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paeds > GI > Flashcards

GI Flashcards

1
Q

coeliac - features in kids

A

stools - pale, bulky, increased/diarrhoea
abdo - distension
systemic - fatigue, pallor
growth - weight loss + failure to thrive

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2
Q

coeliac - investigations in kids

A

diagnosis (reintroduce gluten 6wk before):
anti-TTG
jejunal biopsy - villous atrophy

plus:
FBC - microcytic anaemia
stool culture + calprotectin - rule out other

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3
Q

commonest cause of haematemesis in kids

A

mallory weiss

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4
Q

commonest cause of opening bowels at night in kids

A

colitis

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5
Q

commonest cause of blood mixed with stool in kids

A

gastroenteritis - usually bacterial

poss colitis

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6
Q

commonest cause of mucus in stool in kids

A

inflammation

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7
Q

viral GE hx - things to ask about in kids

A

dehydration risk - eating, drinking, urinating

sources - contacts, travel, animals, unusual/contaminated foods

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8
Q

IBD - symptoms in kids

A

abdo pain
stools - diarrhoea, tenesmus, mucus, blood
constitutional - fatigue, fever, weight loss
chron’s - mouth ulcers + perianal disease

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9
Q

IBD - investigations in kids

A

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

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10
Q

chron’s - treatment to induce remission in kids

A

prednisolone 2-4wk → taper 4-8wk
calcium + vit D ± PPI
or
6wk enteral nutrition eg NG + gradually reintroduce food

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11
Q

UC - treatment in kids

A

mild:
mesalazine oral/suppositories

mod:
steroids 2-4wk + taper
then mesalazine

*mesalazine = 5-ASA
treatment involves inducing + maintaining remission

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12
Q

anorexia nervosa management (kids)

A 
refer psych
nutrition - vitamins (thiamine, B complex, multivits),
diet plan, dietitian
monitor - obs, bloods esp phosphate, ECG
therapy - CBT, family CBT
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13
Q

GE - investigations in kids

A

U+Es + glucose if dehydrated
blood cultures if starting abx

stool culture if BmITS:
blood/mucus
immunosuppressed
travel
?septicaemia
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14
Q

signs of dehydration in an infant

A

sunken - fontanelle + eyes
surfaces - dry membranes + reduced turgor
circulation - tachy, weak pulse, hypotn, ↑CRT
oliguria

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15
Q

severe dehydration in GE - red flags that indicate need for treatment? what is the treatment?

A

shock
persistent vomiting
hypoglycaemia
red flags

IV fluids - 1-2x bolus then maintenance

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16
Q

management + counselling of mild-mod dehydration in GE in kids

A

ORS
glucose + electrolytes
50ml/kg in 4h + maintenance

± usual fluids but not juice/fizzy
continue breast/formula
safety net

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17
Q

2 commonest pathogens that cause GE in kids

A

rotavirus

adenovirus

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18
Q

intussusception - presentation + examination finding

A 
episodes of:
severe colicky pain - legs drawn up
pallor + crying +- vomiting
recovery + lethargy
red currant jelly stool

sausage lump may be palpable

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19
Q

e coli in kids - presentation

A

bloody diarrhoea
abdo pain, fever + lethargy
seizures
haemolytic uraemic syndrome

20
Q

how does haemolytic anaemic syndrome present?

A

progressive:
haemolytic anaemia
low platelets
AKI (uraemia)

± jaundice

21
Q

differentials - blood in stool WITH D+V in kids

A 
intussusception
gastroenteritis - docs to the RESCue:
Rotavirus
E coli
Shigella
Campylobacter
22
Q

vomiting in kids - RFgs

A

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

23
Q

viral GE - advice for parents on home management? safety netting?

A

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
24
Q

diarrhoea
symptoms to ask about?
red flags for acute illness?
investigations?

A

blood + mucus

rule out:
sepsis
dehydration/shock - consistency, frequency, duration, fluid intake/wee

send stool for microbiology if BmITS:
blood/mucus
immunocompromised
travel
?septicaemia
25
Q

lyme disease - 3 stages

mgmt

A

1 - rash + nonspecific symptoms
2 - meningitis, facial palsy, arthritis, carditis
3 - neuropsych probs + fatigue

cefuroxime + amoxicillin - can give based on clinical diagnosis

26
Q

intussusception - mgmt

A

fluid resus
if stable + no peritonitis/perf - air insufflation under radiological control
if not - surgery

27
Q

intusussception - investigation

A

USS - target-like mass

28
Q

constipation - examination + mgmt

A

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

29
Q

red flags constipation

A

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

30
Q

faecal impaction due to constipation - management + counselling

A

movicol on escalating dose regimen
inform this can initially increase soiling + abdo pain

add stimulant laxative if not disimpacted in 2wk

31
Q

appendicitis - symptoms

A 
central abdo pain that radiates to RIF
low grade pyrexia
minimal vomiting
but can be anything
>4y
32
Q

congenital diaphragmatic hernia - what is it? outcomes?

A

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

33
Q

cows milk protein intolerance/allergy - features? outcome?

A 
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

34
Q

cows milk protein allergy - diagnosis

A

often clinical - cut out and see

if need to test:
skin prick / patch testing
CMP-specific + total IgE (RAST)

35
Q

cows milk protein allergy - management

A

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

36
Q

how long should D+V last in kids? max duration?

A

D - 5-7d, max 2wk

V - 1-2d, max 3d

37
Q

hirschprung’s - what is it? presentation? diagnosis? associations? management?

A

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

38
Q

pyloric stenosis - age group affected, presentation, diagnosis + management

A 
at 2-6wk
projectile, non-bilious vomiting
usually 30min after feed
diagnosis - USS or test feed
treatment - surgery

hypertrophy of circular muscles of pylorus

39
Q

meconium ileus - presentation, association + management

A

delayed meconium
distension + bilious vomiting
most have CF

management:
1° - contrast enema - may dislodge mucus plugs
2° - nasogastric n-aycetylcysteine
3° - surgery

40
Q

umbilical hernia - when found? assoc? outlook?

A

may be found on newborn exam
should resolve by 3y
assoc - afrocaribbean, down’s

41
Q

chronic diarrhoea in kids - differentials

A

cows milk intolerance
coeliac
post-GE lactose intolerance
IBD

42
Q

D+V in kids - management if no signs of dehydration

A

continue usual feeds + encourage fluids

discourage juice + fizzy

43
Q

causes of jaundice in first 24h of life

A

ABO haemolytic disease
Rhesus haemolytic disease
G6PD
Hereditary spherocytosis

ARGH! just been born and i’ve already got fuckin jaundice

44
Q

causes of jaundice in 2-14d of life

A

usually physiological eg breastfeeding

45
Q

jaundice after 14d - investigations

A

prolonged jaundice screen, incl:
c + uc bilirubin - biliary atresia
coombs - autoimmune haemolytic anaemia
TFTs

46
Q

jaundice after 14d - causes

A

Biliary atresia
Infection (congenital) eg CMV, toxoplasmosis
Galactosaemia

Hypothyroidism
UTI
Breastmilk

big hub of bilirubin in me skin

47
Q

intussusception - age? RF?

A

age 3mo-2y

HSP

paeds (18 decks)

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