GI Flashcards
GI symptoms affecting the mouth/face
angular cheilitis ulcers swollen lips facial rash thrush dental caries recurrent cold sores pigmented lips
what condition is pigmented lips associate with
Peutz-Jeghers syndrome
features of Peutz-Jeghers syndrome
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
causes of angular cheilitis
infection drooling eczema candida immunodeficiency IBD
causes of mouth ulcers
IBD
Coeliac disease
features of OFG
orofacialgranulomatosis
ulcers
swollen lips
facial rash
Granulomas
associated with Crohns disease
cause of recurrent thrush and ulcers
immunodeficiency
causes of dental caries
reflux
regurgitations
high sugar diet
poor dental hygiene
all endoscopies are carried out under GA in paediatric, true or false
true
imaging for small bowel
MRI (preferable - thickness of bowel wall and nodes)
barium follow through study
symptoms affecting the oesophgus
retrosternal pain vomiting back arching cough / aspiration pneumonia malaena dysphagia odynophagia food bolus obstruction
causes of: retrosternal pain vomiting back arching cough / aspiration
GORD
If GORD leads to oesophageal erosion, what can develop
malaena
anaemia
Causes of:
dysphagia
odynophagia
food bolus obstruction
eosinophilic oesophagitis
achalasia (much rarer)
symptoms affecting stomach
epigastric pain
vomiting
malaena
symptoms of gastritis
epigastric pain
vomiting
malaena
causes of gastritis and ulcers
H.Pylori
H.pylori infection can present before 2 years old, true or false
false, rarely does
symptoms affecting small bowel
(colicky) pain diarrhoea malaena vomiting failure to thrive
causes of diarrhoea
IBD
coeliac
food allergy
causes of blood in stool
Meckels diverticulum =
ectopic gastric tissue in the small bowel
bilious vomit?
bowel obstruction
needs urgent surgical review
the younger a child is the more likely they are to have bowel perforation from bowel obstruction, true or false
true
consequences of small bowel disease
failure to thrive, stunted growth
symptoms affecting the large bowel
diarrhoea
constipation
bleeding
pain
causes of diarrhoea
infection
IBD
coeliac disease
common cause for PR bleeding
constipation
passage of bulky stools
IBD
infection
symptoms affecting perianal area
fissures ulcers abscess fistula skin tags
perianal crohns disease has a better/worse outcome than other types of crohns disease
worse prognosis
usually requires biological therapy
causes of fissures
crohns disease
constipation
child sexual abuse
symptoms of perianal crohns disease
fissures ulcers abscess fistula skin tags
kids commonly can develop haemorrhoids, true or false
false, very rare
skin tags are mistaken for haemorrhoids
skin manifestations of GI conditions
anaemia - pallor erythema nodosum pyoderma gangrenosum dermatitis herpetiformis eczema finger clubbing jaundice
what GI condition is erythema nodosum associated with
crohns disease
what GI condition is pyoderma gangrenosum associated and finger clubbing with
crohns and UC
what GI condition is associated with dermatitis herpetiformis
coeliac disease
eczema below the age of 6 months can be associated with with GI condition
cows milk protein allergy
what other conditions are associated with erythema nodosum
TB
sarcoidosis
features of erythema nodosum
painful
ulcerate
confined to legs and buttocks
features of pyoderma gangrenosum
confined to arms and legs
not responsive to antibiotics
management of erythema nodosum and pyoderma gangrenosum
steroids
features of dermatitis herpetiformis
can appear anywhere on the body
usually around elbows, knees, sacral/buttocks or perioral
structure for GI history taking
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
what are possible pathologies associated with pain in the following regions: retrosternal epigastric RIF RUQ
retrosternal - GORD
epigastric - gastritis
RIF - appendicitis
RUQ - gallstones
causes of gastroenteritis
viral (most common)
bacterial
parasitic
viral causes of gastroenteritis
noravirus
adenovirus
rotavirus (has vaccine)
bacterial causes of gastroenteritis
E.coli 0157 –> HUS
C. difficile
salmonella
cryptosporidium
parasitic causes of gastroenteritis
giardia
treatment of all gastroenteritis involves antibiotics, true or false
FALSE!
most cases are viral anyway but if it happened to be E.coli 0157, then this would worsen HUS
what is HUS
haemolytic uraemic syndrome
- haemolytic anaemia
- thrombocytopaenia
- AKI
management of gastroenteritis
trial oral rehydration and oral rehydration solution e.g. diarolyte, rehydrat
consider ondansetron for vomiting
if not tolerated: NG tube, IV fluids
define diarrhoea, generally
> 3 stools / day
causes of diarrhoea
infection
IBD
malabsorption / enteropathies
non-infectious causes of malabsorption
Coeliac disease IBD CF food allergies lactose intolerance other rare disease
what is ‘toddler’s diarrhoea’
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
gastroesophageal reflux is very common in infancy, true or false
true
generally benign and self limiting
cause of gastroesophageal reflux in infancy
overfeeding
? CMPA especially if rash
management of gastroesophageal reflux
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
what is coeliac disease
autoimmune enteropathy to gluten
symptoms of coeliac disease
diarrhoea abdominal pain failure to thrive dermatitis herpetiformis pale stools bloating anaemia excessive tiredness constipation - atypical
investigations for coeliac disease
anti TTG
anti endomesial antibodies
FBC, LFT, U+E, CRP, iron studies, stool cultures, feacal calprotectin
these are dependent on normal IgA
what is the gold standard diagnosis for coeliac disease
endoscopy with duodenal (D2) biopsy
only in children you can diagnose coeliac disease with blood tests, what are the requirements for this
classical symptoms AND
TTG >10x upper limit of normal
then second sample required (either TTG or EMA)
histology of coeliac disease biopsy
crypt hyperplasia
flattening of villi
lymphocytic infiltration
associations of coeliac disease
T1DM autoimmune thyroid disease juvenile chronic arthritis other autoimmune conditions Downs syndrome Turner syndrome Williams syndrome
complications of Coeliac disease
anaemia malabsorption failure to thrive osteoporosis short stature delayed puberty female infertility intestinal malignancies (T-cell lymphomas, MALT)
management of coeliac disease
gluten free diet for life
annual review by dietician for: height, weight, FBC, ferritin, TTG
you can only accurately diagnose coeliac disease if you have gluten in your diet, true or false
true
what foods include gluten
pasta bread noodles pastries crackers cereal
features of crohns disease
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
investigations for crohns disease
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
histological features of crohns disease biopsy
skip lesions oedema inflammation crypt abscesses non caseating granulomas
management of crohns disease
induce remission: elemental diet, prednisolone
maintenance: azathioprine, +- infliximab/adalimumab
surgery is last line
high calorie, low bulk nutrition
complications of crohns disease
perforation fistulae colon Ca sclerosing cholangitis autoimmune hepatitis
we try to avoid steroids in children, true or false
true, can magnify osteoporosis and can affect growth
what can be used to score crohns disease
wPCDAI
D.Dx for daily soiling
constipation with faecal impaction
general definitions/features of constipation
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
features of organic disease in constipation
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
how many stool types are there on the bristol stool chart
6
RF for constipation
low fibre intake low fluid intake excessive dairy products lack of exercise obesity problems with toilet training
management of constipation
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
laxatives make the bowel lazy, true or false
false
longstanding constipation is worse
why do you get soiling associated with constipation
faecal impaction causes overflow diarrhoea
what is infant dyschezia
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
is infant dyschezia the same as constipation
no
what is IBDU
IBD unspecified
no clear cut between crohns and UC
what scoring system is used for UC
PUCAI
what is UC
multifactorial autoimmune condition
confined to large bowel only
continuous lesions
severities of UC
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
what is toxic megacolon
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
complications of UC
CRC growth failure arthropathy episcleritis erythema nodosum/pyoderma gangrenosum autoimmune liver disease
investigations for UC
stool cultures x3 FBC, LFT< U+E, ferritin faecal calprotectin upper and lower GI endoscopy MRI small bowel
histology of UC biopsy
PMN cells
crypt abscesses
NO granulomas
UC management
steroids to induce remission maintenance therapy: mild - mesalazine only mod-severe - mesalazine + azathioprine non-responders - mesalazine + azathioprine + biologic cure = colectomy
D.Dx of food bolus obstruction
eosinophilic oesophagitis
oesophageal stricture (from GORD)
didnt chew well enough
what is eosinophilic oesophagitis EO
immune condition characterised by eosinophilic infiltration of the oesophageal mucosa
2nd most common cause of oesophagitis following GORD
symptoms of EO
dysphagia
odynophagia
food bolus obstruction
management of EO
1st line: dietary management top 6 food elimination - seafood, nuts, dairy, eggs, wheat, soya
2nd line: topical budesonide
complication of EO
oesophageal stricture
main investigations in paediatric gastroenterology
FBC U+E LFT CRP ferritin Coeliac screen stool cultures faecal calprotectin MRI / barium study - small bowel upper and lower GI endoscopy
causes of vomiting due to obstruction
pyloric stenosis
intussusception
intestinal volvulus
adhesions post surgery
which of the following present with bile stained vomit: pyloric stenosis intussusception intestinal volvulus adhesions post surgery
intussusception
intestinal volvulus
adhesions post surgery
GI conditions causing abdominal pain
colic intussusception appendicitis mesenteric adenitis constipation IBD coeliac disease
Non-GI causes of abdominal pain
migraine
DKA
infection elsewhere
stress
rare but severe causes of abdominal pain
malignancy - neuroblastoma, Wilms tumour
testicular torsion
bowel obstruction
what can be associated with intussuscpetion
preceding infection e.g. tonsillitis
can lead to lymphadenopathy of Peyer’s patches which acts as a lead on point for this
