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Paeds > GI (paeds) > Flashcards

GI (paeds) Flashcards

1
Q 
CMPI 
Aetiology 
Presentation 
Investigations 
Management
A

aetiology
can be fam Hx - but rememeber 50% will have grown out of it by 5 - so reassurance is a big key part of consultation

IgE or non IgE mediated 
IgE mediated 
GI symptoms - bloating/ diarrhoea 
\+ 
Uticaria, lip oedema, rash, wheeze, cough, etc 
FTT 
Abdo pain

Investigations
Mainly clinical - just eliminate cow’s milk/ can do milk challenge in hospital
IgE skin prick test etc if u really can be arsed
IgE RAST

Management 
Breastfeeding - mother avoid cows milk 
Bottlefed - 
eHF - extensive Hydrolysed feed 
AAF - Amino acid based feed
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2
Q 
Lactose intolerance 
Aetiology 
Presentation 
Investigations 
Management
A 
Aetiology 
Can be post viral infection eg GI 
More common in afrocaribbean
Presentation 
Green frothy stools 
Abdominal pain 
FTT etc

Investigations

  • Clinical
  • Can do hydrogen breath test if you really can be arsed
  • Stool chromatography

Management
- Avoid lactose

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3
Q

Toddler’s diarrhoea

A

Undigested food in stool
Resolves after 5
Make sure they have enough fat in their diet
Watch their weight centile

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4
Q

Undigested food in stool =

A

toddler’s diarrhoea

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5
Q

Meckel diverticulum

A 
Rule of 2s 
2% 
2 inches 
2 feet 
2 year olds

investigations
technetium scan

Presentation
Rectal bleed
Diarrhoea
Can –> intusussception

If asymptomatic leave
If symptomatic - surgery

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6
Q

GORD

Aetiology 
Presentation 
Investigations 
Management 
Complications
A

<8 weeks old

Aetiology 
Cerebral palsy 
Premature 
fluid feeds 
horizontal feeding 
Presentation 
Posseting after feeds 
FTT 
Wheeze 
Cough

Investigations
Clinical is main
24hr pH if severe/ unsure

Management
Thicken feeds 
Feed upright 
Rx cause 
Alginate therapy 
PPI

Complications
FTT
Oesophagitis
Aspiration pneumonia

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7
Q

Malrotation

A

failure of the midgut to rotate

Bilious vomiting in 1st week of life = malrotation until proven otherwise

Aetiology
- associated with CDH

Presentation 
Bilious vomiting 
scaphoid abdomen in CDH 
Bloating 
peritonitis etc

Investigations
Upper GI contrast study

Management
NBM etc
LADD procedure - rotate anticlockwise

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8
Q 
Hischprung's 
Aetiology 
Presentation 
Investigations 
Management
A

Hischprung’s is the absence of ganglionic cells in the myenteric plexus
Associated with downs (+ boys)

FAILURE TO PASS MECONIUM IN FIRST 48HRS –> HISCHPRUNG’S

Presentation

  • Failure to pass meconium
  • Severe bloating
  • PR exam –> release –> explosive release of gas and stools

Investigations
Suction rectal biopsy

Management
- Surgical resection

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9
Q 
Intussusception 
Aetiology 
Presentation 
Investigations 
Management 
Complications
A

Aetiology
Meckel’s/ infection
There is telescoping of the bowel, most commonly at the ICV

Presentation 
Red current jelly stool 
Bilious vomiting 
Pale/ screaming 
Drawing of knees to chest 
Sausage mass - RLQ

Investigations
USS - target sign

Management 
NBM 
Fluids 
Rectal air insufflation 
Laparotomy if peritonitis 
Complications 
Peritonitis 
Necrosis 
Perforation 
Shock
Obstruction
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10
Q 
Pyloric stenosis 
Aetiology 
Presentation 
Investigations 
Management 
Complications
A

2-8 weeks
Male
First born
Fam Hx

Hypertrophy of the circular muscle in the pylorus of the stomach –> delayed/ decreased gastric emptying

Presentation
Projectile vomit
- After feeds
- NON bile stained

Constipation 
FTT 
Olive shaped mass - RUQ 
Visible peristalsis 
Hypokalaemiam hypocholraemic, hyponatremic alkalosis

Investigations
USS - delayed gastric emptying
AXR - String sign, double track sign, beak sign

Management 
Fluids - 0.9% saline 5% dex 
NBM 
KCl - 20mmol
Atropine 
Ramstedt pyloromyotomy
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11
Q 
Coeliac disease 
Aetiology 
Presentation 
Investigations 
Management 
Complications
A 
Aetiology/ associations 
T1DM 
Thyroid 
Downs 
Fam H 
Presentation 
GI 
Pale floating stools, abdo distension and pain 
Skin - dermaitits herpetiformis 
Malabsorption 
- anaemia symptoms 
- buttock wasting 
- dental problems 
Investigations 
Bloods 
- Anti TTG 
- Anti endomysial 
- Anti alpha gliadin antibodies 
Biopsy - jejunum 
- Villous atrophy and crypt hyperplasia 
- Increased intraepithelial lymphocytes 
- Lymphocytic infiltration of the lamina propria

Management
Avoid gluten
flu jab - hyposplenism

Complications 
Sub-fertility 
FTT 
osteoporosis 
Dental problems
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12
Q

Constipation
Red flags
Management
Complications

A

Remember usually just low fibre diet/ psychological

Red flags
Failure to pass meconium in 48hrs –> hischprungs
Gross distension –> hischprungs
Bilious vomiting (first week) - malrotation
anal fissure + incontinence –> sexual abuse
Anal fistula etc - crohn’s
FND/ hair - spina bifida

Management 
Palpable faeces on abdo examination? - no --> reassure and monitor - psych support 
Yes --> 
Macrogol - movicol (try for 2 weeks) 
Stimulant - senna 
Osmotic - lactulose 
Enema/ manual evacuation

FTT etc/ malabsorption
OVERFLOW INCONTINENCE

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13
Q 
Crohn's 
Aetiology 
Presentation 
investigations 
Management 
Complications
A

Aetiology - genetic component (smoking –> worsens)

associated with primary sclerosing cholangitis

Presentation 
GI 
- tenesmus 
- diarrhoea 
- blood and mucus 
MSK 
- arthralgia
EYE 
- ant uv. episleritis 
SKIN 
- polyderma gangrenosum 
- erythema nodosum 
MALNUTRITION 
- anaemia, hypocalcaemia, osteoporosis 
Investigations 
Bloods 
- faecal calprotecin ^ 
- malabsorption - low Ca, anaemia etc 
Biopsy 
- Non caseating granuloma 
- Goblet cells 
- Skip lesions 
- Transmural lesions

Small bowel enema

  • Rose thorn ulcers
  • String sign
  • fistulae

management

  • Pred
  • 5 ASA - mesalazine
  • Methotrexate
  • Azathioprine
  • Infliximab

Complications
Anaemia
osteoporosis
increased risk of colon cancer

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14
Q

Crohn’s investigations

A

1) Bloods
^ faecal calprotectin
anaemia, hypoCa etc

2) Biopsy 
Non- caseating granuloma 
Goblet cells 
Skip lesions 
Transmural lesions

3) Small bowel enema
Rose thorn patterns
String sign
Fistulae

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15
Q

Duodenal atresia

A

Assocaited with downs

Bilious vomiting hours after birth

AXR - double bubble sign

Rx - surgery

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16
Q

Biliary atresia

A

absence or destruction of the extrahepatic biliary tree or intrahepatic bile ducts

Presentation 
jaundice >14 days 
hepatomeg, splenomeg 
pale stools dark urine 
FTT

management - kasai procedure

17
Q

FTT causes

A

Inadequate intake
Impaired swallowing – cerebral palsy/ GORD/ cleft palate
Child abuse/ neglect
Low socioeconomic status

Inadequate absorption
Toddler diarrhoea/ Gastroenteritis/ IBS/ IBD/ Coeliac/ lactose intolerance/ CMPI/ biliary atresia/ CF/ NEC

Increased calorie use
Diabetes/ hyperthyroid/ chronic disease/ Downs

Genetic

Haem – thalassaemia

Cardiac – congenital cardiac lesions

18
Q

Hiscprung’s association

A

Down’s

19
Q

Investigations pyloric stenosis

A

USS - delayed gastric emptying

XR
double track
String
Beak

Paeds (14 decks)

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