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GI Flashcards

1
Q

In which age group in children is GOR most common?

A

Children under 1 years old

Resolves usually afterwards

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2
Q

What does projectile vomiting suggest?

A

Pyloric stenosis or intestinal obstruction

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3
Q

What does a baby not keeping down any feed suggest?

A

Pyloric stenosis or intestinal obstruction

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4
Q

What does a baby with bile stained vomit suggest?

A

Intestinal obstruction. Malrotation +/- volvulus, duodenal or bowel atresia. Hisprungs. Etc.

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5
Q

What does haematemesis or malena suggest?

A

Peptic ulcer
Oesophagitis
Varices

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6
Q

What does abdomen distension suggest?

A

Intestinal obstruction leading to food being stuck.

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7
Q

What is the brief pathophysiology behind GOR?

A

Babies have immature lower oesophageal sphincter which allows stomach contents to reflux easily into oesophagus.

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8
Q

Risk factors for GOR

A

Premature baby
Horizontal laying, not upright most of the time.
Sedentary activity.

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9
Q

Imaging of choice for GOR

A

Barium meal + endoscopy

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10
Q

What advice would you give for GOR children’s parents?

A

Small meals
No overfeeding
Burp regularly
Thickened milk or formula

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11
Q

What medications exist for GOR in children?

A

Gaviscon (mixed with feeds)

Ranitidine +/- omeprazole

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12
Q

What surgery can be used to correct severe cases of GOR?

A

Fundoplication

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13
Q

What is Sandifer syndrome?

A

Rare, brief episodes of abnormal movements associated with GOR (in infants). Resolves on treating the GOR.

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14
Q

What are clinical features of Sandifer syndrome?

A

Torticollis and dystonia

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15
Q

Pyloric stenosis is most common in ______ of life

A

First few weeks

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16
Q

What is the “mass” that feels like a large olive in the abdomen?

A

Pyloric muscle hypertrophy causing the mass

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17
Q

How would a baby look with pyloric stenosis?

A

Thin, pale and failing to thrive

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18
Q

What is the risk of feeding with pyloric stenosis children?

A

Projectile vomiting

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19
Q

Food is prevented from travelling to the ______ in pyloric stenosis

A

Duodenum

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20
Q

Gold standard investigation for pyloric stenosis? And what would it show?

A

Abdo USS

Shows thickened pylorus

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21
Q

Why would you get low chloride and metabolic alkalosis with pyloric stenosis?

A

Loss of HCl from stomach due to vomiting

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22
Q

What is the treatment for pyloric stenosis?

A

Laparoscopic pyloromyotomy

Widens pyloric canal with an incision

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23
Q

What does NESTS stand for with Crohn’s (Crow’s) disease?

A 
No blood or mucus
Entire GI tract
Skip lesions
Terminal ileum/transmural inflammation
Smoking = risk factor
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24
Q

What does CLOSEUP stand for with UC (U C CLOSEUP)?

A 
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa affected
Smoking is protective
Excrete blood and mucus
Use aminosalycylates
Primary sclerosing cholangitis
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25
Q

What are common clinical features of IBD?

A 
Diarrhoea
Abdominal pain
Bleeding
Weight loss
Anaemia
Fevers malaise dehydration
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26
Q

Give some extra-GI signs of IBD

A 
Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis and iritis
Inflammatory arthritis
PSC (In UC)
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27
Q

What blood tests can be done for IBD?

A 
CRP (inflammation)
Faecal calprotectin
Anaemia (B12/folate/iron)
TFT
Kidney function tests
LFT
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28
Q

What is the gold standard test for IBD?

A

Endoscopy and biopsy

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29
Q

Why are USS/CT/MRI used in IBD?

A

Find fistulas, abscess and strictures

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30
Q

Which medications are used to a) induce remission in Crohn’s, b) maintain remission in Crohn’s?

A

a) Steroids

b) Immunosuppresants - azathioprine, infliximab

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31
Q

What is the 2 most common medication types used in UC?

A
  1. Mesasalazine (aminosalicylate)

2. Steroids

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32
Q

What surgical options are there for UC patients?

A

Surgical resection of colon and rectum and then put in ileostomy or J pouch

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33
Q

List 3 GI causes of constipation

A

Hirschsprung’s
Intestinal obstruction
Anal stenosis/malformation

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34
Q

What conditions usually result in meconium ileus?

A

Cystic fibrosis

Hirschsprung’s

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35
Q

What feeding allergy can usually result in constipation?

A

Cow’s Milk Protein allergy

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36
Q

Which lifestyle factors can result in long-standing constipation issues in children?

A 
Low fibre diet
Habitual holding of stool in bowel
Poor fluid intake/dehydration
Sedentary
Psychosocial issues at home/school
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37
Q

Define encopresis

A

Faecal incontinence in children who are past the age of toilet training

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38
Q

How can chronic constipation affect the rectum?

A

Rectum stretched and loses sensation.
Only hard, large stools remain in rectum.
Only loose stools leak out and cause soiling.

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39
Q

List causes of encopresis

A 
Spina bifida
Hirschsprung's
Cerebral palsy
LD
Psychosocial stress
Abuse
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40
Q

What is meconium comprised of?

A

Sticky, thick, dark green poop.

Intestinal epithelial cells, Ianugo, amniotic fluid, bile and water.

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41
Q

Meconium aspiration syndrome: list some clinical features

A

Amniotic fluid is meconium-stained (green.
Baby has meconium stains.
Baby has breathing problems or slow HR.
Limp baby.

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42
Q

How can meconium aspiration syndrome be confirmed?

A

Chest X-ray in babies with breathing problems and born in meconium stained amniotic fluid.

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43
Q

How can children with constipation present?

A 
Straining
Rabbit dropping stools
Retentive posture
Rectal bleeding
Encopresis
Loose, smelly stools
Hard stools palpable in abdomen
Loss of PR tone
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44
Q

What does ribbon stool suggest?

A

Anal stenosis

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45
Q

What can failure to thrive with constipation suggest?

A

Coeliac disease
HypOthyroidism
Safeguarding concerns

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46
Q

A baby has constipation with acute severe abdo pain and bloating. What are 2 main differentials?

A

Intestinal obstruction

Intussusception

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47
Q

What advice can you give to parents if their child is constipated?

A

Praise and encourage proper toileting
High fibre diet and good hydration
Encourage activity

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48
Q

What is the first line drug used in constipation in children?

A

Movicol (laxative)

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49
Q

List some complications of long-term constipation

A 
Anal fissures
Haemorrhoids
Loss of anal sensation
Encopresis
Psychosocial issues
Chronic pain
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50
Q

What are main causes of intussusception?

A

Concurrent viral infection (Viral URTI)

Others: 
HSP
Cystic fibrosis
Intestinal polyps
Meckel's diverticulum
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51
Q

What are the 2 main clinical characteristics of intussusception?

A

Redcurrant jelly stool

Sausage shaped mass on RUQ palpation

52
Q

Gold standard investigation of intussception is ______

A

USS abdomen

Also contrast enema

53
Q

Give a non-surgical way to treat intussusception

A

Therapeutic enema

54
Q

When is surgical resection indicated in intussuception?

A

Gangrenous or perforated bowel

55
Q

What can cause abdominal pain in girls exclusively?

A 
Dysmenorhoea (period pain)
Mittelscherz (ovulation pain)
Ectopic pregnancy/Pregnancy
PID
Ovarian torsion
56
Q

What can cause abdominal pain in boys exclusively?

A

Testicular torsion

57
Q

Give some red flags for abdominal pain

A 
Persistent or bile vomiting
Severe chronic diarrhgoea
Fever
Rectal bleeding
Weight loss or faltering growth
Dysphagia
Night time pain
Abdominal tenderness
58
Q

What bloods can be done for abdominal pain?

A

Anaemia (IBD/Coeliac)
ESR/CRP (IBD)
Anti-TTG/Anti-EMA (Coeliac)
Faecal calprotectin (IBD)

59
Q

Can UTI cause abdominal pain in children? And how would you find out?

A

Yes. Use urine dipstick test to check for leukocytes, nitrites and blood. Send for MC&S to culture urine growth

60
Q

List differentials of appendicitis

A 
Ectopic pregnancy
Ovarian cysts
Meckel's diverticulum
Mesenteric adenitis
Appendix mass
61
Q

What is the most common position of the appendix?

A

Retrocaecal

62
Q

What is mesenteric adenitis?

A

Inflamed abdominal lymph nodes.

Associated with tonsillitis or URTI. Causes abdo pain especially in younger children

63
Q

How does the pain present with appendicitis

A

Generalised abdo pain that moves to the RIF over time

64
Q

_______’s point is palpated in the abdomen to reveal tenderness in appendicitis

A

McBurney

65
Q

What is Rovsing’s sign?

A

Palpating LIF causes pain in RIF. (in appendicitis)

66
Q

Which acute condition is guarding, rebound tenderness and percussion tenderness found in?

A

Appendicitis

67
Q

Why can appendicitis lead to peritonitis?

A

Appendix inflames and becomes gangrenous. Ruptures and releases faecal content into abdomen, irritating the peritoneum.

68
Q

How can gynae and ovarian causes be excluded in appendicitis in females?

A

USS abdomen

69
Q

What are complications of appendicitis surgery?

A

Bleeding, infection, pain, scars
Damage to bowel and other structures around
Anaesthetic risks
VTE (DVT/PE)

70
Q

What are the genes associated with Coeliac disease?

A

HLA-DQ2 (90%)

HLA-DQ8

71
Q

Give some clinical features of coeliac disease

A 
Diarrhoea
Failure to thrive/weight loss
Fatigue
Mouth ulcers
Anaemia symptoms
Dermatitis herpetiformis
72
Q

What is Dermatitis herpetiformis?

A

Itchy, blistering skin rash on abdomen. Occurs with Coeliac disease

73
Q

Give 2 gold standard blood tests for Coeliac disease

A

Anti-TTG and Anti-EMA antibodies

74
Q

Which immunoglobulin deficiency can cause a false negative for Coeliac disease?

A

IgA

75
Q

What would an endoscopy with biopsy show for a Coeliac patient?

A

Crypt hypertrophy

Villi atrophy

76
Q

What is the only treatment for Coeliac disease?

A

Life-long gluten free diet

77
Q

List some complications of Coeliac disease

A 
Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Non-Hodgkin's Lymphoma
78
Q

How is the bowel affected in Hirschsprung’s?

A

Section is devoid of parasympathetic ganglion cells.

Unable to peristalsis due to lack of innervation.

Bowel becomes +++ distended due to faecal collection

79
Q

Give 2 gold standard investigations for Hirshsprung’s

A

Rectal biopsy

AXR

80
Q

How does HAEC present?

A

2-4 week old neonate with Hirschsprung’s. Fever, abdo distension, diarrhoea with blood and sepsis features.

81
Q

How is HAEC treated?

A

Antibiotics
Fluid resuscitation
Decompression of obstructed bowel

82
Q

How is Hirschsprung’s affected bowel definitively treated?

A

Surgical removal of aganglionic bowel section and pull-through.

83
Q

When the bile duct is narrowed or absent, this is called biliary ______

A

Atresia

84
Q

What pigment builds up in the body due to biliary atresia?

A

Conjugated bilirubin

85
Q

What is Kasai portoenterostomy?

A

Surgical treatment for biliary atresia.

Small intestine attached to liver opening to bypass all bile ducts.

Allows jaundice to be cleared as liver empties into small intestine directly.

86
Q

How can breast milk cause jaundice?

A

Substances in breast milk inhibit gluconryl-transferase, reducing bilirubin conjugation and resulting in jaundice.

87
Q

List the causes of vomiting in children

A 
Bulimia
Intestinal obstruction
Infections
Appendicitis
overfeeding
GOR
Pyloric stenosis (projectile)
Gastroenteritis
88
Q

What kind of infections can cause vomiting in children?

A

UTI
Tonsilitis
Meningitis

89
Q

What the 2 most common viral causes of gastroenteritis?

A

Norovirus

Rotavirus

90
Q

What 3 factors are present in Haemolytic Uraemic Syndrome?

A

Low platelets
Low RBCs
Kidney failure

91
Q

Haemolytic Uraemic Syndrome is caused by which bacteria and which toxin?

A

E. coli O157
Shigella

Shiga toxin

92
Q

Which pathogen is responsible for Traveller’s diarrhoea?

A

Campylobacter

93
Q

Which pathogen grows best on left over fried rice (food not refrigerated after cooking)?

A

Bacillus cereus

94
Q

How does gastroenteritis commonly present?

A

Abdo cramps/pain
Diarrhoea +/- blood
Fever
Vomiting

95
Q

What investigations are done for gastroenteritis?

A

Stool - microscopy, culture and abx sensitivities

96
Q

Why is dioralyte used in gastroenteritis treatment?

A

Rehydrate child after diarrhoea episodes

97
Q

Can complications arise from gastroenteritis?

A

Yes:
IBS
GBS
Reactive arthritis

98
Q

What is the gold standard investigation for Meckel’s diverticulum?

A

Technetium scan

shows uptake by ectopic gastric mucosa

99
Q

How does a child with infant colic present?

A

Inconsolable crying/screaming
Drawing up of knees
Farting many times daily

100
Q

What is a potential secondary cause if infant colic does not resolve?

A

GORD

Cow’s milk protein allergy

101
Q

By which age does Cow’s milk protein allergy usually resolve?

A

5 years old

102
Q

Give some symptoms of Cow’s milk protein allergy

A

Skin: rashes, eczema
GI: N+V, abdo pain
Resp: runny nose, wheeze

103
Q

_____-feeding exclusively can protect against Cow’s milk protein allergy

A

Breast

104
Q

How do lactose intolerance and CMPA differ?

A 
Lactose = sugar in milk
CMPA = protein in milk, presents earlier in childhood
105
Q

What are the 5 main causes of faltering weight?

A 
Inadequate intake
Inadequate retention
Malabsorption
Failure to utilise nutrients
Increased requirements
106
Q

Give some examples of inadequate intake in FTT

A

Feeding problems
Psychosocial deprivation
Impaired suck/swallow

107
Q

Give 2 examples of inadequate retention in FTT

A

Vomiting

Severe GORD

108
Q

Give examples of malabsorption in FTT

A

Coeliac
CF
CMPA
Cholestatic liver disease

109
Q

Give examples of failure to utilise nutrients

A 
Metabolic disorders
Chromosomal disorders (DS)
Extreme prematurity
Metabolic disorders
Congenital hypothyroidism
110
Q

Give examples of increased requirements

A 
Thyrotoxicosis
CF
Malignancy
HIV/Immunodeficient
Congenital heart disease
CKD
111
Q

What blood tests can be done to identify iron-deficiency anaemia?

A

FBC

Serum ferrittin

112
Q

What professionals can aid with feeding issues?

A

SALT
Dietician
Health visitor
GP

113
Q

What are the 2 main features of neonatal hepatic syndrome?

A
  1. Neonatal jaundice

2. Hepatic inflammation

114
Q

How many babies present with neonatal hepatic syndrome?

A

Low birthwieght
Faltering growth
Jaundice

115
Q

What does liver biopsy show with neonatal hepatic syndrome?

A

Giant cell hepatitis

116
Q

What are choledocal cysts?

A

Cystic dilations of extrahepatic biliary tree.

117
Q

How are choledocal cysts investigated?

A

USS

MR cholangiopancreatography

118
Q

What would be found on blood tests to investigate liver failure?

A 
Bilirubin elevated
AST/ALT elevated
ALP elevated
Coagulation abnormal
Plasma ammonia elevated
119
Q

What can an EEG and CT show with liver failure?

A

EEG: Acute hepatic encephalopathy

CT: Cerebral oedema

120
Q

What is kernicterus?

A

Encephalopathy resulting from excess unconjugated bilirubin.

(Not enough albumin to bind the excess bilirubin)

121
Q

Why is kernicterus rarer nowadays?

A

Prophylactic anti-D immunoglobulins for rhesus-negative mothers.

Less cross reactivity between baby’s and mother’s blood –> less haemolysis and RBC breakdown.

122
Q

Give 2 causes of jaundice <24 hours of age

A
  1. Rhesus haemolytic disease
  2. ABO incompatibility
  3. G6PD deficiency
  4. Spherocytosis
  5. Pyruvate Kinase deficiency
123
Q

Which test can show antibodies in ABO compatiblity on the surface of foetal red cells?

A

Coomb’s test

124
Q

Give 2 causes of jaundice between 24h to 2 weeks of age

A 
Physiological jaundice
Breast milk jaundice
Infection - UTI
Haemolysis: G6PD deficiency, ABO incompatibility
Bruising
Polycythaemia
Crigler-Najjar syndrome
125
Q

Give 2 causes of UNconjugated jaundice in children >2 weeks of age

A 
Physiological jaundice
Breast milk jaundice
Infection
Hypothyroidism
Haemolysis: G6PD deficiency
High GI obstruction - e.g. pyloric stenosis
126
Q

Give 2 causes of conjugated jaundice in children >2 weeks of age

A

Bile duct obstruction

Neonatal hepatitis

Paeds (8 decks)

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