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GI Paeds Flashcards

1
Q

Is constipation common?

A

Yes

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2
Q

What is constipation?

A

Infrequent passing of stool

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3
Q

What should be asked about constipation?

A

How often
How hard
Painful?
Change in habit?

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4
Q

What are other signs or symptoms of constipation?

A 
Poor apetite
Irritable
Lack of energy
Abdominal pain or distension
Withholding or straining
Diarrhoea
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5
Q

Why can children get constipated?

A

Poor diet - insufficient fluids or excessive milk
Stress about potty training or school toilet
Physical - intercurrent
illness/medication
Family history
Psychological - secondary constipation
Organic - anorectal malformation, hypothyroid

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6
Q

What is the vicious cycle of constipation?

A

Withholding of stool leads to constipation, which leads to large hard stool, which leads to pain or anal fissure, which leads to withholding of stool

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7
Q

What dietary changes can help with constipation?

A

Increased fibre
Increased fruit and veg
Increased fluids
Decreased milk

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8
Q

What is the most important social factor of management?

A

Explain treatment to patients

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9
Q

What are psychological factors in treatment of constipation?

A

Reduce aversive factors - make toilet a pleasant experience - correct height, not cold, fuck school toilets
Soften stool and remove pain
Avoid punitive behaviour from parents
Reward good behaviour - general praise and and star charts

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10
Q

What can be done to soften stool and stimulate defecation?

A

Osmotic laxatives
Stimulant laxatives
Isotonic laxatives

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11
Q

What is an example of an osmotic laxative?

A

Lactulose
Movicol
Laxido

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12
Q

What are examples of stimulant laxatives?

A

Senna

Picolax

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13
Q

What do stimulant laxatives do?

A

Aggravate/irritate the desensitised colon

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14
Q

What are presenting features of Crohn’s in children?

A 
May have diarrhoea
May have rectal bleeding
Abdominal pain is common
Fever is uncommon
Weight loss very common
Growth failure very common
May lead to arthritis
May have a mass
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15
Q

Is it common for children with ulcerative colitis to have a pancolitis?

A

Yes

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16
Q

What is the most common crohn’s presentation?

A

Panenteric disease

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17
Q

What are common features of UC in children?

A

Diarrhoea and rectal bleeding extremely common
May have abdominal pain
Weight loss and growth failure unlikely
May develop arthritis

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18
Q

What determines Crohn’s symptoms?

A

Location of disease

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19
Q

What are you looking for in history and examination of children with IBD?

A 
Intestinal symptoms
Extra-intestinal manifestations ie arthritis, uveitis, erythema nodosum
Exclude infection
Family history
Growth and sexual development
Nutritional status
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20
Q

What lab investigations should be done for IBD?

A

FBC and ESR
Biochemistry
Microbiology

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21
Q

What biochemistry tests should be done for IBD?

A

Stool calprotectin
Raised CRP
Low albumin

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22
Q

What should be assessed in FBC?

A

Anaemia
Thrombocytosis
Raised ESR

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23
Q

What are definitive investiagyions for IBD?

A 
Radiology - MRI, barium meal
Colonoscopy
Upper GI endoscopy
Enteroscopy
Capsule endoscopy
Mucosal biopsy gold standard
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24
Q

What medications can be used for IBD?

A

Anti-inflammatory medicines
Immuno-suppressive
Biologicals (infliximab)

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25
What are the 3 broad treatment groups for IBD?
Medical Nutritional Surgical
26
What is fecal impaction?
Stool accumulates in the rectum to the point that the body can't remove it
27
How is fetal impaction generally treated?
Empty impacted rectum Empty colon Maintain regular stool passage Slow weaning off treatment
28
How is fetal impaction generally treated?
Empty impacted rectum Empty colon Maintain regular stool passage Slow weaning off treatment
29
What do the different types of stool from the bristol stool chart indicate?
``` Type I - Very constipated Type II - Slightly constipated Type III+IV - Normal Type V - Lacking fibre Type VI+VII - Inflammation ```
30
What are the different types of child vomiting?
Vomiting with retching Projectile vomiting Bilious vomiting Effortless vomiting
31
What are features of pre-ejection phase in vomiting with retching?
Pallor Nausea Tachycardia
32
What are features of post-ejection phase of vomiting with retching?
Weakness Shivering Lethargy
33
What can cause stimulation of vomiting centre?
``` Enteric pathogens Intestinal inflammation Metabolic derangement Infection Head injury Visual stimuli Middle ear stimuli ```
34
What are features of pyloric stenosis on test feed?
Palpation of olive tumour Visible gastric peristalsis Projectile NON BILIOUS vomiting
35
What are blood gas features ofpyloric stenosis?
Raised pH - metabolic alkalosis due to vomiting stomach acid Hypochloraemia Hypokalaemia
36
What is medical management for pyloric stenosis?
Fluid resuscitation - correct electrolyte imbalance and alkalosis Refer to surgeons
37
What surgical procedure is done for pyloric stenosis?
Ramstedts pyloromyotomy
38
What colour is bilious vomit?
Green
39
What causes bilious vomiting?
Intestinal obstruction - green vomit is obstruction until proven otherwise
40
What conditions cause bilious vomiting?
``` Intestinal atresia in newborn babies Malrotation Intussusception Ileus Crohn's disease with strictures ```
41
What investigations are done into bilious vomit?
Abdo X-ray Contrast meal Exploratory laparotomy
42
What causes effortless vomiting?
Gastro-oesophageal reflux
43
Is gasto-oesophageal reflux self limiting?
Normally yes - resolves spontaneously
44
When is reflux not self limiting?
Cerebral palsy Progressive neurological problems Oesophageal atresia Generalised GI motility problem
45
What are presenting symptoms of reflux?
``` Vomiting Haematemasis Feeding problems Failure to thrive Resp - Apnoea, cough, wheeze, chest infections ```
46
How is reflux assessed?
``` History and examination Radiology - video fluoroscopy, barium swallow pH study Oesophageal imedance monitoring Endoscopy ```
47
What are aims for barium swallow?
``` Identify: Dysmotility Hiatus hernia Reflux Gastric emptying Strictures ```
48
How is a pH meter used?
pH catheter inserted into oesophagus with sensor to detect pH
49
How is reflux generally managed?
Feeding advice Nutritional support Medical treatment Surgery
50
What is involved in feeding advice for reflux?
Thickeners for liquids Appropriateness of foods - texture and amount Behavioural programme - oral stimulation and removal of aversive stimuli Feeding position
51
What is involved in nutritional support for reflux?
Calorie supplements Exclusion diet - milk free (may have cow's milk allergy) Nasogastric tube Gastrostomy
52
What is involved in medical treatment of reflux?
Feed thickener - gaviscon, thick and easy Prokinetic drugs Acid supressing drugs - H2 receptor blockers, PPIs
53
What are indications for surgery in reflux?
Failure of medical treatment - persistet failure to thrive, aspiration, and oesophagitis
54
What surgery is done for reflux?
Nissen funcoplication
55
What are complications of nissen fundoplication?
Dumping syndrome Bloating Retching More problematic with neuro pathology
56
How is chronic diarrhoea defined?
4 or more stools per day for more than 4 weeks
57
What is diarrhoea lasting less than one week?
Acute diarrheoa
58
What is diarrhoea that lasts 2-4 weeks?
Persistent diarrhoea
59
What are the 3 main causes of diarrhoea?
Motility disturbance Active secretion - secretory diarrhoea Malabsorption of nutrients - osmotic diarrhoea
60
What types of diarrhoea are caused by motility disturbance?
Toddler diarrhoea | Irritable bowel syndrome
61
What types of diarrhoea are caused by active secretion?
Acute infective diarrhoea | IBD
62
What types of diarrhoea are caused by osmotic diarrhoea?
Food allergy Coeliac disease CF
63
What is the most common cause of secretory diarrhoea?
Cholera
64
What is used to treat secretory diarrhoea?
Oral rehydration therapy
65
What causes osmotic diarrhoea?
Food that is not absorbed remains in lumen and pulls water out of cells into lumen through osmosis
66
What should be asked about in history of chronic diarrhoea?
Age at onset Abrupt or gradual onset Family history Nocturnal defecation 0 organic pathology
67
What should be done in faecal analysis in chronic diarrhoea?
Appearance Stool culture Determination of secretory vs osmotic Stop feed to determine osmotic or secretory - will stop if osmotic
68
What are differences in lab results between osmotic and secretory diarrhoea?
Osmotic has lower volume Osmotic stops in response to feeding Osmotic has high stool osmolality
69
What can cause fat malabsorption?
Pancreatic disease - lack of lipase, classically CF | Hepatobiliary disease - cholestasis
70
What is coeliac disease?
Gluten sensitive enteropathy
71
What are features of coeliac disease?
``` Abdominal bloatedness Diarrhoea Failure to thrive Short stature Constipation Tiredness Dermatitis herpatiformis ```
72
What are screening tests for coeliac disease?
``` Serum Anti-tissue transglutaminase Serum Anti endomysial Serum IgA Duodenal biopsy - gold standard Genetic testing ```
73
How is coeliac disease treated?
Gluten-free diet for life Gluten must not be removed prior to diagnosis as serological and histological features will resolve In very young <2yrs, re-challenge and re-biopsy may be warranted Increased risk of rare small bowel lymphoma if untreated
74
When can coeliac be treated without biopsy?
Symptomatic Anti tissue transglutaminase >10 times upper limit Positive anti endomysial antibodies Positive in genetic testing
75
What are complications of untreated coeliac disease?
Growth failure Osteoperosis Small bowel lymphomas

Paediatrics (25 decks)

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