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Paediatrics > GI > Flashcards

GI Flashcards

1
Q

What is gastro-oesophageal reflux and how does it differ from GORD?

A

Passage of gastric contents into the oesophagus - can be normal in infants if asymptomatic

GORD involves the presence of symptoms or complications from the reflux

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2
Q

Why are infants predisposed to GORD?

A
  • Short, narrow oesophagus
  • Delayed gastric emptying
  • Shorter, lower sphincter
  • Liquid diet
  • Larger ratio of gastric volume to oesophageal volume
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3
Q

What are some risk factors for GORD in infants?

A

Prematurity, hiatus hernia, history of diaphragmatic hernia or oesophageal atresia, family history of reflux

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4
Q

What are the clinical features of GORD?

A

Distressed behaviour eg excessive crying, back-arching

Unexplained feeding difficulties eg refusing feeds, gagging, choking

Faltering growth

Hoarseness/chronic cough in children

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5
Q

What are the differentials of GORD?

A

Pyloric stenosis, intestinal obstruction, sepsis, UTI, gastroenteritis

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6
Q

What is the management of GORD?

A

Ensure infant is not overfed (no more than 150ml/kg/day)

Decrease feed volume by increasing frequency eg 2-3 hourly

Gaviscon

Omeprazole, ranitidine

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7
Q

What is coeliac disease?

A

A life long gluten sensitive autoimmune disease of the small intestine

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8
Q

What environmental and genetic factors are implicated in coeliac disease?

A

Gliadin and HLA-DQ2/DQ8

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9
Q

Explain the pathophysiology of coeliac disease

A

T cell mediated immune disorder

Anti-gluten CD4 T cell response - anti-gluten antibodies - autoantibodies against tissue transglutaminase endomysium and activation of intraepithelial lymphocytes

Leads to epithelial cell destruction and villous atrophy

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10
Q

What conditions are related to coeliac disease?

A

Type 1 diabetes, Down syndrome, Turner syndrome, autoimmune thyroid disease, rheumatoid arthritis and Addison’s disease

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11
Q

How does the classical form of coeliac disease present?

A

Most commonly at 9-24 months of age with features of malabsorption - failure to thrive, weight loss, loose stool, steatorrhoea, anorexia, abdominal pain

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12
Q

What does histology show in coeliac disease?

A

Crypt hyperplasia and villous atrophy

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13
Q

What extra intestinal features can be seen in coeliac disease?

A

Dermatitis herpetiformis, dental enamel hypoplasia, osteoporosis, delayed puberty, short stature, iron deficiency anaemia, arthritis, peripheral neuropathy

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14
Q

How is coeliac disease investigated?

A

IgA and IgA tissue transflutaminase

Can also used IgA endomysial antibodies

Duodenal biopsy

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15
Q

How do you ensure that investigations for coeliac disease are accurate?

A

Will only be accurate if the patient is having gluten in the diet at the time of testing and for at least 6 weeks before

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16
Q

What is cow’s milk protein allergy?

A

An immune-mediated allergic response to naturally occurring milk proteins casein and whey

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17
Q

What are the two types of cow’s milk protein allergy?

A

IgE mediated - type 1 hypersensitivity reaction where CD4+ TH2 cells stimulate B cells to produce IgE antibodies against cow’s milk protein which trigger the release of histamine and other cytokines from mast cells and basophils

Non-IgE mediated - involves T cell activation against cow’s milk protein

18
Q

What are some risk factors for cow’s milk protein allergy?

A

Personal history of atopy

Family history of atopy

19
Q

What are the clinical features of IgE-mediated cow’s milk protein allergy?

A

Acute onset (up to 2 hours after ingestion)

Pruritus
Urticaria
Angio-oedema
Oral pruritus
Nausea + vomiting
Colicky abdominal pain
Cough, chest tightness, wheezing
Sneezing, rhinorrhoea
20
Q

What are the clinical features of non IgE-mediated cow’s milk protein allergy?

A

Non-acute and generally delayed onset (manifest up to 48 hours or even 1 week after ingestion)

GORD, blood/mucus in stools, abdominal pain, infantile colic, food refusal, constipation, faltering growth, some resp symptoms

21
Q

What are some differentials of cow’s milk protein allergy?

A

Food intolerance, allergic reaction to other allergens, Meckel’s diverticulum, GORD, coeliac, IBD, pancreatic insufficiency, UTI

22
Q

How is cow’s milk protein allergy managed?

A

Avoidance of cow’s milk

Extensively hydrolysed formula - casein and whey are broken down into smaller peptides

Amino acid formula

23
Q

What are some viral causes of gastroenteritis in children?

A

Rotavirus, norovirus, adenovirus

24
Q

When is the rotavirus oral vaccine given?

A

At 8 and 12 weeks

25
Q

What are some bacterial causes of gastroenteritis?

A

Campylobacter (can cause bloody diarrhoea) and E-coli

26
Q

What life threatening complications can verocytotoxin producing E-coli have?

A

Haemorrhage colitis and haemolytic uraemia syndrome

27
Q

What are the paediatric fluid requirements?

A

0-10kg = 100ml/kg/day

10-20kg = requirement for the 1st 10kg (1000ml) + 50ml/kg/day

> 20kg = requirement for the 1st 20kg (1500ml) + 20ml/kg/day

28
Q

What is Reiter’s syndrome?

A

Urethritis, arthritis and uveitis

29
Q

What are reactive complications associated with bacterial gastroenteritis?

A

Arthritis, carditis, urticaria, erythema nodosum and conjunctivitis

30
Q

What is a rare but significant complication of rotavirus gastroenteritis?

A

Toxic megacolon

31
Q

Which part of the digestive tract does Crohn’s commonly target?

A

Distal ileum or proximal colon

32
Q

What are some pathological features of Crohn’s disease?

A

Transmural inflammation producing deep ulcer and fissures (cobblestone)

Skip lesions

Non-caseating granulomatous inflammation

Can form fistulas

33
Q

What are some clinical features of Crohn’s disease?

A

Episodic abdominal pain and diarrhoea which may contain blood/mucus

Malaise, anorexia, low grade fever

Oral aphthous ulcers and perianal disease

34
Q

What are some extra intestinal features of IBD?

A

Enteropathic arthritis, erythema nodosum, pyoderma gangrenosum, episcleritis, anterior uveitis

35
Q

How is Crohn’s investigated?

A

Routine bloods, CRP, faecal calprotectin, stool sample, colonoscopy with biopsy, CT scan abdomen pelvis, MRI scan

36
Q

How is Crohn’s managed?

A

Inducing remission - fluid resuscitation, nutritional support, corticosteroid and immunosuppressive drugs (eg mesalazine)

Maintaining remission - azathioprine/mesalazine, biological agents eg infliximab

Surgical management - ileocaecal resection

37
Q

What is ulcerative colitis characterised by?

A

Diffuse continual mucosal inflammation of the large bowel, beginning in the rectum and spreading proximally

38
Q

What are some pathological features of ulcerative colitis?

A

Inflammation of the mucosa and submucosa, crypt abscesses and goblet cell hypoplasia

39
Q

What are the clinical features of ulcerative colitis?

A

Bloody diarrhoea, mucus discharge, increased frequency, urgency of defecation and tenesmus

40
Q

What are some red flags in a child with constipation?

A

Delay in passing meconium for more than 48 hours after birth

Family history of Hirschsprung’s

Ribbon stool pattern

Leg weakness or motor delay

Abnormal appearance of the anus

Evidence of faltering growth/developmental delay

41
Q

What behavioural interventions can be suggested for a child with constipation?

A

Scheduled toileting (encouraging to open bowels at pre-planned intervals or activities)

Bowel habit diary

Encouragement and rewards systems

Paediatrics (7 decks)

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