Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PAEDIATRICS > GIT + WRAP UP > Flashcards

GIT + WRAP UP Flashcards

1
Q

What is the pathogenesis of pyloric stenosis?

A

Circular fibres at the junction thicken and hypertrophy –> excess thickening –> bulky, hypertonic pylorus –> outflow obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the clinical features of pyloric stenosis?

A 
Projectile vomiting after food
More common in boys, peak age 6wks
FHx
Still hungry, wanting to feed
Not unwell
EXAM
- palpable pylorus at RUQ 'olive'
- visible peristalsis/distension
- dehydrated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What investigations should be performed in a child with pyloric stenosis?

A

U/S - elongated and thick pylorus ‘cervix sign’ as it distends stomach (best taken after a feed - distends stomach)
- Dehydration, hypochloraemia (loss of acid), hypokalaemia (H loss, push K into cells), alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you manage pyloric stenosis?

A

Cease oral feeds
Rehydrate IV - NS + 5% glucose + with 20mmol/L KCl
+/- NGT to drain stomach
Paed surgery consult - Ramstedt’s pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does a transoesophageal fistula present?

A

Difficulty feeding with coughing and choking
Baby coughs and goes blue
Respiratory distress, produces copious frothy white mucus
TOF cough due to floppy larynx
Tympanic LUQ from air in stomach
Gastric tube could not be inserted
Polyhydramnios, small for gestational age, maternal age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you investigate TOF? Treatment?

A

X-ray - darker shadow showing blind end of oesophagus, stomach is distended from air (via trachea of TOF)
Rx: stop oral feeds, IV fluids etc.
- Paed surgery consult - either join together if long enough or distend a bit first before attaching/use goretex or other pieces of GIT to join

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the differences in mild, moderate, severe dehydration

A

MILD (3%) - thirsty, decreased urine output, dry MM, mildly tachy
MOD (5%) - sunken eyes/fontanelles, mod tachy, lethargic, increased RR, skin turgor
SEVERE (10%) = SHOCKED - altered LOC, cool peripheries, mottled, slow cap refill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the rehydration protocol for mild/moderate/severe dehydration?

A

Mild: oral fluids if tolerating, admit if inadequate (0.5mL/kg ever 5 minutes), consider parenteral rehydration

Moderate: 4 options:

  1. Aggressive and diligent oral
  2. Rapid NG rehydration (gastrolyte) 10mL/kg/hr for 4hrs
  3. Rapid IV rehydration NS + 5% glucose 10mL/kg/hr for 4hrs
  4. Standard IV rehydration (maintenance + replace dehydration)

Severe: oxygen, use IO route if IV not accessible
give 20mL/kg bolus NS, repeat until signs of shock are reversed
- Give oxygen
- Get a UEC, BGL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the key clinical features of intussusception?

A 
Peak incidence 6-9mo
1. Colicky abdo pain (draw legs up)
2. Vomiting
3. Abdominal mass
4. Red currant jelly stool (blood and mucus)
U/S - target sign
recent viral illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a volvulus and how does a volvulus present?

A

Malrotation of intestine - twisting of bowel and supporting mesentery causing ischaemia

  • Previously well
  • Bilious vomiting
  • Abdo pain
  • Taut, tender sometimes distended abdo
  • High pitched or no bowel sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some other differentials for vomiting in a child?

A 
Bowel obstruction
Intussusception
Volvulus
Pyloric stenosis
Gastroenteritis
Acute appendicitis
GORD
Oesophagitis
TOF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How will a bowel obstruction present in a child?

A

Blood/bile in vomit
Abdo distension
No poo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common cause of diarrhoea in a child?

A

Viral gastroenteritis
- Rotavirus, adenovirus
Bacterial: E.coli, campylobacter, salmonella, shigella
Protozoa: Giardia, cryptosporidium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some causes of bloody diarrhoea?

A

Intussusception
Paediatric IBD
Infection
HUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the triad of symptoms for HUS?

A
  1. Microangiopathic haemolytic anaemia
  2. Thrombocytopaenia
  3. AKI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How will a malabsorption diarrhoea present?

A

Fat: steatorrhoea, pale, bulky, foul smelling stools
Carbohydrate: frequent watery diarrhoea
FTT, weight loss, abdo distension, abdo pain, excoriated anus from acidic stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does paediatric Crohn’s disease present?

A

Blood, mucopurulent diarrhoea
Abdo pain and cramping
Decreased growth and weight
Anorexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you calculate maintenance fluids for a child?

A

4:2:1 per hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you classify neonatal jaundice?

A

<24 hours = always pathological

  • Haemolysis (Rhesus, ABO incompatibility, G6PD, PKU, haematoma, hereditary spherocytosis)
  • Infection

24hrs - 2 weeks
- NORMAL - physiological, Breast feeding (lack of input), breast milk, Gilbert’s or Crigler Najaar

> 2 weeks
- Biliary atresia, Congenital hypothyroidism (should find on Guthrie), neonatal hepatitis,, breast milk (inhibits enzyme that conjugates bili)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is breastfeeding jaundice?

A

Inadequate breastfeeding = inadequate intake –> not enough bowel movements to remove bili from the blood –> increased enterohepatic circulation –> increased bili reabsorption from intestines

21
Q

How is intussusception treated?

A

Fluid resuscitation
NGT if bowel obstruction
Air or barium enema: injected into colon –> X-ray fluoroscopy to watch air/contrast material flow into the large intestine –> creates pressure within the large intestine and “un-telescopes” intussusception –> relieving the obstruction
- If unsuccessful will need surgical reduction
- Surgery straight away if perforation
Sometimes give prophylactic antibiotics for risk of perforation with enema

22
Q

What are the clinical features required to make a diagnosis of gastroenteritis?

A

Needs to have vomiting AND diarrhoea AND fever

23
Q

What are the common causative organisms of gastroenteritis in children?

A

Norovirus, adenovirus
Rotavirus becoming less common because of the vaccination
Salmonella, campylobacter, E.coli

24
Q

What are some differential diagnoses for gastro?

A 
Acute appendicitis
Mesenteric adenitis
UTI
Sepsis - meningitis
Intussusception
Malrotation
Coeliac disease
Lactose intolerance
IBD
Sepsis
Vomiting - meningitis
25
Q

What are the principles of fluid rehydration in children?

A 
Fluid deficit (mL) = wt (kg) x percent (%) dehydration x 10
e.g. 20kg = 20 x 5 x 10 = 1000mL
Maintenance (4:2:1 rule x 10mL per kg) 
Replace ongoing losses (ADD TO THE VOLUME GIVEN DAILY)-  For upper GIT losses use 0.9% NS + 5% glucose + KCl 20mmol/1000mL
26
Q

Why are babies at high risk of jaundice?

A

Cephalohaematoma from birth trauma - haemolysis
Immature GIT - needs milk to stimulate enterohepatic circulation
Immature liver
Higher Hb levels - foetal Hb has shorter half life

27
Q

How do you treat neonatal jaundice?

A

Phototherapy - monitor 4-6hourly, then 8-12hrly
Exchange transfusion if severe, symptomatic (lethargy, hypotonia, poor sucking, or high-pitched cry), or not responding to phototherapy

28
Q

What is the most common cause of appendicitis?

A

Faecoliths obstructing the lumen

29
Q

What are some differentials for appendicitis?

A 
Mesenteric adenitis
Acute gastroenteritis
IBD
UTI
Intussusception
Malrotation
Coeliac disease
Meckel's diverticulum 
Gynae in girls
30
Q

What investigations are required for appendicitis?

A

FBC and CRP
U/S is not usually helpful
CT more accurate but radiation

31
Q

What are the management options for appendicitis?

A

Active observation on admission- may spontaneously resolve
Conservative - broad spectrum antibiotics
Percutaneous drainage
Appendicectomy

32
Q

What usually causes intussusception and where does it usually occur?

A

In children there is usually no lead point
- Usually occurs after a viral illness –> lymphatic congestion + inflammation of Peyer’s patches –> obstruction –> necrosis and perforation
Ileocolic location
Pathological lead points: Meckel’s diverticulu, HSP, small bowel lymphoma

33
Q

What investigations are required for intussusception?

A

Abdominal x-ray - look for perforation
Ultrasound - target sign, pseudokidney sign
Stool sample for occult blood
Air enema - diagnostic and therapeutic

34
Q

What is the management for intussusception?

A

Fluid resusc +
Analgesia
Air enema (if haemodynamically stable and no evidence of perforation)
Surgical (if enema fails or signs of perf or signs of necrotic bowel (e.g. red currant jelly))

35
Q

What are some investigations for volvulus?

A

Abdominal x-ray looking for caecum
Upper GIT contrast study - corkscrew tapering
Contrast enema
Abdominal ultrasound

36
Q

What kind of biochemical changes occur with pyloric stenosis?

A

Hypochloraemic hyperkalaemic metabolic alkalosis

37
Q

What is necrotising enterocolitis and how does it present?

A
  • Portions of bowel undergo necrosis postnatally
  • Mostly seen in premature babies
  • Unknown cause, could be due to hypoxia at birth, OR premmy babies who have poor digestion, immune systems, poor circulation
    Features: Feeding intolerance, bloody stools from intestinal necrosis and haemorrhage, abdominal distension, and peritonitis due to perforation
    Treat: fluid resusc, TPN, broad spec Abx
38
Q

What is a congenital diaphragmatic hernia and how does it present?

A

Defect in foetal diaphragm allowing abdominal contents to protrude into the thoracic cavity
Severe respiratory distress at birth due to pulmonary hypoplasia and pulmonary hypotension

39
Q

Why does congenital diaphragmatic hernia have such a high mortality?

A

Presence of abdominal organs in the chest cavity –> inadequate lung development –> pulmonary hypoplasia and pulmonary hypotension –> severe respiratory distress

40
Q

How does a TOF develop?

A

Failure of correct division of tracheal primordium from oesophagus during early embryological development

41
Q

What is the difference between gastrochisis and omphalocele?

A

Gastrochisis - abdominal contents are present outside abdomen WITHOUT a covering membrane, due to defect in anterior abdominal wall
Omphalocele - herniated bowel etc, enclosed in a membranous sac, due to issue with the umbilical cord

42
Q

What maternal condition is associated with TOF?

A

Polyhydramnios

43
Q

What is the management for a volvulus?

A

Fluid resusc
NGT NBM
Broad spec Abx if suspect necrosis
Urgent surgery

44
Q

What investigations do you do for neonatal jaundice?

A

Serum bili - repeat 4-6hourly
Bili check across forehead (BiliCheck)
FBC and group
Coombs

45
Q

How do you calculate replacement of deficit of fluids?

A

Weight (kg) * percent deficit (e.g. 5) * 10

46
Q

What fluids can be used for oral rehydration?

A
  • Babies who are breastfed should receive small frequent breastfeeds, can be supplemented with an ORS
  • For all other children, offer an ORS
  • If an ORS is unavailable, or refused, dilute juice/lemonade (mixed as 1 part
    juice/lemonade with 4 parts water) can be used only if a child does not
    have any clinical signs of dehydration
47
Q

How do you ensure that the NG tube is in the stomach?

A

Aspirate the fluid and check acidity using litmus tape

48
Q

What signs need to be assessed during rehydration of a child?

A

Reassess at 4-6hrs, then 8hrly afterwards

  • weight change
  • clinical signs of dehydration
  • urine output
  • ongoing losses
  • signs of fluid overload, such as puffy face and extremities
49
Q

Why does pyloric stenosis give hypokalaemia?

A

Metabolic alkalosis from vomiting HCl - body desires more H+ ions - swaps them for K+ - hypokalaemia

PAEDIATRICS (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions