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Paediatrics > GI > Flashcards

GI Flashcards

1
Q

GORD prevalence

A

40% of infants
within 1st 2 weeks of life

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2
Q

pathophysiology Gord infants

A

tone of muscular portion of lower oesophagus is too low..made worse by
- short, narrow oesophagus
- delayed gastric emptying
- shorter, lower oesophageal sphincter is above diaphragm
- liquid diet and high calorie intake - distending the stomach
- larger ratio of gastric volume to oesophageal volume
- recumbent position

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3
Q

risk factors GORD infants

A

prematurity
parental hx of heartburn
obesity
hiatus hernia
hx of repaired congenital diaphragmatic hernia or oesophageal atresia
neurodisability such as cerebral palsy

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4
Q

symptoms GORD infants

A

crying, unusual neck postures, back arching
feeding difficulties
hoarseness
chronic cough
episode of pneumonia
faltering growth
retrosternal or epigastric pain

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5
Q

hx gord infants

A

full feeding history
relationship of sx to feeds

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5
Q

GORD infants ddx

A

pyloric stenosis
intestinal obstruction
acute surgical abdomen
upper GI bleed
sepsis
raised ICP
bacterial gastroenteritis
UTI

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6
Q

GORD when consider other diagnoses

A

if onset >6 mths of age or sx persist beyond 1 year

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6
Q

GORD infants management

A

reassurance - effortless regurgitation
alginate mixed with water after feeds if breastfed
make sure not over ded or decreased frequency, can try feed thickener if formula fed

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7
Q

GORD infants complications/prognosis

A

90% spontaneously resolve within 1st year of life
complications - reflux oesophagitis, recurrent aspiration pneumonia, recurrent acute otitis media, dental erosion
apnoea
ALTE

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8
Q

coeliac immune mechanisms

A

T cell mediated immune disorder, development of anti-gluten CD4 T cell response, anti gluten antibodies, autoantibodies against tissue transglutaeminase, endomysium and activation of intraepithelial lymphocytes…result in epithelial cells destruction and villous atrophy

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9
Q

gluten foods

A

bread
beers
biscuit
breakfast cereal
cakes
pasta
pies

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10
Q

coelic associated conditiions

A

type 1 DM
down’s
turner’s
thyroid disease
RA
addison’s

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11
Q

coeliac younger children sx

A

GI sx - loose stools, steatorrhoea, anorexia, abdo pain
9-24 mths of age
failure to thrive
weight loss
histology - crypt hyperplasia and villous atrophy

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12
Q

coeliac older children sx

A

more likely to have extra-intestinal sx
can also have intestinal

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13
Q

silent form coeliac

A

damaged small intestine mucosa + positive serology
no clinical sx

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13
Q

latent form coeliac

A

predisposing gene HLADQ2 and/or HLADQ8
normal intestinal mucosa
posittive serology is possible

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14
Q

potential form coeliac

A

normal mucosa,positive autoimmune serology, geneticallly predisposed to develop at some point, may or not have sex

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15
Q

atypical form coeliac

A

osteoporosis, peripheral neuropathy, anaemia, infertility
no intestinal sx

16
Q

extra-intestinal sx coeliac

A

dermatitis herpetiformis
dental enamel hypoplasia
osteoporosis
delayed puberty
short stature
iron def anaemia
liver and billiary tract disease
arthritis
peripheral neuropathy

17
Q

coeliac ddx

A

tropical sprue
CF
IBD

18
Q

investigations coeliac

A

offer serological testing - gluten in diet for at least 6mths
- total IgA and tTG
- then try EMA
- if total IgA deficient consider IgG EMA
- genetic testing
- endoscopic intestinal biopsy
gold standard is duodenal biopsy, classified by Marsh

19
Q

complications coeliac

A

anaemia
osteoporosis
refractory coelic disease
malignancy
fertility issues
depression/anxiety

20
Q

cow’s milk protein allergy epidemiology

A

7% of formula or mixed fed infants
0.5% of exclusively breastfed infants

21
Q

cow’s milk protein allergy pathophysiology

A

IgE mediated - type 1 hypersensitivity. CD4 TH2 cells stimulate B cells to produce IgE antibodies against cow’s milk protein…triggers histamines and other cytokines from mast cells and masophils
non IgE - T cell activation

22
Q

cow’s milk protein allergy risk factors

A

personal hx of atopy
fhx of atopy
not breastfeeding (exclusively breastfeeding is protective factor)

23
Q

clinical features cow’s milk allergy

A

ige - acute,prutirits, eyrhtema, acute urticaria, angioedema, nausea, vomiting, diarrhoea
lower and upper resp sx
non ige - non acute, delayed, pruritus, erythema, atopic eczema, GORD,loose stools, blood in stool, infantile colic, food aversion, constipation, perianal redness, apllor, faltering growth, lower resp sx

24
Q

CMPA investigations

A

clinical feature
specific IgE antibodies but low specificity
non IgE - clinically diagnosed

25
Q

CMPA management

A

avoidance of cow’s milk including in mothers die
for at least 6 mths of until 9-12 months old
if formula fed - alternative formula - extensively hydrolyed or amino acid

26
Q

CMPA complication

A

malabsoprtion
iron def anaemia
faltering growth
anaphylaxis (rare)

27
Q

rotavirus

A

most common cause of infantile gastoenteritis
vaccine against at 8 and 12 weeks
faecal oral route or by environmental contamination
peaks over winter mths

28
Q

norovirus

A

commonest cause in all age groups
faecal oral or environmental contamination

29
Q

adenovirus

A

resp infection too
gastroenteritis <2 yrs of age

30
Q

campylobacter

A

most common
bloody diahrroea
undercooked meat and unpasteurised milk

31
Q

e.coli

A

some strains such as VTEC - haemorhhagic colitis and haemolytic uraemic syndrome
contaminated food, person to person contact, contact with infected animals

32
Q

increased risk of dehydration in infants gastroenteritis

A

children <6mths
children >5 diarrhoeal stools in last 24 hrs
childre vomited >2x in last 24 hrs
children who stopped breastfeeding during illness

33
Q

when should ddx be considered in children with gastroenteritis

A

temp >38 if <3mths or >39 if >3mths old
breathlesness
altered GCS
meningism
blood in stool
bilious vomit
severe abdo pain
abdo distention`

34
Q

gastroenteritis investigations

A

stool sample - if septicaemia, blood in stool or child is immunocompromised
blood test - Na, K, Cr, Ur and glu if IV fluids going to be used or signs of hypernatraemia

35
Q

gastoenteritis manegemtn

A

continue breast feeding
encourage fluid intake
decreased diuretic drink intake
oral rehydration salt solution
(50ml/kg over 4 hrs plus maintenance fluid)
if dehydrated Iv hydration

36
Q

gastroenteritis following rehydration

A

full strength milk and slowly re introduce child’s solidfood
hygiene
not return to school until at least 48 hours passed since last episode and not swim for 2 weeks after last episode

37
Q

gastroenteritis complications

A

haemolytic uraemic syndrome - which can result in acute renal failure and haemolytic anaemia
arthritis, carditis, erythema nodosum and conjuncitivits, reiter’s syndrome
toxic megacolon
acquired lactose intolerance

38
Q

see crohn’s

A
39
Q

see UC

A
40
Q
A
41
Q
A

Paediatrics (17 decks)

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