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Paediatrics > GI > Flashcards

GI Flashcards

1
Q

why is GORD common in infancy

A

*functional immaturity of the lower oesophageal sphincter
*predominantly fluid diet
*horizontal posture
*short oesophagus

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2
Q

at what age should GORD resolve by itself

A

1yr

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3
Q

clinical presentation of GORD

A

chronic cough
hoarse cry
distress, crying after feeding
reluctance to feed
poor weight gain

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4
Q

management/advice to prevent GORD

A

small, frequent meals
burping regularly
not overfeeding
keep baby upright after feeding

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5
Q

complications of GORD

A

sandifer’s syndrome
oesophagitis
failure to thrive
recurrent pulmonary aspiration

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6
Q

what is intussusception

A

invagination of proximal bowel into a distal segment
most common cuase of intestinal obstruction infants

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7
Q

what age is intussusception is common

A

3months -2yrs

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8
Q

clinical presentation of intussusception

A

severe colicky pain
pale
refusal of feeds
bile-stained vomit
red currant jelly stool
distension

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9
Q

what investigation is diagnostic in intussusception

A

USS - diagnostic

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10
Q

what is seen in xray in intussusception

A

absence of gas in distal colon or rectum
distended small bowel

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11
Q

initial intussusception management

A

supportive (IV fluids , NG tube )
air enema

surgery if air enema is unsuccessful or peritonitis

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12
Q

complications of intussusception

A
  • necrosis
  • bleeding
  • peritonitis
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12
Q

complications of intussusception

A
  • necrosis
  • bleeding
  • peritonitis
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13
Q

risk factors of pyloric stenosis

A

male
first borns
fh
2-7 weeks

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14
Q

clinical presentation of pyloric stenosis

A

projectile vomiting
hunger and dehydration
visible gastric peristalsis
weight loss

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15
Q

investigations of pyloric stenosis

A

bloods showing hypochloraemic metabolic alkalosis with hyponatraemia and hypokalaemia

USS showing thickening of pylorus

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16
Q

management of pyloric stenosis

A

correct fluid and electrolyte disturbances with IV fluids and then surgery

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17
Q

difference between marasmus and kwashiorkor

A

marasmus - deficiency of all macronutrients
kwashiorkor - protein deficiency malnutrition

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18
Q

clinical presentation of marasmus

A
  • muscle wasting
  • stunted growth
  • anaemia
  • children appear withdraw and apathetic
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19
Q

clinical presentation of kwashiorkor

A
  • flaky paint dermatosis
  • distended abdomen
  • oedema
  • hepatomegaly
  • diarrhoea
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20
Q

management for marasmus and kwashiorkor

A

specially formulated milk-based feeds or ready to use therapeutic food

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21
Q

what is Hirschsprung’s disease

A

congenital condition where ganglion cells of the myenteric and submucosal plexuses are absent in the large bowel resulting in a narrow contracted segment

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22
Q

function of myenteric/ auerbach’s plexus

A

responsible for stimulating peristalsis of the large bowel

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23
Q

presentation of hirschsprung disease

A

failure to pass meconium in 24hrs
vomiting
abdo pain and distention
chronic constipation
poor weight gain and failure to thrive

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24
Q

neonatal period presentation of Hirschsprung disease

A

failure to pass meconium in 24hrs

25
Q

what is hirschprung associated enterocolitis

A

inflammation and obstruction of the intestine in neonates with hirschprungs disease

26
Q

complication of hirschprung associated enterocolitis

A

toxic megacolon and perforation of the bowel

27
Q

how does hirschprung associated enterocolitis present

A

2-4 weeks after birth with fever, abdo distention, diarrhoea and features of sepsis

28
Q

what is cows milk allergy

A

hypersensitivity to protein in cow’s milk

29
Q

types of cows milk allergy

A
  • IgE mediated - reaction within 2 hours of ingestion (allergy)
  • non-IgE mediated- reaction between 2-72hrs (intolerance)
  • mix of both
30
Q

risk factors for cows milk allergy

A
  • formula fed babies
  • personal or fh or atopic conditions
31
Q

clinical presentation of cows milk allergy

A

GORD
abdo pain
wind
diarrhoea
vomiting
allergy symptoms e.g. urticaria, SOB, angio-oedema

32
Q

management of cows milk allergy

A
  • breastfeeding mothers should avoid dairy products
  • replace formula with special hydrolysed formulas (protein broken down so immune response not triggered)

milk ladder - expose to new dairy products every 6months or so until they develop symptoms

33
Q

when shows kids outgrow cows milk allergy

A

by 3yrs

34
Q

what is meckel’s diverticulum

A

congenital malformation of the distal ileum which is formed from tissue similar to that found in the pancreas or stomach

35
Q

complications of meckel’s diverticulum

A

ulcers
peritonitis
volvulus
intussusception

36
Q

clinical presentation of meckel’s diverticulum

A

generally asymptomatic

rectal bleeding- not bright red or melaena

37
Q

treatment for meckels

A

surgical resection

38
Q

what is biliary atresia

A

congenital condition where a section of the bile duct is either narrowed or absent which can result in cholestasis

39
Q

clinical presentation of biliary atresia

A

jaundiced shortly after birth which lasts for more than 2 weeks in term babies and more than 3 weeks in premature babies

pale stools and dark urine
hepatomegaly
splenomegaly

40
Q

management of biliary atresia

A

surgery- kasai procedure
patients might require full liver transplant

41
Q

what are choledochal cysts

A

congenital swelling or dilatation of the bile ducts which can affect the extrahepatic and/or intrahepatic segments

42
Q

classic triad of choledochal cysts

A

abdo pain
abdo mass
jaundice

43
Q

investigations for choledochal cysts

A

UUS or radionuclide scanning

44
Q

treatment for choledochal cysts

A

surgical excision

45
Q

reasons for physiological jaundice in babies

A
  • shorter life span of red cells
  • hepatic bilirubin metabolism is less efficient in the first few days of life
46
Q

when does physiological jaundice resolved

A

resolves itself in 2 weeks

47
Q

complication of jaundice

A

kernicterus

48
Q

what is kernicterus

A

encephalopathy due to deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei
(passes bbb)

49
Q

what can kernicterus develop into

A

choreoathetoid cerebral palsy
sensorineural deafness
learning difficulties

50
Q

clinical presentation of kernicterus

A

lethargy
poor feeding
increased muscle tone
seizures

51
Q

at what level do babies become clinically jaundiced

A

80 µmol/L

52
Q

what type of bilirubin in present in jaundice <24hrs or congenital jaundice

A

jaundice <24hrs = unconjugated bilirubin
congenital = conjugated

53
Q

causes of jaundice <24hrs

A

rhesus haemolytic disease
ABO incompatibility
G6PD deficiency
spherocytosis

54
Q

in ABO incompatibility what blood group is mother and foetus

A

mother - group o
foetus - group a or b

55
Q

sensitisation in ABO incompatibility and Rh incompatibility

A

no sensitisation needed in ABO incompatibility so 1st pregnancy can be affected

sensitisation needed in Rh incompatibility so 1st pregnancy is safe

56
Q

what is toddler’s diarrhoea

A

commonest cause of persistent/ chronic loose stools in preschool children
not serious and child is well

57
Q

when does toddler’s diarrhoea stop

A

most outgrow symptoms by 5yrs

58
Q

possible cause of toddler’s diarrhoea

A

maturation delay in intestinal motility leading to intestinal hurry

59
Q

management for toddler’s diarrhoea

A

high fat diet
reduce fruit juice or squash
dont drink too much water
adequate fibre

4 Fs’: fat, fluid, fruit juices and fibre

Paediatrics (16 decks)

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