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3a Child Health > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is GORD?

A

Reflux of stomach contents beyond the oesophagus

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2
Q

Name 3 risk factors for GORD

A

Prematurity, cerebral palsy, hiatus hernia

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3
Q

Why are infants more prone to GORD?

A

Short, narrow oesophagus, delayed gastric emptying and shorter LOS with liquid diet and high calorie requirement

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4
Q

What is the presentation of GORD?

A

Effortless regurgitation between feeds with excessive crying, unusual neck postures, back arching, hoarseness, faltering growth

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5
Q

What is the management of GORD?

A

Mix Alginate (Gaviscon) with feeds and then try PPI for 4 weeks
Surgery is nissen fundoplication

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6
Q

What is pyloric stenosis?

A

Narrowing of the pyloric sphincter between stomach and duodenum

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7
Q

What is the presentation of pyloric stenosis?

A

Projective vomiting, failure to thrive, dehydration, weight loss, abdominal mass of peristalsis (olive sized)

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8
Q

What are the biochemical findings of pyloric stenosis?

A

Metabolic alkalosis, hypochloric, hypokalaemia

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9
Q

What is IBS?

A

A functional bowel disorder with hypersenstivity of the gut

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10
Q

What is the ABC of IBS?

A

Abdominal pain, Bloating and Change in bowel habits

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11
Q

What is IBS treatment?

A

Mebeverine is an anti-spasmodic
Loperamide for IBS-D
Ispaghula husk for IBS-C

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12
Q

What is gastroenteritis?

A

Inflammation from stomach to intestines

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13
Q

What is the most common viral cause of gastroenteritis in children?

A

Rotavirus

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14
Q

What is the criteria for constipation?

A

Less than 3 stools per week

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15
Q

What can constipation be secondary to?

A

Hirschprungs, CF or hypothyroidism

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16
Q

What are the presentations of constipation?

A

PR bleeding, rectal bleeding, abnormal posture (retentive), faecal impaction with an overflow of loose, smelly stools

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17
Q

Not passing meconium within 48 hours of birth is a red flag for what?

A

CF or Hirschprungs

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18
Q

Constipation with ribbon stool?

A

Anal stenosis

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19
Q

Constipation with abnormal anus?

A

Anal stenosis, IBD or abuse

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20
Q

Constipation with failure to thrive?

A

Coeliac disease, hypothyroidism, safeguarding

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21
Q

What is the 1st line laxative for constipation?

A

Movicol

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22
Q

What are the causes of appendicitis?

A

Faecolith, foreign body, intestinal worms

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23
Q

Where is McBurney’s point?

A

2/3 from ASIS to umbilicus

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24
Q

What are the 3 signs of appendicitis?

A

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

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25
Q

Name some differentials of appendicitis

A

Ovarian cyst, ectopic pregnancy, mesenteric adenitis, bacillus cereus, meckel diverticulum

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26
Q

What is an inguinal hernia?

A

A reducible swelling in the groin often extending into the scrotum

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27
Q

What does NESTS stand for in Chrons Disease?

A

No blood or mucus
Entire GI tract
Skip lesions and cobblestoning
Terminal ileum most affected and transmural inflammation
Smoking is a risk factor

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28
Q

What are the strongest associated genes with Chrons Disease?

A

CARD15 and NOD2

29
Q

What does CLOSE UP stand for in Ulcerative Colitis?

A

Continuous inflammation
Limited to colon and rectum
Only superficial mucosa affected
Smoking is protective
Excrete blood and mucus
Use aminosalicylates
Primary sclerosing cholangitis

30
Q

What does A PIE SAC stand for in IBD?

A

Ankylosing spondylitis
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Aphthous ulcers, amyloidosis
Clubbing

31
Q

What is the gold standard diagnosis for IBD?

A

OGD with colonoscopy and biopsy

32
Q

What can raise in flares of IBD?

A

CRP

33
Q

What can induce remission of Chrons Disease?

A

Polymeric diet (liquid)

34
Q

What does CUSHINGOID stand for?

A

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

35
Q

What is coeliac disease?

A

An autoimmune condition triggered by gluten peptides in wheat, barley and rye

36
Q

What are the genes associated with coeliac disease?

A

HLA-DQ2, DQ8

37
Q

What are the symptoms of coeliac disease?

A

dermatitis herpetiformis, angular stomatitis, mouth ulcers, steatorrhoea, failure to thrive, weight loss, bloating

38
Q

What are the tests for coeliac disease?

A

Anti-TTG and anti-EMA
Endoscopy and duodenal biopsy showing villous atrophy, crypt hyperplasia and increased epithelial lymphocytes

39
Q

What do you test new cases of coeliac disease for?

A

Type 1 diabetes

40
Q

Name 3 complications of coeliac disease?

A

T cell lymphoma of the intestine, vitamin deficiency, osteoporosis, ulcerative jejunitis, anaemia

41
Q

What are inadequate nutritional intake causes of failure to thrive?

A

Maternal malabsorption if breastfeeding, iron deficiency, anaemia, neglect, poverty

42
Q

What are feeding difficulty causes of failure to thrive?

A

poor suck - cerebral palsy, cleft lip or palate, pyloric stenosis

43
Q

What are malabsorption causes of failure to thrive?

A

IBD, CF, coeliac, cow milk intolerance

44
Q

What are increased energy needs causes of failure to thrive?

A

CF, congenital heart disease, HIV, malignancy

45
Q

What is kwashiorkor?

A

Extreme malnutrition with oedema

46
Q

What is the presentation of kwashiorkor?

A

Flaky pain skin rash with hyperkeratosis, distended abdomen and enlarged liver, angular stomatitis

47
Q

What is the presentation of marasmus?

A

Normal hair, wizened appearance, thin limbs with little muscle or fat

48
Q

What is Hirschprungs?

A

A congenital condition where ganglion nerve cells of the myenteric plexus are absent in the distal bowel and rectum so the bowel loses motility

49
Q

Name some genes and associations for Hirschprungs

A

Family history, males (4:1), Downs, neurofibromatosis, MEN II

50
Q

What is the presentation of Hirschprungs?

A

Acute intestinal obstruction shortly after birth, more than 24 hour delay passing meconium, abdominal pain and distension, bilious vomiting

51
Q

What is the gold standard diagnosis for Hirschprungs?

A

Suction rectal biopsy

52
Q

What is intussusception?

A

The bowel folds in on itself narrowing the lumen leading to a palpable mass in the abdomen

53
Q

What is the presentation of intussusception?

A

Severe colicky abdominal pain with sausage shaped RUQ mass, pale, lethargic and unwell child, redcurrent jelly stool, vomiting, intestinal obstruction

54
Q

What is the diagnosis of intussusception?

A

Target sign on USS
X-ray of abdomen showing distended small bowel and absence of gas in distal colon or rectum

55
Q

What is cow milk protein allergy?

A

An immune mediated allergic response to proteins whey and casein in milk that can be IgE mediated or non-IgE

56
Q

What is the presentation of IgE mediated cow milk protein allergy?

A

Acute and rapid onset, pruritus, erythema, acute urticaria, acute angio-oedema, nausea, vomiting, abdominal pain

57
Q

What is the presentation of non-IgE mediated cow milk protein allergy?

A

Non-acute and delayed, eczema, pruritus, erythema, GORD, loose stools

58
Q

What is biliary atresia?

A

A congenital condition with progressive destruction or absence of the extrahepatic biliary tree and intrahepatic biliary ducts

59
Q

What is the presentation of biliary atresia?

A

Failure to thrive, mildly jaundiced, pale stools and dark urine from conjugated bilirubin

60
Q

What is the surgery for biliary atresia?

A

Kasai portoenterostomy

61
Q

What is a choledochal cyst?

A

Congenital abnormality of the duct that transports bile from the liver to the gallbladder and small intestine

62
Q

What is the presentation of choledochal cyst?

A

Often asymptomatic but can also be abdominal mass, pain in RUQ, jaundice, nausea and vomiting

63
Q

Give some physiological causes of neonatal jaundice

A

breakdown of in-utero Hb, immature liver

64
Q

Give some pathological causes of neonatal jaundice

A

onset less than 24 hours, G6PD deficiency, spherocytosis

65
Q

Give some prolonged causes of neonatal jaundice

A

Biliary atresia, hypothyroidism, breast milk jaundice, UTI

66
Q

What is the management options for neonatal jaundice?

A

Phototherapy, exchange transfusion

67
Q

What is neonatal hepatitis syndrome?

A

Inflammation of the liver, 1-2 months after birth
Can be due to Alpha-Antitrypsin deficiency and galactosaemia

68
Q

What can be given to stimulate the liver to excrete additional bile in neonatal hepatitis syndrome?

A

Phenobarbital

3a Child Health (14 decks)

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