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Yr 4 - Paediatrics > GI Corrections > Flashcards

GI Corrections Flashcards

1
Q

What are some causes of bilious vomiting in neonates? (5)

A

1) Necrotising enterocolitis

2) Meconium ileus

3) Jejunal/ileal atresia

4) Malrotation with volvulus

5) Duodenal atresia

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2
Q

What is bilious vomiting in within 24 hours of birth most commonly caused by?

A

Intestinal atresia –> duodenal, jejunal or ileal atresia.

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3
Q

What is bilious vomiting classically caused by?

A

Obstruction beyond the sphincter of Oddi (where the common bile duct enters the duodenum).

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4
Q

When does NEC typically present?

A

Usually 2nd week of life

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5
Q

When does meconium ileus typicallly present?

A

First 24-48 hours of life

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6
Q

when does intestinal atresia usually present?

A

Within first 24 hours of life

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7
Q

When does malrotation with volvulus typically present?

A

3-7 days after birth

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8
Q

What is a key risk factor for duodenal atresia?

A

Down syndrome

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9
Q

What is seen on an AXR in duodenal atresia?

A

‘Double bubble’ sign

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10
Q

What is the diagnostic investigation for necrotising enterocolitis?

A

AXR

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11
Q

Is hypoglycaemia common in the neonatal period?

A

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.

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12
Q

Define typical blood glucose level for neonatal hypoglycaemia

A

<2.6 mmol/L

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13
Q

What are some causes of persistent/severe hypoglycaemia in neonates?

A

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

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14
Q

Features of neonatal hypoglycaemia?

A

1) asymptomatic

2) autonomic:
- poor feeding/sucking
- weak cry
- drowsy
- hypotonia
- seizures

3) other:
- apnoea
- hypothermia

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15
Q

What does management of neonatal hypoglycaemia depend on?

A

a) the severity of the hypoglycaemia

b) if the newborn is symptomatic

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16
Q

In neonatal hypoglycaemia, what is the management if the newborn is asymptomatic?

A

1) encourage normal feeding (breast or bottle)

2) monitor blood glucose

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17
Q

In neonatal hypoglycaemia, what is the management if the newborn is symptomatic (or the blood glucose is very low)?

A

1) admit to the neonatal unit

2) IV infusion of 10% dextrose

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18
Q

Pneumatosis intestinalis (intramural gas) is a hallmark feature of what condition in neonates?

A

NEC

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19
Q

What is the use of maternal labetalol a risk factor for in neonates?

A

Foetal hypoglycaemia

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20
Q

What is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?

A

Meckel’s diverticulum

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21
Q

What are some causes of neonatal hypotonia?

A

1) Neonatal sepsis

2) Werdnig-Hoffman disease (spinal muscular atrophy type 1)

3) Hypothyroidism

4) Prader-Willi

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22
Q

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?

A

CMV

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23
Q

XR fluid levels in Hirschsprung’s disease vs meconium ileus?

A

Hirschsprung’s –> dilated loops of bowel with fluid levels .

Meconium ileus –> distended coils of bowel but no fluid levels (as the meconium is viscid).

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24
Q

what is the usual clinical presentation of Hirschsprung’s?

A

Delayed passage of meconium + distension of abdomen.

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25
Q

If a formula-fed baby is suspected of having mild-moderate cow’s milk protein intolerance, what is the 1st management step?

A

An extensive hydrolysed formula should be tried.

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26
Q

In an infant with bilious vomiting & obstruction, what is the likely condition?

A

Intesinal malrotation (can then progress to a volvulus).

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27
Q

What condition is Hirschprung’s disease associated with?

A

Down’s syndrome

3x more common in males

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28
Q

1st line management of Hirschsprung’s?

A

rectal washouts/bowel irrigation

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29
Q

How does malrotation typically present?

A

Bilious vomiting in neonates in first 30 days of life.

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30
Q

Why can CF cause foul smelling stools?

A

As CF can give rise to pancreatic insufficiency and consequently steatorrhoea caused by GI malabsorption of fats.

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31
Q

Which vaccine do people with coeliac disease receive every 5 yeas?

A

Pneumoccal vaccine due to hyposplenism.

This protects against infections caused by encapsulated organisms like Streptococcus pneumoniae.

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32
Q

What can precipitate a G6PD deficiency crisis?

A

1) Infections e.g. LRTI

2) Drugs e.g. ciprofloxacin, primaquine, sulphonamides, sulphasalazine, sulfonylureas

3) Fava (broad) beans

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33
Q

What is seen on a blood film in G6PD deficiency?

A

Heinz bodies

34
Q

What is the key investigation in pyloric stenosis?

A

US

35
Q

What is incubation period for Giardiasis?

A

ranges from 1 to 2 weeks, but it can extend up to 6 weeks in some cases

36
Q

What are some causes of chronic diarrhoea in children? (4)

A

1) cows’ milk intolerance (most common cause in developed world)

2) toddler diarrhoea

3) coeliac disease

4) post-gastroenteritis lactose intolerance

37
Q

When does intussusception typically present?

A

3-12 months

38
Q

When does Hirschsprung’s typically present?

A

24-48h

39
Q

What is kolionychia? What condition is it seen in?

A

Spooning of the nails.

Iron deficiency anaemia.

40
Q

Is conjugated or unconjugated bilirubin raised in biliary atresia?

A

Conjugated

41
Q

Risk factors for testicular cancer?

A

1) infertility

2) cryptochidism

3) FH

4) Klinefelter’s syndrome

5) mumps orchitis

42
Q

What is the gold standard investigation to confirm a diagonsis of coeliac disease?

A

Small bowel biopsy

43
Q

Incubation period of:
- Staphylococcus aureus
- Bacillus cereus
- Salmonella
- E. coli
- Shigella
- Campylobacter
- Giardiasis
- Amoebiasis

A

1-6 hrs: Staphylococcus aureus, Bacillus cereus

12-48 hrs: Salmonella, Escherichia coli

48-72 hrs: Shigella, Campylobacter

> 7 days: Giardiasis, Amoebiasis

44
Q

Wbat is the most appropriate treatment for sigmoid volvulus?

A

Urgent larapotomy

45
Q

What is the diagnostic investigatoin for NEC?

A

AXR

46
Q

What is Zollinger Ellison syndrome?

A

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.

47
Q

Features of Zollinger Ellison?

A
  • multiple gastroduodenal ulcers: epigastric pain
  • diarrhoea
  • malabsorption
48
Q

What condition is Zollinger Ellison often associated with?

A

MEN type 1

49
Q

What makes up MEN-1?

A
  • parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
  • pituitary (70%)
  • pancreas (50%, e.g. Insulinoma, gastrinoma)
  • also: adrenal and thyroid
50
Q

Are direct or indirect inguinal hernias more likely to become strangulated?

A

Indirect

50
Q

What is the annual probability of strangulation of an inguinal hernia?

A

3%

51
Q

What are the 2 types of abdominal wall hernias in children?

A

1) Congenital inguinal hernia

2) Infantile umbilical hernia

52
Q

Mx of a congenital inguinal hernia?

A

Should be surgically repaired soon after diagnosis as at risk of incarceration.

URGENT referral for surgery.

53
Q

Who are congenital inguinal hernias more common in? (2)

A

Premature babies & boys

54
Q

Who are infantile umbilical hernias more common in? (2)

A

Premature babies & Afro-Caribbean babies

55
Q

Mx of infantile umbilical hernias?

A

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.

56
Q

What is the most common ocular malignancy found in children?

A

Retinoblastoma

57
Q

What is the average age of diagnosis of a retinoblastoma?

A

18 months

58
Q

What is the most common presenting symptom of a retinoblastoma?

A

Absence of red-reflex, replaced by a white pupil (leukocoria).

59
Q

Mx of bilateral vs unilateral inguinal hernias?

A

Bilateral –> laparoscopic mesh repair

Unilateral –> open mesh repair

60
Q

Why do femoral hernias need to be repaired, regardless of whether they are symptomatic or not?

A

Due to the risk of strangulation

61
Q

What is the diagnostic criteria for functional constipation?

A

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.

62
Q

What is functional constipation caused by?

A

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

63
Q

What are some contributing factors to functional constipation?

A

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

64
Q

Pathophysiology of encopresis/soiling:

A

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

65
Q

What are long term issues associated with constipation in paeds?

A

1) Decreased food intake

2) Vomiting

3) Urinary incontinence, UTI

4) Anal prolapse, fissures, haemorrhoids

5) Low self-esteem, depression

66
Q

What type of pneumonia can present as abdo pain?

A

Lower lobe pneumonia

67
Q

Define diarrhoea

A

Loose/watery and large frequent stools at least 3 times daily.

68
Q

Define chronic diarrhoea

A

Duration >4 weeks

69
Q

Secretory vs osmotic diarrhoea?

A

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.

70
Q

Possible investigations in diarrhoea?

A

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

71
Q

What 2 serotypes are seen in coeliac disease?

A

HLA-DQ2

HLA-DQ8

72
Q

Give some neuro features that may be seen in coeliac disease

A

1) Recurring headaches

2) Peripheral neuropathy

3) Epilepsy & seizures

4) Anxiety

5) Depression

6) Cerebellar ataxia

7) Chronic fatigue

73
Q

Give some bone/joint features of coeliac

A

1) Arthralgia

2) Arthritis

3) Osteoporosis

4) Bone fractures

74
Q

Give a key dermatological manifestation of coeliac

A

Dermatitis herpetiformis

75
Q

Give 2 derm manifestations of IBD

A

1) erythema nodosum
2) pyoderma gangrenosum

76
Q

Give 3 eye manifestations of IBD

A

1) uveitis
2) scleritis
3) episcleritis

77
Q

Give 3 liver manifestations of IBD

A

1) fatty liver

2) PSC

3) gallstones

78
Q

Give 3 joint manifestations of IBD

A

1) arthritis

2) sacro-ileitis

3) ankylosing spondylitis

79
Q
A

Yr 4 - Paediatrics (78 decks)

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