GI Flashcards
coeliac - features in kids
stools - pale, bulky, increased/diarrhoea
abdo - distension
systemic - fatigue, pallor
growth - weight loss + failure to thrive
coeliac - investigations in kids
diagnosis (reintroduce gluten 6wk before):
anti-TTG
jejunal biopsy - villous atrophy
plus:
FBC - microcytic anaemia
stool culture + calprotectin - rule out other
commonest cause of haematemesis in kids
mallory weiss
commonest cause of opening bowels at night in kids
colitis
commonest cause of blood mixed with stool in kids
gastroenteritis - usually bacterial
poss colitis
commonest cause of mucus in stool in kids
inflammation
viral GE hx - things to ask about in kids
dehydration risk - eating, drinking, urinating
sources - contacts, travel, animals, unusual/contaminated foods
IBD - symptoms in kids
abdo pain
stools - diarrhoea, tenesmus, mucus, blood
constitutional - fatigue, fever, weight loss
chron’s - mouth ulcers + perianal disease
IBD - investigations in kids
faecal calprotectin - marks gut damage (not IBD specific)
endoscopy:
mainstay of diagnosis - flex sig then colonoscopy if needs be
bloods: FBC - anaemia B12, folate + iron - deficiency in small bowel disease / aggressive colitis LFTs - other effects of disease CRP - disease activity
rule out:
coeliac - anti-TTG
stool culture
chron’s - treatment to induce remission in kids
prednisolone 2-4wk → taper 4-8wk
calcium + vit D ± PPI
or
6wk enteral nutrition eg NG + gradually reintroduce food
UC - treatment in kids
mild:
mesalazine oral/suppositories
mod:
steroids 2-4wk + taper
then mesalazine
*mesalazine = 5-ASA
treatment involves inducing + maintaining remission
anorexia nervosa management (kids)
refer psych nutrition - vitamins (thiamine, B complex, multivits), diet plan, dietitian monitor - obs, bloods esp phosphate, ECG therapy - CBT, family CBT
GE - investigations in kids
U+Es + glucose if dehydrated
blood cultures if starting abx
stool culture if BmITS: blood/mucus immunosuppressed travel ?septicaemia
signs of dehydration in an infant
sunken - fontanelle + eyes
surfaces - dry membranes + reduced turgor
circulation - tachy, weak pulse, hypotn, ↑CRT
oliguria
severe dehydration in GE - red flags that indicate need for treatment? what is the treatment?
shock
persistent vomiting
hypoglycaemia
red flags
IV fluids - 1-2x bolus then maintenance
management + counselling of mild-mod dehydration in GE in kids
ORS
glucose + electrolytes
50ml/kg in 4h + maintenance
± usual fluids but not juice/fizzy
continue breast/formula
safety net
2 commonest pathogens that cause GE in kids
rotavirus
adenovirus
intussusception - presentation + examination finding
episodes of: severe colicky pain - legs drawn up pallor + crying +- vomiting recovery + lethargy red currant jelly stool
sausage lump may be palpable
e coli in kids - presentation
bloody diarrhoea
abdo pain, fever + lethargy
seizures
haemolytic uraemic syndrome
how does haemolytic anaemic syndrome present?
progressive:
haemolytic anaemia
low platelets
AKI (uraemia)
± jaundice
differentials - blood in stool WITH D+V in kids
intussusception gastroenteritis - docs to the RESCue: Rotavirus E coli Shigella Campylobacter
vomiting in kids - RFgs
3 vom - “blood, bile, projectile”:
blood - usually MW
bile - proximal BO, meconium ileus
projectile - pyloric stenosis if <2mo
3 other - 1 at the top, 1 in the middle, 1 at the bottom:
fontanelle bulging - ^ICP - meningitis
abdo distension - proximal BO
stool bloody or jelly - GE (salmonella/campy), intusussception
fever - UTI/meningitis
cough - whooping cough
viral GE - advice for parents on home management? safety netting?
48h nursery rule
continue breast/formula, must reintroduce by 24h
diarrhoea lasts 5-7d - 5ml/kg ORS after episodes
get help if: unwell behaviour - irritable/lethargic looks - mottled/pale/cold sx - vomiting > 3d + decreased urine
diarrhoea
symptoms to ask about?
red flags for acute illness?
investigations?
blood + mucus
rule out:
sepsis
dehydration/shock - consistency, frequency, duration, fluid intake/wee
send stool for microbiology if BmITS: blood/mucus immunocompromised travel ?septicaemia
lyme disease - 3 stages
mgmt
1 - rash + nonspecific symptoms
2 - meningitis, facial palsy, arthritis, carditis
3 - neuropsych probs + fatigue
cefuroxime + amoxicillin - can give based on clinical diagnosis
intussusception - mgmt
fluid resus
if stable + no peritonitis/perf - air insufflation under radiological control
if not - surgery
intusussception - investigation
USS - target-like mass
constipation - examination + mgmt
check/ask re impaction - severe constp symps, overflow, mass palpable
movicol (+ stimulant lax if no response) - maintenance for several weeks then taper when bowels regular
increase fibre + fluids
increase activity level
red flags constipation
neonatal:
from birth/first weeks of life
meconium >48h
the poo itself:
ribbon
abdo distension w vomiting - obstruction/hirschprungs
systemic:
faltering growth
leg weakness, locomotor delay
faecal impaction due to constipation - management + counselling
movicol on escalating dose regimen
inform this can initially increase soiling + abdo pain
add stimulant laxative if not disimpacted in 2wk
appendicitis - symptoms
central abdo pain that radiates to RIF low grade pyrexia minimal vomiting but can be anything >4y
congenital diaphragmatic hernia - what is it? outcomes?
herniation of abdo into chest from incomplete diaphragm formation
can → pulmonary hypoplasia + HTN → resp distress after birth
50% mortality
can be screen detected
think of the hernia squishing the lungs, increasing the pressure inside and preventing their growth
cows milk protein intolerance/allergy - features? outcome?
skin - urticaria + atopic eczema GI - regurg, vomiting, diarrhoea resp - wheeze + chronic cough mood - irritability + crying growth - failure to thrive
immediate (minutes) - allergy
delayed (hours-days) - intolerance
usually resolves by 1-2y
cows milk protein allergy - diagnosis
often clinical - cut out and see
if need to test:
skin prick / patch testing
CMP-specific + total IgE (RAST)
cows milk protein allergy - management
if formula fed:
1° - extensively hydrolysed milk
2° - amino acid based formula
if breastfed:
eliminate CMP from mum’s diet + continue breastfeeding
when breastfeeding stops - use eHF milk until 12mo
safety net anaphylaxis
refer paeds if severe
how long should D+V last in kids? max duration?
D - 5-7d, max 2wk
V - 1-2d, max 3d
hirschprung’s - what is it? presentation? diagnosis? associations? management?
aganglionic segment of bowel assoc with down’s
neonate - meconium absent or >24h
older - constipation + distension
diagnosis:
1) abdo xray
2) confirmation - full thickness rectal biopsy
rectal washouts then anorectal pull through procedure - dodgy bowel pulled out + healthy bits joined together
pyloric stenosis - age group affected, presentation, diagnosis + management
at 2-6wk projectile, non-bilious vomiting usually 30min after feed diagnosis - USS or test feed treatment - surgery
hypertrophy of circular muscles of pylorus
meconium ileus - presentation, association + management
delayed meconium
distension + bilious vomiting
most have CF
management:
1° - contrast enema - may dislodge mucus plugs
2° - nasogastric n-aycetylcysteine
3° - surgery
umbilical hernia - when found? assoc? outlook?
may be found on newborn exam
should resolve by 3y
assoc - afrocaribbean, down’s
chronic diarrhoea in kids - differentials
cows milk intolerance
coeliac
post-GE lactose intolerance
IBD
D+V in kids - management if no signs of dehydration
continue usual feeds + encourage fluids
discourage juice + fizzy
causes of jaundice in first 24h of life
ABO haemolytic disease
Rhesus haemolytic disease
G6PD
Hereditary spherocytosis
ARGH! just been born and i’ve already got fuckin jaundice
causes of jaundice in 2-14d of life
usually physiological eg breastfeeding
jaundice after 14d - investigations
prolonged jaundice screen, incl:
c + uc bilirubin - biliary atresia
coombs - autoimmune haemolytic anaemia
TFTs
jaundice after 14d - causes
Biliary atresia
Infection (congenital) eg CMV, toxoplasmosis
Galactosaemia
Hypothyroidism
UTI
Breastmilk
big hub of bilirubin in me skin
intussusception - age? RF?
age 3mo-2y
HSP
