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Phase 3a Paeds > GI > Flashcards

GI Flashcards

1
Q

In paeds IBD, what is the ratio M:F and which type of IBD is MC?

A

M>F (2:1)
crohns > UC

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2
Q

What are the causes of chronic paediatric diarrhoea?

A

5Cs
CF
CMPI
Crohns
Colitis
Coeliacs

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3
Q

What is Ulcerative colitis?

A

Autoimmune colitis, associated with HLA B27 gene (either have gene or don’t) + pANCA

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4
Q

RF for UC?

A

FHx
jewish
smoking = protective
Associated with PSC

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5
Q

where does UC affect?

A

Colon only
starts at rectum (proctis) to sigmoid to proximal colon

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6
Q

Where is the inflammation in UC?

A

confined to mucosa (+ submucosa)

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7
Q

Sx of UC?

A

Colonic
LLQ pain
Tenesmus (rectal defecation pain - feel need to pass stool when bowel empty)
Bloody mucusy diarrhoea
extra intestinal Sx

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8
Q

What are the extra intestinal Sx?

A

Aphthous mouth ulcers
uveitis/epicleritis
Erythema nodosum
spondylarthritis

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9
Q

Dx of UC?
what score is used in UC?
what is it out of and what is severe to no disease?

A

FIT + fecal elastase (non specific)
pANCA +ve
Colonoscopy + biopsy

PUCAI (paediatric UC activity index)
measures disease activity
severe = >65/85
mod = 64-35
mild = 34-10
no disease = <10

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10
Q

what would be seen on colonoscopy and biopsy in UC?

A

submucosal continuous goblet cell depletion + ulceration

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11
Q

Tx for acute UC (induce remission)?

A
  1. PO/rectal ASA (aminosalicyclate) eg. mesalazine, sulfasalazine
  2. corticosteroid
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12
Q

Tx for long term UC ?

A

ASA, azathioprine, mercaptopurine
Surgery

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13
Q

Tx for severe UC?

A
  1. IV corticosteroids
  2. IV Ciclosporin
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14
Q

What surgery can be done for UC?

A

Panproctocolectomy = colonic removal = ilio-anal asantamoses (J Pouch)

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15
Q

complication of UC?

A

toxic megacolon

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16
Q

What is crohns?

A

Not autoimmune
defect in epithelial barrier allows bacteria through and immune system activated therefore inflammation and destruction deep in mucosa, forming GRANULOMAS.

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17
Q

RF for crohns?

A

fHx
jewish
Smoking (2x more likely)

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18
Q

where does crohns affect?

A

Whole git (from mouth to anus)
esp terminaal ilium + proximal colon (usually rectum spared)

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19
Q

How deep does inflammation occur?

A

transmural
(all 4 layers, mucosa, submucosa, muscle, serosa)

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20
Q

Sx of crohns?

A

Whole git

RLQ Pain

mucusy diarrhoea

Malabsorption - B12, Folate, Fe deficiency (as small intestine involved, colon = only H2O absorption)

Gallstones

Less extra intestinal Sx but *more mouth ulcers

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21
Q

Dx of Crohns?
what score is used and what is a significant score?

A

FIT + fecal elastase
ASCA +ve
Endoscopy and biopsy

Score = PCDAI (Paediatric crohns disease activity index)
>30 = significant

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22
Q

what is seen in the endoscopy and biopsy in crohns?

A

Endoscopy = transmural skip lesions, granulomatous, cobble stoning (inflammation is patchy, normal gut in-between)

Biopsy = transmural inflammation with non caveating granulomas

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23
Q

what is the Tx for crohns flares?

A

PO prednisolone or IV hydrocortisone

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24
Q

Tx for crohns remission?

A

Azathioprine
methotrexate
influximab

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25
Q

can surgery be used as a Tx for crohns?

A

No

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26
Q

Complications of crohns?

A

weight loss
fistulas
strictures
short bowel syndrome

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27
Q

What is coeliacs?
RF?

A

autoimmune Type 4 hypersensitivity reaction vs alpha gliadin (in gluten) = inflammation of epithelial cells

HLA DQ2+8
Autoimmunity (T1DM, Thyroid, downs and turner’s)

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28
Q

Sx of coeliacs?

A

Bloating

Fatigue

mouth ulcers

Malabsorption (haematinic deficiency - Fe, B12, folate) - anemia

Steatorrhoea - increased fat excretion in stool (not absorbed)

Weight loss + failure to thrive (FTT)
2 or less centile weights or fall 2+ centile

Dermatitis hepetiformis

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29
Q

what is dermatitis herpetiformis?

A

Red bumpy skin rash on shins + knees due to IgA skin deposit

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30
Q

Dx of coeliacs?

A

On gluten diet:
1. Anti ttg Ab (best, most specific)

High total Ig A (may get false negative in IgA deficient Px)

  1. EMA (endomysial Ab)

GS = Biopsy

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31
Q

what would be found in a biopsy in coeliacs?

A

villous atrophy + crypt hypoplasia

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32
Q

Tx of coeliacs?

A

Stop eating gluten
PCV 5y booster

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33
Q

complication of coeliacs?

A

EATL lymphoma

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34
Q

what is appendicitis?
what ages does it affect?
due to?

A

10-20y
Medical emergency due to Faecolith (impacted faeces blocking appendix) or filial worms

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35
Q

Sx of appendicitis?

A

Umbilical pain that’s migrated to RIF pain

Rosving (palpate LLQ and pain on RLQ)

obturator

Psoas sign

Rebound tenderness

Fever, N+V

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36
Q

Dx of appendicitis?

A

FBC = High WCC + CRP

Abdo Xray/USS = Faecolith

Young female = pregnancy test bhCG

GS = CT abdo

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37
Q

If the investigations of appendicitis come back negative but the Sx indicate appendicitis then what should be done?

A

laparoscopy

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38
Q

Tx for appendicitis?

A

Abx
Appendectomy

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39
Q

Ddx of appendicitis?
why?

A

-Mesenteric adenitis (inflammation of mesenteric LN)
No rosving, systemically well

-Ectopic

40
Q

Complications of appendicitis?

A

gangrene
rupture
peritonitis

41
Q

what is intussusception?
What ages does it affect?
M or F MC?

A

1-2y/o
Invaginating/telescoping bowel (folds in on itself)
M>F

42
Q

what are the RF of intussusception?

A

Meckel diverticulum
URTI
Henoch Schonlein Purpura
CF

43
Q

Sx of intussusception?

A

Infantile colic (severe) abdo pain

Pale, unwell + lethargic

Recurrent jelly stools (Late)

RUQ Sausage mass (palpation)

Knees to chest

Inconsolable crying

Intestinal obstruction (N+V, Constopation, distension)

44
Q

Dx of intussusception?
what is seen?

A
  1. Abdo USS = target sign (hyper - o - echogenicity)

Abdo Xray = distended

Contrast enema

45
Q

Tx of intussusception?

A

Rectal air insufflation
Surgical if not working

46
Q

Complications of intussusception?

A

Gangrenous bowel
Obstruction
Perforation
Peritonitis

47
Q

What is hirschprung?

A

Congenital condition - aganglionic bowel

No parasympathetic ganglion cells - failed ganglion migration so no nerve cells of myenteric plexus In distal bowel + rectum = uncoordinated peristalsis = large bowel

48
Q

RF of hirschprung?
M or F MC?

A

M>F (3:1)
MEN 2A/B
Downs
newborns

49
Q

what part of the colon does hirschprung usually affect ?

A

rectosigmoid colon

50
Q

Sx of hirschprung?

A

Failure to pass meconium <24/48hr (even with gastriflin)
Abdo pain + distension
billows vomiting
FTT

51
Q

What sign is seen in hirschprung?
What is it?

A

Squirt sign
DRE = Forceful expulsion of stool and gas

52
Q

Dx of hirschprung?
what is seen?

A
  1. Abdo Xray with barium contrast = dilated bowel loops and fluid level

GS. Rectal suction biopsy - absence off ganglionic cells

53
Q

Tx of hirschprung?

A

Manual evacuation with bowel imaging then surgery (Swenson procedure)

54
Q

Complications of hirschprung?

A

HAEC
(superinfection with C.diff + severe diarrhoea - IV fluid, electrolyte balance and IV Vancomycin)

SBP

55
Q

what is the MC GI tract congenital abnormality?

A

Meckels diverticulum

56
Q

What is Meckels diverticulum?

A

Remanent of omphalomesenteric duct, congenital diverticulum of small intestine

57
Q

what is the rule of 2 is meckels?

A

2% population
2ft from ileocoecal valve
2 inches long
2y/o

58
Q

Sx of meckels?

A

Severe, painless dark red PR bleeding
(ulcers due to 2-3x tissue types - pancreatic, gastric)

Commonest cause of painless massive GI bleeds in infants

59
Q

Dx of meckels?

A

Technetium 99m scan

60
Q

Tx of meckels?

A

surgical resection +/- transfusion if severe haemorrhage

61
Q

complications of meckels?

A

Intussusception
Volvulus
Diverticulitis

62
Q

What is intestinal malrotation?

A

Congenital abnormality, mesentery is not fixed/shorter = abnormal rotation +/- Ladd band formation = intestines settle incorrectly

63
Q

Sx of intestinal malrotation?

A

1st week of life
bilous vomiting, constipation + abdo distension

64
Q

Dx of intestinal malrotation?

A
  1. Abdo USS
    GS. Urgent GI contrast study
65
Q

Tx of intestinal malrotation?

A

Surgery, laparotomy
LADD procedure

66
Q

What is pyloric stenosis?

A

hypertrophy of pyloric sphincter - prevents food travelling to duodenum

67
Q

what gender and age experience pyloric stenosis?

A

5:1 M>F
2-7 weeks, around 1 month most

68
Q

Sx of pyloric stenosis?

A

First few weeks:
FTT, thin, pale, dehydrated
PROJECTILE non bilous vomiting
Olive mass in RUQ
Visible peristalsis post feed

69
Q

Dx of pyloric stenosis? what is seen?

A

Abdo USS = Thickened pylorus (target, astral rupple)

VBG = Low Cl- + K+, metabolic alkalosis

70
Q

Tx of pyloric stenosis?
1st and GS?

A

1st = fluids and electrolytes
GS = Laparoscopic Ramstedt pyloromyotomy

71
Q

what is the MC cause of infant vomiting?

72
Q

what is Gastro oesophageal Reflux (GOR)?

A

immature functional oesophageal LOS - Inappropriate relaxation of LOS, reflux into oesophagus

73
Q

RF for GOR?
what age does it usually occur?

A

cerebral palsy!
Prematurity!
Laryngimalacia

<8 weeks

74
Q

Sx of GOR?

A

Chronic milky vomit/regurgitation (worse lying flat/after feed)
Gain weight normally
Problematic reflux = Chronic cough, hoarse cry, distress post feeding, reluctance to feed, FTT

75
Q

Dx of GOR?

A

Clinical + 24hr pH monitor +/- endoscopy + biopsy

76
Q

Tx of GOR?
1st, 2nd and 3rd?

A

1st = small meals, keep upright
breastfed = gaviscon
bottle = thickener

2nd = Alginate (thickener)

3rd = 4 wk PPI/H2-R Antacid
Nissen procedure

77
Q

Complication of chronic vomiting in GOR?

A

Torticollis
Sandifer syndrome (neuro Sx = acute dysarthria, seizures, CN4 Palsy)

78
Q

What is cows milk protein allergy (CMPA)?
RF?

A

allergy / intolerance to cows milk

RF = Formula feed, personal / FHx of atopy

79
Q

when does cows milk protein allergy present?
age?

A

Child weened from breast milk to formula feed
Presents around <1y/o
Intolerance = 3y
allergy = 5y

80
Q

what is cows milk protein ALLERGY and Sx?

A

T1 hypersensitivity to protein in cows milk - IgE mediated = Rapid <2hr response

Flushing, Hives, angioedema, Rhinorrhoea, urticaria, Cough/wheeze, eczema +/- anaphylaxis

81
Q

what is cows milk protein INTOLERANCE and Sx?

A

Non allergy / IgE = over several days

Abdo pain, loose stools, poor sleep, dry skin/rashes, colic, perianal redness

82
Q

Dx of cows milk protein allergy?

A

Clinical
IgE skin prick test (RAST)
GS = Elimination test

83
Q

Ddx of cows milk protein allergy?

A

Lactose intolerance
allergy to lactose sugar
CMPA sufferers do not have an allergy to lactose

84
Q

If a baby is having cows milk <1y/o, what are they at risk of?

A

Fe deficiency anemia

85
Q

Tx of cows milk protein allergy?

A

Extensively hydrolysed feed
(if breastfeeding = lower maternal dairy intake)

Milk ladder reintroduction:
Biscuit - muffin - pancake - cheese - yogurt - milk

86
Q

What is gastroenteritis?

A

Inflammation. of stomach (gastritis - N+V) to intestines (enteritis - diarrhoea)

87
Q

what causes gastroenteritis in developing and developed countries?

A

Developing = Bacteria from contaminated food

Developed = viral, hydration

88
Q

what are the causative organisms of gastroenteritis?

A

MC = Viral:
Rotavirus (kids)
Norovirus (adults)

Bacterial:
E.coli (traveller with HUS)
C.Jejuni MC (undercooked BBQ + GBS)
Salmonella (undercooked chicken)
Bacillus cenus = rice

89
Q

what does E.Coli 0157 cause?

A

Abx = increased risk
HUS (Haemolytic uremic syndrome)

90
Q

Sx of gastroenteritis?

A

N+V
Abdo pain
diarrhoea (+/- bloody)

91
Q

Dx of gastroenteritis?

A

FBC, ESR/CRP, U+E, stool MC+S, travel Hx
Assess dehydration

92
Q

Tx of gastroenteritis?

A

Isolation of Px in hospital, school isolation until ASx >48hrs

Dehydration = PO fluids, discourage fruit juices / carbonated drinks - dehrdration = 50ml/kg ORS

93
Q

what is toddler diarrhoea?
Sx?
age it occurs?
RF?

A

Functional GI immaturity
Chronic loose stools (pees, carrot appearance), systemically well, no FTT
5 years old or less
Premature

94
Q

Causes of constipation?

A

1^ = idiopathic, functional, Opiates, over enthusiastic potty training

2^ = Hypothyroid, Hirschprung, LD, CF, CMPI, S.C lesions, abuse, anal stenosis

95
Q

what is the ROME III criteria for paediatric functional constipation?

A

<2 defacation / week
painful hard stool
rectal fecal mass

Can result in overflow diarrhoea (involuntary watery encopresis in pants)

96
Q

Tx of Constipation?

A

1st = Movicol
2nd = Senna +/- lactulose
3rd = Enema or manual evacuation

97
Q

what are threadworms caused by?
Sx?
Dx?
Tx?

A

Enterobius vermicularis (pinworm)

Itchy bum with white things in stool

perianal sellotape MC+S

Mebenazole to all household >6m + hygiene advice

Phase 3a Paeds (14 decks)

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