GASTROENTEROLOGY PAEDS Flashcards

Question

Define Enteritis

Answer 1

Inflammation of intestines | Diarrhoea

Answer 2

Inflammation all the way from the stomach to the intestines | Nausea, vomiting, and diarrhoea

Answer 3

``` INFECTION (gastroenteritis) IBD LACTOSE INTOLERANCE COELIAC DISEASE CYSTIC FIBROSIS IBS MEDICATIONS ```

Answer 4

``` VIRAL most common - Rotavirus - Norovirus - Less common: adenovirus Others: Bacterial - E. Coli, campylobacter Jejuni, shigella, salmonella, bacillus cereus, staphylococcus aureus toxin, giardiasis ```

Answer 5

Increases the risk of HAEMOLYTIC URAEMIC SYNDROME | - E. Coli produces the Shiga toxin which destroys blood cells and leads to HUS

Answer 6

Anti-tissue transglutinase (anti-TTG) | Anti-endomysial (anti-EMA)

Answer 7

``` Often Asymptomatic- low threshold for testing Failure to thrive Diarrhoea Fatigue Weight loss Mouth ulcers Anaemia secondary to iron, B12 or folate deficiency Dermatitis herpetiformis ```

Answer 8

``` Type 1 diabetes Thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis Down’s syndrome ```

Answer 9

HLA-DQ2 gene (90%)

Answer 10

Pt. Must remain on diet containing gluten ! Check total IgA levels (to exclude a deficiency) Check coeliac specific antibodies (Anti-TTG, Anti-EMA) Endoscopy and intestinal biopsy (Crypt hypertrophy, Villious atrophy)

Answer 11

``` Vitamin deficiency Anaemia Osteoporosis Ulcerative jejunitis Enteropathy-associated T-cell lymphoma of the intestine Non-Hodgkin Lymphoma Small bowel adenocardinoma (rare) ```

Answer 12

N - No blood or mucus (less common in crohns) E - Entire GI tract S - Skip lesions (on endoscopy) T - Terminal ilium most affected T - Transmural (full thickness) inflammation S - Smoking is a risk factor (Don’t set the NEST on fire!)

Answer 13

``` C - Continuous inflammation L- Limited to colon or rectum O - Only superficial mucosa affected S - Smoking is preventative E - Excrete blood and mucus U - Use AMINOSALICYLATES P - Primary sclerosing cholangitis ```

Answer 14

``` Finger clubbing Erythema nodosum Pyoderma gangrenous Episcleritis and iritis Inflammatory arthritis Primary sclerosing cholangitis (UC) ```

Answer 15

Blood tests: Anaemia, infection, thyroid, kidney, LFT FAECAL CALPROTECTIN - released by intestines when inflamed (more sensitive and specific in adults Endoscopy (ODG and colonoscopy) with biopsy - gold standard Imaging (Ultrasound, CT and MRI) - to look for any complications

Answer 16

STEROIDS Enteral nutrition: alternative to steroids in children where there are concerns about growth or side effects (taken orally, via NG tube, ND tube or NJ tube, or gastronomy) If steroids don’t work alone —> immunosuppressant medication can be given: Azathioprine, infliximab, mercaptopurine, methotrexate, adalimumab

Answer 17

Treatment tailored to individual patients First line: Azathioprine, mercaptopurine Alternatives: Methotrexate, infliximab, Adalimumab

Answer 18

If disease only affects distal ilium - possible to resect the area to prevent flares Crohns typically affects entire GI tract - surgery used to treat strictures and fistulas secondary to the disease

Answer 19

Mild to mod disease: 1st line: AMINOSALICYLATE ( e.g. mesalazine oral or rectal) 2nd line: CORTICOSTEROIDS (e.g. prednisolone) Severe disease: 1st line: IV CORTICOSTEROIDS (e.g. hydrocortisone) 2nd line: IV CICLOSPORIN

Answer 20

AMINOSALICYLATE (e.g. mesalazine oral or rectal) AZATHIOPRINE MERCAPTOPURINE

Answer 21

UC only affects colon and rectum Removing colon and rectum (panproctocolectomy) - removes disease Permanent iliostomy or ilio-anal anastomosis (J-pouch)

Answer 22

Congential condition Bile duct narrowed or absent —> cholestasis (bile cannot be transported from liver to bowel Unconjugated bilirubin therefore cant be excreted

Answer 23

Significant jaundice shortly after birth - HIGH LEVELS OF CONJUGATED BILIRUBIN Suspect biliary atresia in babies with PERSISTANT JAUNDICE - lasting more than 14 days in term babies, and more than 21 days in pre-term babies

Answer 24

KASI PORTOENTEROSOMY - attach a section of the small intestine to the opening of the liver (where the bile duct usually attaches) Patients often require a full liver transplant to resolve the problem

Answer 25

``` Meconium Ileus Hirschsprung’s disease Oesophageal atresia Duodenal atresia Intussusception Imperforate anus Mallo at ion of the intestines with a volvulus Strangulated hernia ```

Answer 26

The bowel invaginates/ telescopes into itself | Thickens the overal size of the bowel and narrows lumen in the folded areas

Answer 27

``` Concurrent viral illness Henoch-Schonlein Purpura Cystic fibrosis Intestinal polyps Meckles diverticulum ```

Answer 28

``` Severe colicky abdo pain Pale, lethargic and unwell child REDCURRENT JELLY STOOL RUQ mass on palpating (sausage shaped) Vomiting Intestinal obstruction ```

Answer 29

USS and contrast enema

Answer 30

THERAPEUTIC ENEMAS - force folded bowel back into right position SURGICAL RESECTION - may be needed in enema doesn’t work, or if the bowel becomes gangrenous or perforated

Answer 31

Central abdo pain that moves down to the RIF overtime and eventually becomes localised in the RIF Tenderness at McBurney’s point (1/3 distance from ASIS to umbilicus) Other features: Anorexia, N&V, Rovsing’s sign (Palpation on LIF causes pain in RIF), Guarding on abdo palpation, Rebound tenderness, percussion tenderness (these 2 types of tenderness suggest peritonitis)