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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
Q

What is the diagnosis of pyloric stenosis?

A

Clinical olive on abdomen observe feed and for visible peristalsis

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26
Q

What investigations do you do for pyloric stenosis

A

Ultrasound or barium meal

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27
Q

What is the treatment of pyloric stenosis

A

Correct electrolytes and fluids. Nothing by mouth and surgery

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28
Q

What is gastroenteritis?

A

Infective vomiting and diarrhoea

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29
Q

What is the most common cause of Gastroenteritis in The developing world

A

Rotavirus in developing world

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30
Q

What is the most common bacterial cause of gastroenteritis

A

Campylobacter jejuni

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31
Q

What is the common presentation of gastroenteritis

A

Vomiting and diarrhoea
Dehydration
Reduced consciousness, sunken fontanelle, dry mucus membranes, tachypnoea, tachycardia, prolonged cap refill, weight loss, reduced skin turgor

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32
Q

What investigations to you do for gastroenteritis

A

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

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33
Q

What is the management of gastroenteritis

A

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

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34
Q

What are the causes of acute abdomen pain from birth to year one?

A

Gastroenteritis, constipation, UTI (medical causes)
Intussception, volvulus, incarcerated hernia (Surgical courses)
Infantile colic, Hirschsprung’s disease

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35
Q

What are the causes of acute abdomen pain from the ages of 2 to 5 years old

A

Gastroenteritis, constipation, UTI (medical causes)
Appendicitis, intussusception, Val verse, trauma (surgical causes)
Mesenteric lymphadenitis, henoch-schonlein purpura, sickle cell crisis

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36
Q

What are the Causes of acute abdomen pain from a six-year-old to you in 11-year-old

A

Gastroenteritis, constipation, UTI (medical courses)
Appendicitis, trauma (surgical causes)
Mesenteric lymphadenitis, henoch schonlein purpura, sickle cell crisis, pneumonia, functional pain

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37
Q

What are the Causes of acute abdomen pain from a 12-year-old to you in 18-year-old

A

Gastroenteritis, constipation (medical courses)
Appendicitis, trauma, ovarian/testicular torsion (surgical causes)
Dysmenorrhea, mittelschmerz, threatened abortion, ectopic pregnancy, pelvic

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38
Q

What is intussusception?

A

Invagination of the proximal bowel into the distal segment

Commonest involves ileum into caecum

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39
Q

The commonest cause of postnatal intestinal obstruction in infants 2 months to 2 years

A

Intussusception

40
Q

How does intussusception present

A

Paroxysmal, Severe Colicky pain and sausage shaped mass palpable in abdomen
Redcurrant jelly stool it’s a late sign
distension and shock

41
Q

What investigations do you do for intussusception

A

X-ray distended bowel loops

USS Diagnosis and checking insufflation

42
Q

What is the treatment for intussusception

A

75% reduced by air insufflation (NG tube)

25% reduced by surgery

43
Q

What is malrotation?

A

Ileocaecal and duodenaljejunal flex are predisposed to volvulus due to short base

44
Q

How does malrotation present?

A

As obstruction +/- compromised blood flow
Bile or blood stained vomit
Peritonitis
Ischaemic bowel
Usually 1-3 days with Ladds band obstructing duodenum

45
Q

What is the management of malrotation

A

NBM
NG tube
Surgical management

46
Q

What is henoch schonlein purpura?

A

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
Q

When does Henoch-Schonlein Purpura normally appear?

A

Usually post streptococcal infection, mycoplasma, EBV, vaccination
Environmental - allergens, cold, insect bites

48
Q

When time of the year does Henoch-Schonlein Purpura normally present?

A

Winter

49
Q

What is presentation of Henoch-Schonlein Purpura?

A

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
Q

What is the management of Henoch-Schonlein Purpura

A

Steroids of really severe and if Renal and joint involvement

51
Q

How does malabsorption present

A

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
Q

What is coeliac’s disease

A

Autoimmune disease characterised by HLA B8

Gluten causes damage to the Villi in the intestinal mucosa causing cryptic hyperTrophy

53
Q

How to coeliac’s disease present?

A

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
Q

What diagnosis do you do for coeliac’s disease

A

Trans glutaminase antibodies, anti endomysial antibodies
Check IgA levels
Jejunal biopsy is gold standard

55
Q

What is the management of coeliac’s disease

A

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
Q

What does diarrhoea represent

A

Transient dietary protein intolerances

57
Q

What does diarrhoea normally present with

A

Eczema, acute colitis, abdominal migraine

58
Q

Is constipation common?

A

In breastfed children

59
Q

What can cause constipation?

A

Febrile illness, superficial fissure causing refrainment from defecation
Start potty training, psychological stress

60
Q

How does psychological stress cause constipation?

A

faecal loading, reduced sensation of internal sphincter and finally soiling as the internal sphincter is overcome

61
Q

What are organic causes of constipation?

A

Hypothyroidism,Hypercalcaemia

UTI,Hirshsprung

62
Q

What is the management of constipation

A

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
Q

How does lactulose work in constipation?

A

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
Q

How does senna work in constipation?

A

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
Q

What is Hirschsprung’s disease?

A

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
Q

How does Hirschsprung’s disease present?

A

Failure to pass meconium and bow distension

Later bile stained vomit

67
Q

What do you see on PR with Hirschsprung’s

A

Narrow segment and gush of poo and flatulence on removal

68
Q

What is associated with Hirschsprung’s

A

Hirschsprung’s enterocolitis

In later life chronic constipation without overflow soiling

69
Q

How do you diagnosis Hirschsprung’s

A

Ganglion absence

70
Q

DKA is a triad of what

A

Hyperglycaemia
Ketosis
Acidosis

71
Q

What are risk factors for a DKA

A

Family history of diabetes, poor social circumstances, younger than five years old, adolescent girls, previous DKA

72
Q

What are signs of a serious DKA

A

Hypokalaemia, hypoglycaemia, dehydration, hypovolaemia, renal failure, cerebral oedema

73
Q

What are symptoms of acidosis

A

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
Q

What are GI red flags

A

Bile stained vomit, haematemesis,

Projectile vomiting, abdo pain on movement, blood in stool, severe dehydration, headache or seizure, failure to thrive

75
Q

What is indicated by bile stained vomit?

A

Intestinal obstruction

76
Q

What is indicated by haematemesis?

A

Peptic ulceration, gastritis, oesophageal varices

77
Q

What is indicated by projectile vomiting?

A

Pyloric stenosis

78
Q

What is indicated by abdominal pain on movement

A

Surgical abdomen (e.g appendicitis)

79
Q

What is indicated by blood in the stool?

A

Intussusception, gastroenteritis

80
Q

What is indicated by severe dehydration?

A

Severe gastroenteritis, DKA, systemic infection

81
Q

What is indicated by headache or seizures?

A

Raised intracranial pressure

82
Q

What is indicated by failure to thrive?

A

GORD, coeliacs

83
Q

What test do you do to confirm pyloric stenosis?

A

Test feed, NG tube insertion and aspiration to empty the stomach, small feed of dioralyte
Olive mass palpable just below the liver edge

84
Q

Differential diagnoses of vomiting

A

GORD, cows milk intolerance, intestinal obstruction, infection

85
Q

Is GORD acute or chronic

A

Chronic

86
Q

What are common symptoms of GORD?

A

Recurrent regurgitation, difficulties feeding, arching of back and neck and sore throat

87
Q

What investigations do you do for GORD?

A

pH impedance study

24 hr pH probe

88
Q

What is the management of GORD

A

Smaller and more frequent meals, feed thickeners, optimise position

89
Q

Is cows milk protein intolerance acute or chronic

A

Chronic

90
Q

What are common symptoms of cows milk protein intolerance

A

Abdominal pain, eczema, flatulence, bloody stools, diarrhoea or constipation

91
Q

What are investigations for cows milk protein intolerance

A

Skin prick or specific IgE antibody testing

92
Q

What is the management of cows milk protein intolerance

A

Cows milk elimination diet, hypoallergenic infant formula, mother to avoid cows milk

93
Q

What are common symptoms of intestinal obstruction?

A

Bilious vomiting, constipation, abdominal pain

94
Q

What are the investigations of intestinal obstruction?

A

US, abdominal x ray, contrast study

95
Q

What is the management of intestinal obstruction?

A

Surgical intervention

Phase 3A - Paediatrics (11 decks)

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