Paed:GI Flashcards
What is faltering growth?
Failure to gain adequate weight during childhood. Fall across 2 centiles on growth chart.
What are the causes of faltering growth?
Reduced intake
Lack of absorption
Too much energy used up
Abnormal central control of growth/appetite
What is GORD?
Motility disorder involving involunary passage of gastric contents into oesophagus. Due to improper relaxation of LOS as a result of functional immaturity
What makes GORD resolve by around 12months?
Maturation of LOS
Solid foods
More time upright
Clinical features of GORD?
Poor weight gain Vomiting Pain Irritability Dysphagia
Complications of GORD
FtT due to severe vomiting
Oesophagitis
Recurrent pulmonary aspiration
Dystonic neck posturing
Investigation of GORD
24h oesophageal PH monitoring 24h impedance monitoring endoscopy barium swallow/meal PPI test
Management of GORD
If uncomplicated: add inert thickening agent (carobel, nestargel), position head up 30deg after feeds
COmplicated: Do acid suppression (ranitidine or omep), surgery: Fundoplication
What is Coeliac Disease?
Proximal small intestine damage caused by gliadin provoking an immunological response to mucosa. Villi become shorter, then absent so the mucosa is flat.
Classical presentation of coeliacs?
FtT Irritability Abdo distension abnormal stools Malabsorptive syndrome at 8-24 months after intro of wheat containign solid foods.
Diagnosis of coeliac?
Via small bowel biopsy
IgA tissue transglutaminase antibodies and the endomysial antibodies.
management of coeliac?
avoidance of wheat from diet.
What is Toddlers Diarrhoea?
Chronic non-specific diarrhoea. Commonest cause of loose stools in preschool children. Child still thrives, no systemic sx
Management of toddlers diarrhoea?
Low fruit and juice. increased fat to slow gut transit. Loperamide.
What is pyloric stenosis?
Hypertrophy of pyloric muscle causing gasteic outflow obstruction.
When does pyloric stenosis present and how?
Commonly in boys 2-7 weeks.
Vomiting increasing in freq.+force over time, until projectile.
Hunger after vomiting until dehydrated.
W loss if delayed presentation.
What is the metabolic picture of pyloric stenosis?
Hypochloraemic metabolic alklalosis with low Na and K due to vomiting stomach contents.
Hypochloraemic, hyponatraemic, hypokalaemic.
Diagnosis of pyloric stenosis
Test feed and exam.
USS if necessary.
Can see peristalsis
Treatment of Pyloric Stenosis
Correct fluid and electrolyte imbalance.
Pyloromyotomy
What is IBS?
Mixed group of abdominal symptoms for which no organic cause can be identified.
Symptoms of IBS?
Consipation, diarrhoea, abdo pain/discomfort, bloating.
Abdo pain that is either relieved by defecation or is ass w/ altered stool form or bowel freq.
2 or more of: Urgency Incompelte evac abdo distension mucus oin stool worsenign sx after foood
Treatment of IBS?
Dietary changes
Where does UC affect?
Confined to the colon
What is UC?
Relapsing and remitting inflammatory disorder of the colonic mucosa.
Macrosopic changes of UC?
NO skip lesions.
Microscopic changes of UC?
Depleted goblet cells
increased cyrpt abcesses
mucosal inflammation
Symptoms of UC?
Episodic diarrhoea with blood and mucus
LLQ pain
FtT
Delayed puberty
Treatment of UC?
Steroids –> Oral Prednisolone
5-ASA –> Sulfasalazine
Azathioprine for relapse
Surgery
Diagnosis of UC?
Colonoscopy with biopsy.
Faecal calprotectin raised.
pANCA raised.
Where is Crohns?
Mouth to anus
What is crohns disease?
Chronic inflammatory GI disease characterised by transmural granulomatous inflammation affecting any part of the gut from mouth to anus.
Features of Crohns macrosopcially?
Skip lesions
Cobblestone appearance
Features of Crohns microscopically?
Transmural inflammation
Goblet cells
LEss crypt abcesses then UC
Symptoms of Crohns
Classical presentaion of: Abdo pain, diarrhoea, weight loss. FtT. Urgency and bleeding with defecation. anal strictures and abcesses. lethargy. Delayed puberty. RIF tenderness
Extraintestinal signs of Crohns?
Apthous oral ulcerations, clubbing, skin joint and eye problems, arthralgia, uveitis
Diagnosis of Crohns?
NEgative pANca
Raised faecal calprotectin
Increased ESR/CRP
Colonoscopy and biopsy
Treatment of crohns
Budesonide azathiproine infliximab Methotrexate Surgery
What is constipation?
Infrequent passage of stool ass w/ pain and difficulty or delay in defacation
What is encoparesis?
Involuntary faecal soiling or incontinence secondary to chronic constipation.
What are the ROME III criteria?
- <2 defecations per week
- > 1 episode of faecal incontinence per week
- Retentive posturing or stool retention
- painful or hard bowel movements
- presence of a large fecal mass in the rectum
- large diameter stools that may obstruct toilet
Red flags in constipation?
Delayed passage of meconium Fever vomiting bloody diarhoea FtT tight empty rectum with palpable abdo fecal mass abnormal neuro exam
Complications of constipation?
Acquired megacolon
anal fissure
overflow incontinence
behavioural problems
management of constipation
Behavioural and toilet training advice
Stool soften w/ macrogol laxative eg. polyethene glycol
Stimulant laxative - senna
What is diarrhoea?
Change in consistency of stools and/or icnrease in freq. of evacuations. With or without fever/vomiting which lasts less than 7 days and not longer than 14.
What are the causes of acute diarrhoea?
Viruses: Rotavirus
Bacteria: Campylobacter jejuni, salomonella, e.coli
Parasites: giardia lambia
Clinical features of diarrhoea
Diarrhoea +/- bloody stools (dysentery) Fever Vomiting Dehydration Decreased consciousness
what do you see when examining dehydrated patient?
PRolonged CRT
Abnormal skin turgor
Absent tears
Investigations for acute diarrhoea
Stool microbiology
Serum electrolytes
Treatment of acute diarrhoea
antibiotics
probiotics
What is Hirchsprungs disease?
Absence of gagion cells from myenteric and submucoasal plexuses of part of large bowel results in narrow, contracted segment.
How does Hirchsprungs present?
Often presents in neonatal period with intestinal obstruction. Heralded by failure to pass meconium in first 24h of life. Develop abdo distension and bile stained vomit.
What would DRE of hirchsprungs reveal?
Narrowed segment and release of gas and liquid stool
Diagnosis of Hirchsprungs
Suction rectal biopsy
Management of Hirchsprungs
Surgery
Colostomy followed by anastomosis
What are the causes of Gastroenteritis?
Commonest in developed countries: Rotavirus
Also caused by: adenovirus, norovirus, coronavirus
Campylobacter jejuni is most common bacterial infection.
What are the symptoms of appendicitis?
Anorexia
Vomiting
Abdo pain
Appendicitis is uncommon below age 3
What are the signs of appendicitis?
Flushed face
low ggrade fever 37.2-38
abdo pain aggravated by movement
guarding in RIF
Investigations for appendicitis?
USS supports dx.
FBC + U+E usefuk
Management of appendicitis?
Appendicectomy +/- abx
What is Intussusception?
Invagination of proximal bowel into a distant segment
What area of bowel is most commonly involved in intussusception?
Ileum passing into caecum through ileocaecal valve
Presentation of intussusception?
Paroxysmal, severe colicky pain and pallor
refusal of feeds, vomiting, may become bile stained
sausage shaped mass in abdo
redcurrant jelly stool (blood stained mucus)
abdo distension
X ray changes in ISS?
Distended small bowel and absence of gas in distal colon and rectum
Treatment of inussusception
Rectal air insufflation
—> if fails need operative reduction.
What is Meckel Diverticulum?
Ileal remnant of vitello-intestinal duct
presentation of meckel diverticulum?
severe rectal bleeding. Intussusception, volvuvlus or diverituclits.
Needs surgical resection.
What are the two presentations of malrotation?
Obstruction
Obstruction with a compromised blood supply
Presentation of malrotation?
Obstruction w/ bilous vomting in first few days of life.
What type of inguinal hernia is most common?
Indirect due to a patent processus vaginalis
Clinical features of inguinal hernia?
Intermittent swelling in groin or scrotum on crying/straining
Swelling may be visible by raising intraabdo pressure
Irreducible lump - firm and tender.
irritability and vomiting
Treatment of inguinal hernias?
Reduce them w/ analgesia
Surgery
What is infant colic?
Paroxysmal inconsolable crying or screaming often accompanied by drawing up of the knees and passage of excess flatus. Several times a day, especially in evening.
When does colic occur?
First few weeks of life and resolves by four months.
what should you check for in colic?
Cows milk allergy or GO reflux disease
What is marasmus?
Lack of calories and discrepancy between height and weight. HIV associated.
Signs of marasmus?
Distended abdo diarrhoea constipation infection decreased albumin
Treatment of marasmus?
Fortified ready to use food if >6months
Parenteral feeding
Balanced diet
What is Kwashiorkor?
Due to decreased intake of protein and essential AAs.
Signs of Kwashiorkor?
Poor growth diarrhoea apathy anorexia diarrhoea skin and hair depigmentation distended abdo decreased glucose decreased potass, magnesium, haemoglobin, cholesterol, albumin
Management of Kwashiorkor?
Reducation of child and family.
Reintroduce protein to diet and build up.
Vitamins
What is biliary atresia?
This is a condition of uncertain cause where part, or all, of the extrahepatic bile ducts are obliterated by inflammation and subsequent fibrosis, leading to biliary obstruction and jaundice
What is Wilson disease?
AR disorder, results in buildup of intracellular hepatic copper with subsequent hepatic dysfunction, neurological abnormalities and haemolytic aneamia.
Symptoms of wilsons disease?
Rare under 5.
Chronic active hepatitis
Neuro sx: mood disorder, psychosis, features consistent with parkinsons
haemolysis in severe cases
Diagnosis of wilson disease?
Low plasma concentration of Caeruloplasmin
elevated 24h urinary copper excretion
opthalmoscopy to detect kayser-fleischer ring
Treatment of wilson disease?
Lifelong chelating agents eg. D-penicillamine
or Liver transplant
What is choleductal cyst?
Choledochal cyst is a congenital dilatation of part or whole of the bile duct
List some causes of liver failure?
Chronic hepatitis Biliary atresia Drug induced Autoimmune hepatitis Wilsons disease alpha 1 antitrypsin deficiency
Symptoms of liver failure?
Jaundice, Gi haemorrhage Pruritis Anaemia FtT
