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Paeds > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

GORD Referral paeds

A

SAME Day if haematemesis, melaena, dysphagia
Assessment if red flag sx
Refer if Cx

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2
Q

Red flags for paeds GORD

A 
Faltering growth
Unexplained distress
Unresponsive
Unexplained IDA
No improvement after 1yr
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3
Q

Cx of paeds GORD

A 
Reccurent aspiratoion pneumonia
unexplained apnoea
unexplained epileptic like seizure
Unexplained upper airway inflam.
dental erosion w/neurodisability
recurrently acute otitis media
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4
Q

2 Mx of GORD

A

Reasure: v common, <8wks old, self resolves

R/v only if: projectile, bilestained vomit/haematemesis, >1yr

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5
Q

Non-pharm Mx of GORD

A

NOT positional while asleep
Bf: assess bf, if issue persists try alginate therapy for 1-2w (stop at intervals to assess)
FF: R/v Feeding Hx, aim for 150-180ml/kg/day, offer thickened formula, alginate therapy

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6
Q

Pharm Mx of paed GORD

A 
4 wk trial of PPI/histamine antagonist if 1+:
- unexplained feeding diffuclty
- distressed behaviour
- faltering growth
(also if complaining of heartburn)
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7
Q

PACES of GORD in paeds

A

Dx: immaturity of foodpipe leads to food coming back up
Is common usually self resolves
BF: assess, alginate
FF: r/v feed Hx, smaller volumes, thickener, alginate
safety net: if green or bloody seek help

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8
Q

Pyloric stenosis

A

Ix: USS, U+E
IV fluid resus. essential to correct electrolyte imbalance before surg. (1.5x maintenance rate w/5% dextrose+0.45%saline)
Ramstedt pyloromyotomy
(divide down to but not inc. mucosa)

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9
Q

Infant Colic

A

Reassure is common and tends to self resolve
Information: NHS choices, health visitor
Try holding baby w/gentle motion, white noise
Encourage parents to look after themselves too w/support and sleep
NB. infacol and coleif have insuf. evidence

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10
Q

Appendicitis in paeds

A 
Ix: FBC, urine pregnancy test, CT abdo 
Surgical emergency:
admit, NBM
IV fluids
appendicectomy (?cefoxitin IV)
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11
Q

Intussusception Ix

A

USS
AXR if suspecting obstruction
Contrast enema

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12
Q

Intusseusception Mx

A

ABCDE
?IV fluids/NG feeding
Unless signs of peritonitis attempt rectal air insufflation (w/fluoro guidance by a radiologist)
- 25% will need surgery

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13
Q

Contraindications to contrast enema reduction in intussusception

A

Peritonitis
Perforation
hypovolaemic shock
Broad spec ABx (clind+gent/tazocin/cefotixin+vanc)
2nd line: surgical reduction w/broad spec ABx

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14
Q

Recurrent intussusception

A

Consider investigation for pathological lead point eg Meckels diverticulum

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15
Q

PACES counselling of Intussusception

A

Dx: part of bowel has become stuck to another telescopically
Young children
May need NG/IV
Explain procedures (air insuff. -> operation 25%)
5% risk of recurrence (usually within days of treatment)

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16
Q

Meckel’s Diverticulum

A

Ix: T99m pertechnetate
Asymptomatic: Incidental finding, no Mx, if detected surgically excise as prophylaxis
Symptomatic:
- bleeding: excise w/trx if Hb unstable
- obstruction: excision and adhesiolysis
- Perforation/peritonitis: excision or small bowel segmental resection + Abx

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17
Q

Malrotation

A

Ix: upper GI contrast, CT abdo w/contrast, AXR
If signs of vascular compromise: EMERGENCY laparotomy
Ladd procedures derotates the bowel by dividing Ladd band
Duodenojejunal flexure placed on right and caecum and appendix on left (appendix usually removed)
ABx: cefazolin

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18
Q

Recurrent Abdominal pain

A

Inspect for anal fissure, check growth of child
Urine MC&S
Abdo USS (gallstones, ureteric obstruction)
Coeliac antibodies and TFTs
IBS and functional dyspepsia are Dx of exclusion

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19
Q

Abdominal migraine

A

offer anti-migraine meds

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20
Q

IBS Advise to parents

A

Reassure

Encourage patient to ID sources of stress/anxiety or foods that may aggravate symptoms

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21
Q

Peptic ulcer Dx in children

A 
if suspected: lansoprozole 30mg
Ix for H pylori
If positive;Amox+metroORclari
If this fails upper GI endoscopy
- if normal: functional dyspepsia
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22
Q
  • 7d triple therapy in peptic ulcer Dx:
A

PPI BD, 1g amoc BD + clari 500mg BD or metro 400 mg BD

If penicillin allergy omit amox and use other 3

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23
Q

Eosinophilic oesophagitis

A

oral corticosteroids (fluticasone or budesonide)`

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24
Q

Gastroenteritis in children

A 
Assess for: dehydration and shock
Consider admission
Rehydration
?stool analysis
prevent spread
FU
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25
Q

Maintenance and Rehydration volumes in children

A 
Maintenance:
0-10kg = 100ml/kg
10-20 = 1000ml + 50ml/kg >10
20+ kg = 1500ml +20m/kg >20
Rehydration
<5: 50ml/kg over 4hrs as well as maintenance w/oral hydration solution
>5: 200mL ORS after each loose stool
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26
Q

Notifiable gastroenteritis

A 
campylobacter
Listeria
E coli 0157
Shigella
Salmonella
27
Q

Dehydration in children

A

likely viral cause
Ix: U+E, FBC, stool MC+S only if bloody diarrhoea
Mx: ORS, IV fluids only for shock, deterioration or persistent vomiting

28
Q

Fluid resuscitation in children

A

Glucose free crystalloids w/Na in the range 131-154
Bolus of 20ml/kg over <10m
- different in DKA bc of risk of cerebral oedema

29
Q

IV fluids monitoring

A

Glucose and electolytes at least evert 24hr

30
Q

Neonatal fluid requirements and resus

A 
Maintenance (day):
1: 50-60ml/kg
2: 70-89ml/kg
3: 80-100ml/kg
4: 100-120ml/kg
5-28: 120-150ml/kg
for neonates use isotonic crystalloids w/5-10% dextrose
31
Q

Hypernatraemic dehyration

A

ORS first line
If IV introduce slowly to avoid cerebral odema
Replace deficit over 48hrs

32
Q

Antidiarrhoeal and antiemetics in children

A 
NOT used
ineffective
SE
focus away from rehydration
increased time sheding bacteria in stool
33
Q

Gastro indications for Antibiotics in children

A 
NOT routinely gastroenteritis 
ONLY for:
suspected/confirmed sepsis
extra-intestinal spread
salmonella gastroenteritis if <6m
Malnourished or IC children
Specific infections:
C dif, cholera, shigell
34
Q

Nutrition after diarrhoea

A

needs increasing

?Zn deficiency

35
Q

Post-gastroenteritis syndrome

A

introduction of normal diet causes watery diarrhoea

start ORS

36
Q

Coeliac Dx Ix

A

Ix: FBC+ smear (macrocytic an.),
Serology (anti-tTG, anti-EMA (if IgA def. IgG DGP))
OGD and duodenal biopsy (v. young may have confirmatory EMA + HLADQ2/8 testing instead)

37
Q

Coeliac Dx Mx

A 
Remove all wheat, rye, barley
Referral to dietician
Annual r/v: 
- height, wt, BMI
- Sx
- Adherence to diet
-?bloods (serology, FBC, TF, LFT, vit D/B12, folate, Ca)
38
Q

Non-adherence to coeliac diet

A

micronutrient def. (osteopenia)
small increased risk of bowel ca esp small bowel lymphoma
hyposplenism

39
Q

PACES counselling of coeliac dx

A 
Dx; unable to digest gluten
Common 1 in 100
Mx: gluten free diet
Dietician
Importance of diet
FU necessary every 6-12m
Regular height and weight measurements
Support: coeliac UK
40
Q

Crohns Dx Ix

A 
FBC (inc. Fe, B12, folate)
CRP + ESR
?Stool testing
Upper GI and small bowel contrast scan
Colonoscopy and biopsy
ask about impact on life
41
Q

Education for Crohns pts

A 
Stop smoking (Reduce relapse)
risk of osteoporosis
unintended wt loss could be sign of flare
do NOT have live vaccines if on IS Mx
42
Q

Medical Mx of Crohns Dx

A

Steroids (pred) to induce and maintain remission
IS drugs (azothioprine, MTX)
Biologics (infliximab)
Aminosalycates (mesalazine)

43
Q

PACES Counselling of Crohns Dx

A 
Dx: unkown cause, inflammation, malabs, diarr.
Life long w/relapses
Mx by gastroenterologist medically
Cx: malabs and cancer
no special diet but may find triggers
Suport: Crohns and Colitis UK
44
Q

Ulcerative colitis Assessed by:

A

Paediatric ulcerative colitis activity index (PUCAI)
Sev: >65pts
Mild-mod:>10-64

45
Q

Mild-moderate proctitis in UC in children

A

Oral and/or topical aminosalicylates

Second line: topical corticosteroid or pred PO

46
Q

Mild left sided and extensive UC in children

A

PO aminosalicylate
consider adding topical AS, PO beclometasone
Alternative: PO pred

47
Q

If no improvement after 4 wks of aminosalicylate therapy in UC in children

A 
Consider adding oral pred
if still no:
PO tacrolimus
biologicals: infliximab, adilimumab
- surgery and option
48
Q

Maintaining remission in UC in children

A

AS mainstay

consider PO azothioprine or mercaptopurine if requiring steroids freq.

49
Q

Severe fulminating UC in children

A 
EMERGENCY - do they need surgery?
Increased risk of needing surg:
>8 stool/day
Pyrexia
tachycardia
AXR w/colonic dilatation
Low: albumin, HB, High: plt. CRP
Offer IV corticosteroids to induce remission
(second line ciclosporin)
50
Q

Surgical Mx of fulminating UC in children

A

Colectomy w/ileostomy or ileojejunal pouch

51
Q

PACES for UC

A

Unknown cause, inflammation of bowel -> Sx
1:420
No cure, Dx will come and go
Medications available to reduce flares and treat when they happen
Cx: growth issues, bowel ca
FU: will be seen by gastroenterologist

52
Q

Constipation in children

A

Exclude red flag symptoms
Laxatives (several mo. possibly)
Examine for impaction (commence disimpaction is present)
Otherwise: maintenance laxative rx
Behaviour intervention (gastrcolic reflex, star chart)
Diet and lifestyle (hydration)
FU to assess response

53
Q

Disimpaction therapy

A

step 1: movicol paed plan (polyethylene glycol + electrolyte) escalating dose 2w
step 2: Add a stimulant (senna/sodium picosulphate)
- If movicol not tolerated a stimulant can be used w/lactulose or docusate (softners)

54
Q

Maintenance therapy for constipation in children

A

Movicol +/- stim. laxative

Reduce dose over monthsi in respoonse to improvement

55
Q

Types of laxative

A

Bulk forming: fybogel, methylcellulose
Osmotic: lactulose, movicol
Stim.; Bisacodyl, senna, sodim picosulphate
stool-softener: arachis oil, docusate

56
Q

All else fails constipation in children

A

enema

manual evacuation under anaesthetic

57
Q

Constipation in under 1yr old

A

Increase fluids
lactulose
neonates may not poo for days if they are absorbing milk like nobody’s business

58
Q

PACES of Constipation in children

A 
Simple constipation is very common
Mx: break cycle or hard stool to pass
Takes time for movicol to work 
- disimpaction 2w escalating dose
- maintenance long term until habits reestablished
Encourage gastrocolic reflex
Behavioural motivation interventions
emphasises is safe long term, most common cause of failure is inadqeuate use
Aim: 1+ large soft stool
59
Q

Hirschprung Dx Ix

A

AXR (if obstructed), contrast enema (narrow aganglionic segment)
Definitive: full thickness rectal biopsy

60
Q

Hirschprung Dx Mx

A

Initally bowel irrigation
Surgical: colostomy followed by anastamosis of innervated bowel and anus
aka anaorectal pull-through
Total colonic agangliosis would require initial ileostomy w/later corrective surgery

61
Q

Anal fissure in children

A

Ensures stools soft (fibre, fluids, ?laxative)
Pain: simple analgesia, warm bath
Importance of anal hygiene
Advise against stool holding
IF not improved in 2w or significant pain present again
consider topical anaesthetic or GTN

62
Q

Threadworm in children

A

Exclusion NOT required
Single dose of mebendazole (repeat in 2wks if persistent)
Children <6m hygiene alone, <6w seek ID specialist
Trace contacts
Rigorous hygiene 2wks if medendazole, 6wks if hygiene alone

63
Q

Rigorous hygiene for threadworm

A

Hand washing
cut nails regularly, avoid scratching anus
shower each morning and wash perineum
Change bed linen and nightwear nightly for several days (do NOT shake and wash on hot cycle)
dust and vacuum

Paeds (23 decks)

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