Gastrointestinal Flashcards
GORD
Presence of the symptoms of reflux. Regurgitation - Reflux of stomach contents beyond the oesophagus. Contents from the stomach reflux through the lower oesophageal sphincter.
Immaturity of the lower esophageal sphincter = content reflux easily.
GORD impacts ___% of infants
40
When does GORD usually appear?
first 2 weeks of life
Who is GORD more common in?
premature babies
Symptoms of GORD
-Symptoms should have started in the first 2 months of life -Distressed behaviour
-Feeding difficulty
-Chronic crying
-Faltering Growth
-If onset is >6 months or symptoms continue over 1 year, it is unlikely to be reflux - Often after large feeds. - Chronic cough, hoarse cry, reluctance to feed and poor weight gain.
Ix for GORD
-Urinalysis to rule out UTI (RARELY = barium meal and endoscopy.)
Management of GORD
-Usually resolves by 1 year of life -Can mix alginate with feeds (Gaviscon) for breastfed babies
-For formula fed, encourage smaller, more regular feeds otherwise use thickened formula
-Consider trial to PPI for 4 weeks
Referral if symptoms still persisting. Treatment = gaviscon, thickened milk and PPIs
Red Flags for GORD
-Projectile vomiting.-Bile stained vomiting -Reduced consciousness and bulging fontanelle Signs of infection
Advice for parents with children who have GORD?
small meals, burping regularly and not-over feeding.
Sandifer’s syndrome is a rare complication of GORD. What is it?
Brief episodes of abnormal movement associated with GORD. Torticollis and dystonia. Tx = resolvement of GORD.
What is torticolis?
-Torticollis = forceful contraction of the neck = twisting of the neck.
What is Dystonia?
-Dystonia = abnormal muscle contraction = arching of the back.
Why is it important to differiate GORD ?
Important to differentiate this as normally babies do regurgitate as the lower oeseopahgeal sphincter is still immature therefore it is easily for stomach contents to regurg however the key thing with this is that babies will be well and growing normally
What is poor feeding in paediatrics?
Poor feeding refers to an infant or child not feeding as expected, either due to reduced intake, difficulties during feeding, or an underlying medical condition.
Poor feeding in infants is characterized by ________ intake or difficulties during ________.
Reduced; feeding
What are some common causes of poor feeding in infants?
Infection (e.g., sepsis, UTI, respiratory infections).
Gastroesophageal reflux disease (GERD).
Congenital heart disease.
Neurological conditions (e.g., cerebral palsy).
Structural abnormalities (e.g., cleft palate).
Feeding aversion or maternal factors (e.g., poor latch, inadequate milk supply).
Congenital ________ disease and ________ reflux are common causes of poor feeding in infants.
Heart; gastroesophageal
What are some red flags associated with poor feeding in infants?
Lethargy or drowsiness.
Persistent vomiting.
Poor weight gain or weight loss.
Signs of dehydration (e.g., sunken fontanelle, reduced wet nappies).
Difficulty breathing.
Cyanosis or pallor.
Red flags in poor feeding include lethargy, ________ gain, and signs of ________.
Poor weight; dehydration
What key points should be included in the history of a child with poor feeding?
Feeding history (frequency, duration, difficulties).
Associated symptoms (e.g., vomiting, cough, fever).
Growth and development milestones.
Antenatal and birth history.
Family history of conditions affecting feeding.
A detailed history for poor feeding should include ________ history and associated ________.
Feeding; symptoms
What are some physical examination findings to look for in poor feeding?
Signs of dehydration (e.g., dry mucous membranes, sunken eyes).
Growth parameters (e.g., weight, length, head circumference).
Respiratory distress (e.g., tachypnoea, intercostal recession).
Cardiac murmurs or cyanosis.
Neurological signs (e.g., abnormal tone, reflexes).
Structural abnormalities (e.g., cleft palate).
A physical examination for poor feeding should assess for signs of ________, respiratory distress, and ________ abnormalities.
Dehydration; structural
What investigations might be indicated for an infant with poor feeding?
Blood tests: FBC, CRP, blood glucose, electrolytes.
Urine analysis: To rule out UTI.
Echocardiogram: If congenital heart disease is suspected.
Swallow study: For structural abnormalities or aspiration.
Imaging: Chest X-ray or brain imaging if neurological causes are suspected.
Blood ________, urine analysis, and ________ are key investigations in poor feeding.
Tests; echocardiogram
What is the role of growth charts in evaluating poor feeding?
Growth charts are used to monitor weight, length, and head circumference over time to assess for faltering growth or failure to thrive.
________ charts help assess faltering growth or failure to ________ in poor feeding.
Growth; thrive
How is gastroesophageal reflux disease (GERD) managed in infants with poor feeding?
Positioning (upright after feeds).
Thickened feeds.
Medications if severe (e.g., proton pump inhibitors like omeprazole).
GERD in infants is managed with upright positioning, ________ feeds, and ________ if severe.
Thickened; proton pump inhibitors
What are the principles of management for poor feeding?
Treat the underlying cause (e.g., infection, structural abnormality).
Nutritional support (e.g., NG feeding if needed).
Parent education on feeding techniques.
Monitoring growth and hydration status.
Multidisciplinary involvement if complex (e.g., dietitian, speech therapist).
Management of poor feeding includes treating the underlying ________ and providing ________ support.
Cause; nutritional
What is faltering growth, and how does it relate to poor feeding?
Faltering growth refers to insufficient weight gain or inappropriate weight loss in infants, often secondary to poor feeding or inadequate nutrient intake.
Faltering growth in infants is often secondary to ________ or inadequate ________ intake.
Poor feeding; nutrient
Pyloric Stenosis
Progressive hypertrophy of the pyloric sphincter causing gastric outlet obstruction
Pyloric Stenosis is more common in ____
Boys
Epidemiology of Pyloric Stenosis
Affects 1 in 500 - Family history - First borns
Symptoms of Pyloric Stenosis
Presents 4-6 weeks of age - Non bilious, forceful, projectile vomiting after every feed approx 30 mins - Will continue to feed despite vomiting - Weight loss - Dehydration - Constipation - Visible peristalsis
Signs of Pyloric Stenosis
Palpable olive sized pyloric mass felt
Ix for Pyloric Stenosis
Test feed with NG tube and empty stomach to feel for visible peristalsis and olive shaped mass + USS + Blood gas
Gold Standard Ix for Pyloric Stenosis
USS
What will USS show for Pyloric Stenosis
Hypertrophic pylorus (target sign)
What will a blood gas show for Pyloric Stenosis
Hypochloremic, Hypokalemic Metabolic Alkalosis (loss of hydrogen and chloride ions due to vomiting gastric contents)
Management for Pyloric Stenosis
Correct metabolic imbalances - NaCl - Fluid bolus for hypovolemia - NG tube and aspiration of the stomach - Ramstedt’s Pyloromyotomy
How long after Ramstedt’s Pyloromyotomy can feeding commence?
feeding can commence 6 hours after procedure
What is Irritable Bowel Syndrome (IBS)?
IBS is a functional gastrointestinal disorder characterized by recurrent abdominal pain or discomfort associated with altered bowel habits in the absence of identifiable organic disease.
Irritable Bowel Syndrome (IBS) is a ________ gastrointestinal disorder with no identifiable ________ cause.
Functional; organic
What are the common clinical features of IBS in children?
Recurrent abdominal pain (often in the lower abdomen).
Altered bowel habits: diarrhoea, constipation, or alternating patterns.
Relief of symptoms after defecation.
Bloating or abdominal distension.
Mucus in stools (sometimes).
IBS symptoms often include recurrent abdominal ________ and altered ________ habits.
Pain; bowel
What are the criteria for diagnosing IBS in children?
Abdominal pain or discomfort at least once a week for the last three months.
Symptoms associated with two or more of the following:
Related to defecation (improved or worsened).
Change in stool frequency.
Change in stool form (appearance).
Diagnosis of IBS includes abdominal ________ occurring at least ________ a week for three months.
Pain; once
What investigations are used to exclude organic causes in children with suspected IBS?
Stool tests: for infections or inflammatory markers (e.g., calprotectin).
Blood tests: FBC, CRP, ESR, coeliac serology.
Imaging: Abdominal ultrasound (if red flags present).
Lactose tolerance or hydrogen breath test (if lactose intolerance is suspected).
Stool tests for IBS rule out infections or ________, while blood tests check for coeliac disease or ________.
Inflammation; anaemia
What are the red flag symptoms in children with suspected IBS that require further investigation?
Unintentional weight loss.
Persistent diarrhoea.
Nocturnal symptoms.
Rectal bleeding.
Family history of inflammatory bowel disease or coeliac disease.
Red flags for IBS include ________ bleeding and unintentional ________ loss.
Rectal; weight
What is the initial management of IBS in children?
Reassurance and education about the functional nature of IBS.
Dietary advice:
Avoid triggers like caffeine, fizzy drinks, or fatty foods.
Trial of a low FODMAP diet (if appropriate).
Regular meals with a balanced diet.
Encouraging adequate hydration and physical activity.
Dietary advice for IBS includes avoiding ________ foods and considering a ________ diet.
Trigger; low FODMAP
What pharmacological treatments may be used in paediatric IBS?
Antispasmodics (e.g., hyoscine, peppermint oil) for abdominal pain.
Laxatives for constipation (e.g., polyethylene glycol).
Anti-diarrhoeal agents (e.g., loperamide) for diarrhoea.
Probiotics may be trialled to improve gut flora.
Antispasmodics like ________ are used for abdominal pain in IBS, while ________ agents treat diarrhoea.
Peppermint oil; anti-diarrhoeal
How can psychological support help children with IBS?
Psychological therapies like cognitive behavioural therapy (CBT) or counselling can reduce stress and improve coping mechanisms, as stress often exacerbates IBS symptoms.
Psychological therapies like ________ help reduce stress, which often worsens ________ symptoms.
CBT; IBS
What complications can arise from IBS in children?
Reduced quality of life due to chronic symptoms.
Social or school avoidance.
Anxiety and depression.
Nutritional deficiencies (in severe cases).
IBS complications include reduced ________ of life and potential nutritional ________.
Quality; deficiencies
What lifestyle modifications are recommended for children with IBS?
Regular sleep routines.
Adequate physical activity.
Stress reduction techniques (e.g., mindfulness, relaxation exercises).
Structured daily routines for meals and activities.
Lifestyle changes for IBS include ________ reduction and maintaining regular ________ routines.
Stress; sleep
Gastroenteritis
Infection and inflammation in stomach and intestines
Most common causes for Gastroenteritis
Rotavirus and Norovirus
Other causes of Gastroenteritis
-Bacterial: campylobacter jejuni, shigella, salmonella, e.coli (0157)
Symptoms of Gastroenteritis
-Nausea -Diarrhoea
-Vomiting
-Fever
-Dehydration
Ix for Gastroenteritis
-Clinical diagnosis -Stool sample may help identify cause
Management of Gastroenteritis
-Oral rehydration solution IV fluid only required for shock or clinical deterioration
Constipation
An extremely common condition affecting children characterised by decreased frequency, increased harness of the stool and painful defecation. - Most cases of constipation are idiopathic
Secondary Causes of Constipation
Hirschprung’s disease - Cystic fibrosis - Hypothyroidism - Spinal cord lesions - Sexual abuse - Intestinal obstruction - Cows milk intolerance
Symptoms of Constipation
Less than 3 stools a week - Hard stools that are difficult to pass - Rabbit dropping stools - Straining and painful passages of stools - Abdominal pain - Overflow soiling caused by faecal impaction - Palpable hard stools in the abdomen
Management of Constipation
Idiopathic constipation can be diagnosed clinically, once red flags have been considered. - Correction of any reversible contributors e.g. high fibre diet, good hydration - Laxatives: Movicol is first line - Disimpaction regimen may be needed with high dose of laxatives at first followed by half the disimpaction dose as maintenance - Encouragement of visiting the toilet to reduce withholding.
What is the first line laxative for Constipation tx ?
Movicol
What is appendicitis?
Appendicitis is the inflammation of the appendix, a small, blind-ended tube attached to the cecum, typically caused by obstruction of the appendiceal lumen.
Appendicitis is the inflammation of the ________, often caused by obstruction of the ________ lumen.
Appendix; appendiceal
What are the common causes of appendiceal lumen obstruction?
Fecaliths (hardened stool).
Lymphoid hyperplasia (e.g., after viral infections).
Foreign bodies.
Parasites (e.g., worms).
Common causes of appendiceal obstruction include fecaliths, ________ hyperplasia, foreign bodies, and ________.
Lymphoid; parasites
What are the classic clinical features of appendicitis in children?
Abdominal pain, initially periumbilical and later localized to the right iliac fossa (RIF).
Nausea and vomiting.
Fever.
Reduced appetite (anorexia).
Guarding and rebound tenderness in RIF.
In appendicitis, abdominal pain typically starts in the ________ region and later localizes to the ________.
Periumbilical; right iliac fossa
What atypical symptoms of appendicitis may be seen in younger children?
Diffuse or poorly localized abdominal pain.
Vomiting as the primary symptom.
Irritability or lethargy.
Diarrhoea or urinary symptoms (e.g., dysuria).
Atypical symptoms of appendicitis in younger children may include ________ pain and ________ as the primary symptom.
Diffuse; vomiting
What is McBurney’s point?
McBurney’s point is located one-third of the way along a line from the anterior superior iliac spine (ASIS) to the umbilicus, where tenderness is often observed in appendicitis.
McBurney’s point is located between the ________ and the ________.
Anterior superior iliac spine (ASIS); umbilicus
What investigations are commonly used to diagnose appendicitis in children?
Blood tests: raised white cell count (WCC) and CRP.
Ultrasound: to visualize an inflamed or swollen appendix.
CT scan (if ultrasound is inconclusive).
Urinalysis: to rule out urinary tract infection (UTI).
In suspected appendicitis, ________ is the preferred imaging modality, while a ________ scan is used if the diagnosis is unclear.
Ultrasound; CT
What is the Alvarado score?
The Alvarado score is a clinical scoring system used to assess the likelihood of appendicitis. It includes parameters such as migratory pain, anorexia, nausea/vomiting, tenderness in RIF, rebound pain, fever, WCC, and neutrophil count.
The ________ score is used to assess the likelihood of appendicitis and includes symptoms like ________ pain and fever.
Alvarado; migratory
What is the definitive management for appendicitis?
Appendectomy, which can be performed laparoscopically or via open surgery.
The definitive treatment for appendicitis is ________, which can be performed laparoscopically or via ________ surgery.
Appendectomy; open
When might conservative management of appendicitis be considered?
Conservative management, involving antibiotics alone, may be considered in specific cases, such as mild appendicitis or in patients unfit for surgery.
In mild cases of appendicitis or patients unfit for surgery, ________ management with ________ may be considered.
Conservative; antibiotics
What are the potential complications of untreated appendicitis?
Appendiceal rupture.
Peritonitis.
Abscess formation.
Sepsis.
Complications of untreated appendicitis include ________ rupture, ________, and abscess formation.
Appendiceal; peritonitis
How can appendicitis present differently in cases of pelvic appendicitis?
Pelvic appendicitis may cause lower abdominal pain, diarrhoea, urinary symptoms, and tenderness during a rectal or vaginal examination.
Pelvic appendicitis may cause ________ abdominal pain, diarrhoea, and ________ symptoms.
Lower; urinary
Why might a child with appendicitis have a normal appetite?
A normal appetite is rare in appendicitis and should prompt reconsideration of the diagnosis, as anorexia is a typical feature.
A child with appendicitis typically presents with ________, and a normal ________ is uncommon.
Anorexia; appetite
What is a hernia?
A hernia is the protrusion of an organ or tissue through an abnormal opening or weakened area in the surrounding muscle or connective tissue.
A hernia is the ________ of an organ or tissue through an ________ or weakened area in muscle or connective tissue.
Protrusion; abnormal opening
What are the two main types of hernia in paediatrics?
Inguinal hernia.
Umbilical hernia.
The two main types of hernia in children are ________ hernia and ________ hernia.
Inguinal; umbilical
What is the difference between a direct and indirect inguinal hernia?
Indirect inguinal hernia: Protrusion occurs through the deep inguinal ring, following the inguinal canal, often congenital due to a patent processus vaginalis.
Direct inguinal hernia: Protrusion occurs directly through the posterior wall of the inguinal canal, usually acquired and rare in children.
An ________ inguinal hernia occurs through the deep inguinal ring, while a ________ inguinal hernia occurs directly through the posterior wall of the inguinal canal.
Indirect; direct
What are the risk factors for an inguinal hernia in children?
Prematurity.
Male sex.
Family history of inguinal hernia.
Conditions causing increased intra-abdominal pressure (e.g., cystic fibrosis, ascites).
Risk factors for inguinal hernia in children include prematurity, ________ sex, and conditions that increase ________ pressure.
Male; intra-abdominal
What are the clinical features of an inguinal hernia in children?
Swelling in the groin, more noticeable when crying or straining.
Reducible lump.
Non-tender unless complicated.
The clinical features of an inguinal hernia include a ________ lump in the groin that becomes more noticeable when ________ or straining.
Reducible; crying
What is the management of an inguinal hernia in children?
Surgical repair (inguinal herniotomy), often performed urgently in infants to prevent complications like incarceration.
The management of inguinal hernia involves ________, typically performed urgently in ________.
Surgical repair; infants
What are the complications of an untreated inguinal hernia?
Incarceration: Trapping of hernia contents, leading to obstruction.
Strangulation: Compromised blood supply, leading to ischaemia.
Complications of an untreated inguinal hernia include ________, where the contents are trapped, and ________, where the blood supply is compromised.
Incarceration; strangulation
What is an umbilical hernia?
An umbilical hernia is a protrusion of abdominal contents through the umbilical ring, often due to incomplete closure of the abdominal wall.
An ________ hernia is the protrusion of abdominal contents through the ________ ring.
Umbilical; umbilical
What are the typical features of an umbilical hernia in children?
Swelling at the umbilicus, more prominent when crying.
Reducible and non-tender lump.
Most resolve spontaneously by 3-5 years of age.
Most umbilical hernias in children resolve spontaneously by ________ years of age.
36955
What is the management of an umbilical hernia in children?
Observation for spontaneous resolution.
Surgical repair if it persists beyond 5 years or is symptomatic.
Umbilical hernias are usually managed with ________, but ________ repair is performed if they persist beyond 5 years or are symptomatic.
Observation; surgical
What is an epigastric hernia, and how does it differ from umbilical and inguinal hernias?
An epigastric hernia is a defect in the linea alba above the umbilicus, involving preperitoneal fat. Unlike umbilical and inguinal hernias, it often causes pain and is not reducible.
An epigastric hernia occurs in the ________ above the umbilicus and typically involves ________ fat.
Linea alba; preperitoneal
What is the risk of hernia recurrence after repair in children?
Recurrence is rare but may occur if there is incomplete closure or underlying risk factors like prematurity or connective tissue disorders.
Hernia recurrence after repair is ________, but risks increase with incomplete closure or ________ disorders.
Rare; connective tissue
What is Inflammatory Bowel Disease (IBD)?
IBD is a group of chronic inflammatory conditions of the gastrointestinal tract, primarily including Crohn’s disease and ulcerative colitis.
IBD consists of chronic inflammatory conditions of the GI tract, primarily ________ disease and ________ colitis.
Crohn’s; ulcerative
What is the difference between Crohn’s disease and ulcerative colitis?
Crohn’s disease: Can affect any part of the GI tract, from mouth to anus, with skip lesions and transmural inflammation.
Ulcerative colitis: Limited to the colon and rectum, with continuous inflammation confined to the mucosa and submucosa.
________ disease affects the entire GI tract with skip lesions, while ________ colitis is confined to the colon and rectum with continuous inflammation.
Crohn’s; ulcerative
What are the common clinical features of IBD in children?
Abdominal pain.
Chronic diarrhea (may be bloody in ulcerative colitis).
Weight loss and growth failure.
Fatigue.
Perianal disease (specific to Crohn’s).
Common symptoms of IBD in children include abdominal ________, chronic ________, and weight ________.
Pain; diarrhea; loss
What are the extraintestinal manifestations of IBD in children?
Arthritis.
Erythema nodosum.
Uveitis or episcleritis.
Primary sclerosing cholangitis.
Aphthous ulcers.
Extraintestinal manifestations of IBD include arthritis, ________ nodosum, and ________ cholangitis.
Erythema; primary sclerosing
What investigations are used to diagnose IBD in children?
Blood tests: FBC, CRP, ESR, LFTs, and iron studies.
Stool tests: Calprotectin, culture, and Clostridium difficile testing.
Imaging: Endoscopy with biopsy, MRI for small bowel disease.
Key stool test for IBD diagnosis is ________, while endoscopy with ________ is essential for confirmation.
Calprotectin; biopsy
How does fecal calprotectin help in diagnosing IBD?
Fecal calprotectin is a marker of intestinal inflammation, useful for distinguishing IBD from irritable bowel syndrome (IBS).
________ calprotectin is a marker of intestinal inflammation used to distinguish IBD from ________.
Fecal; IBS
What is the first-line management for mild-to-moderate ulcerative colitis in children?
Aminosalicylates, such as mesalazine.
First-line treatment for mild-to-moderate ulcerative colitis is _______
Mesalazine
What are the treatment options for Crohn’s disease in children?
Exclusive enteral nutrition (EEN).
Corticosteroids for acute flares.
Immunomodulators (e.g., azathioprine).
Biologics (e.g., infliximab).
In Crohn’s disease, ________ nutrition is a key dietary intervention, while ________ are used for acute flares.
Exclusive enteral; corticosteroids
What is exclusive enteral nutrition (EEN), and how is it used in Crohn’s disease?
EEN involves using a liquid formula diet for 6-8 weeks as a first-line treatment to induce remission, particularly in pediatric Crohn’s disease.
Exclusive enteral nutrition involves a liquid formula diet for ________ weeks to induce ________ in Crohn’s disease.
6-8; remission
What surgical options are available for IBD in children?
Colectomy for ulcerative colitis refractory to medical treatment.
Resection of strictures or fistulas in Crohn’s disease.
Surgery for refractory ulcerative colitis involves ________, while ________ is performed for strictures in Crohn’s disease.
Colectomy; resection
