GI Corrections Flashcards
What are some causes of bilious vomiting in neonates? (5)
1) Necrotising enterocolitis
2) Meconium ileus
3) Jejunal/ileal atresia
4) Malrotation with volvulus
5) Duodenal atresia
What is bilious vomiting in within 24 hours of birth most commonly caused by?
Intestinal atresia –> duodenal, jejunal or ileal atresia.
What is bilious vomiting classically caused by?
Obstruction beyond the sphincter of Oddi (where the common bile duct enters the duodenum).
When does NEC typically present?
Usually 2nd week of life
When does meconium ileus typicallly present?
First 24-48 hours of life
when does intestinal atresia usually present?
Within first 24 hours of life
When does malrotation with volvulus typically present?
3-7 days after birth
What is a key risk factor for duodenal atresia?
Down syndrome
What is seen on an AXR in duodenal atresia?
‘Double bubble’ sign
What is the diagnostic investigation for necrotising enterocolitis?
AXR
Is hypoglycaemia common in the neonatal period?
Yes - normal term babies often have hypoglycaemia especially in the first 24 hrs of life but without any sequelae.
They can utilise alternate fuels like ketones and lactate.
Define typical blood glucose level for neonatal hypoglycaemia
<2.6 mmol/L
What are some causes of persistent/severe hypoglycaemia in neonates?
1) Preterm birth (<37 weeks)
2) Maternal diabetes
3) IUGR
4) Hypothermia
5) Neonatal sepsis
6) Inborn errors of metabolism
7) Nesidioblastosis
8) Beckwith-Wiedemann syndrome
Features of neonatal hypoglycaemia?
1) asymptomatic
2) autonomic:
- poor feeding/sucking
- weak cry
- drowsy
- hypotonia
- seizures
3) other:
- apnoea
- hypothermia
What does management of neonatal hypoglycaemia depend on?
a) the severity of the hypoglycaemia
b) if the newborn is symptomatic
In neonatal hypoglycaemia, what is the management if the newborn is asymptomatic?
1) encourage normal feeding (breast or bottle)
2) monitor blood glucose
In neonatal hypoglycaemia, what is the management if the newborn is symptomatic (or the blood glucose is very low)?
1) admit to the neonatal unit
2) IV infusion of 10% dextrose
Pneumatosis intestinalis (intramural gas) is a hallmark feature of what condition in neonates?
NEC
What is the use of maternal labetalol a risk factor for in neonates?
Foetal hypoglycaemia
What is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?
Meckel’s diverticulum
What are some causes of neonatal hypotonia?
1) Neonatal sepsis
2) Werdnig-Hoffman disease (spinal muscular atrophy type 1)
3) Hypothyroidism
4) Prader-Willi
A baby is born with microcephaly, moderate hepatosplenomegaly and a petechial rash. Shortly after admission to the neonatal intensive care unit, they have a seizure.
What infection has the baby likely been exposed to in-utero?
CMV
XR fluid levels in Hirschsprung’s disease vs meconium ileus?
Hirschsprung’s –> dilated loops of bowel with fluid levels .
Meconium ileus –> distended coils of bowel but no fluid levels (as the meconium is viscid).
what is the usual clinical presentation of Hirschsprung’s?
Delayed passage of meconium + distension of abdomen.
If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance, what is the 1st management step?
An extensive hydrolysed formula should be tried.
In an infant with bilious vomiting & obstruction, what is the likely condition?
Intesinal malrotation (can then progress to a volvulus).
What condition is Hirschprung’s disease associated with?
Down’s syndrome
3x more common in males
1st line management of Hirschsprung’s?
rectal washouts/bowel irrigation
How does malrotation typically present?
Bilious vomiting in neonates in first 30 days of life.
Why can CF cause foul smelling stools?
As CF can give rise to pancreatic insufficiency and consequently steatorrhoea caused by GI malabsorption of fats.
Which vaccine do people with coeliac disease receive every 5 yeas?
Pneumoccal vaccine due to hyposplenism.
This protects against infections caused by encapsulated organisms like Streptococcus pneumoniae.
What can precipitate a G6PD deficiency crisis?
1) Infections e.g. LRTI
2) Drugs e.g. ciprofloxacin, primaquine, sulphonamides, sulphasalazine, sulfonylureas
3) Fava (broad) beans
What is seen on a blood film in G6PD deficiency?
Heinz bodies
What is the key investigation in pyloric stenosis?
US
What is incubation period for Giardiasis?
ranges from 1 to 2 weeks, but it can extend up to 6 weeks in some cases
What are some causes of chronic diarrhoea in children? (4)
1) cows’ milk intolerance (most common cause in developed world)
2) toddler diarrhoea
3) coeliac disease
4) post-gastroenteritis lactose intolerance
When does intussusception typically present?
3-12 months
When does Hirschsprung’s typically present?
24-48h
What is kolionychia? What condition is it seen in?
Spooning of the nails.
Iron deficiency anaemia.
Is conjugated or unconjugated bilirubin raised in biliary atresia?
Conjugated
Risk factors for testicular cancer?
1) infertility
2) cryptochidism
3) FH
4) Klinefelter’s syndrome
5) mumps orchitis
What is the gold standard investigation to confirm a diagonsis of coeliac disease?
Small bowel biopsy
Incubation period of:
- Staphylococcus aureus
- Bacillus cereus
- Salmonella
- E. coli
- Shigella
- Campylobacter
- Giardiasis
- Amoebiasis
1-6 hrs: Staphylococcus aureus, Bacillus cereus
12-48 hrs: Salmonella, Escherichia coli
48-72 hrs: Shigella, Campylobacter
> 7 days: Giardiasis, Amoebiasis
Wbat is the most appropriate treatment for sigmoid volvulus?
Urgent larapotomy
What is the diagnostic investigatoin for NEC?
AXR
What is Zollinger Ellison syndrome?
A condition characterised by excessive levels of gastrin 2ary to a gastrin secreting tumour.
The majority of these tumours are found in the first part of the duodenum.
Features of Zollinger Ellison?
- multiple gastroduodenal ulcers: epigastric pain
- diarrhoea
- malabsorption
What condition is Zollinger Ellison often associated with?
MEN type 1
What makes up MEN-1?
- parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
- pituitary (70%)
- pancreas (50%, e.g. Insulinoma, gastrinoma)
- also: adrenal and thyroid
Are direct or indirect inguinal hernias more likely to become strangulated?
Indirect
What is the annual probability of strangulation of an inguinal hernia?
3%
What are the 2 types of abdominal wall hernias in children?
1) Congenital inguinal hernia
2) Infantile umbilical hernia
Mx of a congenital inguinal hernia?
Should be surgically repaired soon after diagnosis as at risk of incarceration.
URGENT referral for surgery.
Who are congenital inguinal hernias more common in? (2)
Premature babies & boys
Who are infantile umbilical hernias more common in? (2)
Premature babies & Afro-Caribbean babies
Mx of infantile umbilical hernias?
Conservative –> most resolve without intervention before the age of 3 years.
If large or symptomatic –> elective repair at 2-3 years of age.
If small and asymptomatic –> elective repair at 4-5 years of age.
What is the most common ocular malignancy found in children?
Retinoblastoma
What is the average age of diagnosis of a retinoblastoma?
18 months
What is the most common presenting symptom of a retinoblastoma?
Absence of red-reflex, replaced by a white pupil (leukocoria).
Mx of bilateral vs unilateral inguinal hernias?
Bilateral –> laparoscopic mesh repair
Unilateral –> open mesh repair
Why do femoral hernias need to be repaired, regardless of whether they are symptomatic or not?
Due to the risk of strangulation
What is the diagnostic criteria for functional constipation?
Rome criteria.
Must include 2 or more of the folliowing in a child with a developmental age of at least 4 years:
1) <3 defecations per week
2) At least 1 episode of faecal incontinence per week
3) History of painful or hard bowel movements
4) Presence of a large faecal mass in the rectum
5) History of large diameter stools that may obstruct the toilet
Criteria must be fulfilled at least once per week for at least 2 months before diagnosis.
What is functional constipation caused by?
Situational, psychological, developmental or dietary issues.
Behavioural:
- young children may ignore the urge
- negative feelings towards public toilets
Food allergies:
- milk, egg, wheat (most common allergens associated with constipation)
Dietary factors:
- reduced fluid and dietary fibre intake
What are some contributing factors to functional constipation?
1) Changes in routine, diet
2) Stressful events e.g. birth of a sibling, parental divorce
3) Entering kindergarten and school
4) Intercurrent illness
5) Perianal irritation
Pathophysiology of encopresis/soiling:
1) Prolonged stool retention and rectal distension
2) Loss of rectal senstation
3) Decreased urge to defecate
4) Liquid stool proximally percolate downstream around hard stools
5) Faecal soiling
What are long term issues associated with constipation in paeds?
1) Decreased food intake
2) Vomiting
3) Urinary incontinence, UTI
4) Anal prolapse, fissures, haemorrhoids
5) Low self-esteem, depression
What type of pneumonia can present as abdo pain?
Lower lobe pneumonia
Define diarrhoea
Loose/watery and large frequent stools at least 3 times daily.
Define chronic diarrhoea
Duration >4 weeks
Secretory vs osmotic diarrhoea?
Secretory –> intestinal mucosa directly secretes fluids and electrolytes into the lumen. Eg. cholera, congenital diarrhoea.
Osmotic –> malabsorption of an ingested substance pulls water into the lumen. E.g. lactose intolerance, pancreatic insufficiency.
Possible investigations in diarrhoea?
1) Stool virology, MCS and ova/cysts/parasites
2) Faecal calprotectin
3) Bloods: U&Es, LFTs, TFTs, FBC, CRP, immunoglobulins, coeliac Abs
4) Faecal elastase
5) Faecal alpha 1 antitrypsin (protein losing enteropathy)
6) USS abdomen
7) Endoscopy & biopsies
What 2 serotypes are seen in coeliac disease?
HLA-DQ2
HLA-DQ8
Give some neuro features that may be seen in coeliac disease
1) Recurring headaches
2) Peripheral neuropathy
3) Epilepsy & seizures
4) Anxiety
5) Depression
6) Cerebellar ataxia
7) Chronic fatigue
Give some bone/joint features of coeliac
1) Arthralgia
2) Arthritis
3) Osteoporosis
4) Bone fractures
Give a key dermatological manifestation of coeliac
Dermatitis herpetiformis
Give 2 derm manifestations of IBD
1) erythema nodosum
2) pyoderma gangrenosum
Give 3 eye manifestations of IBD
1) uveitis
2) scleritis
3) episcleritis
Give 3 liver manifestations of IBD
1) fatty liver
2) PSC
3) gallstones
Give 3 joint manifestations of IBD
1) arthritis
2) sacro-ileitis
3) ankylosing spondylitis
