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Paediatrics > GI, Vomiting, Malabsorption, Lower GI disorders, Paediatric Liver Disease > Flashcards

GI, Vomiting, Malabsorption, Lower GI disorders, Paediatric Liver Disease Flashcards

1
Q

What are some signs and symptoms of constipation?

A 
Poor appetite
Irritable
Lack of energy
Abdominal pain or distension
Withholding or straining
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2
Q

Why do children become constipated?

A

Social (poor diet, insufficient fluids, excessive milk, potty training / school toilet)
Physical (intercurrent illness, medication)
Family history
Psychological (secondary)
Organic

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3
Q

How can constipation be treated with diet?

A

Increase fibre
Increase fruit and vegetables
Increase fluids
Decrease milk

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4
Q

How can constipation be treated psychologically?

A

Make going to toilet a good experience (correct height, not cold, school toilets)
Avoid punitive behaviour from parents

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5
Q

What treatments can soften stool and stimulate defecation?

A 
Osmotic laxatives (lactulose)
Stimulant laxatives (senna, picolax)
Isotonic laxatives (movicol)
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6
Q

What are the advantages of laxatives?

A

Non invasive

Given by parents

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7
Q

What are the disadvantages of laxatives?

A

Non compliance

Side effects

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8
Q

What is the treatment for impaction?

A

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

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9
Q

What are the presenting features for Crohn’s ad ulcerative colitis?

A 
Diarrhoea 
Rectal bleeding 
Abdominal pain 
Fever 
Weight loss 
Growth failure 
Arthritis 
Mass
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10
Q

What lab investigations are used in crohn’s and ulcerative colitis?

A

FBC and ESR (anaemia, thrombocytosis, raised ESR)

Biochemistry (stool calprotectin, raised CRP, low albumin)

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11
Q

What other investigations can be used for Crohn’s and ulcerative colitis?

A 
MRI 
Barium meal 
Colonoscopy 
Upper GI endoscopy 
Mucosal biopsy 
Capsule endoscopy 
Enteroscopy
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12
Q

What are the methods of treatment for Crohn’s and ulcerative colitis?

A

Medical (anti-inflammatory, immunosuppressive, biologics)
Nutritional (immune modulation, supplements)
Surgical

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13
Q

What are the different types of vomiting?

A

Vomiting with Retching
Projectile vomiting
Bilious vomiting
Effortless vomiting

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14
Q

What are the different phases of vomiting with retching?

A

Pre-ejection phase (pallor, nausea, tachycardia)
Ejection phase (retch, vomit)
Post-ejection phase

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15
Q

What can stimulate the vomiting centre?

A 
Enteric pathogens
Intestinal inflammation
Metabolic derangement
Infection
Head injury
Visual stimuli
Middle ear stimuli
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16
Q

What are the symptoms of pyloric stenosis?

A

Projectile non-bilious vomiting
Weight loss
Dehydration +/- shock
Electrolyte disturbance (Metabolic alkalosis ↑pH, ↓Cl, ↓K)

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17
Q

What type of vomiting is associated with gastroesophageal reflux?

A

Effortless vomiting

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18
Q

What are the presenting symptoms for gastroesophageal reflux?

A 
Vomiting 
Haematemesis 
Feeding problems 
Failure to thrive 
Apnoea 
Cough
Wheeze 
Chest infections
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19
Q

What are the investigations for pyloric stenosis?

A

Test feed
US
Blood gases

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20
Q

What is the management for pyloric stenosis?

A

Fluid resuscitation

Refer to surgeons (Ramstedts pyloroyotomy)

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21
Q

What investigations are used for gastroesophageal reflux?

A 
Barium swallow 
Video fluoroscopy 
pH study 
Oesophageal impendance monitoring 
Endoscopy
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22
Q

What is the treatment for gastroesophageal reflux?

A

Feeding advice
Nutritional support (calorie supplements, exclusion diet, NG tube, gastrostomy)
Drugs (feed thickener, pro kinetic drugs, H2 receptor blockers, PPI)
Surgery

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23
Q

What are the indications for gastroesophageal reflux surgery?

A

Failure of medical treatment

Persistent failure to thrive, aspiration and oesophagiitis

24
Q

What are the causes of bilious vomiting?

A 
Intestinal atresia (in newborn babies only)
Malrotation +/- volvulus
Intussusception
Ileus
Crohn’s disease with strictures
25
Q

What are the investigations for bilious vomiting?

A

Abdominal x-ray
Consider contrast meal
Surgical opinion re exploratory laparotomy

26
Q

What is chronic diarrhoea?

A

4 or more stools per day more than 4 weeks

27
Q

What are the causes of diarrhoea?

A 
Motility disturbance (Toddler Diarrhoea, Irritable Bowel Syndrome)
Active secretion (Acute Infective Diarrhoea, Inflammatory Bowel Disease)
Malabsorption of nutrients (Food Allergy, Coeliac Disease, Cystic Fibrosis)
28
Q

What is osmotic diarrhoea?

A

Movement of water into the bowel to equilibrate osmotic gradient

29
Q

What can cause fat malabsorption?

A 
Pancreatic disease (cystic fibrosis) 
Hepatobiliary disease (chronic liver disease, cholestasis)
30
Q

What is secretary diarrhoea?

A

Associated with toxin production from E coli

Intestinal fluid secretion is driven by active CL secretion via CFTR

31
Q

What are the causes of motility diarrhoea?

A

Irritabel bowel syndrome

Congenital hyperthyroidism

32
Q

What is inflammatory diarrhoea?

A

Malabsorption due to intestinal damage
Secretory effect of cytokines
Accelerated transit time in response to inflammation
Protein exudate across inflamed epithelium

33
Q

What are the investigations for diarrhoea?

A

History
Consider growth and weight gain of child
Faeces analysis

34
Q

What are the signs of coeliac disease in children?

A 
Abdominal bloatedness
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpatiformis
35
Q

Who are the susceptible asymptomatic groups for coeliac disease?

A

Type 1 diabetes
Autoimmune thyroid disease
Down’s syndrome
First-degree relatives of people with coeliac disease

36
Q

What are the screening tests for coeliac disease?

A

Serology screens (anti-tissue transglutaminase, anti-endomysial, concurrent IgA deficiency)
Duodenal biopsy
Genetic testing

37
Q

What are the histological features of coeliac disease?

A

Villous atrophy
Crypt hyperplasia
Lymphocytic infiltration of surface epithelium

38
Q

What is the treatment for coeliac disease?

A

Strict gluten free diet

39
Q

What is the risk of azathioprine?

A

Lymphoma risk

40
Q

What are the advantages of breast milk?

A 
Well tolerated 
Less allergenic 
Low renal solute load 
Improves cognitive development 
Reduces infection
41
Q

What is included in liver function tests?

A

Bilirubin
ALT/AST
Alkaline phosphatase
Gamma glutamyl transferase (GGT)

42
Q

What liver function tests will be elevated in biliary disease?

A

Alkaline phosphatase

GGT

43
Q

What liver function tests will be elevated in hepatocellular damage?

A

ALT/AST

44
Q

What are some other tests which can assess liver function?

A 
Coagulation (prothrombin time) 
Albumin 
Bilirubin 
Blood glucose 
Ammonia
45
Q

What are the signs of chronic liver disease in children?

A 
Ascites 
Portal hypertension 
Clubbing 
Splenomegaly 
Cholestasis 
Brusing and petechiae 
Spider neavi 
Muscle wasting 
Jaundice 
Hypotonia
Growth failure
46
Q

What are the early causes of neonatal jaundice?

A

Haemolysis

Sepsis

47
Q

What are the intermediate causes of neonatal jaundice?

A

Breast milk
Sepsis
Haemolysis

48
Q

What are the prolonged causes of neonatal jaundice?

A

Extrahepatic obstruction
Neonatal hepatitis
Hypothyroidism
Breast milk

49
Q

What are the features of physiological jaundice?

A 
Shorter RBC lifespan in infants 
Relative polycythaemia
Relative immaturity of liver function
Unconjugated jaundice
Develops after first day of life
50
Q

What are the features of great milk jaundice?

A

Unconjugated jaundice

Can persist up to 12 weeks

51
Q

What is kernicterus?

A

Unconjugated bilirubin is fat soluble and crosses the BBB

Neurotoxic and deposits in the brain

52
Q

What are the early signs of kernicterus?

A

Encephalopathy
Poor feeding
Lethargy
Seizures

53
Q

What are the consequences of kernicterus?

A

Severe choreoathetoid cerebral palsy
Learning difficulties
Sensorineural deafness

54
Q

What type of jaundice can phototherapy treatment be used?

A

Unconjugated jaundice

55
Q

What types of biliary obstruction can cause prolonged neonatal jaundice?

A 
Biliary atresia (Conjugated jaundice, pale stools)
Choledochal cyst (Conjugated jaundice, pale stools)
Alagille syndrome (Intrahepatic cholestasis, dysmorphism, congenital cardiac disease)
56
Q

What is the treatment for biliary atresia?

A

Kasai portoenterostomy

Paediatrics (20 decks)

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