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3 - PAEDS > GI > Flashcards

GI Flashcards

1
Q

Red flags in constipation and soiling

A 
Failure to pass meconium within 24hrs
FTT, gross abdo distension
Spinal pathology
Bilious vomiting
Abnormal anal patency
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2
Q

Management of constipation

A

Diet - increase hydration + fibre
Behaviour - toilet footrest, start charts

Movicol paediatric plain - treatment for at least 3 months. Dont stop immediately - want a prolonged period of good bowel habit, to allow baggy bowel to recover

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3
Q

Management of Viral/Bacterial gastroenteritis

A

Oral rehydration solution (ORS) - Dont prescribe anti-diarrhoeals - can give NG tube if not tolerated PO

Give fluid deficit replacement (50 x Bodyweight)/4hrs
+
Maintenance fluid replacement

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4
Q

Most common causes of viral and bacterial gastroenteritis

A

Viral - rotavirus, adenovirus, astrovirus

Bacterial - salmonella, campylobacter, shigella, E.coli, C.diff, vibrio cholerae

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5
Q

Clinical features of GOR and GORD

A

GOR - effortless regurgitation of milk/gastric contents (posset). Not active process, no contraction of abdominal muscles

GORD - GOR but with complications - FTT, LRTI, aspiration, choking, apnoea, hoarsenss

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6
Q

Management of GORD/GOR

A

Review feeding technique - keep upright immediately after feeds/smaller volumes

Thickened formula - Enfamil, SMA Staydown - for 6 months MAX

Dont routinely offer antacids/PPI

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7
Q

What constitutes recurrent abdominal pain, and what are some investigations?

A

2+ discrete episodes in a 3 month period

Abdo USS/Xray, faecal calprotectin, 13C breath test for H pylori. IgA - tTG (coeliac)

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8
Q

Investigations and management of Appendicitis

A

FBC - leukocytosis, Abdo/pelvic CT scan

Appendectomy, + broad spec Abx if peritonitis/perf

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9
Q

Presentation of coeliac disease

A

Persistent GI symptoms - diarrhoea, pain, bloating
Fatigue, FTT
severe persistent mouth ulcers
Unexplained iron, vitamin B12, or folate deficiency

Associated with dermatitis herpetiformis

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10
Q

Investigations in coeliac disease

A

IgA-tTG (tissue transglutaminase)
HOWEVER - must be on a gluten diet - for at least 3 months in order to register positive diagnostic test

Bowel biopsy - showing chronic villous atrophy, crypt hyperplasia —> remission on exclusion of gluten

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11
Q

How much should babies feed - Amounts

A

0-6 weeks - 150ml/Kg
6 weeks - 4 months - 150ml/Kg
4 - 6 months - 150ml/Kg
6+ months - 120ml/Kg

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12
Q

Conversion between mL to Ounce

A

1 ounce = 30 (~28) mL

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13
Q

Pattern of weight gain for babies?

A

0-3 months = 200g / week
3-6 months = 150g / week
6-9 months = 100g / week
9-12 months = 75g / week

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14
Q

Presentation of an inguinal hernia

A 
Direct v indirect
Commonly in R groin
Intermittent lump in groin/scrotum - present on crying/ straining
May be irreducible
Can't get above lump
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15
Q

Management of inguinal hernia

A

Surgical - due to risk of strangulation

High risk if cant reduce at all

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16
Q

Pathological predisposition to intussusception

A

Usually following viral illness

Immature, enlarged peyer’s patches (lymphoid tissue in bowel) –> invagination of bowel and obstruction

17
Q

Clinical features of intussusception

A 
acute onset, colicky pain
Early vomiting, rapidly becoming bilious
Sausage shaped mass, usually in RUQ
strawberry current (bloody stool)
Absence of lower bowel signs
18
Q

Investigation in intussusception

A

Abdo USS - Doughnut, or Target sign

AXR - dilated bowel loops

19
Q

Management of intussusception

A

Drip + suck - to remove pooled fluid from gut

Air enema to reduce bowel
Failing that - laparotomy

20
Q

Causes of jaundice?

A

Serum Bilirubin >25-30 mmol/L

Unconjugated - haemolysis, Gilberts, G6PD

Conjugated - cirrhosis, post-hepatic obstruction e.g. biliary atresia, choledochal cyst

21
Q

What is mesenteric adenitis

A

Non-specific abdo pain, lasting 24-48hrs
Following infection, commonly strep throat
Inflammation of lymphoid tissue within mesentery

22
Q

Investigations in pyloric stenosis?

A

Serum electrolytes - may show hypochloraemic alkalosis +- a mild hypokalaemia

USS pylorus - shows thickened sphincter, ^ canal length

23
Q

Management of pyloric stenosis

A

correct fluid/electrolyte imbalance

Ramstedt’s pyloromyotomy

24
Q

Different types of undescended testicle?

A

Anorchidism - no testicle there
Retractile - exaggerated cremasteric reflex
Ascending - short spermatic cord (later presentation)
Testicular maldescent - arrested (usually in inguinal canal, or ectopic (in suprainguinal pouch)

25
Q

management of undescended testicle

A

If not descended by 6 months, investigate

If continues, surgical correction - orchidopexy - by 12 months

26
Q

Presentation of biliary atresia?

A

Persistent jaundice, shortly after birth
Pale stool, dark urine
Splenomegaly due to portal hypertension
jaundice lasting >14 days - BA must be investigated

27
Q

Investigations in biliary atresia

A

serum and total bilirubin
PT, and INR with be ^^
Serum AST/ALT, ALP and gamma GT ^^
USS - hepatobiliary scintigraphy

28
Q

Management of biliary atresia

A

Kasai - portoenterostomy
Ursodeoxychloric acid to encourage bile flow

2nd line - liver transplantation

29
Q

What are HBsAG and Anti-HBs

A

HBs = Hep B surface antigen - indicates active acute/chronic infection

Anti-HBs = anti- Hep B surface antigen = indicates resolved infection / prior vaccination

30
Q

What are Anti-HBc - IgM and IgG

A

IgM - anti - Hep B core antibodies - appear first during acute infection

IgG - appear later - during resolved acute infection/chronic - but not after vaccination

31
Q

Difference between Hep A and Hep B

A

Hep A - faecal oral transmission. mild illness lasting 2-4 weeks. can be re-infected in future

Hep B - often transmitted vertically from mother. Often chronic carriers.

32
Q

Clinical features of Hirschprung’s disease

A

Aganglionic bowel - lacking parasympathetic nerve cells –> severe constriction

Failure to pass meconium in first 48hrs of life + vomiting

This is a GI emergency

33
Q

Investigations and management in Hirschprung’s

A

Bowel biopsy is diagnostic
Consider barium enema studies

Surgical - anorectal pull through - removal of aganglionic bowel - maybe stoma until older

34
Q

Investigations and management of IBD

A

Fecal calprotectin. Endoscopy/colonoscopy for diagnosis

Induce remission with Liquid diet for 6 weeks, or steroids (pred)
+ DMARDS - Azathioprine, methotrexate, infliximab, mesalazine

35
Q

What is toddlers diarrhoea?

A

Fast transit - through immature gut
Diarrhoea with undigested food - however children usually well and thriving

Most children grow out of it by age 5

36
Q

What is volvulus

A

Twisting of the small bowel around axis of the superior mesenteric artery

  • severe obstruction +- ischaemia - GI emergency
    Requires urgent laparotomy, correction (remove appendix while youre at it)

3 - PAEDS (13 decks)

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