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Paediatrics > GI > Flashcards

GI Flashcards

1
Q

What leads infant growth

A

Nutrition

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2
Q

Is breast feeding or bottle feeding better

A

breast

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3
Q

What is the base of all formula feeds

A

Cow’s milk

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4
Q

Why is cow’s milk not suitable as the main drink until 1yr

A

Contains no iron

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5
Q

When should weaning commence

A

6 mnths

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6
Q

Reasons for weaning

A

Encourage tongue and jaw movements preparing for speech

Milk alone is inadequate

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7
Q

What is the most common food allergy in children

A

Cows Milk Protein Allergy

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8
Q

What type of reaction is CMPA

A

Delayed reaction

non- IgE mediated

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9
Q

Signs of CMPA

A

Diarrhoea
Abdo. Discomfort
Distension
Eczema

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10
Q

Ix for suspected CMPA

A

4wk trial avoidance
Special formula
Milk free diet for breast feeding mothers
Reintroduction at 4wks

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11
Q

1st line feed choice CMPA

A

Hyrolysed feed

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12
Q

2nd line feed choice CMPA

A

Amino acid based feeds

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13
Q

Which supplement may be required in CMPA

A

Calcium

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14
Q

Which milks are not advised for babies

A

Soya
Rice
Goats and Sheep
Oats and nut milks

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15
Q

Why is Rice milk not advised?

A

Contains arsenic

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16
Q

Why is goats and sheep milk not indicated

A

very allergenic

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17
Q

What is biliatry atresia

A

Type biliary obstruction

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18
Q

Pathology biliary atresia

A

Congenital fibro-inflammatory disease of bile ducts

Leading to destruction of extra-hepatic bile ducts

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19
Q

Signs biliary atresia

A

PALE STOOLS
Dark urine

Jaundice:
Prolonged
Conjugated

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20
Q

Why is timely Dx crucial for biliary atresia

A

Treatment time determines prognosis

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21
Q

Rx for Biliary atresia

A

Kasai Poroenterostomy:

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22
Q

Other causes biliary obstruction

A

Choledochoal cyst

Alagille Syndrome

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23
Q

Define chronic constipation

A

Infrequent passage stools

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24
Q

Causes of chronic constipation

A 
Poor diet:
Insufficient fluids 
Excessive milk 
Poor training 
School diet 
Intercurrent illness
Medications
FH 
Organic
Psychological Secondary Cause
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25
Q

Which medications can cause constipation

A

Opiates

Gaviscon

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26
Q

Describe constipation cycle

A

Viscious cycle
Child has a bad experience so shows faecal withholder behaviour
Contracts external anal sphincter
Can lead to megarectum

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27
Q

Which stool chart is used

A

Bristol

28
Q

Advantages laxatives

A

Non invasive

Given by parents

29
Q

Disadvantages laxatives

A

Non-compliance

side effects

30
Q

Treatment of chronic constipation

A

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)

31
Q

Which laxatives can be used

A 
Osmotic laxatives (Lactulose)
Simulant laxatives (Senna, Picolax)
Isotonic Laxatives
32
Q

Define chronic diarrhoea

A

4 or more stools/day

For >4 weeks

33
Q

Describe osmotic diarrhoea

A

Movement H20 into bowel

Usually features of malabsorption (e.g CF, coeliac)

34
Q

Describe Secretory diarrhoea

A

Classically associated with toxin production
Need to rule out E.coli
Also cholera
Predominantly driven by active Cl- secretion via CFTR

35
Q

Potential causes diarrhoea

A

Motility disturbance:
Toddler Diarrhoea
IBS

Active Secretion:
Acute infective diarrhoea
IBD

Malabsorption of Supplements:
Food allergy
Coeliac disease
CF (particularly fat)

36
Q

2 types IBS

A

Crohn’s D

UC

37
Q

Pathological features UC

A

Bloody mucous diarrhoea
Limited to colon
Tends to start distally and spread proximally
No skip lesions
Superficial inflammation (does not affect all the layers)

38
Q

Pathological features CD

A

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

39
Q

CD manifestations skin

A

Erythema Nodusum

40
Q

Differences between adults and child IBD

A

Children CD>UC
Children M>F
Isolated ileal disease less common children
UC is typically pan colitis (less commonly proctitis)

41
Q

Ix for IBD

A 
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
42
Q

Management for IBD

A

Polymeric diet or oral prednisolone

Steroid sparing agents (Azathioprine, Methotrexate)

Biologics (Infliximab/ Adalibumab)

Surgery

43
Q

Which layer of the GIT is affected in CD

A

All layers

44
Q

Which layer of the GI is affected in UC

A

Top layer

45
Q

Where does UC affect in GIT

A

Limited to colon

46
Q

Where does CD affect in GIT

A

Can affect anywhere

47
Q

What should bilious vomiting always ring

A

ALARM BELLS

48
Q

Potential causes bilious vomiting

A

Intestinal atresia
Malrotation
Ileus

49
Q

What is bilious vomiting underlying cause

A

Due to intestinal obstruction until proven otherwise

50
Q

Ix for bilious vomiting

A

Abdo. x-ray
Contrast meals

Surgical opinion:
Exploratory laparotomy

51
Q

What colour is bilious vomiting

A

Bile is green

NOT yellow

52
Q

Rx for bilious vomiting

A 
Urgent surgical opinion 
IV access
IV fluids 
Nil by mouth 
NG tube

Treat underlying cause

53
Q

Is GORD common

A

Yes very common

54
Q

Features of GORD

A 
Vomiting 
Hematemesis (rarely)
Feeding problems 
Failure to thrive 
Apnoea 
Cough 
Wheeze 
Chest infections
55
Q

Rx for GORD

A

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

56
Q

Medical Rx for GORD

A

Feed thickener (e.g Gaviscon)
Pro-kinetic drugs
Acid suppressing drugs (PPI, H2 receptor antag)

57
Q

Feeding advice Rx for GORD

A

Thickeners for liquids
Feeding position (450
Behavioural programme

58
Q

Surgery Rx for GORD

A

Nissen Fundoplication

59
Q

Genetic susceptibility in Coeliac

A

HLA-DQ2

HLA-DQ8

60
Q

Associations with coeliac disease

A

Other auto-immune diseases

61
Q

Histological features of coeliac disease

A

Partial/total villous atrophy
Lymphocyte infiltration
Crypt hyperplasia

62
Q

Clinical features of coeliac

A 
Abdo. pain 
Bloating 
Diarrhoea 
Failure to thrive 
Short stature 
Constipation 
Fatigue
Dermatitis Herpatiformis
63
Q

Skin manifestation of coeliac

A

Dermatitis Herpatiformis

64
Q

Ix for coeliac disease

A

Anti-tissue transglutaminase (screening test)
Anti-endomysial
Anti-gliadin
Serum IgA

Gold Standard:
Duodenal biopsy

Genetic testing:
HLA DQ2
HLA DQ8

65
Q

Rx for coeliac

A

Diet free life

66
Q

Complications of coeliac disease

A

Risk rare small bowl lymphoma
Infertility
Osteoporosis

Paediatrics (13 decks)

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