GI Flashcards by Nayungma Rai

why is GORD common in infancy

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

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at what age should GORD resolve by itself

1yr

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clinical presentation of GORD

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

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management/advice to prevent GORD

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

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complications of GORD

sandifer’s syndrome
oesophagitis
failure to thrive
recurrent pulmonary aspiration

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what is intussusception

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

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what age is intussusception is common

3months -2yrs

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clinical presentation of intussusception

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

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what investigation is diagnostic in intussusception

USS - diagnostic

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what is seen in xray in intussusception

absence of gas in distal colon or rectum
distended small bowel

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initial intussusception management

supportive (IV fluids , NG tube )
air enema

surgery if air enema is unsuccessful or peritonitis

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complications of intussusception

necrosis
bleeding
peritonitis

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complications of intussusception

necrosis
bleeding
peritonitis

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risk factors of pyloric stenosis

male
first borns
fh
2-7 weeks

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clinical presentation of pyloric stenosis

projectile vomiting
hunger and dehydration
visible gastric peristalsis
weight loss

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investigations of pyloric stenosis

bloods showing hypochloraemic metabolic alkalosis with hyponatraemia and hypokalaemia

USS showing thickening of pylorus

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management of pyloric stenosis

correct fluid and electrolyte disturbances with IV fluids and then surgery

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difference between marasmus and kwashiorkor

marasmus - deficiency of all macronutrients
kwashiorkor - protein deficiency malnutrition

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clinical presentation of marasmus

muscle wasting
stunted growth
anaemia
children appear withdraw and apathetic

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clinical presentation of kwashiorkor

flaky paint dermatosis
distended abdomen
oedema
hepatomegaly
diarrhoea

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management for marasmus and kwashiorkor

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

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what is Hirschsprung’s disease

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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function of myenteric/ auerbach’s plexus

responsible for stimulating peristalsis of the large bowel

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presentation of hirschsprung disease

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

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neonatal period presentation of Hirschsprung disease

failure to pass meconium in 24hrs

what is hirschprung associated enterocolitis

inflammation and obstruction of the intestine in neonates with hirschprungs disease

complication of hirschprung associated enterocolitis

toxic megacolon and perforation of the bowel

how does hirschprung associated enterocolitis present

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

what is cows milk allergy

hypersensitivity to protein in cow's milk

types of cows milk allergy

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

risk factors for cows milk allergy

- formula fed babies - personal or fh or atopic conditions

clinical presentation of cows milk allergy

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

management of cows milk allergy

- 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

when shows kids outgrow cows milk allergy

by 3yrs

what is meckel's diverticulum

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

complications of meckel's diverticulum

ulcers peritonitis volvulus intussusception

clinical presentation of meckel's diverticulum

generally asymptomatic rectal bleeding- not bright red or melaena

treatment for meckels

surgical resection

what is biliary atresia

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

clinical presentation of biliary atresia

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

management of biliary atresia

surgery- kasai procedure patients might require full liver transplant

what are choledochal cysts

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

classic triad of choledochal cysts

abdo pain abdo mass jaundice

investigations for choledochal cysts

UUS or radionuclide scanning

treatment for choledochal cysts

surgical excision

reasons for physiological jaundice in babies

- shorter life span of red cells - hepatic bilirubin metabolism is less efficient in the first few days of life

when does physiological jaundice resolved

resolves itself in 2 weeks

complication of jaundice

kernicterus

what is kernicterus

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

what can kernicterus develop into

choreoathetoid cerebral palsy sensorineural deafness learning difficulties

clinical presentation of kernicterus

lethargy poor feeding increased muscle tone seizures

at what level do babies become clinically jaundiced

80 µmol/L

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

jaundice <24hrs = unconjugated bilirubin congenital = conjugated

causes of jaundice <24hrs

rhesus haemolytic disease ABO incompatibility G6PD deficiency spherocytosis

in ABO incompatibility what blood group is mother and foetus

mother - group o foetus - group a or b

sensitisation in ABO incompatibility and Rh incompatibility

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

what is toddler's diarrhoea

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

when does toddler's diarrhoea stop

most outgrow symptoms by 5yrs

possible cause of toddler's diarrhoea

maturation delay in intestinal motility leading to intestinal hurry

management for toddler's diarrhoea

high fat diet reduce fruit juice or squash dont drink too much water adequate fibre 4 Fs': fat, fluid, fruit juices and fibre