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Paediatrics > GI Paeds > Flashcards

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
Q

What are the 3 broad treatment groups for IBD?

A

Medical
Nutritional
Surgical

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26
Q

What is fecal impaction?

A

Stool accumulates in the rectum to the point that the body can’t remove it

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27
Q

How is fetal impaction generally treated?

A

Empty impacted rectum
Empty colon
Maintain regular stool passage
Slow weaning off treatment

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28
Q

How is fetal impaction generally treated?

A

Empty impacted rectum
Empty colon
Maintain regular stool passage
Slow weaning off treatment

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29
Q

What do the different types of stool from the bristol stool chart indicate?

A 
Type I - Very constipated
Type II - Slightly constipated
Type III+IV - Normal
Type V - Lacking fibre
Type VI+VII - Inflammation
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30
Q

What are the different types of child vomiting?

A

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting

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31
Q

What are features of pre-ejection phase in vomiting with retching?

A

Pallor
Nausea
Tachycardia

32
Q

What are features of post-ejection phase of vomiting with retching?

A

Weakness
Shivering
Lethargy

33
Q

What can cause stimulation of vomiting centre?

A 
Enteric pathogens
Intestinal inflammation
Metabolic derangement
Infection
Head injury
Visual stimuli
Middle ear stimuli
34
Q

What are features of pyloric stenosis on test feed?

A

Palpation of olive tumour
Visible gastric peristalsis
Projectile NON BILIOUS vomiting

35
Q

What are blood gas features ofpyloric stenosis?

A

Raised pH - metabolic alkalosis due to vomiting stomach acid
Hypochloraemia
Hypokalaemia

36
Q

What is medical management for pyloric stenosis?

A

Fluid resuscitation - correct electrolyte imbalance and alkalosis
Refer to surgeons

37
Q

What surgical procedure is done for pyloric stenosis?

A

Ramstedts pyloromyotomy

38
Q

What colour is bilious vomit?

A

Green

39
Q

What causes bilious vomiting?

A

Intestinal obstruction - green vomit is obstruction until proven otherwise

40
Q

What conditions cause bilious vomiting?

A 
Intestinal atresia in newborn babies
Malrotation
Intussusception
Ileus
Crohn's disease with strictures
41
Q

What investigations are done into bilious vomit?

A

Abdo X-ray
Contrast meal
Exploratory laparotomy

42
Q

What causes effortless vomiting?

A

Gastro-oesophageal reflux

43
Q

Is gasto-oesophageal reflux self limiting?

A

Normally yes - resolves spontaneously

44
Q

When is reflux not self limiting?

A

Cerebral palsy
Progressive neurological problems
Oesophageal atresia
Generalised GI motility problem

45
Q

What are presenting symptoms of reflux?

A 
Vomiting
Haematemasis
Feeding problems
Failure to thrive
Resp - Apnoea, cough, wheeze, chest infections
46
Q

How is reflux assessed?

A 
History and examination
Radiology - video fluoroscopy, barium swallow
pH study
Oesophageal imedance monitoring
Endoscopy
47
Q

What are aims for barium swallow?

A 
Identify:
Dysmotility
Hiatus hernia
Reflux
Gastric emptying
Strictures
48
Q

How is a pH meter used?

A

pH catheter inserted into oesophagus with sensor to detect pH

49
Q

How is reflux generally managed?

A

Feeding advice
Nutritional support
Medical treatment
Surgery

50
Q

What is involved in feeding advice for reflux?

A

Thickeners for liquids
Appropriateness of foods - texture and amount
Behavioural programme - oral stimulation and removal of aversive stimuli
Feeding position

51
Q

What is involved in nutritional support for reflux?

A

Calorie supplements
Exclusion diet - milk free (may have cow’s milk allergy)
Nasogastric tube
Gastrostomy

52
Q

What is involved in medical treatment of reflux?

A

Feed thickener - gaviscon, thick and easy
Prokinetic drugs
Acid supressing drugs - H2 receptor blockers, PPIs

53
Q

What are indications for surgery in reflux?

A

Failure of medical treatment - persistet failure to thrive, aspiration, and oesophagitis

54
Q

What surgery is done for reflux?

A

Nissen funcoplication

55
Q

What are complications of nissen fundoplication?

A

Dumping syndrome
Bloating
Retching
More problematic with neuro pathology

56
Q

How is chronic diarrhoea defined?

A

4 or more stools per day for more than 4 weeks

57
Q

What is diarrhoea lasting less than one week?

A

Acute diarrheoa

58
Q

What is diarrhoea that lasts 2-4 weeks?

A

Persistent diarrhoea

59
Q

What are the 3 main causes of diarrhoea?

A

Motility disturbance
Active secretion - secretory diarrhoea
Malabsorption of nutrients - osmotic diarrhoea

60
Q

What types of diarrhoea are caused by motility disturbance?

A

Toddler diarrhoea

Irritable bowel syndrome

61
Q

What types of diarrhoea are caused by active secretion?

A

Acute infective diarrhoea

IBD

62
Q

What types of diarrhoea are caused by osmotic diarrhoea?

A

Food allergy
Coeliac disease
CF

63
Q

What is the most common cause of secretory diarrhoea?

A

Cholera

64
Q

What is used to treat secretory diarrhoea?

A

Oral rehydration therapy

65
Q

What causes osmotic diarrhoea?

A

Food that is not absorbed remains in lumen and pulls water out of cells into lumen through osmosis

66
Q

What should be asked about in history of chronic diarrhoea?

A

Age at onset
Abrupt or gradual onset
Family history
Nocturnal defecation 0 organic pathology

67
Q

What should be done in faecal analysis in chronic diarrhoea?

A

Appearance
Stool culture
Determination of secretory vs osmotic
Stop feed to determine osmotic or secretory - will stop if osmotic

68
Q

What are differences in lab results between osmotic and secretory diarrhoea?

A

Osmotic has lower volume
Osmotic stops in response to feeding
Osmotic has high stool osmolality

69
Q

What can cause fat malabsorption?

A

Pancreatic disease - lack of lipase, classically CF

Hepatobiliary disease - cholestasis

70
Q

What is coeliac disease?

A

Gluten sensitive enteropathy

71
Q

What are features of coeliac disease?

A 
Abdominal bloatedness
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpatiformis
72
Q

What are screening tests for coeliac disease?

A 
Serum Anti-tissue transglutaminase
Serum Anti endomysial
Serum IgA
Duodenal biopsy - gold standard
Genetic testing
73
Q

How is coeliac disease treated?

A

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
Q

When can coeliac be treated without biopsy?

A

Symptomatic
Anti tissue transglutaminase >10 times upper limit
Positive anti endomysial antibodies
Positive in genetic testing

75
Q

What are complications of untreated coeliac disease?

A

Growth failure
Osteoperosis
Small bowel lymphomas

Paediatrics (25 decks)

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