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3a > Paed:GI > Flashcards

Paed:GI Flashcards

1
Q

What is faltering growth?

A

Failure to gain adequate weight during childhood. Fall across 2 centiles on growth chart.

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2
Q

What are the causes of faltering growth?

A

Reduced intake
Lack of absorption
Too much energy used up
Abnormal central control of growth/appetite

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3
Q

What is GORD?

A

Motility disorder involving involunary passage of gastric contents into oesophagus. Due to improper relaxation of LOS as a result of functional immaturity

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4
Q

What makes GORD resolve by around 12months?

A

Maturation of LOS
Solid foods
More time upright

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5
Q

Clinical features of GORD?

A 
Poor weight gain
Vomiting
Pain 
Irritability
Dysphagia
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6
Q

Complications of GORD

A

FtT due to severe vomiting
Oesophagitis
Recurrent pulmonary aspiration
Dystonic neck posturing

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7
Q

Investigation of GORD

A 
24h oesophageal PH monitoring
24h impedance monitoring
endoscopy
barium swallow/meal
PPI test
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8
Q

Management of GORD

A

If uncomplicated: add inert thickening agent (carobel, nestargel), position head up 30deg after feeds
COmplicated: Do acid suppression (ranitidine or omep), surgery: Fundoplication

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9
Q

What is Coeliac Disease?

A

Proximal small intestine damage caused by gliadin provoking an immunological response to mucosa. Villi become shorter, then absent so the mucosa is flat.

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10
Q

Classical presentation of coeliacs?

A 
FtT
Irritability
Abdo distension
abnormal stools
Malabsorptive syndrome at 8-24 months after intro of wheat containign solid foods.
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11
Q

Diagnosis of coeliac?

A

Via small bowel biopsy

IgA tissue transglutaminase antibodies and the endomysial antibodies.

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12
Q

management of coeliac?

A

avoidance of wheat from diet.

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13
Q

What is Toddlers Diarrhoea?

A

Chronic non-specific diarrhoea. Commonest cause of loose stools in preschool children. Child still thrives, no systemic sx

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14
Q

Management of toddlers diarrhoea?

A

Low fruit and juice. increased fat to slow gut transit. Loperamide.

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15
Q

What is pyloric stenosis?

A

Hypertrophy of pyloric muscle causing gasteic outflow obstruction.

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16
Q

When does pyloric stenosis present and how?

A

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.

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17
Q

What is the metabolic picture of pyloric stenosis?

A

Hypochloraemic metabolic alklalosis with low Na and K due to vomiting stomach contents.
Hypochloraemic, hyponatraemic, hypokalaemic.

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18
Q

Diagnosis of pyloric stenosis

A

Test feed and exam.
USS if necessary.
Can see peristalsis

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19
Q

Treatment of Pyloric Stenosis

A

Correct fluid and electrolyte imbalance.

Pyloromyotomy

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20
Q

What is IBS?

A

Mixed group of abdominal symptoms for which no organic cause can be identified.

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21
Q

Symptoms of IBS?

A

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
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22
Q

Treatment of IBS?

A

Dietary changes

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23
Q

Where does UC affect?

A

Confined to the colon

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24
Q

What is UC?

A

Relapsing and remitting inflammatory disorder of the colonic mucosa.

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25
Q

Macrosopic changes of UC?

A

NO skip lesions.

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26
Q

Microscopic changes of UC?

A

Depleted goblet cells
increased cyrpt abcesses
mucosal inflammation

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27
Q

Symptoms of UC?

A

Episodic diarrhoea with blood and mucus
LLQ pain
FtT
Delayed puberty

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28
Q

Treatment of UC?

A

Steroids –> Oral Prednisolone
5-ASA –> Sulfasalazine
Azathioprine for relapse
Surgery

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29
Q

Diagnosis of UC?

A

Colonoscopy with biopsy.
Faecal calprotectin raised.
pANCA raised.

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30
Q

Where is Crohns?

A

Mouth to anus

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31
Q

What is crohns disease?

A

Chronic inflammatory GI disease characterised by transmural granulomatous inflammation affecting any part of the gut from mouth to anus.

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32
Q

Features of Crohns macrosopcially?

A

Skip lesions

Cobblestone appearance

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33
Q

Features of Crohns microscopically?

A

Transmural inflammation
Goblet cells
LEss crypt abcesses then UC

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34
Q

Symptoms of Crohns

A 
Classical presentaion of: Abdo pain, diarrhoea, weight loss.
FtT. 
Urgency and bleeding with defecation.
anal strictures and abcesses.
lethargy.
Delayed puberty.
RIF tenderness
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35
Q

Extraintestinal signs of Crohns?

A

Apthous oral ulcerations, clubbing, skin joint and eye problems, arthralgia, uveitis

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36
Q

Diagnosis of Crohns?

A

NEgative pANca
Raised faecal calprotectin
Increased ESR/CRP
Colonoscopy and biopsy

37
Q

Treatment of crohns

A 
Budesonide
azathiproine
infliximab
Methotrexate
Surgery
38
Q

What is constipation?

A

Infrequent passage of stool ass w/ pain and difficulty or delay in defacation

39
Q

What is encoparesis?

A

Involuntary faecal soiling or incontinence secondary to chronic constipation.

40
Q

What are the ROME III criteria?

A
  • <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
41
Q

Red flags in constipation?

A 
Delayed passage of meconium
Fever
vomiting
bloody diarhoea
FtT
tight empty rectum with palpable abdo fecal mass
abnormal neuro exam
42
Q

Complications of constipation?

A

Acquired megacolon
anal fissure
overflow incontinence
behavioural problems

43
Q

management of constipation

A

Behavioural and toilet training advice
Stool soften w/ macrogol laxative eg. polyethene glycol
Stimulant laxative - senna

44
Q

What is diarrhoea?

A

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.

45
Q

What are the causes of acute diarrhoea?

A

Viruses: Rotavirus
Bacteria: Campylobacter jejuni, salomonella, e.coli
Parasites: giardia lambia

46
Q

Clinical features of diarrhoea

A 
Diarrhoea +/- bloody stools (dysentery)
Fever
Vomiting
Dehydration
Decreased consciousness
47
Q

what do you see when examining dehydrated patient?

A

PRolonged CRT
Abnormal skin turgor
Absent tears

48
Q

Investigations for acute diarrhoea

A

Stool microbiology

Serum electrolytes

49
Q

Treatment of acute diarrhoea

A

antibiotics

probiotics

50
Q

What is Hirchsprungs disease?

A

Absence of gagion cells from myenteric and submucoasal plexuses of part of large bowel results in narrow, contracted segment.

51
Q

How does Hirchsprungs present?

A

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.

52
Q

What would DRE of hirchsprungs reveal?

A

Narrowed segment and release of gas and liquid stool

53
Q

Diagnosis of Hirchsprungs

A

Suction rectal biopsy

54
Q

Management of Hirchsprungs

A

Surgery

Colostomy followed by anastomosis

55
Q

What are the causes of Gastroenteritis?

A

Commonest in developed countries: Rotavirus
Also caused by: adenovirus, norovirus, coronavirus
Campylobacter jejuni is most common bacterial infection.

56
Q

What are the symptoms of appendicitis?

A

Anorexia
Vomiting
Abdo pain
Appendicitis is uncommon below age 3

57
Q

What are the signs of appendicitis?

A

Flushed face
low ggrade fever 37.2-38
abdo pain aggravated by movement
guarding in RIF

58
Q

Investigations for appendicitis?

A

USS supports dx.

FBC + U+E usefuk

59
Q

Management of appendicitis?

A

Appendicectomy +/- abx

60
Q

What is Intussusception?

A

Invagination of proximal bowel into a distant segment

61
Q

What area of bowel is most commonly involved in intussusception?

A

Ileum passing into caecum through ileocaecal valve

62
Q

Presentation of intussusception?

A

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

63
Q

X ray changes in ISS?

A

Distended small bowel and absence of gas in distal colon and rectum

64
Q

Treatment of inussusception

A

Rectal air insufflation

—> if fails need operative reduction.

65
Q

What is Meckel Diverticulum?

A

Ileal remnant of vitello-intestinal duct

66
Q

presentation of meckel diverticulum?

A

severe rectal bleeding. Intussusception, volvuvlus or diverituclits.
Needs surgical resection.

67
Q

What are the two presentations of malrotation?

A

Obstruction

Obstruction with a compromised blood supply

68
Q

Presentation of malrotation?

A

Obstruction w/ bilous vomting in first few days of life.

69
Q

What type of inguinal hernia is most common?

A

Indirect due to a patent processus vaginalis

70
Q

Clinical features of inguinal hernia?

A

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

71
Q

Treatment of inguinal hernias?

A

Reduce them w/ analgesia

Surgery

72
Q

What is infant colic?

A

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.

73
Q

When does colic occur?

A

First few weeks of life and resolves by four months.

74
Q

what should you check for in colic?

A

Cows milk allergy or GO reflux disease

75
Q

What is marasmus?

A

Lack of calories and discrepancy between height and weight. HIV associated.

76
Q

Signs of marasmus?

A 
Distended abdo
diarrhoea
constipation
infection
decreased albumin
77
Q

Treatment of marasmus?

A

Fortified ready to use food if >6months
Parenteral feeding
Balanced diet

78
Q

What is Kwashiorkor?

A

Due to decreased intake of protein and essential AAs.

79
Q

Signs of Kwashiorkor?

A 
Poor growth
diarrhoea
apathy
anorexia
diarrhoea
skin and hair depigmentation
distended abdo
decreased glucose
decreased potass, magnesium, haemoglobin, cholesterol, albumin
80
Q

Management of Kwashiorkor?

A

Reducation of child and family.
Reintroduce protein to diet and build up.
Vitamins

81
Q

What is biliary atresia?

A

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

82
Q

What is Wilson disease?

A

AR disorder, results in buildup of intracellular hepatic copper with subsequent hepatic dysfunction, neurological abnormalities and haemolytic aneamia.

83
Q

Symptoms of wilsons disease?

A

Rare under 5.
Chronic active hepatitis
Neuro sx: mood disorder, psychosis, features consistent with parkinsons
haemolysis in severe cases

84
Q

Diagnosis of wilson disease?

A

Low plasma concentration of Caeruloplasmin
elevated 24h urinary copper excretion
opthalmoscopy to detect kayser-fleischer ring

85
Q

Treatment of wilson disease?

A

Lifelong chelating agents eg. D-penicillamine

or Liver transplant

86
Q

What is choleductal cyst?

A

Choledochal cyst is a congenital dilatation of part or whole of the bile duct

87
Q

List some causes of liver failure?

A 
Chronic hepatitis
Biliary atresia
Drug induced
Autoimmune hepatitis
Wilsons disease
alpha 1 antitrypsin deficiency
88
Q

Symptoms of liver failure?

A 
Jaundice,
Gi haemorrhage
Pruritis
Anaemia
FtT

3a (25 decks)

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