Gastroenterology part 2 Flashcards
Why do 50% of all newborns become jaundiced?
Incr release of Hb from breakdown of RBC
Shorter RBC lifespan in children
Hepatic bilirubin metabolism less effective 1st few days life
What serious condition can neonatal jaundice lead to
Kernicterus
What is kernicterus
Unconjugated bilirubin is deposited in BG –> encephyalopathy as can cross BBB
Sx acute kernicterus
Lethargy
Sx severe kernicterus (2)
Irritability
Seizures
What condition can kernicterus lead to
Cerebral palsy
Causes of neonatal jaundice - <24hrs old (5)
Rhesus ABO incompatibility G6DP deficiency Spherocytosis Infection - TORCH/Rubella/CMV, HSV
How can ABO incompatibility lead to neonataljanudice>
Group O women’s IgG’s haemolyse RBC of group A infants
or group B
Causes of jaundice - 24h to 2w (7)
Physiological Breast milk jaundice Infection Haemolysis Bruising Polycythaemia Crigler-nijjar
Causes of jaundice - conjugated - >2 weeks (3)
Bile duct obstruction
Neonatal hepatitis
Biliary atresia
Causes of jaundice - unconjugated - >2w (6)
Physiological/breast milk Infection - UTI Hypothyroidism Haemolytic - G6PD GI obstruction - pyloric stenosis Crigler Nijjar
Ix neonatal jaundice
Serum bilirubin - is it conjugated or unconjugated
FBC
Coombs
Infection screen prn
Mx neonatal jaundice
Correct dehydreation
Phototherapy - UV light 450nm. Cover infants eyes and repeat serum biliruin levels at 4-6hrs
exchange transfusion if severe via art line
What will happen if you perform phototherapy on a conjugated hyperbilirubinaemia baby
baby will get macular rash and bronzed skin
What is biliary atresia
Progressive fibrosis and obliteration of extrahepatic and intrahepatic biliary tree
What happens if you do not intervene with biliary atresia?
Chronic liver disease and death within 2 years
PS biliary atresia (5)
Mild jaundice Pale stools Faltering growth Hepatomegaly Splenomegaly
Ix biliary atresia (4)
LFTs
Abdo USS
ERCP
Liver biopsy
What would you see on an abdominal USS - biliary atresia
Contracted/absent GB
Tx biliary atresia
Palliative surgery
If fails offer liver transplant
What age does coeliac disease PS
8-24m (when gluten intro;d to diet)
PS coeliac disease (5)
FTT ABdo distention Buttocks wasting irritable Anaemia
Ix Coeliac (3)
+ve IgA antibodies serology
Flat mucosa jejunal biopsy
Resolution of Sx once gluten withdrawn
Mx coeliac (3)
Gluten free diet
Annual review to check height + W
Gluten challenge
What is a 1’ food allergy
Child fails to devlop immune tolerance against food
What is a 2’ food allergy
Initially tolerate but becomes allergic due to cross reactivity betw proteins + those in allergens
Sx IgE med food allergies (3)
Anaphylaxis
Facial swelling
10-15mins post ingestion
Sx non-IgE mediated food allergy (3)
Diarrhoea
Vom
Abdo pain
RF food allergy (4)
FHx Atopy PMHx Age Asthma
What is T2HS?
Neutrophils bind to substance, lytic enzymes are released –> tissue damage
Mx T1 HS
Child must be able to manage attacks
Anti-histamines/epipen
Mx T2HS allergy
Avoid food
Def malabsoprtion
Subnormal intestinal absorption of dietary constituents w/ XS faecal nutrient loss
DDx malabsorption - intraluminal (5)
Lactose intolerance CF Pancreaitits Pernicious anemia Protein E malnutrition
DDx malabsorption - mucosal abnormality (4)
Coeliac
Short bowel syndrome
CMPA
IBD
Ix malabsorption
bloods
coeliac ab
stools MCS
If still unclear - endoscopy/biopsy/ sweat test a1-antitrypsin etc
What is colic? (3)
Paroxysmal insolable crying
Drawing up of knees
Excessive flatulence
What % of babies suffer w/ oclic
40%
Mxc colic
Entirely benign
Visit GP if worried
HV/Cry-SIS - give support to parents
