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Year 4 Child Health > GI > Flashcards

GI Flashcards

1
Q

GI symptoms affecting the mouth/face

A 
angular cheilitis 
ulcers 
swollen lips 
facial rash 
thrush 
dental caries 
recurrent cold sores 
pigmented lips
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2
Q

what condition is pigmented lips associate with

A

Peutz-Jeghers syndrome

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3
Q

features of Peutz-Jeghers syndrome

A 
Autosomal dominant 
benign hamartomatous polyps in GI tract 
risk of bleeding and intussusception 
pigmented macules on lips 
may develop cancer 
breast, testes, ovarian, pancreas in adulthood
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4
Q

causes of angular cheilitis

A 
infection 
drooling 
eczema 
candida 
immunodeficiency 
IBD
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5
Q

causes of mouth ulcers

A

IBD

Coeliac disease

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6
Q

features of OFG

orofacialgranulomatosis

A

ulcers
swollen lips
facial rash

Granulomas
associated with Crohns disease

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7
Q

cause of recurrent thrush and ulcers

A

immunodeficiency

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8
Q

causes of dental caries

A

reflux
regurgitations
high sugar diet
poor dental hygiene

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9
Q

all endoscopies are carried out under GA in paediatric, true or false

A

true

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10
Q

imaging for small bowel

A

MRI (preferable - thickness of bowel wall and nodes)

barium follow through study

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11
Q

symptoms affecting the oesophgus

A 
retrosternal pain 
vomiting 
back arching 
cough / aspiration pneumonia 
malaena 
dysphagia 
odynophagia 
food bolus obstruction
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12
Q 
causes of:
retrosternal pain 
vomiting 
back arching 
cough / aspiration
A

GORD

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13
Q

If GORD leads to oesophageal erosion, what can develop

A

malaena

anaemia

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14
Q

Causes of:
dysphagia
odynophagia
food bolus obstruction

A

eosinophilic oesophagitis

achalasia (much rarer)

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15
Q

symptoms affecting stomach

A

epigastric pain
vomiting
malaena

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16
Q

symptoms of gastritis

A

epigastric pain
vomiting
malaena

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17
Q

causes of gastritis and ulcers

A

H.Pylori

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18
Q

H.pylori infection can present before 2 years old, true or false

A

false, rarely does

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19
Q

symptoms affecting small bowel

A 
(colicky) pain 
diarrhoea 
malaena 
vomiting 
failure to thrive
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20
Q

causes of diarrhoea

A

IBD
coeliac
food allergy

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21
Q

causes of blood in stool

A

Meckels diverticulum =

ectopic gastric tissue in the small bowel

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22
Q

bilious vomit?

A

bowel obstruction

needs urgent surgical review

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23
Q

the younger a child is the more likely they are to have bowel perforation from bowel obstruction, true or false

A

true

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24
Q

consequences of small bowel disease

A

failure to thrive, stunted growth

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25
Q

symptoms affecting the large bowel

A

diarrhoea
constipation
bleeding
pain

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26
Q

causes of diarrhoea

A

infection
IBD
coeliac disease

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27
Q

common cause for PR bleeding

A

constipation
passage of bulky stools
IBD
infection

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28
Q

symptoms affecting perianal area

A 
fissures 
ulcers 
abscess 
fistula 
skin tags
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29
Q

perianal crohns disease has a better/worse outcome than other types of crohns disease

A

worse prognosis

usually requires biological therapy

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30
Q

causes of fissures

A

crohns disease
constipation
child sexual abuse

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31
Q

symptoms of perianal crohns disease

A 
fissures 
ulcers 
abscess 
fistula 
skin tags
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32
Q

kids commonly can develop haemorrhoids, true or false

A

false, very rare

skin tags are mistaken for haemorrhoids

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33
Q

skin manifestations of GI conditions

A 
anaemia - pallor
erythema nodosum 
pyoderma gangrenosum 
dermatitis herpetiformis 
eczema 
finger clubbing 
jaundice
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34
Q

what GI condition is erythema nodosum associated with

A

crohns disease

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35
Q

what GI condition is pyoderma gangrenosum associated and finger clubbing with

A

crohns and UC

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36
Q

what GI condition is associated with dermatitis herpetiformis

A

coeliac disease

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37
Q

eczema below the age of 6 months can be associated with with GI condition

A

cows milk protein allergy

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38
Q

what other conditions are associated with erythema nodosum

A

TB

sarcoidosis

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39
Q

features of erythema nodosum

A

painful
ulcerate
confined to legs and buttocks

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40
Q

features of pyoderma gangrenosum

A

confined to arms and legs

not responsive to antibiotics

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41
Q

management of erythema nodosum and pyoderma gangrenosum

A

steroids

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42
Q

features of dermatitis herpetiformis

A

can appear anywhere on the body

usually around elbows, knees, sacral/buttocks or perioral

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43
Q

structure for GI history taking

A 
age of patient 
height / weight 
are they normally well 
weight loss 
infectious: contacts, travel, food, fever, drinking water 
N+V - how often 
stools: diarrhoea, constipation, PR bleeding, night rising 
acute vs chronic >6wk
mouth ulcers 
appetite + feeding: quantify e.g. milk 
sleep 
Hx: allergies, eczema, autoimmunity 
FH - atopy, IBD, autoimmune 
medications - NSAIDs
44
Q 
what are possible pathologies associated with pain in the following regions:
retrosternal 
epigastric 
RIF 
RUQ
A

retrosternal - GORD
epigastric - gastritis
RIF - appendicitis
RUQ - gallstones

45
Q

causes of gastroenteritis

A

viral (most common)
bacterial
parasitic

46
Q

viral causes of gastroenteritis

A

noravirus
adenovirus
rotavirus (has vaccine)

47
Q

bacterial causes of gastroenteritis

A

E.coli 0157 –> HUS
C. difficile
salmonella
cryptosporidium

48
Q

parasitic causes of gastroenteritis

A

giardia

49
Q

treatment of all gastroenteritis involves antibiotics, true or false

A

FALSE!

most cases are viral anyway but if it happened to be E.coli 0157, then this would worsen HUS

50
Q

what is HUS

A

haemolytic uraemic syndrome

  • haemolytic anaemia
  • thrombocytopaenia
  • AKI
51
Q

management of gastroenteritis

A

trial oral rehydration and oral rehydration solution e.g. diarolyte, rehydrat
consider ondansetron for vomiting
if not tolerated: NG tube, IV fluids

52
Q

define diarrhoea, generally

A

> 3 stools / day

53
Q

causes of diarrhoea

A

infection
IBD
malabsorption / enteropathies

54
Q

non-infectious causes of malabsorption

A 
Coeliac disease 
IBD 
CF 
food allergies 
lactose intolerance 
other rare disease
55
Q

what is ‘toddler’s diarrhoea’

A

benign condition due to colonic immaturity
self limiting - improves y 5-6 years
child is thriving
up to 10 stools a day
still investigate to rule out pathologies
management: reduces excessive fruit juice, increase fat, normal fibre, rarely use loperamide

56
Q

gastroesophageal reflux is very common in infancy, true or false

A

true

generally benign and self limiting

57
Q

cause of gastroesophageal reflux in infancy

A

overfeeding

? CMPA especially if rash

58
Q

management of gastroesophageal reflux

A

assess for overfeeding
reassurance that it is self limiting
consider CMPA and try hydrolysed formula
gaviscon as thickener
consider PPI
further investigate if there are any red flags

59
Q

what is coeliac disease

A

autoimmune enteropathy to gluten

60
Q

symptoms of coeliac disease

A 
diarrhoea 
abdominal pain 
failure to thrive 
dermatitis herpetiformis 
pale stools 
bloating 
anaemia 
excessive tiredness 
constipation - atypical
61
Q

investigations for coeliac disease

A

anti TTG
anti endomesial antibodies
FBC, LFT, U+E, CRP, iron studies, stool cultures, feacal calprotectin
these are dependent on normal IgA

62
Q

what is the gold standard diagnosis for coeliac disease

A

endoscopy with duodenal (D2) biopsy

63
Q

only in children you can diagnose coeliac disease with blood tests, what are the requirements for this

A

classical symptoms AND
TTG >10x upper limit of normal
then second sample required (either TTG or EMA)

64
Q

histology of coeliac disease biopsy

A

crypt hyperplasia
flattening of villi
lymphocytic infiltration

65
Q

associations of coeliac disease

A 
T1DM 
autoimmune thyroid disease 
juvenile chronic arthritis 
other autoimmune conditions 
Downs syndrome 
Turner syndrome 
Williams syndrome
66
Q

complications of Coeliac disease

A 
anaemia 
malabsorption 
failure to thrive 
osteoporosis 
short stature 
delayed puberty 
female infertility 
intestinal malignancies (T-cell lymphomas, MALT)
67
Q

management of coeliac disease

A

gluten free diet for life

annual review by dietician for: height, weight, FBC, ferritin, TTG

68
Q

you can only accurately diagnose coeliac disease if you have gluten in your diet, true or false

A

true

69
Q

what foods include gluten

A 
pasta 
bread 
noodles 
pastries 
crackers 
cereal
70
Q

features of crohns disease

A

autoimmune disease
entire GI tract can be affected
diarrhoea, PR bleeding, weight loss, anaemia, abdominal pain, perianal/oral disease
extra-GI symptoms: liver, eyes, skin

71
Q

investigations for crohns disease

A

FBC, LFT, U+E, CRP, ferritin, coeliac screen
faecal calprotectin
stool cultures x3
upper and lower GI endoscopy
MRI small bowel / barium study if younger

72
Q

histological features of crohns disease biopsy

A 
skip lesions 
oedema 
inflammation 
crypt abscesses
non caseating granulomas
73
Q

management of crohns disease

A

induce remission: elemental diet, prednisolone
maintenance: azathioprine, +- infliximab/adalimumab
surgery is last line
high calorie, low bulk nutrition

74
Q

complications of crohns disease

A 
perforation 
fistulae 
colon Ca 
sclerosing cholangitis 
autoimmune hepatitis
75
Q

we try to avoid steroids in children, true or false

A

true, can magnify osteoporosis and can affect growth

76
Q

what can be used to score crohns disease

A

wPCDAI

77
Q

D.Dx for daily soiling

A

constipation with faecal impaction

78
Q

general definitions/features of constipation

A

at least 2 of the following for at least 1 month:
<3 defecations / week
at least 1 episode / week of feacal incontinence
history of excessive stool retention or retentive posturing
history of painful/hard bowel movements
presence of large faecal ass in rectum
history of stools with large diameter that may obstruct the toilet

79
Q

features of organic disease in constipation

A

delayed passage >24hr meconium after birth - Hirschsprungs disease
recurrent rectal prolapse - CF
abnormal position of anus
explosive passage of stool following PR exam - Hirschsprungs disease
skin tags / healed fissures - crohns, sexual abuse

80
Q

how many stool types are there on the bristol stool chart

A

6

81
Q

RF for constipation

A 
low fibre intake 
low fluid intake 
excessive dairy products 
lack of exercise 
obesity 
problems with toilet training
82
Q

management of constipation

A

stool softeners e.g. laxido, magrocol
aim for BSC type 5 for 2 weeks then type 4 for 6 months
may need stimulant e.g. senna or docusate

83
Q

laxatives make the bowel lazy, true or false

A

false

longstanding constipation is worse

84
Q

why do you get soiling associated with constipation

A

faecal impaction causes overflow diarrhoea

85
Q

what is infant dyschezia

A

problem in learning to defecate with poor coordination of straining and opening external anal sphincter
babies appear in pain then settle when stool passes
self limiting - 2-4 weeks
no treatment required

86
Q

is infant dyschezia the same as constipation

A

no

87
Q

what is IBDU

A

IBD unspecified

no clear cut between crohns and UC

88
Q

what scoring system is used for UC

A

PUCAI

89
Q

what is UC

A

multifactorial autoimmune condition
confined to large bowel only
continuous lesions

90
Q

severities of UC

A

mild: distal colon, <3stools/day, little blood
moderate: 3-5 stools/day, abdo pain, weight loss
severe: >5 stools/day, frank blood, anaemia, hypoalbuminaemia, leukocytosis, pain, risk of toxic megacolon and perforation

91
Q

what is toxic megacolon

A

transverse colon diameter >5cm in adults on plain AXR film
rare in children so no other paeds parameters
managament: drip and suck, IV antbx, early surgical review

92
Q

complications of UC

A 
CRC
growth failure 
arthropathy 
episcleritis 
erythema nodosum/pyoderma gangrenosum 
autoimmune liver disease
93
Q

investigations for UC

A 
stool cultures x3 
FBC, LFT< U+E, ferritin
faecal calprotectin 
upper and lower GI endoscopy 
MRI small bowel
94
Q

histology of UC biopsy

A

PMN cells
crypt abscesses
NO granulomas

95
Q

UC management

A 
steroids to induce remission 
maintenance therapy:
mild - mesalazine only 
mod-severe - mesalazine + azathioprine 
non-responders - mesalazine + azathioprine + biologic 
cure = colectomy
96
Q

D.Dx of food bolus obstruction

A

eosinophilic oesophagitis
oesophageal stricture (from GORD)
didnt chew well enough

97
Q

what is eosinophilic oesophagitis EO

A

immune condition characterised by eosinophilic infiltration of the oesophageal mucosa
2nd most common cause of oesophagitis following GORD

98
Q

symptoms of EO

A

dysphagia
odynophagia
food bolus obstruction

99
Q

management of EO

A

1st line: dietary management top 6 food elimination - seafood, nuts, dairy, eggs, wheat, soya
2nd line: topical budesonide

100
Q

complication of EO

A

oesophageal stricture

101
Q

main investigations in paediatric gastroenterology

A 
FBC
U+E 
LFT
CRP 
ferritin 
Coeliac screen 
stool cultures 
faecal calprotectin 
MRI / barium study - small bowel 
upper and lower GI endoscopy
102
Q

causes of vomiting due to obstruction

A

pyloric stenosis
intussusception
intestinal volvulus
adhesions post surgery

103
Q 
which of the following present with bile stained vomit:
pyloric stenosis 
intussusception 
intestinal volvulus 
adhesions post surgery
A

intussusception
intestinal volvulus
adhesions post surgery

104
Q

GI conditions causing abdominal pain

A 
colic 
intussusception 
appendicitis 
mesenteric adenitis 
constipation 
IBD 
coeliac disease
105
Q

Non-GI causes of abdominal pain

A

migraine
DKA
infection elsewhere
stress

106
Q

rare but severe causes of abdominal pain

A

malignancy - neuroblastoma, Wilms tumour
testicular torsion
bowel obstruction

107
Q

what can be associated with intussuscpetion

A

preceding infection e.g. tonsillitis

can lead to lymphadenopathy of Peyer’s patches which acts as a lead on point for this

Year 4 Child Health (22 decks)

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