Gastrointestinal Flashcards
What is GORD?
Reflux of stomach contents beyond the oesophagus
Name 3 risk factors for GORD
Prematurity, cerebral palsy, hiatus hernia
Why are infants more prone to GORD?
Short, narrow oesophagus, delayed gastric emptying and shorter LOS with liquid diet and high calorie requirement
What is the presentation of GORD?
Effortless regurgitation between feeds with excessive crying, unusual neck postures, back arching, hoarseness, faltering growth
What is the management of GORD?
Mix Alginate (Gaviscon) with feeds and then try PPI for 4 weeks
Surgery is nissen fundoplication
What is pyloric stenosis?
Narrowing of the pyloric sphincter between stomach and duodenum
What is the presentation of pyloric stenosis?
Projective vomiting, failure to thrive, dehydration, weight loss, abdominal mass of peristalsis (olive sized)
What are the biochemical findings of pyloric stenosis?
Metabolic alkalosis, hypochloric, hypokalaemia
What is IBS?
A functional bowel disorder with hypersenstivity of the gut
What is the ABC of IBS?
Abdominal pain, Bloating and Change in bowel habits
What is IBS treatment?
Mebeverine is an anti-spasmodic
Loperamide for IBS-D
Ispaghula husk for IBS-C
What is gastroenteritis?
Inflammation from stomach to intestines
What is the most common viral cause of gastroenteritis in children?
Rotavirus
What is the criteria for constipation?
Less than 3 stools per week
What can constipation be secondary to?
Hirschprungs, CF or hypothyroidism
What are the presentations of constipation?
PR bleeding, rectal bleeding, abnormal posture (retentive), faecal impaction with an overflow of loose, smelly stools
Not passing meconium within 48 hours of birth is a red flag for what?
CF or Hirschprungs
Constipation with ribbon stool?
Anal stenosis
Constipation with abnormal anus?
Anal stenosis, IBD or abuse
Constipation with failure to thrive?
Coeliac disease, hypothyroidism, safeguarding
What is the 1st line laxative for constipation?
Movicol
What are the causes of appendicitis?
Faecolith, foreign body, intestinal worms
Where is McBurney’s point?
2/3 from ASIS to umbilicus
What are the 3 signs of appendicitis?
Rosvings sign - palpation of LIF causes RIF pain
Psoas sign - RIF pain on right hip flexion
Obturator sign - RIF pain on right hip flexion and internal rotation
Name some differentials of appendicitis
Ovarian cyst, ectopic pregnancy, mesenteric adenitis, bacillus cereus, meckel diverticulum
What is an inguinal hernia?
A reducible swelling in the groin often extending into the scrotum
What does NESTS stand for in Chrons Disease?
No blood or mucus
Entire GI tract
Skip lesions and cobblestoning
Terminal ileum most affected and transmural inflammation
Smoking is a risk factor
What are the strongest associated genes with Chrons Disease?
CARD15 and NOD2
What does CLOSE UP stand for in Ulcerative Colitis?
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa affected
Smoking is protective
Excrete blood and mucus
Use aminosalicylates
Primary sclerosing cholangitis
What does A PIE SAC stand for in IBD?
Ankylosing spondylitis
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Aphthous ulcers, amyloidosis
Clubbing
What is the gold standard diagnosis for IBD?
OGD with colonoscopy and biopsy
What can raise in flares of IBD?
CRP
What can induce remission of Chrons Disease?
Polymeric diet (liquid)
What does CUSHINGOID stand for?
Long-term steroid use
Cataracts
Ulcers
Striae and thin skin
HTN and hirturism
Immunosuppression
Necrosis of femoral heads
Glucose elevated
Osteoporosis
Impaired wound healing
Depression
What is coeliac disease?
An autoimmune condition triggered by gluten peptides in wheat, barley and rye
What are the genes associated with coeliac disease?
HLA-DQ2, DQ8
What are the symptoms of coeliac disease?
dermatitis herpetiformis, angular stomatitis, mouth ulcers, steatorrhoea, failure to thrive, weight loss, bloating
What are the tests for coeliac disease?
Anti-TTG and anti-EMA
Endoscopy and duodenal biopsy showing villous atrophy, crypt hyperplasia and increased epithelial lymphocytes
What do you test new cases of coeliac disease for?
Type 1 diabetes
Name 3 complications of coeliac disease?
T cell lymphoma of the intestine, vitamin deficiency, osteoporosis, ulcerative jejunitis, anaemia
What are inadequate nutritional intake causes of failure to thrive?
Maternal malabsorption if breastfeeding, iron deficiency, anaemia, neglect, poverty
What are feeding difficulty causes of failure to thrive?
poor suck - cerebral palsy, cleft lip or palate, pyloric stenosis
What are malabsorption causes of failure to thrive?
IBD, CF, coeliac, cow milk intolerance
What are increased energy needs causes of failure to thrive?
CF, congenital heart disease, HIV, malignancy
What is kwashiorkor?
Extreme malnutrition with oedema
What is the presentation of kwashiorkor?
Flaky pain skin rash with hyperkeratosis, distended abdomen and enlarged liver, angular stomatitis
What is the presentation of marasmus?
Normal hair, wizened appearance, thin limbs with little muscle or fat
What is Hirschprungs?
A congenital condition where ganglion nerve cells of the myenteric plexus are absent in the distal bowel and rectum so the bowel loses motility
Name some genes and associations for Hirschprungs
Family history, males (4:1), Downs, neurofibromatosis, MEN II
What is the presentation of Hirschprungs?
Acute intestinal obstruction shortly after birth, more than 24 hour delay passing meconium, abdominal pain and distension, bilious vomiting
What is the gold standard diagnosis for Hirschprungs?
Suction rectal biopsy
What is intussusception?
The bowel folds in on itself narrowing the lumen leading to a palpable mass in the abdomen
What is the presentation of intussusception?
Severe colicky abdominal pain with sausage shaped RUQ mass, pale, lethargic and unwell child, redcurrent jelly stool, vomiting, intestinal obstruction
What is the diagnosis of intussusception?
Target sign on USS
X-ray of abdomen showing distended small bowel and absence of gas in distal colon or rectum
What is cow milk protein allergy?
An immune mediated allergic response to proteins whey and casein in milk that can be IgE mediated or non-IgE
What is the presentation of IgE mediated cow milk protein allergy?
Acute and rapid onset, pruritus, erythema, acute urticaria, acute angio-oedema, nausea, vomiting, abdominal pain
What is the presentation of non-IgE mediated cow milk protein allergy?
Non-acute and delayed, eczema, pruritus, erythema, GORD, loose stools
What is biliary atresia?
A congenital condition with progressive destruction or absence of the extrahepatic biliary tree and intrahepatic biliary ducts
What is the presentation of biliary atresia?
Failure to thrive, mildly jaundiced, pale stools and dark urine from conjugated bilirubin
What is the surgery for biliary atresia?
Kasai portoenterostomy
What is a choledochal cyst?
Congenital abnormality of the duct that transports bile from the liver to the gallbladder and small intestine
What is the presentation of choledochal cyst?
Often asymptomatic but can also be abdominal mass, pain in RUQ, jaundice, nausea and vomiting
Give some physiological causes of neonatal jaundice
breakdown of in-utero Hb, immature liver
Give some pathological causes of neonatal jaundice
onset less than 24 hours, G6PD deficiency, spherocytosis
Give some prolonged causes of neonatal jaundice
Biliary atresia, hypothyroidism, breast milk jaundice, UTI
What is the management options for neonatal jaundice?
Phototherapy, exchange transfusion
What is neonatal hepatitis syndrome?
Inflammation of the liver, 1-2 months after birth
Can be due to Alpha-Antitrypsin deficiency and galactosaemia
What can be given to stimulate the liver to excrete additional bile in neonatal hepatitis syndrome?
Phenobarbital
