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Peadiatrics > Gi Disorders > Flashcards

Gi Disorders Flashcards

1
Q

What is posseting

A

Non forceful return of milk in small amounts often with return of swallowed air

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2
Q

Difference between Regurgitation and posseting

A

Regurge is larger more frequent losses.

All babies get posseting but Regurge indicates GORD

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3
Q

When to investigate vomiting

A

Prolonged, Bilous, systemically unwell or failing to thrive

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4
Q

Bile stained vomit ->

A

?intestinal obstruction

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5
Q

Blood stained vomit query

A

Oesophagitis, ulceration, oral/nasal bleeding, malrotation

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6
Q

Projectile vomiting in first few weeks of life query

A

Pyloric stenosis

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7
Q

Query If abdominal distension with vomiting

A

Lower intestinal obstruction (check for strangulated Inguinal hernia )

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8
Q

What factors contribute to GOR in infants

A

Immature lower oesophageal sphincter
Milk rather than solid food
Supine posture

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9
Q

How many infants with GOR have severe symptoms ? What are they ?

A

10%

Failure to thrive, oesophagitis, recurrent aspiration pneumonia

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10
Q

Who is GOR most serve in

A

Infants with chronic lung disorders (eg. Bronchopulmonary dysplasia), cerebral palsy & neurodevelopmental problems

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11
Q

Investigation for GOR

A 
24hr ambulatory oesophageal pH monitoring - gold standard in older children 
Barium studies (anatomical abnormalities) 
Endoscopy in suspected oesophagitis
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12
Q

Management of GOR

A

Reassurance most cases
Prokinetic drugs DOMPERIDONE - increase gastric emptying and decrease pressure on LOS
Decrease acid secretion - H2 antagonists /PPIs

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13
Q

Incidence of pyloric stenosis and cause ?

Who gets more ?

A

1-5/1000
Hyper trophy of pyloric smooth muscle
Males 5x
FHx common - especially maternal

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14
Q

Features of pyloric stenosis ? When do features not occur ?

A

Persistent, projectile non-bilious vomiting between 2 and 6 weeks old. Infant appears worried, hungry and eager to feed after vomit
Doesn’t occur in newborn or beyond 3/12

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15
Q

Signs of pyloric stenosis

A

Visible peristalsis and palpable pyloric mons during test feed

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16
Q

How is a diagnosis of pyloric stenosis made

A

USS abdomen - confirms diagnosis by showing hypertrophic pylorus
Classic electrolyte disturbance -> metabolic alkalosis (elevated serum HCO3-)

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17
Q

Management of pyloric stenosis

A

Medical - correction of fluid and electrolyte abnormalities

Surgical - pyloromyoectomy (romsteats procedure)

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18
Q

What is gastroenteritis and how does it present

A

Infection of GI tract (usually viral)

Diarrhoea and vomiting

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19
Q

Pathogens causing gastroenteritis ? Most common?

A

Rotavirus - most common
Bacteria - shigella, salmonella, campylobacter ssp., E. coli
Parasites - entamoeba histolytica, giardia lamblia, cyptosppridium ssp.

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20
Q

Features of viral gastroenteritis

A

Prodromal infection followed by d&v

Vomiting may precede D and is not usually bile / blood stained

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21
Q

What suggests a bacterial gastroenteritis

A

Abdominal pain and blood / mucus in the stool (invasive pathogen)

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22
Q

What do you need to differentiate gastroenteritis form ? What is assessed and how do you make a diagnosis?

A

Pyloric stenosis & intussuseption
Assess dehydration and measure U&E’s
Stool culture & microscopy , stool viral antigen detection

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23
Q

3 levels of dehydration

A

Mild
Moderate 5-10% weight loss
Severs >10% weight loss

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24
Q

Features of mild dehydration

A

Dry mucous membranes, fewer wet nappies

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25
Q

Signs of moderate dehydration

A

Sunken eyes and fontanelle, decreased skin turgor, deep respiration, rapid weak pulse, decreased /absent tears

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26
Q

Signs of severe dehydration

A

Low BP, drowsy, cool, cyanotic extremities, deep and rapid respiration, tachycardia, weak pulses, prolonged cap refil

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27
Q

When should oral rehydration be bypassed and straight to IV

A

Signs of circulatory failure

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28
Q

What’s given for oral rehydration ? How do they work

A

Solutions eg. Dioralyte, rehidrat

Contain dextrose to stimulate sodium and water reabsorbtion across bowel wall

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29
Q

What characterises infantile colic ? How often does this happen and at what age?

A

Recurrent inconsolable crying accompanied by drawing up of the legs.
Several times / day especially in evening
Begins at 2 weeks and resolves by 4/12

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30
Q

What are the differentials for infantile colic

A

Colic, otitis media, incarcerated hernia, uti, anal fissure, intussusception

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31
Q

What can sometimes cause infantile colic

A

GOR / cows milk protein intolerance

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32
Q

How to diagnose infantile colic

A

Rule out DDs

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33
Q

Management of infantile colic

A

No interventions proven effective

Benign condition with good prognosis

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34
Q

DDs for acute abdomen

A

Appendicitis, intussusception, merkels diverticulum, mesenteric adenitis, malrotation with volvulus

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35
Q

4 extra abdominal causes of acute abdomen

A

Lower lobe pneumonia - referred pain to abdo
Primary peritonitis - seen with ascities from nephrosis / liver disease
DKA - cause abdo pain
UTI (inc pyelonephritis)

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36
Q

Usual cause of appendicitis

A

When gets obstructed by faecolith or inflamed by lymphatic hyperplasia

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37
Q

Symptoms of appendicitis

A

Anorexia (decreased appetite), vomiting (usually only few times)
Abdominal pain - central and colicky -> localises to RIF

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38
Q

Signs of appendicitis

A

Mid - low grade fever - 37.2-38
Tachycardia
Persistent tenderness and guarding at RIF

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39
Q

DDs of appendicitis

A

Surgical - Intussusception, volvulus, strangulated hernia, ovarian torsion
Medical - mesenteric adenitis, gastroenteritis, uti, lower lobe pneumonia, DKA, sickle cell crisis

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40
Q

Management of appendicitis

A

Appendectomy

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41
Q

What is meckels diverticulum

A

Remnant of the fetal Vitello-intestinal duct

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42
Q

What is the rule of 2s with meckels diverticulum

A

2% of people, 2 inches long, 2 feet proximal to ileoceacal value

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43
Q

What’s contained in meckels diverticulum

A

Ectopic gastric mucosa or pancreatic tissue

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44
Q

Features of meckels diverticulum

A

Most asymtomatic

May present with severe PR bleeding which is neither bright red or true malaena

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45
Q

How may meckels present

A

Intussusception, volvulus around a bend or diverticulitis

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46
Q

Diagnosis of meckels

A

Technetium scan - will demonstrate increased uptake by gastric mucosa in -70%

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47
Q

Treatment of meckels

A

Surgical resection

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48
Q

What is intussusception

A

Invagination of proximal bowel into distal segment

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49
Q

Where does intussusception usual,y occur and at what age?

A

Just proximal to ileoceacal valve

6-9/12

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50
Q

What is the classic train of intussusception? What’s a late sign ?

A

1- paroxysmal, colicky abdominal pain
2- vomiting - may be bile stained
3- sausage shaped abdo mass (usually in R upper quadrant)

Red currant jelly stools

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51
Q

Diagnosis of intussusception

A

AXR- distended small bowel and absence of gas in distal colon
Uss - target sign (donut sign)

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52
Q

Management of intussusception

A

Reduction by AIR ENEMA

53
Q

When is an air enema contraindicated

A

Long Hx 24-48hrs or if there are signs of intestinal obstruction, peritonitis or shock

54
Q

What happens if air enema is unsuccessful

A

Operative reduction

55
Q

What is mesenteric adenitis

A

Non specific inflammation of mesenteric lymph nodes - thought to provide a peritoneal reaction that causes abdo pain (may mimic appendicitis )

56
Q

Features of mesenteric adenitis

A

Less severe pain than appendicitis and tenderness in RIF is variable
Often accompanied by URTI and cervical lymphadenopathy
May have systemic - fever, headache, pharyngitis

57
Q

Management of mesenteric adenitis

A

Non specific abdo pain is a worry - may require hospital observation
Persisting RIF tenderness warrants surgical exploration to identify appendicitis

58
Q

What predisposes to volvulus and why

A

Small bowel mesentery not fixed at duodenal-jejunal flexure / ileoceacal region then its base is shorter than normal

59
Q

What is the commonest form of malrotation

A

When caecum remains high and fixed to posterior abdominal wall - Ladd’s bands may cross the duodenum contributing to obstruction

60
Q

Features of malrotation

A

Obstruction

Obstruction with compromised blood supply

61
Q

What happens if obstruction causes an obstructed blood supply

A

Bowel infarction -> may be blood in gastric aspirates or in stool

62
Q

What may happen in first 1-3 days of life that could indicate volvulus and what should be done ?

A

Dark green Bilous vomiting

Urgent upper GI contrast study

63
Q

Management of malrotation / volvulus

A

Surgical correction

64
Q

Food intolerance more common in who

A

Strong FHx of atopy of IgA deficiency

65
Q

How does food intolerance present

A

Protracted diarrhoea (+/- vomiting) and failure to thrive

66
Q

Eg of some food intolerances

A

Cows milk, soya, wheat, fish, egg, chicken, rice, nuts

67
Q

How to diagnose food intolerance

A

Removal of food -> cures

Bring back -> brings on Sx

68
Q

What can cows milk protein intolerance cause

A

Protein losing enteropathy and blood loss

69
Q

How is cows milk protein intolerance managed

A

Casein-hydosylate based formula as 30% also will have / develop soya intolerance

70
Q

What is a common cause of lactose intolerance

A

Lactase deficiency

71
Q

Cause of lactase deficiency

A

Post gastroenteritis , or primary in afro Caribbean / oriental

72
Q

Why does lactase deficiency cause lactose intolerance

A

Leads to sugar accumulation in bower -> watery diarrhoea

Bacterial acid production lowers stool pH -> excoriation (sore / red) perianal region

73
Q

What part of gluten causes immunological response in coeliac

A

Gliardin

74
Q

What changes occur in coeliac

A

Atrophy of villi and crypt hyperplasia -> reduced absorption surface

75
Q

Genetic association for coeliac

A

HLA DQ2

76
Q

Most common features of coeliac

A

Anaemia (iron or folate), diarrhoea, ataxia, irritability, growth failure

77
Q

How do some children with coeliac present when weaning

A

Failure to thrive (rare and Steatorrhoea occurs first)

78
Q

Examination findings for coeliac

A

Poor weight gain, abdominal distension, buttock wasting

79
Q

Most common cause of loose stools in preschool children

A

Toddler diarrhoea (chronic non specific diarrhoea)

80
Q

Features of toddler diarrhoea

A

Variable consistency and common presence of undigested vegetables ( peas and carrots diarrhoea)

81
Q

What is important in toddler diarrhoea

A

Child is well and thriving

There is no precipitating dietary factors

82
Q

Prognosis of toddler diarrhoea

A

Outgrow by 5 years

May have delay in feacal continence

83
Q

Screening test for coeliac

A

Specific IgA antigliardin or antiendomysial antibodies

84
Q

Diagnosis of coeliac

A

Jejunal biopsy (flat) followed by improvement on gluten being removed from diet

85
Q

Management of coeliac

A

Life long gluten free

Identification of other autoimmune associated

86
Q

What autoimmune conditions are associated with coeliac

A

Thyroid

Pernicious anaemia

87
Q

What has increased risk with coeliac

A

Small bowel malignancy (especially Lymphoma (t cell))

88
Q

Is crohns transmural or mucous membrane

A

Transmural

89
Q

Most commonly affected place in crohns

A

Distal ileum and Colin

90
Q

Histology all hallmark of crohns

A

Non caseating epitheloid cell granulomata

91
Q

Features of crohns (most common) ?

Less common?

A

Abdo pain, diarrhoea and growth failure.

Oral / perianal ulcers

92
Q

Extra intestinal Sx of crohns

A

Growth failure, intermittent fever, arthritis, uveitis, erythema nodosum

93
Q

Diagnosis of crohns

A

Characteristic changes in barium follow through, colonoscopy and histology (narrowing, fissuring, mucosal irregularities, Mural thickening)

94
Q

Crohns acute treatment

A

Steroids

Elemental diet for 6/52

95
Q

Preventing relapse crohns

A

Azathiopine

Anti-TNFa (infliximab) as 3rd line

96
Q

What complications in crohns require surgery

A

Fistulae, obstruction, medical treatment failure

97
Q

What layers are affected in UC

A

Mucus membrane

98
Q

Features of UC

A

Rectal bleeding, diarrhoea, colicky pain, weight loss

99
Q

Diagnosis of UC

A

Endoscopy - continuous mucosal ulceration

Histology

100
Q

Extra intestinal features of UC

A

Erythema nodosum, arthritis, spondylitis, pyoderma gangrenosum

101
Q

Management of mild UC attacks

A

Steroids

102
Q

Extensive UC management

A

Sulfasalazine

103
Q

Management of severe fulminating disease in UC

A

Medical emergency - Brad spec Abx, IV fluids & steroids

104
Q

Outcome of UC in 1/3

A

Colectomy

105
Q

Complications of UC

A

Increased incidence of adenocarcinoma

106
Q

Other name for Hirschsprung’s disease

A

Congential aganglionic mega colon

107
Q

What is Hirschsprung’s

A

Absence of myenteric and submucosal plexuses ganglion cells for a variable segment of bowel extending from the anus to colon

108
Q

What is aganglionic segment of Hirschsprung’s like

A

Narrow and contracted

Ending proximally in normal segment of dilated and normally inervated colon

109
Q

Features of Hirschsprung’s in infants

A

Present in neonatal period with meconium ileus and subsequent Bilous vomiting and abdominal distension due to intestinal obstruction

110
Q

Features of Hirschsprung’s in older children

A

Chronic severe constipation present form birth

Abdominal distension & absence of feaces in narrow rectum

111
Q

Severe life threatening complication of Hirschsprung’s

A

Hirschsprung’s enterocolitis

112
Q

Diagnosis of Hirschsprung’s

A

Barium enema - transition zone where bowel lumen narrows

Definitive (absence of ganglion cells on suction rectal biopsy)

113
Q

Management of Hirschsprung’s

A

Surgical resection of affected area -> colostomy -> anastomosis of normal bowel to anus

114
Q

2 causes of bile duct obstruction in peads

A

Biliary atresia

Choledochal cyst

115
Q

What is biliary atresia and how does it present

A

Destruction / absence of extrahepatic biliary tree

Persistent neonatal jaundice

116
Q

What type of jaundice in biliary atresia and other feature of jaundice

A

Predominantly conjugated bilirubin

Pale stools, dark urine

117
Q

Other features of biliary atresia

A

Failure to thrive due to malabsorbtion & hepatosplenomegaly
Bleeding disorder due to vit k deficiency

118
Q

Diagnosis of biliary atresia

A

Abdominal uss, liver biopsy, intraoperative cholangiography can all be used to confirm

119
Q

Management of biliary atresia

A 
Kasai procedure (hepatoportoenterostomy) before 6/52
Liver transplant if unsuccessful
120
Q

What is a choledochal cyst

A

Cystic dilation of extrahepatic biliary system

121
Q

Common presentation of choledochal cysts

A

Infancy with cholestasis

122
Q

Diagnosis of choledochal cysts

A

Uss / radionuclide scan

123
Q

Treatment of choledochal cyst

A

Surgical excision of cyst and formation of roux-en-Y anastomosis to the biliary duct

124
Q

Complications of choledochal cyst

A

2% risk of malignancy (in any part of the biliary tree)

125
Q

What is not a feature of functional constipation

A

Pain

126
Q

How does functional constipation present

A

Infrequency of stools, difficulty in bowel movements, and stool retention

127
Q

Treatment for functional constipation

A

Look for psychological factors (bullying, family stress, uncomfortable school toilets)
Stool softeners - lactulose / docusate
Stimulant laxatives - sodium picosulphate, Senna

128
Q

What is the functional constipation viscous cycle

A

Withholding -> megarectum -> worsened constipation with over flow diarrhoea

Peadiatrics (14 decks)

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