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GI and Urology Flashcards

1
Q

Describe abdominal migraine symptoms

A

Recurrent episodes of central abdominal pain
Attacks last 1-72 hours
Completely normal between
Often associated with nausea and anorexia

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2
Q

What is the management of abdominal migraine?

A

Education
Pizotifen - reduces frequency and intensity of attacks
Propranolol may also be effective

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3
Q

What is Hirschsprung’s disease?

A

Absence of ganglion cells in the bowel wall nerve plexus causing a narrow, contracted segment of large bowel causing constipation
Usually causes delayed meconium
Can present later

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4
Q

How do we diagnose Hirschsprung’s disease?

A

Barium enema

Rectal biopsy

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5
Q

How do we treat Hirschsprung’s disease?

A

Surgical resection of that part of bowel

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6
Q

Define encopresis

A

Voluntary passage of whole, formed stools in inappropriate places by a child mature enough to be continent

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7
Q

What is the dietary advice for constipation?

A

Decrease white bread, have wholewheat and bran
High fibre cereals
Eat fruit and veg, beans and nuts to soften stool
6-8 glasses of water a day

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8
Q

How do we treat constipation in babies?

A

Boiled water or fresh orange juice between milk feeds

Glycerin suppositories

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9
Q

What is the most common microbe causing gastroenteritis?

A

Rotavirus

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10
Q

What symptom suggests a bacterial cause of gastroenteritis?

A

Blood in stools

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11
Q

What is the most common cause of bacterial gastroenteritis?

A

Campylobacter jejuni

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12
Q

What factors put the child at increased risk of dehydration?

A 
< 6 months
6+ diarrhoea episodes in 24 hours
3+ vomiting episodes in 24 hours
Unable to tolerate extra fluids
Malnutrition
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13
Q

When would you do a stool culture in gastroenteritis?

A

Patient is septic
Blood/mucus present
Immune compromised
Recent foreign travel

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14
Q

Why don’t we give anti-diarrhoea drugs in gastroenteritis?

A

Prolongs excretion of the bacteria

Causes unnecessary side effects

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15
Q

When do we give antibiotics in gastroenteritis?

A

Suspected or confirmed sepsis

Otherwise assume viral

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16
Q

What are the signs of kernicterus?

A

Decreased awareness
Floppy
Poor feeding
Seizures

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17
Q

What is the management of kernicterus?

A

Exchange transfusion

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18
Q

What are the complications of kernicterus?

A

Cerebral palsy
Hearing loss
Learning disabilities
Tics

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19
Q

Define intussusception

A

Telescoping of one part of bowel into another

Usually ileum into caecum

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20
Q

At what age is intussusception most likely to occur?

A

3 - 24 months

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21
Q

Intussusception commonly follows …

A

A viral infection

Eg. Adenovirus or rotavirus

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22
Q

How does intussusception present?

A

Episodic screaming/crying in pain
Pallor
Blood and mucus in stool - red currant jelly

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23
Q

What do you feel on examination of intussusception?

A

Sausage shaped mass in the abdomen

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24
Q

What will the abdo x-ray show in intussusception?

A

Rounded edge of the intussusception against the gas-filled limes of distal bowel
Signs of proximal obstruction

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25
What scan confirms intussusception and by what sign?
Ultrasound | Doughnut sign
26
What is the management of intussusception?
Reduction via air or barium enema | Laparotomy if above fails
27
What are the indications for urine culture in children?
``` Suspected pyelonephritis < 3 months old At risk of serious illness Recurrent UTIs Sx and dipstick don’t correlate Positive leukocytes or nitrites Infection not responding in 24-48 hours ```
28
If a child has an atypical UTI, when should the USS be performed?
During the acute infection to identify structural abnormalities
29
When should a child have an USS if they are < 6 months and it’s their first UTI?
In 6 weeks
30
If a child > 6 months old has their first UTI do they need an USS?
No
31
When would a DMSA test be performed and what does it show?
4-6 months following an acute infection | Detects renal parenchyma defects and scarring
32
When would a MCUG be performed and what does it show?
Following an atypical or recurrent UTI | shows how well the bladder works - any reflux
33
Give the possible features of HSP
``` Characteristic skin rash on extensor surfaces - buttocks and legs Arthralgia Periarticular oedema Abdominal pain Glomerulonephritis ```
34
At what age does HSP present?
3 - 10 years
35
HSP is often preceded by a ...
URTI
36
Describe the rash of HSP
Symmetrical over buttocks, extensor surface of arms and legs, ankles Trunk usually spared Urticarial initially and rapidly becomes maculopapular and purpuric Usually the first feature
37
Abdominal pain can be a sign of which 2 complications of HSP?
Intussusception | Orchitis
38
What might you except on a dipstick for HSP?
Haematuria | Mild proteinuria
39
What is the management for HSP?
Follow up for one year doing BP and dipstick to detect persistent haematuria or proteinuria
40
What is the incidence of Type 1 diabetes in children?
1 in 500
41
What are the glucose levels for diagnosing diabetes?
Fasting >7 mmol/l | Random >11.1
42
What is the usual presentation of type 1 diabetes in children?
2-3 hx of lethargy, weight loss, polyuria and thirst | May present as bed wetting
43
What is the management of Type 1 diabetes?
Education for children/parents/school MDT Insulin: basal-bolus or twice daily regime Monitor HbA1c
44
How do we manage reflux in babies?
Nurse upright Thicken feeds Take gaviscon before feed Wind the baby after feeds
45
When is pyloric stenosis likely to present?
6 week- commonest | 2-8 weeks
46
What are the symptoms of pyloric stenosis?
Projectile vomiting immediately after food Vomit is not bile stained Weight loss and dehydration Constipation
47
What can be found on examination of pyloric stenosis?
Hard mobile mass to right of epigastrium - palpate after test feed Prominent peristaltic waves may be visible over stomach
48
Which investigation is best for diagnosing pyloric stenosis?
Ultrasound
49
What is the management of pyloric stenosis?
Fully rehydrate Correct electrolytes - May have metabolic alkalosis Surgery
50
When do we admit a child for not taking feeds?
If they are taking <50% of feeding requirements
51
Give a differential diagnosis for acute abdominal pain
``` Inflammatory bowel disease Diabetes Lower lobe pneumonia Appendicitis Peptic ulcer Renal stones Intestinal obstruction UTI HSP Constipation Gastroenteritis Intussusception Mesenteric adenitis ```
52
Mesenteric adenitis usually comes on following what?
A recent viral infection
53
What are the symptoms of appendicitis in a child?
``` Abdominal pain Loss of appetite Reluctant to move Fever Constipation and vomiting ```
54
What is mesenteric adenitis?
Inflammation of intra abdominal lymph nodes
55
What is the management of mesenteric adenitis?
Simple analgesia
56
What is the most common cause of UTI in children?
E. coli 90%
57
How are UTIs caused?
``` Idiopathic Poor hygiene Constipation Neuropathic bladder Obstructed urinary system Vesico-ureteric reflux ```
58
How quickly must a urine sample reached the lab?
Within four hours or store in fridge
59
What does a DMSA scan show?
The differential function between the kidneys and shows scarring
60
How do we detect bladder reflux?
A micturating cystourethrogram | MCUG
61
What are the consequences of vesico-ureteric reflux?
Hydronephrosis | Predisposition to UTIs, hypertension, pyelonephritis and end stage renal failure
62
Describe post streptococcal glomerulonephritis
Basement membrane disease following a throat or skin infection by strep Causes blood in the urine (Coca-Cola urine) Red cells, casts and protein in the urine
63
What is the management of post-strep Glomerulonephritis?
Steroids/immune therapy
64
Give some causes of haematuria
``` Polycystic kidneys Post streptococcal glomerulonephritis Renal stone/tumour/trauma UTI Sickle-cell disease HSP, in basement membrane disease, Alport’s syndrome and IgA nephropathy ```
65
What are the causes of protein in the urine in children?
Nephrotic syndrome Orthostatic Acute renal failure UTI
66
Describe nephrotic syndrome
``` Oedema - Face, limbs and scrotum Minimal change GN Commonly relapses Hyperlipidaemia Hypoalbuminaemia - ascites and pleural effusion ```
67
What is orthostatic proteinuria?
Protein in the urine after exercise or standing
68
What investigations are needed for suspected nephrotic syndrome?
Urine protein/creatinine ratio = high Serum albumin = low Triglycerides and cholesterol = high
69
What are the characteristics of nephrotic syndrome?
Proteinuria Hypoalbuminaemia Oedema Hyperlipidaemia
70
What is the most common cause of nephrotic syndrome in children?
Minimal change Disease | 85%
71
Where is the oedema most noticeable in the body from nephrotic syndrome?
Eyes | Legs
72
What is the 2nd commonest cause of nephrotic syndrome in children?
Focal segmental glomerulosclerosis
73
How do we manage minimal change Disease?
Fluid restrict Low salt diet Prednisolone
74
What is the survival rate for germ-cell tumours in children?
90%
75
What is another name for Wilm’s tumour?
Nephroblastoma
76
How does a nephroblastoma present?
Mass Haematuria Hypertension
77
How does Wilms’ tumour metastasise?
Via the inferior vena cava to the lungs
78
Rhabdomyosarcoma is most common in which sites?
Head and neck | Genitourinary tract
79
What is the five-year survival of rhabdomyosarcoma?
70%
80
How common is nocturnal enuresis in 6 year olds?
10% | Once a week
81
Give some causes of nocturnal enuresis
``` Delayed maturation Decreased ADH production Reduced bladder awareness Emotional stress UTI Polyuria ```
82
Give some causes of diurnal enuresis
``` UTI neurogenic bladder Psychogenic Urgency Congenital abnormality Constipation Sexual abuse ```
83
What is the management of daytime wetting?
Encourage to go to the toilet at regular intervals Manage any constipation or UTI Oxybutynin for muscle stability
84
What is the management of night time wetting?
``` Behavioural strategies e.g. star charts Avoid drinks in the evening Enuresis alarms Desmopressin-only for short periods of time example: holidays or sleepovers Specialist nurse support ```
85
When does the hydrocoele usually resolve by?
12 months
86
Describe what is found on examination of the hydrocoele
No pain Does not extend into the groin Testis cannot be palpated through the fluid Transilluminates
87
An undescended testis may be associated with what?
Inguinal hernia
88
What is the management of an undescended testis?
Orchidoplexy - required by one year old to avoid infertility, torsion and malignancy
89
What factors increase the risk of testicular torsion?
Undescended testis | Testis lying transversely
90
What is the management of testicular torsion?
Surgical exploration within hours of symptom onset | Untwist or remove testes and fixation of contralateral testis
91
What is infantile colic?
Periodic crying affecting infants in the first three months of life May be associated with hunger, swallowed air or discomfort from overfeeding
92
What are the symptoms of infantile colic?
``` Crying that can last several hours Flushed face Distended and tense abdomen Drawn up legs In between attacks child is happy and well ```
93
What is the management of infantile colic?
Reassurance and advice on feeding, winding after feed and carrying baby Consider discontinuing cows milk in mothers diet Usually resolves spontaneously after three months
94
When does volvulus occur in a child?
When the child has intestinal malrotation
95
What are the symptoms of volvulus in a child?
Sudden bouts of crying and pulling legs in Little or no faeces Vomiting especially if bilious Dehydration

Paediatrics (8 decks)

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