection of gastric contents

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4
Q

What does intestinal obstruction lead to?

A

vomioting

the more proximal the obstruction, the more prominent and bile stained the vomiting is

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5
Q

what is gastro-oesophageal reflux

A

involuntary passage of gastric contents into the oesophagus

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6
Q

why does gastro-oesophageal reflux occur

A

immaturity of lower oesophageal sphincter causing insufficient relaxation

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7
Q

what are baby factors contributing to reflux

A

fluid diet
horizontal posture
short intra-abdominal length off oesophagus

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8
Q

What are investigations for GOR?

A

24h oesophageal pH monitoring
24h impedance monitoring
endoscopy
upper Gi contrast study

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9
Q

what is management for GOR?

A

If breast-feeding:

  • Breastfeeding assessment by midwife
  • Alginate therapy

If formula fed:

  • Review feeding hx (trial smaller, frequent feeds)
  • Thickened formula
  • alginate therapy
  • PPI
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10
Q

What causes pyloric stenosis?

A

hypertrophy of pyloric muscle

causes gastric outlet obstruction

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11
Q

When does pyloric stenosis present?

A

2-8 weeks of age

irrespective of gestational age

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12
Q

what are features of pyloric stenosis?

A

Vomiting +
Hunger after vomiting
WL

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13
Q

what is management of pyloric stenosis

A

IV fluid resus

Ramstedt pyloromyotomy

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14
Q

What is a colic

A

common symptom complex

- typical pattern of symptoms: paroxysmal, inconsolable crying > drawing up of knees > passing excessive flatus

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15
Q

What is the cause of colic

A

GI

but no firm evidence

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16
Q

how do you manage colic?

A

reassure patients it is a common problem and resolves by 6m

sources for information / support: NHS Choices leaflet, health vitsitor
Strategies to soothe a crying infant
Look after yourself

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17
Q

What is the commonest cause of abdominal pain in babies

A

Mostly UNDIAGNOSED

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18
Q

What are surgical causes of abdo pain

A 
acute appendicitis 
intestinal obstruction (including insussception) 
inguinal hernia 
peritonitis 
Meckel diverticulum 
Pancreatitis 
Trauma
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19
Q

What are medical causes of abdo pain

A 
gastroenteritis 
pyelonephritis 
hydronephrosis 
renal calculus 
Henoch-Shonlein purpura
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20
Q

what are extra abdominal causes of abdo pain

A

URTI
Lower lobe pneumonia
testicular torsion
hip and spine

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21
Q

what are symptoms of acute appendicitis

A

anorexia
vomiting
abdo pain (initially central, colicky > then RIF)

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22
Q

what are signs of acute appendicitis

A 
flushed face, oral fetter 
fever 
pain aggravated by movement 
persistent tenderness 
guarding in RIF (McBurney's point)
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23
Q

What occurs to guarding in retrocaecal appendix

A

absent

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24
Q

what is a risk in appendicitis in children and why

A

PERFORATUON

because omentum is less well developed and fails to guard the appendix

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25
Q

What are ix for diagnosing appendicitis

A

USS (shows thickened, non compressible appendix with increased blood flow and possible complications e.g. absess, perforation, appendix mass)

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26
Q

what is management for appendicitis

A

NBM
IV fluid
appendicectomy

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27
Q

what is mesenteric adenines

A

enlarged mesenteric lymph nodes

normal appendix

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28
Q

What is insussception?

A

Invagination of proximal bowel into distal segment

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29
Q

What part of the GI tract is most commonly involved in insussception?

A

The ileum (when it passes into the caecum at the ileocaecal value)

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30
Q

What is the most common cause of intestinal obstruction in neonates?

A

insussception

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31
Q

What is the presentation of insussception

A

paroxysmal, severe colicky pain
Pallor during the colicky pAIN
Refusing feeds
Vomiting (may be bile stained depending on location)=
Passage of redcurrant jelly stool (blood stained mucous)

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32
Q

What are findings of abdominal exam in insussception

A

Sausage shaped mass palpable (in RIF)

Abdominal distensions

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33
Q

What are investigations for insussception

A 
X ray (distended bowel with no gas) 
Abdo USS
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34
Q

What is management of insussception

A
  • Rectal air insufflation (if no signs of peritonitis)
    OR
  • contrast enema
  • fluid resus
  • broad spec antibiotics

SECOND LINE: SURGICAL REDUCTION + broad spec anti bionics

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35
Q

What is meckel’s diverticulum=

A

The ideal remnant of the omphalomesenteric duct

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36
Q

What is the omphalomesenteric duct

A

Long narrow tube joining the yolk sac to midgut lumen of foetus
Made up of either gastric mucosa / pancreatic tissue

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37
Q

How does meckel’s diverticulum present?

A

severe rectal bleeding
obstruction
perforation / peritonitis if severe

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38
Q

How do you investigate meckel’s diverticulum

A

Technetium scan (shows increased uptake by ectopic gastric mucosa)

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39
Q

What is management for meckel’s diverticulum

A

Asymptomatic - no tx
Symptomatic - excision of diverticulum, lysis of adhesions
Perforation / peritonitis

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40
Q

What is another word for GI malrotation in neonate?

A

VOLVULUS

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41
Q

What are presentations of GI malrotation in neonate?

A

bilious vomitng
abdo pain
tenderness

42
Q

What is management for GI malrotation

A 
Ladd procedure (detort bowel, surgically divide Ladd bands) - done laparoscopically if non-urgent, open laparotomy if urgent 
\+ antibiotics (cefazolin)
43
Q

What is abdominal migraine’

A

abdominal pain and headaches

pain is usually midline and associated with vomiting and facial pallor

44
Q

How do you treat abdominal migraine?

A

anti migraine medication

45
Q

What does IBS present as

A 
Non specific abdo pain 
explosive, loose, mucous stool 
bloating 
incomplete defecation 
constipation
46
Q

How do you manage IBS

A

reassure
encourage pt to reduce stress
eliminate food that trigger sx

47
Q

what are main causes of gastroenteritis in developed countries?

A

ROTAVIRUS

Other (bacterial):
- campylobacter jejune
Shigella

48
Q

What is important to assess for in gastroenteritis?

A

DEHYDRATION for fluid replacement

49
Q

What further investigation must you do for gastroenteritis

A

stool sample analysis

50
Q

What causes coeliac disease

A

immunological response to gliadin

51
Q

What occurs to the GI system in coeliac

A

Villi become shorter and then absent, leaving a flat mucosa

52
Q

Whjat is classical presentaation of coeliac in children

A

profound malabsorption art 8-24m of age
after introduction of wheat containing food

  • faltering growth
  • abdo distension
  • buttock wasting
  • abnormal stools
  • general irritability
53
Q

How do you manage coeliac?

A

Eliminate all products containing wheat, rye, barley
Monitor body weight, height, BMI
Give calcium, vit D suppllement, conssider iron
Refer to dietician if necessary
ARRANGE ANNUAL REVIEW

54
Q

What is Hirschprung disease?

A

Absence of ganglion cells in myenteric and submucosal plexuses in large bowel
Results in a narrow and contracted segment of large bowel

55
Q

What is the presentation of Hirschprrung disease?

A

Neonatal: intestinal obstruction, unable to pass meconium

Childhood: chronic constipation, abdo distension, bile stained vomiting, growth failure

56
Q

What occurs in PR exam for Hirschprrung disease?

A

Narrowed segment

Gush of liquid stool Shen removing the finger

57
Q

How do you diagnose Hirschprung disease?

A

Full thickness rectal biopsy

Anorectal mamometry

58
Q

How do you manage Hirschprung disease

A

Initially bowel irrigation

then SURGICAL - ANORECTAL PULL THROUGH
initial colostomy
then anastomose normally innervated bowel to anus

59
Q

What is the cause fo regurgutation

A

GOR

Due to immaturity of LOS

60
Q

What must you exclude if baby is projectile vomiting?

A

pyloric stenosis

61
Q

How do you investigate pyloric stenosis?

A

Abdo exam (palpable pyloric mass in RUQ)
Perform test feed
USS
U&E (electrolyte disturbance, dehydration)

62
Q

What sign do you see on abdomen ultrasound for insussception?

A

TARGET SIGN (double lumen)

63
Q

What is eosinophilic oesophagitis?

A

INFLAMMATION OF OESOPHAGUS

DUE To Activation of eosinophils within mucosa/submucosa of oesophagus

64
Q

Who is eosinophilic oesophagitis common in?

A

Children with atopy

65
Q

What are symptoms of eosinophilic oesophagitis

A

vomiting
discomfort when swallowing
bolus dysphagia

66
Q

How do you diagnose eosinophilic oesophagitis

A

By ENDOSCOPY

- linear furrows and trachealisation of oesophagus

67
Q

How do you manage eosinophilic oesophagitis

A

oral corticosteroids (fluticasone / viscous budosenide)

68
Q

How do you. measure dehydration in children’

A

By looking at degree of WL during diarrhoea illness

  • <5% body weight = not clinically detectable
  • 5-10% body weight = clinical dehydration
  • > 10% body weight = shock
69
Q

What are maintenance fluids that are appropriate for children?

A 
0-10kg = 100ml/kg 
10-20kg = 1L + 50ml/kg for every kg over 10 
20+kg = 1500 + 20ml/kg for every kg over 20
70
Q

What fluids do you give to a child with shock?

A

Rapid infusion of 0.9% NaCL

71
Q

what is the normal frequency of defecation in children?

A

Varies with age
infants: 4x day in 1 week
1 year old: 2x day

72
Q

What is the definition of constipation

A

infrequent passage of dry, hardened faces accompanied by straining, pain, bleeding, and associated with hard stools

73
Q

What factors precipitate constipation

A

dehydration
reduced fluid intake
anal fissures
anxiety /psycholocial factors

74
Q

What are primary causes for constipation to exclude

A

hiaschprung disease
Lower SC problems
anorectal abnormalities s

Hypothyroidism, hypercalcaemia
Coeliac’s

75
Q

Should you do DRE in a child

A

NO

76
Q

How do you assess impaction in a baby

A

abdo palpation

will reveal small hard mass usually in LIF

77
Q

How do you manage constipaation with no impaction

A

Maintenance laxatives - Movicol
+/- stimulant
Consider behavioural changes

78
Q

What is movicol

A

Polyethylene glycol + electrolytes

79
Q

How do you manage constipation with impaction

A

Movicol Paediatric Plain (2 week escalating dose)

+/- stimulant

80
Q

What are behavioural changes to consider for constipation

A
  • scheduled toileting
  • bowel diary
  • positive reward system
81
Q

What is cow milks protein allergy

A

Allergic reaction of the immune system to protein in cows milk

82
Q

What are symptoms in cow milks protein allergy

A

D&V
rash
wheezing
faltering growth

83
Q

What is management for cow milks protein allergy

A

Breast: mother to avoid cows milk
Formula: hypoallergenic formula
+ monitor growth

84
Q

How do you investigate for pyloric stenosis

A
  1. Abdo exam:; visible peristalsis, pyloric mass (like an olive) in RUQ
  2. Perform test feed
  3. USS + U&E
85
Q

What are the two top causes of peptic ulceration ?

A

H pylori

NSAIDS

86
Q

What is presentation of a peptic ulcer

A
  • epigastric pain (wakes them up at night, radiates to back)
  • bloating
  • belching
  • vomiting
  • haematemesis
  • perforation
87
Q

What is the difference in presentation between gastric ulcer and duodenal ulcer

A

Gastric ulcer = pain worse on eating (presence of food increaases HCl production)
Duodenal ulcer = pain better on eating

88
Q

How do you investigate peptic ulcer from H pylori

A

TEST before you TREAT
C-13 breath test (as H pylori produces urease)

OR
Stool antigen in children

89
Q

What is mx for H pylori

A

Omeprazole + eradication therapy (amox + clary/metronidazole)

90
Q

What is toddler’s diarrhoea

A

benign condition
due to fast transit of food through digestive system
often contains undigested foods

91
Q

How do you manage toddler’s diarrhoea

A

no need

just plot centiles

92
Q

What part of GI tract does Chron’s affect

A

Distal ileum / proximal colon

93
Q

What is the histological hallmark of Chrons

A

Non-caseating epithelioid cell granulomata

94
Q

What are the 4 PILLARS of treatment (medical management) for Chrons

A
  • Steroids (predinisolone)
  • immunosuppressants (azathioprine, methotrexate)
  • Biological therapies (infliximab)
  • aminosalicates (mesalazine)
95
Q

What part of the GI tract does UC affect

A

COLON mucosa

96
Q

What are histological fts of UC

A

Mucosal inflammation
Crypt damage
Ulceration

97
Q

What are extra intestinal fts of UC

A

Mucosal inflamm
Crypt damage
Ulceration

98
Q

How do you assess UC severity in children

A

PUCAI

Paediatric Ulcerative Colitis Activity Index

99
Q

How do you manage UC

A

Aminosalicylate

Steroids

100
Q

how do you manage anal fissure in children

A

Advise :

  • against stool withholding
  • on importance of anal hygene

Ensure stool are soft

  • increase fibre
  • increase fluid intake
  • consider stool softener

Manage pain:

  • glyceryl trinitrate intra-anally
  • simple analgesia
  • sit in a shallow warm bath to help relieve pain
101
Q

What must you do in the annual review for coeliac disese

A
  • check height, weight, BMI
  • review symptoms
  • review adherence to diet (IgA-tTG titre every 3m until normalised, and then yearly)
  • consider blood tests (coeliaac serology, FBC, TFT; LFT, vit D, B12, folate, calcium, U&E)
102
Q

when do you give oral vs IV fluids for rehudration

A

ORAL REHYDRATION is mainstay

only give IV fluids if in shock/dehydration/vomiting

Y5 Paediatrics (30 decks)

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