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Paediatrics > GI > Flashcards

GI Flashcards

1
Q

What are the differential diagnoses for vomiting?

A

Gastroesophageal reflux
Overfeeding
Pyloric stenosis
Cow’s milk allergy

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2
Q

What are the symptoms of pyloric stenosis?

A

Vomiting - non-bilious, large volume, not keeping down feeds
Irritable and crying
Not gaining weight adequately
On examination - looks slightly dehydrated
Visible gastric peristalsis

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3
Q

What investigations would be done if pyloric stenosis was suspected?

A

Test feed
Ultrasound - see stenosed pyloric sphincter
Blood gases - high pH (metabolic alkalosis), low Cl and K

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4
Q

How is pyloric stenosis managed?

A

Fluid resuscitation

Refer to surgeons - ramstedts pyloromyotomy

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5
Q

What is bilious vomiting?

A

Green vomit

ALARM BELLS

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6
Q

What are the causes of bilious vomiting?

A 
Intestinal obstruction until proven otherwise
Intestinal atresia - only in new borns
Malrotation
Ileus
Crohn's disease with strictures
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7
Q

What investigations would be done if bilious vomiting was suspected?

A

Abdominal x-ray
Consider contrast meal
Surgical opinion

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8
Q

How is bilious vomiting treated?

A

Nil by mouth
IV fluids
Surgical opinion

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9
Q

What are the causes of effortless vomiting?

A

GORD - LOS problem

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10
Q

What are the symptoms of effortless vomiting?

A 
Vomiting
Haematemesis
Feeding problems
Failure to thrive
Apnoea
Cough
Wheeze
Chest infections
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11
Q

How is effortless vomiting investigated?

A 
History and examination usually enough
Radiological - video fluoroscopy, barium swallow
pH study
Oesophageal impedance monitoring
Endoscopy if severe
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12
Q

How is effortless vomiting treated?

A

Feeding advice - thickeners, feeding position, behavioural problem
Nutritional support - calorie supplements, try dairy free milk, NG tube, gastrostomy
Medical - feed thickener (gaviscon), pro kinetic drugs, acid suppressing drugs (PPIs)
Surgery

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13
Q

What is the definition of chronic diarrhoea?

A

4 or more stools per day
Acute diarrhoea <1 week
Persistent diarrhoea - 2-4 weeks
Chronic diarrhoea > 4 weeks

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14
Q

What are the causes of chronic diarrhoea?

A

Motility disturbance - toddler diarrhoea, IBS
Active secretion (secretory) - acute infective diarrhoea (cholera), IBD
Malabsorption of nutrients (osmotic) - food allergy, coeliac disease, CF

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15
Q

What are the types of chronic diarrhoea?

A

Osmotic
Secretory
Motility
Inflammatory

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16
Q

Osmotic diarrhoea

A

Movement of water into the bowel to equilibrate osmotic gradient
Usually a feature of malabsorption
Clinical remission with removal of causative agent
Stool - small volumes, stops when fasting

17
Q

Secretory diarrhoea

A

Associated with toxin production - vibrio cholera, enterotoxigenic Escherichia coli
Intestinal fluid secretion is driven by active Cl- secretion (and therefore water) via CFTR
Stool - large volume, diarrhoea continues with fasting

18
Q

Inflammatory diarrhoea

A

Malabsorption due to intestinal change
Secretory effect of cytokines
Accelerated transit time in response to inflammation
Protein exudate across inflamed epithelium

19
Q

Where is fat malabsorption seen?

A

Pancreatic disease - diarrhoea due to lack of lipase and resultant steoatorrhea
Hepatobiliary disease - chronic liver disease, cholsetasis

20
Q

Coeliac disease

A

Sensitivity to gluten

Autoimmune condition - antibodies form against gluten, complexes form when gluten that attack the small bowel

21
Q

Coeliac disease - genetic susceptibility

A

HLA DQ2 and DQ8

22
Q

What are the symptoms of coeliac disease?

A 
Abdominal bloating
Diarrhoea
Failure to thrive
Short stature
Constipation - maybe
Tiredness
Dermatitis herpetiformit
23
Q

How is coeliac disease investigated?

A

Serological screens - anti-tissue transglutaminase, anti-endomysial, IgA testing
Duodenal biopsy - don’t need
Genetic testing

24
Q

How is coeliac disease treated?

A

Gluten-free diet for life

25
Q

What are the symptoms of constipation?

A 
Poor appetite
Irritability
Lack of energy
Abdominal pain or distension
Withholding or straining
Can have diarrhoea
26
Q

Why do children become constipated?

A

Social – poor diet (insufficient fluids, excessive milk), potty training/school toilet
Physical – intercurrent illness, medication
Family history
Psychological – secondary
Organic

27
Q

What is the cycle of constipation?

A

Pain or anal fissure
Withholding of stool – the longer the stool stays in the colon the drier it gets so the harder it will be to pass
Constipation
Large hard stool

28
Q

How is constipation treated?

A

Explain treatments to parents
Dietary - increase fruit and fibre, decrease milk
Psychological - make going to the toilet pleasant, reward good behaviour
Movicol - isotonic laxative
Lactulose - osmotic laxative

29
Q

How is impactation treated?

A

Empty impacted rectum
Empty colon
Maintain regular stool passage
Slow weaning off treatment

30
Q

What are the symptoms of Crohn’s disease?

A 
Weight loss
Growth failure
Abdominal pain
Diarrhoea 
Rectal bleeding
Arthritis
Mass
31
Q

How is Crohn’s disease treated?

A

Induce remission – nutritional therapy, steroids
Maintain remission – thiopurines
Step-up therapy – anti-TNF
Surgery – only for complications, not curative

32
Q

What are the symptoms of ulcerative colitis?

A

Diarrhoea
Rectal bleeding
Abdominal pain
Less systemic symptoms

33
Q

How is ulcerative colitis treated?

A

Induce remission – 5-ASA, steroids
Maintain remission – 5-ASA, thiopurines
Step-up therapy – anti-TNF
Surgery – for failure to respond to medical therapy, curative

34
Q

How is IBD investigated?

A

Stool calprotectin
FBC & ESR – anaemia, thrombocytosis, raised ESR
Biochemistry – raised CRP, low albumin
Microbiology – no stool pathogens
Definitive - MRI, barium meal, endoscopy (any kind)

35
Q

If an infant had a cow’s milk allergy, what milk would you recommend?

A

Nutramigen - extensively hydrolysed protein feeds

Paediatrics (17 decks)

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