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CH > GI > Flashcards

GI Flashcards

1
Q

What is the most common cause of vomiting in infancy?

A

GI reflux

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2
Q

What are some of the risk factors for GI reflux?

A

Preterm babies

Neurological disorders

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3
Q

What is the clinical presentation of GI reflux?

A
  • Typically develops <8wks with vomiting/regurgitation following feeds
  • Common in 1st year of life
  • Infants put on weight normally and are otherwise well
  • Nearly all resolve by 12months
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4
Q

Why does GI reflux arise?

A

-Common in 1st year of life due to functional immaturity of LOS leading to inappropriate relaxation

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5
Q

How might GI reflex present in babies?

A

May present with back-arching, tense, colours change with distress

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6
Q

What are the investigations in GI reflux?

A

Largely clinical diagnosis, maybe pH study

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7
Q

What is the tx in GI reflex in babies?

A
  • Parental reassurance
  • Is baby being overfed?
  • Hydrolysed milk (may stop vomiting if milk allergy) or Ranitidine (can continue to breastfeed)
  • Position 30 degree upright during feeding
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8
Q

How does gastroenteritis present?

A
  • Acute episode of vomiting followed by diarrhoea, fever.
  • If blood stained–> bacterial (notify PH)
  • Ask about travel hx and nocturnal diarrhoea
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9
Q

What is the main cause of gastroenteritis

A
  • Was Rotavirus but now vaccine

- Norovirus no1 in UK

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10
Q

What is the progression of gastroenteritis?

A

-Recovery of acute symptoms within 48hrs, diarrhoea may persist up to 2wks

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11
Q

What is a complication of gastroenteritis?

A

Secondary or acquired lactose intolerance due to inability to metabolise lactase. Should resolve within 2-3months.

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12
Q

What is the clinical presentation of toddler’s diarrhoea?

A
  • Benign, loose stools up to 12/day
  • M>F
  • Resolved by 5/6years
  • FBC to exclude coeliac
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13
Q

What is the tx of toddler’s diarrhoea?

A

Loperamide may help with toilet training

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14
Q

How does coeliac disease arise?

A
  • The gliadin fraction of gluten provokes an immunological response in the proximal small intestinal mucosa.
  • Villi become progressively shorter than absent, leaving a flat mucosa.
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15
Q

What are the gene associations in coeliac?

A

HLA-DQ2, HLA-DQ8

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16
Q

What is the clinical presentation of coeliac disease?

A

Profound malabsorption syndrome at 8-24months, failure to thrive, abdominal distension and buttox wasting abnormal stools and irritability.

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17
Q

How might coeliac disease present later?

A

Non-specifically with anaemia and growth failure

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18
Q

What is the investigation for coeliac?

A
  • IgA TTG

- If GF diet <2 years old, gluten challenge required later on

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19
Q

Why does constipation tend to arise in children?

A

Due to low fibre, high milk diet

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20
Q

What should you consider in a child presenting with constipation in the following age groups:

a) Babies
b) Older child

A

a) Anorectal abnormalities, Hirschprung’s disease, hypothyroidism and hypercalcaemia
b) Problems with toilet training/stress

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21
Q

What is seen o/e in a child with constipation

A
  • Distended abdomen, palpable faecal masses

- Generally one stool per day passed from age 3

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22
Q

What is the tx of constipation if faecal impaction?

A

1st line Movicol and electrolyte using an escalating dose regime.
2. Add stimulative laxative (lactulose) if Movicol does not lend to disimpaction after 2weeks.

23
Q

What is the tx of constipation- maintenance therapy?

A

1st line: Movicol paediatric plain
2. Add stimulate laxative (lactulose) if no response

Continue maintenance therapy for several weeks until bowel habit is established then slowly decrease dose.

24
Q

Should you use dietary tx alone as a 1st line tx for constipation in kids?

A

NO

25
Q

What is the clinical presentation of infant colic?

A

Persistent crying and screaming in a healthy baby, excess flatus several times a day, particularly at night.

26
Q

What is the epidemiology of infant colic?

A
  • Up to 40% babies
  • Occurs in first few weeks of life and resolves by about 4months
  • If severe and persistent: consider cow’s milk allergy or reflux
27
Q

What are some of the important GI problems to consider in babies?

A 
Pyloric stenosis
Intussusception
Malrotation of the gut 
Hirschsprung's disease
Biliary atresia
28
Q

What is the epidemiology of pyloric stenosis?

A
  • Typically presents in 2nd-4th weeks of life with vomiting, may present later up to 4months
  • M>F
  • Positive FHx
  • 1st borns more commonly affected
29
Q

How does pyloric stenosis arise?

A

Caused by hypertrophy of the circular muscles of the pylorus

30
Q

What are the clinical features of pyloric stenosis?

A
  • ‘Projectile’ vomiting typically 30mins after a feed.
  • Constipation and diarrhoea may be present
  • Palpable mass in upper abdomen may be present
  • Hypochloraemia, hypokalaemia acidosis due to persistent vomiting
31
Q

What are the investigations and tx of pyloric stenosis?

A

Diagnosis: USS
Tx: Ramstedt pylomyotomy, NMB, IV rehydration.

32
Q

How does intussusception arise?

A

Invagination of one portion of the bowel into the lumen of the adjacent bowel, typically ileo-caecal region.

33
Q

What is the epidemiology of intussusception?

A

6-18 months old

34
Q

What are the clinical features of intussusception?

A
  • Paroxysmal abdominal colic pain during which the baby will draw up their knees and turn pale.
  • Vomiting
  • “red currant jelly”
  • “Sausage shaped mass” in RUQ
35
Q

What is the investigation and tx of intussusception?

A

Investigation: USS, ‘target like’ mass

Tx: air inflation under radiological control 1st line.
If this fails or signs of peritonitis: surgery

36
Q

How does malrotation of the gut arise?

A

Failure of the midgut to rotate during development

37
Q

Dark mossy green vomit…

A

EMERGENCY

Malrotation of the gut

38
Q

How does malrotation in the gut present:

a) Infant
b) Older child

A

Usually presents 3-7 days after birth

a) Bile stained vomit
b) GORD, vomiting, abdominal pain

39
Q

What is the investigation and tx of malrotation of the gut?

A
  • Upper Gi contrast study

- Tx: Ladd’s procedure

40
Q

Delayed passage of meconium >24hrs after birth?

A

Hirschsprung’s disease

41
Q

How does Hirschsprung’s disease arise?

A

Absent ganglion cells in the anorectum

42
Q

What is the epidemiology of Hirschsprung’s disease?

A

M>F, increased risk in DS

43
Q

What is the presentation of Hirschsprung’s disease in babies vs older children?

A

Babies: delayed passage of meconium

Older children: constipation, abdominal distension

44
Q

What are the investigations and tx of Hirschsprung’s disease?

A

AXR: dilated bowel loops, absent rectal air
Tx: excision or bypass of a-ganglionic intestine

45
Q

What is the presentation, tx and complications of biliary atresia?

A
  • Disrupted flow and excretion of bile
  • Jaundice >14 days, pale stools, dark urine
  • Urgent Kasai procedure (hepatoportoenterosctomy) best performed <8wks old.
  • Complications: liver cirrhosis, transplant
46
Q

What is the main risk factor for NEC

A

Prematurity

47
Q

What are the features and tx of NEC?

A

Early features: abdominal distension and bloody stools

  • Increased risk when empirical Abx given to infants >5 days
  • Tx: total gut rest, TPN, babies with perforations= laparotomy
48
Q

When does a cow’s milk allergy typically present?

A

In the first 3months of life in formula fed infants

49
Q

What are the clinical features of a cow’s milk allergy?

A
  • Regurgitation and vomiting
  • Diarrhoea
  • Urticaria, atopic eczema
  • ‘Colic’ symptoms: irritability, crying
  • Wheeze, chronic cough
50
Q

How is the diagnosis of cow’s milk allergy made?

A
  • Often clinical
  • Skin prick/patch testing
  • Total IgE + specific IgE (RAST) for cow’s milk protein
51
Q

What is the tx of cow’s milk allergy if formula fed?

A

1st line: extensive hydrolysed formula milk (eHF) in mild-moderate symptoms

52
Q

What is the tx of cow’s milk allergy if breast fed?

A

Continue breast milk
Eliminate cow’s milk from maternal diet
Use eHF milk when breast feeding stops, until 12months of age and at least for 6 months

53
Q

When does cow’s milk intolerance usually resolve?

A

By 1-2years old

CH (7 decks)

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