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Paediatrics for Finals > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Give some differentials for constipation in children

A 
Psychological 
Poor diet
Anal fissure (pain)
Hirschsprung 
Cow's milk allergy 
Hypercalcaemia
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2
Q

What is a disimpaction regime for constipation in children?

A
  1. Movicol Paediatric Plain
    • Stimulant (Senna)
  3. No Movicol, Stimulant + Osmotic (lactulose)
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3
Q

What are some differentials for diarrhoea in children?

A 
Overflow from constipation 
Gastroenteritis 
Systemic infection 
Surgical: appendicitis, volvulus  
Food intolerance 
CF
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4
Q

What are the signs and symptoms of intussusception?

A

Spasms of pain, distress and draw up the legs
Palpable mass in RUQ
Bilious vomiting
Red current jelly stool

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5
Q

How is intussusception investigated and what is seen?

A

USS shows target sign

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6
Q

How is intussusception managed?

A

NG tube and NBM
Rectal insufflation of air
Surgical if conservative doesn’t work

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7
Q

What is Hirschsprung disease?

A

Failure of the parasympathetic ganglions to innervate a section of bowel (often hindgut) leading to failure of coordinated peristalsis and a functional obstruction

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8
Q

What condition is Hirschsprung associated with?

A

Downs syndrome

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9
Q

What are the signs and symptoms of Hirschsprung disease?

How might it present later in life?

A

Failure to pass meconium in 24 hours
Absolute constipation
Bilious vomiting
Abdominal distention

Diarrhoea as a result of enterocolitis by C.Diff

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10
Q

How is Hirschsprung diagnosed?

A

Rectal biopsy shows an aganglionic portion of bowel

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11
Q

How is Hirschsprung managed?

A
  1. Rectal washout whilst awaiting surgery

2. Removal of the aganglionic portion

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12
Q

What are the signs and symptoms of GORD?

A 
Regurgitation 
Irritability 
FTT 
Cough
Sandifer's syndrome - extension of neck and dystonic posture
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13
Q

How is infantile GORD managed?

A

Feed at 30 degrees
Thicken feeds
Feed little and often
Omeprazole

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14
Q

What is Meckel’s diverticulum?

A

Diverticulum of the small intestine

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15
Q

How does Meckel’s diverticulum present?

A

Abdominal pain
Painless rectal bleeding
Obstruction

May present as peptic ulceration if the diverticulum contains ectopic gastric mucosa

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16
Q

What are the signs and symptoms of pyloric stenosis?

A

Projectile non-bilious vomiting
Hungry
FTT
Dehydration and constipation as a result

Olive shaped mass above and slightly to the right of the umbilicus

17
Q

What investigations would you do if you suspect pyloric stenosis? What would the results be?

A
  • Test feed: observe if truly “projectile” and see visible peristalsis
  • ABG: hypochloraemic, hypokalaemic metabolic alkalosis (progresses to acidosis as dehydration worsens)
  • USS
  • Barium meal
18
Q

Describe the location of abdominal contents in malrotation

A

Caecum in RUQ
Duodenal jejunal flexure in midline
Mesentery mobile

19
Q

If an asymptomatic malrotation was picked up, how would you manage it?

A

Ladd’s procedure

20
Q

What are the signs and symptoms of volvulus?

A

Bilious vomiting
Abdominal pain
Shock

21
Q

What imaging is used in diagnosing volvulus? What would the results be?

A

AXR: double bubble sign (both stomach and duodenum dilated) with no other air fluid level

GI contrast study: bird beak obstruction of the duodenum

22
Q

What are the features of congenital diaphragmatic hernias?

A 
Herniation of intestines in to the thorax
Lung hypoplasia 
Apparent dextrocardia 
Pulmonary hypotension 
Lack of surfactant
23
Q

How are congenital diaphragmatic hernias managed?

A

Mechanical ventilation

24
Q

How are infantile umbilical hernias referred and managed?

A

They are ok to be left

Generally refer at age 4/5 but if >2cm or symptomatic then at age 2/3

25
Q

How are infantile inguinal hernias referred and managed?

A

<1 year: manage as high risk of strangulation

>1 year: refer for elective repair

26
Q

What would a baby experiencing colic look like?

A 
Red faced
Crying 
Knees drawn up to chest 
Flatus 
Inconsolable crying 
NORMAL WEIGHT
27
Q

How is colic managed?

A
  • reassurance for the parents
  • increased parenting support
  • can try maternal hypoallergenic diet
28
Q

What are some causes of dehydration in children?

A

Reduced intake: mouth ulcers, teething, tonsillitis
Increased output: diabetes, gastroenteritis
Other losses: fever, burns

29
Q

A dehydrated child needs fluid replacement therapy. How is the volume given calculated?

A 
pre-dehydration weight (kg) x % weight loss x 10
ADD
maintenance needs
ADD
ongoing losses
30
Q

What are the symptoms of lactose intolerance?

A

Watery, foamy diarrhoea
Burning on defecation
Bloating

31
Q

What is the pathophysiology of coeliac disease?

A

Autoimmune condition caused by sensitivity to gluten

32
Q

What are the signs and symptoms of coeliac disease? At what age does it most commonly present?

A

Presents at weaning (6 months - 1 year)

  • diarrhoea (grey, oily, smelly), bloating, pain, mouth ulcers
  • FTT
  • Tired all the time
  • Iron deficiency anaemia
  • Dermatitis herpetiformis
33
Q

What is the pathway for diagnosing coeliac disease?

A

IgA tTGA measured

Negative = test for IgA deficiency and if deficient measure IgG tTGA

?? = IgA endomysial antibody

Positive = biopsy

34
Q

What biopsy results indicate coeliac disease?

A

Flat mucosa
Crypt hyperplasia
Lymphocyte infiltration

35
Q

What are the complications of coeliac disease?

A 
Anaemia (iron, folate, B12)
Hyposplenism
Osteoporosis 
Infertility 
Lymphoma
36
Q

Compare Gastroschisis and Exomphalos and their management

A

G = defect in anterior abdominal wall leading to free loops of bowel being visible outside. They need immediate surgery

E = amniotic membrane and peritoneum covers the protruding bowel. Cover the sac with non-adherent gauze

Paediatrics for Finals (11 decks)

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