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Paediatrics > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is physiological, pathological and prolonged jaundice?

A

Phy: >24hours, Peaks 3-4days, Resolves after 14days
Path: First 24hours
Pro: >14 days at term or >21 days premature

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2
Q

What are the causes of physiological, prolonged and pathological jaundice?

A 
PHYSIOLOGICAL: Bilirubin produced by inc erythrocyte breakdown of fetal Hb replaced by adult Hb
Immaturity of bilirubin conjugation system
Prematurity
Bruising
Sepsis
Haemolytic disease
Infection
Breast milk
PATHOLOGICAL: Rhesus & ABO Haemolytic disease
Red cell enzyme defect (G6PD)
Sepsis
Hereditary spherocytosis
Sickle cell anaemia
PROLONGED: biliary atresia
hypothyroidism
galactosaemia
UTI
breast milk jaundice
congenital infections (TORCH)
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3
Q

What are the investigations for neonatal jaundice?

A

Serum Bilirubin: Tx if >260
PROLONGED: Coomb’s test & Group- Incompatibility, consider haemolytic disease of the newborn, urine culture & MCS, metabolic screen, FBC, conjugated bilirubin
?Infection: TORCH screen, blood culture
Bloods: FBC, blood film, U&E, TFTs, LFT, G6PD (ethnicity)

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4
Q

What are the signs & symptoms of neonatal jaundice?

A

Cephalocaudal progression
Yellowed skin +/- sclera
Kernicterus: Unconjugated bilirubin crossing blood-brain barrier causing permenant neuronal damage
Bilirubin encephalopathy: Irritability, high pitched cry, inc muscle tone, (retrocollis & opisthotonus), abnormal moro reflex

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5
Q

How is physiological and pathological jaundice managed?

A

Serum B <260: Conservative
Serum B >260: Phototherapy (cover eyes)- repeat bilirubin 4-6hrs later
Hydrate (breast milk)
Pathological: Regardless of bilirubin levels phototherapy
Consider: Exchange transfusion

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6
Q

How is prolonged jaundice treated?

A

ANY BABY JAUNDICE >14d= Conjugated Bilirubin
Conjugated bilirubin <25 : Check for metabolic disease
Conjugated bilirubin >25: Check for biliary duct disease (biliary atresia confirmed= abdo USS- requires surgery/liver transplant)

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7
Q

What does the TORCH screen assess for? What are the associated features of these infections?

A 
Toxoplasmosis
Rubella
Cytomegalovirus: Associated hepatomegaly
Herpes Simplex
HIV
Associated features of ALL: Low birth weight, prematurity, jaundice, microcephaly, seizures, anaemia, FTT, encephalitis
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8
Q

What are the red flag signs when taking a GI history and what do they represent?

A

Vomiting: Onset after 6m or persisting beyond 1yo
Projectile vomiting: Pyloric Stenosis
Bile stained vomit: Intestinal obstruction
Abdo distension/tender/mass: Obstruction
Haematemesis
Bulging fontanelle: Raised ICP
Chronic diarrhoea: CMPA
Bloody stools: CMPA, bacterial GE
Rapid inc head circumference w/headache: Raised ICP

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9
Q

What is normal stool passage in children?

A

<1w: 4/day
1yr: 2/day
>4yr: 3/day-3/week

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10
Q

What are the causes of constipation in a child?

A 
Idiopathic: Diet, exercise, poor motility, poor activity
Hirschprungs
Anal disease
Hypersensitivity
Obstruction
Thyroid
Neuro disease
HyperCa
Dehydration
Drugs
Sexual abuse
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11
Q

What are the red flag signs in a child with constipation?

A 
Onset in first few weeks of life
Delay in passing mec
Abdo distension w/vomiting
Fhx Hirschprungs
Ribbon stool pattern
Leg weakness/ motor delay
Abnormal anal appearance: Perianal fistulae, fissures, abscess
Abuse
Cows milk protein allergy
Failure to thrive
Abnormal lumbosacral &amp; gluteal regions
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12
Q

How is constipation managed?

A

Not impacted: Dietary, young = lactulose, older= Movicol
Impacted: Disimpaction regime (with Movicol), Glycerol suppository, phosphate enema, manual evac
Behavioural: Stool chart, toilet time, star chart

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13
Q

What are the causes of GE?

A

Most viral: ROTAVIRUS, Norovirus, Adenovirus
Bacterial: Campylobacter, E.Coli, Shigella, Salmonella
Parasitic: Giardia, Cryptosporidium

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14
Q

What are the signs & symptoms of GE?

A 
Sudden onset watery diarrhoea
vomiting
More common in bottle fed babies
Cramping
Fever
Dehydration
Electrolyte imbalance
URTI w/rotavirus
Bacterial: Bloody stools &amp; tenesmus, dysentry (Blood &amp; mucous in diarrhoea)
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15
Q

What are the complications of GE?

A 
Bacteraemia
Secondary infection
Reiter's syndrome
HUS
Guillain-Barre
Reactive arthropathy
Haemorrhagic colitis
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16
Q

How is GE investigated?

A

Stool microscopy
Blood cultures
Stool C. Diff toxin
Sigmoidoscopy

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17
Q

How is GE treated?

A

Rehydrate: ORS solution (200ml >5yr after every loose stool)
Campylobacter: Erythromycin
Avoid contact for 48hours
Educate parents on sterilising bottles

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18
Q

What are the RFs for GORD in a child?

A 
Prematurity
Obesity
FHx
LOS dysfunction: Hiatus hernia
Oesophageal atresia
Neurodisability
19
Q

What is the pathophysiology of GORD?

A 
Transient lower oesophageal sphincter relaxation &amp; effortless passage of gastric content into oesophagus
Narrow oesophagus 
Delayed gastric emptying
Liquid diet
Low LOS
Usually before 8w
90% resolve <1yr
20
Q

What are the signs & symptoms of GORD in a baby?

A 
Regurgitation
Distressed
Excessive crying/ crying whilst feeding
Hoarseness
Chronic cough
Wheeze
Recurrent pneumonia
Apnoea
Unexplained feeding difficulties
Faltering growth
Retrosternal pain
Unusual neck posture (Sandifer's syndrome)
21
Q

What are the red flag signs for GORD?

A 
Projectile vomiting
Bilious vomiting
Abdo distension
Haematemesis
Raised ICP
22
Q

How is GORD investigated?

A 
When diagnosis is uncertain due to poor Tx response
pH study: X-ray with pH probe
Upper endoscopy
Oesophageal biopsy
Radioisotope milk scan
Barium enema
CXR
23
Q

How is GORD managed?

A

Position: Nurse head-up & prone
Diet: Thickened milk (Carabel), small frequent feeds, avoid food before sleep
Drugs: Gaviscon, Omeprazole/ Ranitidine, Domperidone
Surgery

24
Q

What are the causes of vomiting?

A

Acute: MOST COMMON, infection, food reaction, obstruction, DKA, raised ICP, poisoning
Chronic: PUD, obstruction, GORD, Chronic infection, food allergy, pregnancy, over-feeding
Cyclic: CNS disease, idiopathic, migraine, endocrine, metabolic

25
Q

How is cyclic and chronic vomiting defined?

A

Cyclic: Severe, discrete episodes w/pallor, lethargy & abdo pain
Chronic: Low grade, daily, mild illness

26
Q

How is vomiting investigated?

A

Bloods: FBC, CRP, U&E, LFTs,
H.Pylori test
Endoscopy
Abdo USS

27
Q

Would you be worried if a baby hadn’t passed meconium in the first 48hours-why?

A 
YES consider:
DIOS: Meconium ileus but in older children
CF:Meconium ileus
Obstruction
GI atresia
28
Q

How is pyloric stenosis investigated & treated?

A

Ix: USS >4mm width, >17mm length, pyloric stenosis (olive shaped) mass felt w/feeding test, Blood gas (MA), Bloods: U&E, FBC, LFT, CRP
Tx: Rehydrate: IV 0.45% Saline w/5% Dextrose & 20mmol KCl, Pyloromyotomy

29
Q

What are the signs & symptoms of pyloric stenosis?

A 
Typically 2-7weeks of age
Projectile vomiting non-bile stained
Hungry baby 
Weight loss
Metabolic alkalosis w/ hypoChlor, hypoK
Usually first born male
Constipation
30
Q

What are the signs & symptoms of malrotation w/volvulus?

A

Young child

Green bilious vomiting

31
Q

What is the pathophysiology of malrotation w/volvulus?

A

Abnormal fixation of s.bowel mesentry making it prone to twisting

32
Q

How is Malrotation w/volvulus investigated?

A

Upper GI contrast study
NG tube inject contrast into stomach
Look for emptying

33
Q

How is Malrotation w/volvulus managed?

A

Surgical emergency

Risk of bowel infarct

34
Q

How is bowel obstruction investigated?

A

AXR to evaluate level of obstruction

Barium swallow/enema for exact level

35
Q

What are the causes of bloody diarrhoea?

A 
E.Coli
Campylobacter
Shigella
C.Diff
Amoeba
36
Q

What causes a food allergy?

A

IgE mediated (type 1 hypersensitivity)

37
Q

What are the most common food allergies?

A 
Cows milk
Nuts: Peanuts, tree nuts, sesame
Eggs
Wheat
Soya
Kiwi
38
Q

What are the signs & symptoms of a food allergy?

A 
Diarrhoea +/- mucus/blood
Vomiting
GORD
Abdo pain
Eczema
Urticaria
Asthma
Anaphylaxis
39
Q

How is a food allergy investigated?

A

RAST/ELISA: Detect IgE
Serum IgE/eosinophils
Skin prick test

40
Q

What are the signs & symptoms of a cows milk protein allergy?

A 
Colic
Oesophagitis
Lactose intolerance
Constipation
Blood/mucus in stools

USE: Hydrolysed formula

41
Q

What is the difference between a food allergy & a food intolerance?

A

Intolerance = Adverse reaction to food not immune mediated e.g enzyme deficiency or reaction to food toxins

42
Q

When are investigations for jaundice not needed?

A
  • Jaundice not apparent in first 24hrs
  • Infant clinically well & remains well
  • Serum bilirubin below Tx level
  • Jaundice resolved by day14/21 in preterm
    (e. g breastfeeding causing jaundice)
43
Q

How would you take a jaundice Hx?

A 
Unsettled
Drowsy
RF for: Sepsis, PPROM
Fix: Haemolytic disease
Colour of urine/faeces
44
Q

What is the Rome criteria?

A

Criteria for constipation must Have >2:

  • <2 defecations/week
  • > 1/week of faecal incontinence after child has acquired toilet skills
  • Hx of excessive stool retention/retentive posturing

Paediatrics (26 decks)

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