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Phase 3A - Paediatrics > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What a common gastrointestinal conditions

A

Diarrhoea, abdominal pain, coeliac’s disease, pyloric stenosis, intussusception

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2
Q

How can you tell coeliac disease from a growth chart

A

fall off in weight begins as weaning begins at six months

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3
Q

How can you tell hydrocephalus from a growth chart

A

Head circumference Is much greater than length and weight and suddenly shoots up. Tumours and IVH

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4
Q

How can you tell Turner syndrome from a growth chart

A

Poor growth from young age and absence of puberty growth spurt short stature

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5
Q

How can you tell growth hormone deficiency via a growth chart

A

fall off in height

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6
Q

How can you tell cystic fibrosis via a growth chart

A

Failure to thrive difficulty gaining weight

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7
Q

What are the different types of vomiting

A

Bile stained, blood in vomit, projectile vomit, vomiting at the end of the paroxysmal coughing, abdominal distension

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8
Q

What does bile stained vomiting at indicate

A

Intestinal obstruction

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9
Q

What does blood in vomit indicate

A

Oesophagitis, peptic ulcer, oral or nasal or bleed, malrotation

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10
Q

What does projectile vomit indicate

A

Pyloric stenosis

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11
Q

What is pyloric stenosis

A

Pyloric stenosis is a condition where the passage (pylorus) between the stomach and small bowel (duodenum) becomes narrower.

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12
Q

What does vomit at the end of a paroxysmal cough indicate

A

Whooping cough

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13
Q

What does vomiting with abdominal distension indicate

A

lower intestinal obstruction

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14
Q

What causes Gastro oesophageal reflux and infants

A

Lower oesophageal sphincter immaturity and inappropriate relaxation

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15
Q

When does gastro oesophageal reflux normally resolved by

A

One year

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16
Q

What are conditions that cause chronic reflux

A

Cerebral palsy, Chronic lung disease of prematurity

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17
Q

What are symptoms of Gastro oesophageal reflux

A

Crying after feeds, vomit turn off the feeds, not wanting to lie down, reflux

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18
Q

What investigations do you do for Gastro oesophageal reflux

A

Clinical assessment, barium swallow, PH monitor on for 24 hours, troll medications

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19
Q

What is the management of Gastro oesophageal reflux

A

Thickened feeds, positioning during feeds PPIs, surgery

Reassure mother that this is common and usually self resolves with age

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20
Q

What is the treatment for gastro-oesophageal reflux

A

Gaviscon, omeprazole, ranitidine,
domperidone
Surgery nissen’s fundlopication

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21
Q

What is pyloric stenosis

A

Hypertrophy of pylorus that causes outflow obstruction

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22
Q

Is pyloric stenosis a surgical emergency?

A

Yes

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23
Q

What is the presentation of pyloric stenosis?

A

Projectile vomiting which gets worse over time constant hunger weight loss scaphoids abdomen upset baby

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24
Q

What are ion inbalance do you get in pyloric stenosis?

A

Hypokalaemia hypochloraemic metabolic alkalosis = low plasma potassium due to vomit

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25
What is the diagnosis of pyloric stenosis?
Clinical olive on abdomen observe feed and for visible peristalsis
26
What investigations do you do for pyloric stenosis
Ultrasound or barium meal
27
What is the treatment of pyloric stenosis
Correct electrolytes and fluids. Nothing by mouth and surgery
28
What is gastroenteritis?
Infective vomiting and diarrhoea
29
What is the most common cause of Gastroenteritis in The developing world
Rotavirus in developing world
30
What is the most common bacterial cause of gastroenteritis
Campylobacter jejuni
31
What is the common presentation of gastroenteritis
Vomiting and diarrhoea Dehydration Reduced consciousness, sunken fontanelle, dry mucus membranes, tachypnoea, tachycardia, prolonged cap refill, weight loss, reduced skin turgor
32
What investigations to you do for gastroenteritis
Nothing unless septicaemia as suspected, there is blood or mucus in the store, the child is immuno compromised, recent travel abroad, diarrhoea has not improved in seven days
33
What is the management of gastroenteritis
Fluids less than 5% mild: feed replacement, glucose and electrolytes until subsides 5 to 10% severe: Six hours 100 mL per kilogram More than 10%: IV rehydration
34
What are the causes of acute abdomen pain from birth to year one?
Gastroenteritis, constipation, UTI (medical causes) Intussception, volvulus, incarcerated hernia (Surgical courses) Infantile colic, Hirschsprung’s disease
35
What are the causes of acute abdomen pain from the ages of 2 to 5 years old
Gastroenteritis, constipation, UTI (medical causes) Appendicitis, intussusception, Val verse, trauma (surgical causes) Mesenteric lymphadenitis, henoch-schonlein purpura, sickle cell crisis
36
What are the Causes of acute abdomen pain from a six-year-old to you in 11-year-old
Gastroenteritis, constipation, UTI (medical courses) Appendicitis, trauma (surgical causes) Mesenteric lymphadenitis, henoch schonlein purpura, sickle cell crisis, pneumonia, functional pain
37
What are the Causes of acute abdomen pain from a 12-year-old to you in 18-year-old
Gastroenteritis, constipation (medical courses) Appendicitis, trauma, ovarian/testicular torsion (surgical causes) Dysmenorrhea, mittelschmerz, threatened abortion, ectopic pregnancy, pelvic
38
What is intussusception?
Invagination of the proximal bowel into the distal segment | Commonest involves ileum into caecum
39
The commonest cause of postnatal intestinal obstruction in infants 2 months to 2 years
Intussusception
40
How does intussusception present
Paroxysmal, Severe Colicky pain and sausage shaped mass palpable in abdomen Redcurrant jelly stool it’s a late sign distension and shock
41
What investigations do you do for intussusception
X-ray distended bowel loops | USS Diagnosis and checking insufflation
42
What is the treatment for intussusception
75% reduced by air insufflation (NG tube) | 25% reduced by surgery
43
What is malrotation?
Ileocaecal and duodenaljejunal flex are predisposed to volvulus due to short base
44
How does malrotation present?
As obstruction +/- compromised blood flow Bile or blood stained vomit Peritonitis Ischaemic bowel Usually 1-3 days with Ladds band obstructing duodenum
45
What is the management of malrotation
NBM NG tube Surgical management
46
What is henoch schonlein purpura?
IgA small vessel vasculitis,it is a disorder that causes the small blood vessels in your skin, joints, intestines, and kidneys to become inflamed and bleed
47
When does Henoch-Schonlein Purpura normally appear?
Usually post streptococcal infection, mycoplasma, EBV, vaccination Environmental - allergens, cold, insect bites
48
When time of the year does Henoch-Schonlein Purpura normally present?
Winter
49
What is presentation of Henoch-Schonlein Purpura?
Macular rash is preceded by low-grade fever and abdominal pain can have bloody diarrhoea and swollen painful joints The rash is macula that progresses to papulae in a classical buttocks and back of leg location There is really no involvement in 50% of older but only 10% significant with 1% going to ESRF
50
What is the management of Henoch-Schonlein Purpura
Steroids of really severe and if Renal and joint involvement
51
How does malabsorption present
Abnormal stools, failure to thrive (or poor growth in most but not all cases), Yeah specific nutritional deficiencies, difficult stools to flush that have offensive pervading odour
52
What is coeliac’s disease
Autoimmune disease characterised by HLA B8 | Gluten causes damage to the Villi in the intestinal mucosa causing cryptic hyperTrophy
53
How to coeliac’s disease present?
Failure to thrive in first few years -Commences at six months when weaning begins Irritable, loose stool, abdominal distension, wasting (especially at the buttocks) dermatitis herpetiformis
54
What diagnosis do you do for coeliac’s disease
Trans glutaminase antibodies, anti endomysial antibodies Check IgA levels Jejunal biopsy is gold standard
55
What is the management of coeliac’s disease
Remove gluten from diet if before two years old and do gluten challenge later on in life to see if still susceptible to damage you can get free prescriptions for gluten-free food
56
What does diarrhoea represent
Transient dietary protein intolerances
57
What does diarrhoea normally present with
Eczema, acute colitis, abdominal migraine
58
Is constipation common?
In breastfed children
59
What can cause constipation?
Febrile illness, superficial fissure causing refrainment from defecation Start potty training, psychological stress
60
How does psychological stress cause constipation?
faecal loading, reduced sensation of internal sphincter and finally soiling as the internal sphincter is overcome
61
What are organic causes of constipation?
Hypothyroidism,Hypercalcaemia | UTI,Hirshsprung
62
What is the management of constipation
Mild - increase dietary fibre, stool softeners (lactulose, docusate) and stimulatant (senna) So there-evacuate the overload, followed by 1 to 2 weeks of store softeners large doses of powerful laxatives Encouragement by family is essential Enemas are best avoided
63
How does lactulose work in constipation?
Lactulose is a synthetic sugar used to treat constipation. It is broken down in the colon into products that pull water out from the body and into the colon. This water softens stools.
64
How does senna work in constipation?
Senna is a stimulant laxative. After metabolism of sennosides in the gut the anthrone component stimulates peristalsis thereby increasing the motility of the large intestine.
65
What is Hirschsprung’s disease?
Hirschsprung’s disease is an absence of ganglion cells from mesenteric and submucosal plexuses Abnormal bow from rectum progressing upwards until you get a dilated uninnervated bowel
66
How does Hirschsprung’s disease present?
Failure to pass meconium and bow distension | Later bile stained vomit
67
What do you see on PR with Hirschsprung’s
Narrow segment and gush of poo and flatulence on removal
68
What is associated with Hirschsprung’s
Hirschsprung’s enterocolitis | In later life chronic constipation without overflow soiling
69
How do you diagnosis Hirschsprung’s
Ganglion absence
70
DKA is a triad of what
Hyperglycaemia Ketosis Acidosis
71
What are risk factors for a DKA
Family history of diabetes, poor social circumstances, younger than five years old, adolescent girls, previous DKA
72
What are signs of a serious DKA
Hypokalaemia, hypoglycaemia, dehydration, hypovolaemia, renal failure, cerebral oedema
73
What are symptoms of acidosis
Central-headache, sleepiness, confusion, lots of consciousness, coma Muscular-seizures and weakness Intestinal hi son diarrhoea Respiratory-shortness of breath and coughing Heart - Arrhythmia and increased heart rate Gastric - nausea and vomiting
74
What are GI red flags
Bile stained vomit, haematemesis, | Projectile vomiting, abdo pain on movement, blood in stool, severe dehydration, headache or seizure, failure to thrive
75
What is indicated by bile stained vomit?
Intestinal obstruction
76
What is indicated by haematemesis?
Peptic ulceration, gastritis, oesophageal varices
77
What is indicated by projectile vomiting?
Pyloric stenosis
78
What is indicated by abdominal pain on movement
Surgical abdomen (e.g appendicitis)
79
What is indicated by blood in the stool?
Intussusception, gastroenteritis
80
What is indicated by severe dehydration?
Severe gastroenteritis, DKA, systemic infection
81
What is indicated by headache or seizures?
Raised intracranial pressure
82
What is indicated by failure to thrive?
GORD, coeliacs
83
What test do you do to confirm pyloric stenosis?
Test feed, NG tube insertion and aspiration to empty the stomach, small feed of dioralyte Olive mass palpable just below the liver edge
84
Differential diagnoses of vomiting
GORD, cows milk intolerance, intestinal obstruction, infection
85
Is GORD acute or chronic
Chronic
86
What are common symptoms of GORD?
Recurrent regurgitation, difficulties feeding, arching of back and neck and sore throat
87
What investigations do you do for GORD?
pH impedance study | 24 hr pH probe
88
What is the management of GORD
Smaller and more frequent meals, feed thickeners, optimise position
89
Is cows milk protein intolerance acute or chronic
Chronic
90
What are common symptoms of cows milk protein intolerance
Abdominal pain, eczema, flatulence, bloody stools, diarrhoea or constipation
91
What are investigations for cows milk protein intolerance
Skin prick or specific IgE antibody testing
92
What is the management of cows milk protein intolerance
Cows milk elimination diet, hypoallergenic infant formula, mother to avoid cows milk
93
What are common symptoms of intestinal obstruction?
Bilious vomiting, constipation, abdominal pain
94
What are the investigations of intestinal obstruction?
US, abdominal x ray, contrast study
95
What is the management of intestinal obstruction?
Surgical intervention

Phase 3A - Paediatrics (11 decks)

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