GI Flashcards
GORD presentation
regurgitation distress after feeding apnoea pneumonia anaemia
GORD management
reassurance, avoid over feeding antacid and sodium/magnesium alginate consider domperidone (increases stomach and bowel contractions) +/- omeprazole most resolve 6-9months fundoplication if failure to thrive
pyloric stenosis presentation
projectile vomiting after feeding vomit contains no bile no diarrhoea constipation likely 2-8 weeks of life
pyloric stenosis diagnosis
hypochloraemic, hypokalaemic metabolic alkalosis
visable LUQ peristalsis when feeding`
pyloric stenosis management
ramstedts pyloromyotomy
intussuception presentation
epsodic (colicky) pain - may present with epsodic crying or drawing of legs up (an interception) vomiting PR blood (red current jam) sausage shape mass in abdomen
intussuception investigations
abdominal US with reduction by air enema
ulcerative colitis definition
recurrent inflammatory and ulcerating disease involving mucosa of colon and or rectum
ulcerative colitis symptoms
colicky pain
diarrhoea +/- blood and mucus
ulcerative colitis diagnosis and features
faecal calprotectin and colonoscopy
mucosal / submucosal inflammation
continuous lesions
crypts
ulcerative colitis management
mild - mesalazine (5 aminosalicylate)
moderate - add oral prednisolone
severe - IV hydrocortisone
crohns disease definition
transmural granulomatous inflammation affecting any part of the gut from mouth to anus. commonly terminal ileum
crohns disease symptoms
abdominal pain
diarrhoea
weight loss
crohns disease diagnosis and features
faecal calprotectin and endo/colon oscopy
transmural inflammation
granulomas
skip lesions
crohns disease managment
mild/moderate - prednisolone
gastroenteritis cause
rotavirus commonest in children
gastroenteritis presentation
sudden onset diarrhoea +/- vomiting
IBS definition
abdominal symptoms with no organic cause
IBS diagnosis
recurrent abdominal pain with at least 2 of:
relief by defication
altered stool form
altered bowel frequency
appendicitis presentation
periumbical pain that moves to RIF
rovsings sign (pain in RIF when press LIF)
fever and guarding
coeliac disease definition
T cell response to gluten in small intestine causes villous atrophy and malabsorption
associated with human leukocytes antigen HLA DQ2
coeliac disease presentation
malabsorption after induction of wheat containing foods stinking stools diarrhoea weight loss anaemia
coeliac disease diagnosis
raised IgA anti tissue transglutaminase
biopsy - small intestine villous atrophy
coeliac disease management
gluten free diet
failure to thrive causes
organic - impaired suck/swallow (cleft palate)
non organic - inadequate food
inadequate absorption - coeliac
excessive calories loss - vomiting (GORD)
excessive calorie requirements - malignancy
failure to thrive definition
poor weight gain falling across centile lines
head circumference preserved relative to height
marasmus definition
lack of calories and discrepency between height and weight - HIV associated
marasmus signs
distended abdomen
diarrhoea / constipation
hypoalbuminaemia
kwashiorkor cause
due to low intake of protein and essential amino acids
kwashiorkor signs
poor growth diarrhoea anorexia odema distended abdomen
lactose intolernace presentation
Explosive watery stools, abdominal distension, flatulence, audible bowel sounds
hirschprungs disease presentation
meconium ileus
vomiting (bilious green)
abdominal distension
constipation
hirschprungs disease definition
absence of ganglia in segment of colon
hirschprungs disease management
bowel washouts / irrigation
surgical excision of anganglionic section
parasitic cause of acute diarrhoea
Giardia
toddlers diarrhoea presentation
chronic, non specific diarrhoea
well and thriving
toddlers diarrhoea management
adequate fat and fibre
cows milk protein allergy
Associated with atopy IgA deficiency and IgG subclass abnormalities
cows milk protein allergy diagnosis and management
Diagnosis – elimination diet
Management – Hydrolysed or AA feeds
neonatal jaundice after 24hrs of birth causes
caused by hyperbilirubinaemia
breastfeeding
physiological:
increased bilirubin production due to shorter RBC lifespan
decreased bilirubin conjugation due to hepatic immaturity
absence of gut flora impedes elimination of bile pigment
neonatal jaundice within 24hrs of birth causes
abnormal
sepsis
rheus haemolytic disease
ABO incompatibility
prolonged neonatal jaundice >14 days causes
sepsis
hypothyroidism
breastfeeding
neonatal jaundice complications
kernicterus - acute bilirubin encephalopathy (unconjugated bilirubin can be deposited in basal ganglia)
neonatal jaundice management
phototherapy
necrotising enterocolitis definition
inflammatory bowel necrosis (Bacterial invasion of ischaemic bowel wall)
major risk factor in prematurity
More common in premature baby’s fed with cow’s milk
necrotising enterocolitis signs
abdominal distension in premature baby
billious vomiting
Fresh blood in stool
necrotising enterocolitis management
stop oral feeding
cefotaxime and vancomycin
intestinal malrotation what is it
Obstruction of small bowel – congenital anomaly of rotation of midgut
intestinal malrotation presentation
billious vomiting
Abdo pain
Tenderness (peritonitis/ischaemic bowel)
Bile stained vomit in 1st week of life = Malrotation until proven otherwise!
intestinal malrotation investigations and management
Upper GI Contrast Study (diagnostic)
Surgical correction - Ladd’s procedure
