GI Flashcards
What leads infant growth
Nutrition
Is breast feeding or bottle feeding better
breast
What is the base of all formula feeds
Cow’s milk
Why is cow’s milk not suitable as the main drink until 1yr
Contains no iron
When should weaning commence
6 mnths
Reasons for weaning
Encourage tongue and jaw movements preparing for speech
Milk alone is inadequate
What is the most common food allergy in children
Cows Milk Protein Allergy
What type of reaction is CMPA
Delayed reaction
non- IgE mediated
Signs of CMPA
Diarrhoea
Abdo. Discomfort
Distension
Eczema
Ix for suspected CMPA
4wk trial avoidance
Special formula
Milk free diet for breast feeding mothers
Reintroduction at 4wks
1st line feed choice CMPA
Hyrolysed feed
2nd line feed choice CMPA
Amino acid based feeds
Which supplement may be required in CMPA
Calcium
Which milks are not advised for babies
Soya
Rice
Goats and Sheep
Oats and nut milks
Why is Rice milk not advised?
Contains arsenic
Why is goats and sheep milk not indicated
very allergenic
What is biliatry atresia
Type biliary obstruction
Pathology biliary atresia
Congenital fibro-inflammatory disease of bile ducts
Leading to destruction of extra-hepatic bile ducts
Signs biliary atresia
PALE STOOLS
Dark urine
Jaundice:
Prolonged
Conjugated
Why is timely Dx crucial for biliary atresia
Treatment time determines prognosis
Rx for Biliary atresia
Kasai Poroenterostomy:
Other causes biliary obstruction
Choledochoal cyst
Alagille Syndrome
Define chronic constipation
Infrequent passage stools
Causes of chronic constipation
Poor diet: Insufficient fluids Excessive milk Poor training School diet Intercurrent illness Medications FH Organic Psychological Secondary Cause
Which medications can cause constipation
Opiates
Gaviscon
Describe constipation cycle
Viscious cycle
Child has a bad experience so shows faecal withholder behaviour
Contracts external anal sphincter
Can lead to megarectum
Which stool chart is used
Bristol
Advantages laxatives
Non invasive
Given by parents
Disadvantages laxatives
Non-compliance
side effects
Treatment of chronic constipation
Social:
Explain Rx to parents
Dietary:
Increase fibre, fruits, veg
Decrease milk
Psychological:
Soften stool
Remove pain
Reward good behaviour
Soften stools and stimulate defeacation (Laxatives)
Which laxatives can be used
Osmotic laxatives (Lactulose) Simulant laxatives (Senna, Picolax) Isotonic Laxatives
Define chronic diarrhoea
4 or more stools/day
For >4 weeks
Describe osmotic diarrhoea
Movement H20 into bowel
Usually features of malabsorption (e.g CF, coeliac)
Describe Secretory diarrhoea
Classically associated with toxin production
Need to rule out E.coli
Also cholera
Predominantly driven by active Cl- secretion via CFTR
Potential causes diarrhoea
Motility disturbance:
Toddler Diarrhoea
IBS
Active Secretion:
Acute infective diarrhoea
IBD
Malabsorption of Supplements:
Food allergy
Coeliac disease
CF (particularly fat)
2 types IBS
Crohn’s D
UC
Pathological features UC
Bloody mucous diarrhoea
Limited to colon
Tends to start distally and spread proximally
No skip lesions
Superficial inflammation (does not affect all the layers)
Pathological features CD
Can affect anywhere in the GI tract
Depending on where is affected will determine the symptoms present
Inflammation affect all layers
Skip lesions can occur
CD manifestations skin
Erythema Nodusum
Differences between adults and child IBD
Children CD>UC
Children M>F
Isolated ileal disease less common children
UC is typically pan colitis (less commonly proctitis)
Ix for IBD
History and Examination Exclude infection (stool culture)
Laboratory:
FBC
ESR
Biochemistry:
Stool Calprotectin
CRP
Radiological:
MRI
Barium meal
Endoscopy: Colonoscopy Upper GI endoscopy Mucosal biopsy Capsule endoscopy Enteroscopy
Management for IBD
Polymeric diet or oral prednisolone
Steroid sparing agents (Azathioprine, Methotrexate)
Biologics (Infliximab/ Adalibumab)
Surgery
Which layer of the GIT is affected in CD
All layers
Which layer of the GI is affected in UC
Top layer
Where does UC affect in GIT
Limited to colon
Where does CD affect in GIT
Can affect anywhere
What should bilious vomiting always ring
ALARM BELLS
Potential causes bilious vomiting
Intestinal atresia
Malrotation
Ileus
What is bilious vomiting underlying cause
Due to intestinal obstruction until proven otherwise
Ix for bilious vomiting
Abdo. x-ray
Contrast meals
Surgical opinion:
Exploratory laparotomy
What colour is bilious vomiting
Bile is green
NOT yellow
Rx for bilious vomiting
Urgent surgical opinion IV access IV fluids Nil by mouth NG tube
Treat underlying cause
Is GORD common
Yes very common
Features of GORD
Vomiting Hematemesis (rarely) Feeding problems Failure to thrive Apnoea Cough Wheeze Chest infections
Rx for GORD
Self-limiting
Feeding advice:
Thickeners for liquids
Nutritional support:
Calories supplemnet
Exclusion diet
NG tube
Medial Rx:
Feed thickener
Pro-kinetic drugs
Acid suppressing drugs
Surgery:
Last ressort
Nissen Fundoplication
Medical Rx for GORD
Feed thickener (e.g Gaviscon)
Pro-kinetic drugs
Acid suppressing drugs (PPI, H2 receptor antag)
Feeding advice Rx for GORD
Thickeners for liquids
Feeding position (450
Behavioural programme
Surgery Rx for GORD
Nissen Fundoplication
Genetic susceptibility in Coeliac
HLA-DQ2
HLA-DQ8
Associations with coeliac disease
Other auto-immune diseases
Histological features of coeliac disease
Partial/total villous atrophy
Lymphocyte infiltration
Crypt hyperplasia
Clinical features of coeliac
Abdo. pain Bloating Diarrhoea Failure to thrive Short stature Constipation Fatigue Dermatitis Herpatiformis
Skin manifestation of coeliac
Dermatitis Herpatiformis
Ix for coeliac disease
Anti-tissue transglutaminase (screening test)
Anti-endomysial
Anti-gliadin
Serum IgA
Gold Standard:
Duodenal biopsy
Genetic testing:
HLA DQ2
HLA DQ8
Rx for coeliac
Diet free life
Complications of coeliac disease
Risk rare small bowl lymphoma
Infertility
Osteoporosis
