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Paediatrics > Gastrointestinal and surgery > Flashcards

Gastrointestinal and surgery Flashcards

1
Q

which type of inflammatory bowel disease is more common in children?

A

Crohns

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2
Q

discuss the pathology of crohns disease?

A
  1. transmural inflammation with non-caseating granulomas
  2. most commonly effects the terminal ileum, but may occur anywhere from mouth to anus
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3
Q

local complications of crowns?

A
  1. strictures
  2. adhesions
  3. fistulas
  4. abscesses
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4
Q

how does crohn disease most commonly present? 3

A
  1. weight loss
  2. diarrhea
  3. abdominal pain
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5
Q

extra-intestinal features of IBD?

A

erythema nodosum
pyoderma gangrenosum
uveitis
arthritis

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6
Q

potential systemic features of IBD

A

anemia, tachycardia, fever

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7
Q

diagnosis of IBD?

A
  1. gold standard is colonoscopy and biopsy
  2. FBC for anemia, CRP and ESR are also elevated
  3. stool cultures often necessary to exclude infective causes of colitis
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8
Q

how is the severity of IBD determined? name of the scale and what does it take into account

A

Paris classification
age at diagnosis
location of involvement
behaviour of disease
Childs growth

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9
Q

management of IBD active disease?

A

anti-inflammatories: sulfalazine (DMARD) and Mesalazine

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10
Q

management of relapses of IBD

A
  1. steroids
  2. immunosuppressants to maintain remission: azathioprine
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11
Q

when to consider biologics for IBD?

A

treatment resistant cases

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12
Q

which biologic is commonly used in treatment resistant IBD

A

infliximab (TNF-alpha inhibitor)

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13
Q

define celiac disease?

A

autoimmune disease caused by an abnormal response to the gliadin component of gluten

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14
Q

How may celiac disease present in a young child? 2

A

1) failure to thrive
2) abdominal distension

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15
Q

how may celiac disease present in a older child?

A

weight loss
buttock wasting

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16
Q

what are other features of celiac disease? 3

A

anemia
steatorrhea
micronutrient deficiencies (iron, folate, vitamin D, calcium)

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17
Q

what rash is associated with celiac disease?

A

dermatitis herpetiformis

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18
Q

what are other conditions associated with celiac disease?

A

other autoimmune conditions (diabetes, hashimotos)

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19
Q

what is the gold standard for diagnosis of celiac disease? what does it show?

A

duodenal biopsy which shows villus atrophy and crypt hypertrophy

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20
Q

how can celiac disease be diagnosed by serology ?

A

elevated IgA tissue transglutaminase autoantibody. IgG can also be used if the patient has IgA deficiency. IgA anti-endomysial antibody can also be used

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21
Q

what blood tests besides autoantibodies do you want in someone with suspected celiac?

A

FBC - for anemia
vitamin D
calcium
iron studies

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22
Q

management of Celiac disease?

A

Gluten free diet
supplementation of deficiencies

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23
Q

complications of celiac (from non-adherence to gluten free diet)

A
  1. micronutrient deficiencies
  2. osteopenia
  3. bowel lymphoma
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24
Q

what is a differential diagnosis in someone who presents with a clinical picture suggestive of celiac disease + signs of infection ? what is the management

A

giardia lamblia
metronidazole

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25
Q

what is something that is often confused with GERD? how common is it? and when does it usually resolve

A

simple reflux
occurs in 40% of infants after feeds and resolves by 1 year

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26
Q

when is GERD considered a disease in children?

A

if occurring with complications:
1) failure to thrive
2) esophagitis/esophageal stricture
3) aspiration pneumonitis
4) Sandifer syndrome

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27
Q

what is Sandifers syndrome?

A

a manifestation of GERD which imitates seizures. causes a child to adapt an opisthotonic posture with dystonic neck and trunk movements in reaction to acidic reflux

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28
Q

what are predisposing factors for GERD in child?

A

1) cerebral palsy
2) neurodevelopment disorders
3) bronchopulmonary dysplasia
4) post-surgery

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29
Q

what is the management of GERD in a infant?

A
  1. simple measures such as smaller feeds, winding, and keeping the baby upright
  2. adding thickeners to feeds (carobel)
  3. if not improving consider other causes such as cow milk protein allergy
  4. last line treatment: Nissen fundoplication surgery
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30
Q

how can cows milk protein allergy be divided?

A

IgE and non-IgE mediated

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31
Q

presentation of non-IgE mediated cows milk protein allergy?

A

1) causes delayed gastrointestinal symptoms
2) over time leads to a failure to thrive

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32
Q

presentation of IgE mediated cows milk protein allergy

A

causes immediate symptoms including
1) wheeze
2) conjunctivitis
3) angioedema
4) also GI symptoms

33
Q

what is the management of cows milk protein allergy?

A

management is by avoiding cows milk and substitution with a hydrolyzed formula

34
Q

what does trachea-esophageal fistula commonly occur with ?

A

esophageal atresia

35
Q

presentation of tracheo-esophageal fistula ?

A

frothy and choking newborn (often with polyhydraminos), nasogastric tube cannot be passed

36
Q

how is tracheo-esophageal fistula diagnosed?

A

chest x-ray

37
Q

management of trachea-esophageal fistula?

A

surgical correction

38
Q

what is tracheo-esophageal fistula associated with?

A

VACTERL syndrome

39
Q

components of VACTERL syndrome

A
  1. vertebral anomalies
  2. anorectal anomalies (anal atresia
  3. Cardiac anomalies
  4. tracheoesophageal fistula
  5. renal anomalies
  6. limb anomalies
40
Q

what age range does pyloric stenosis usually occur in ?

A

3-12 weeks

41
Q

presentation of pyloric stenosis ?

A

1) projectile non-bilious vomiting
2) olive-like mass palpable superficially at the epigastric region (level of the pylorus)

42
Q

what are the metabolic consequences of repetitive vomitting?

A

hypokalemic hypochloremic, metabolic alkalosis

43
Q

what is the management of pyloric stenosis ? it is an emergency?

A

yes it is a surgical emergency
1) ABCs + IV fluids + electrolyte correction (remember the role of Cl- in correcting the metabolic alkalosis)
2) surgery

44
Q

name of surgical intervention required to treat pyloric stenosis ?

A

ramstedt pyloromyotomy

45
Q

presentation of duodenal atresia ?

A

presents postnatally with bilious vomitting

46
Q

are most cases of duodenal atresia isolated lesions?

A

yes

47
Q

30% of cases of duodenal atresia occur with??

A

trisomy 21

48
Q

diagnosis of duodenal atresia ? what does it show

A

plain film x-ray
double bubble sign

49
Q

management of duodenal atresia ?

A
  1. ABCs + IV fluids + electrolyte correction
  2. surgery: duodeno-duodenostomy
50
Q

presentation of volvulus?

A
  1. bilious vomitting
  2. abdominal distension
  3. PR blood
  4. often in shock
51
Q

what is mid-gut volvulus associated with?

A

malrotation of the midgut

52
Q

diagnosis of mid-gut volvulus?

A

upper GI series

53
Q

management of volvulus?
emergency ?

A
  1. ABCs, IV fluids, electrolytes
  2. surgical emergency
54
Q

what age range does intussusception usually occur in ?

A

6 months to 2 years

55
Q

presentation of intussusception?

A
  1. intermittent abdominal pain
    examination may show sausage like mass in the abdomen
  2. screaming with drawn up legs and passing “redcurrant jelly” stool
  3. vomitting
56
Q

diagnosis of intussusception?

A

ultrasound showing “donut sign”

57
Q

management of intussusception ?

A
  1. ABCs
  2. air enema or surgery
58
Q

define gastroschisis?

A

abdominal wall defect occurring to the right of the umbilical cord insertion without a covering of membrane

59
Q

gastroschisis is associated with? 3

A
  1. intrauterine growth restriction
  2. prematurity
  3. low birth weight
60
Q

gastroschisis is more common in young mothers taking ….?

A

recreational drugs

61
Q

management of gastroschisis?

A

surgical repair

62
Q

what is the feared complication of surgical reduction of gastroschisis ?

A

abdominal comparent syndrome leading to organ ischemia

63
Q

what defines minor vs major omphalocele (exompthalmos)

A

size: minor < 5cm, major > 5cm

64
Q

omphalocele is associated what genetic syndrome?

A

Beckwith-Widemann syndrome (organomegaly)

65
Q

minor omphalocele is often mistake for…?

A

umbilical hernias

66
Q

in a patient with an omphalocele it essential to do a …. and ….. to exclude other disorders??

A

echocardiogram
genetic karyotyping

67
Q

management of omphalocele ?

A

minor: surgical closure
major: staged surgical closure

68
Q

define hirschprung disease?

A

congenital absence of ganglionic cells in the distal rectum. failure of migration of neural crest cells

69
Q

classic presentation of Hirschprung disease?

A

distal obstruction causing bilious vomiting and a failure to pass meconium within 48 hours

70
Q

diagnosis of hirschprung’s disease ?

A
  1. barium enema (dilation) of proximal segment and distal narrowing
  2. rectal biopsy
71
Q

management of Hirschprung’s disease?

A

resection of the affect bowel segment

72
Q

define necrotizing enterocolitis?

A

acute ischemic necrosis of the intestines occurring mostly in premature infants <32 weeks

73
Q

presentation of NEC?

A

abdominal distension
bilious vomitting
blood PR

74
Q

predisposing factors for NEC?

A

Patent ductus arteriosus
cardiac surgery
sepsis

75
Q

management of NEC?

A
  1. NPO + TPN + Antibiotics for 10 days
  2. Surgery if perforated
76
Q

diagnosis of NEC?

A

gold standard is abdominal X-ray which may show air in the wall of the bowel wall (pneumatosis intestinal, dilation of the bowel, portal venous gas

77
Q

what is the differential for bilious vomitting in a new born? 3

A
  1. severe gastroenteritis
  2. NEC
  3. distal obstruction including; duondenal atresia, meconium ileum, Hirschprung disease, volvulus
78
Q

differential for non-bilious vomitting in a newborn? 3

A
  1. mild gastroenteritis
  2. GORD
  3. pyloric stenosis
79
Q
A

Paediatrics (12 decks)

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