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Paediatric > Paed GI > Flashcards

Paed GI Flashcards

1
Q

what is failure to thrive and how is it classified

A

sub-optimal weight gain in infants or toddlers
usually kids <2nd centile but not always
mild failure to thrive if child slips 2 centiles
severe if child slips 3 centiles

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2
Q

what investigations would you complete for a child that is failing to thrive

A 
centile chart
FBC
serum ferritin
LFT
CRP
diet history and food diary
serum creatinine
U and E
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3
Q

causes of failure to thrive

A

low intake: inorganic: maternal depression, neglect, insufficient food, insufficient breast milk, poor breastfeeding technique, not regular feeding time, conflict over feeding
organic low intake: impaired suck or swallow e.g. neurodevelopment disorders, cleft lip and palate, chronic illnesses leading to anorexia- crohn’s. chronic renal failure
inadequate retention- vomiting, severe GORD
malabsorption: CF, cow’s milk protein intolerance, coeliac disease
failure to utilse: extreme premature, hypothyroidism
increased requirment: hyperthyroidism, congenital heart disease, CF, malignancy, HIV, chronic infections e.g. chronic rheumatic fever

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4
Q

what is marasmus

A 
marasmus manifest from severe protein-energy malnutrition
wasted wizened appearance
no oedema
reduced mid-arm circumference
skin folds thickened
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5
Q

what is classified as severe malnutrition

A

weight to height <3SD below median

under 70% weight for height

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6
Q

what is kwashiorkor

A 
manifests from severe protein-energy malnutrition
oedema
wasting
hyperkeratosis, skin thickening
hair thinning
paint-flaky skin rash
diarrhoea
hypotension
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7
Q

management of marasmus and kwashiorkor

A

correct hypothermia, hypoglycaemia, dehydration (but slowly) and correct electrolytes esp K
small but frequent feeds, low in protein initially but then increase
supplement vitamins
community care unless complications or loss of appetite and child won’t eat

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8
Q

what is posseting vs regurgitating vs vomiting

A

posseting and regurgitating- non-forceful return of milk
posseting- small amount after baby swallows air
regurgitation more large and more frequent return
vomiting- forceful ejection of gastric content

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9
Q

what to suspect if bile stained vomit

A

Necrotising enterocolitis

bowel atresia

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10
Q

haematemesis what to suspect

A

peptic ulcer, oesophagitis, oral or nasal bleed

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11
Q

projectile vomiting in first few weeks what to suspect

A

pyloric stenosis

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12
Q

what is gord

A

gastro-oesophageal reflux disease

involuntary passage of gastric content into oesophagus

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13
Q

causes/contributing factors of GORD

A

inappropriate relaxation of lower oesophageal sphincter due to functional immaturity
mainly liquid diet
mostly horizontal position
short intra-abdominal length of oesophagus
worse in cerebral palsy or other neurodevelopmental disorders, preterm infants

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14
Q

features of GORD

A

recurrent regurgitation or vomiting
usually weight is fine and baby is happy
severe if failure to thrive, oesophagitis, iron deficient anaemia, pulmonary aspiration, recurrent pneumnia, dystonic neck posturing (sandifer syndrome)

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15
Q

investigations for GORD

A

usually clinical diagnosis if complications or atypical hx: oesophageal pH monitoring, endoscopy w oesophageal biopsy

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16
Q

treatment of GORD

A 
most resolve spontaneously by 12m age
if severe- omeprazole
introduce thickening agents to diet
feed with head prone
surgery for severe unresponsive to intensive treatment
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17
Q

what is pyloric stenosis

A

hypertrophy of pyloric muscle causes gastric outlet obstruction

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18
Q

when does pyloric stenosis often present and in which gender more often

A

2-7w regardless of gestation age
male 4:1 female
esp first born, maternal fhx

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19
Q

features of pyloric stenosis

A

vomiting increasing in frequency and forcefulness until projectile vomiting
hungry after vomiting until becomes dehydrated and uninterested in feed
weight loss late sign

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20
Q

management of pyloric stenosis

A

check fluid requirement and correct any emergency electrolyte
test feed with milk and see gastric peristalsis wave from L to R (can do USS if doubt diagnosis)
rx- correct IV 0.45% saline, 5%dextrose, K supplement and surgery

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21
Q

what occurs to electrolytes during pyloric stenosis

A

Na Cl and K low

metabolic alkalosis

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22
Q

what occurs in surgery for pyloric stenosis

A

cut hypertrophied muscle down to but not including mucosa

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23
Q

what is infant colic

A

benign
inconsolable crying/screaming
infant draws up knees and excessive flatus throughout day esp evening
can precipitate NAI if already at risk

24
Q

management of infant colic

A

reassure and support
resolves around 4m often
if severe/persistent- investigate cow’s milk or GORD

25
Q

acute appendicitis features

A

anorexia, few vomiting, abdomen pain central and colicky then localises to r iliac fossa Mcburney;s point, guarding and pain worse on movement, low fever, flushed face

26
Q

managementmfor acute appendicitis

A

repeat observations and vital signs and check fluid
repeat USS
balance between delay or unnecessary surgery
if guarding/ peritonitis most likely needs surgery, give prophylaxis antibiotic
if no peritonitis then may be able to give iv antibiotic and do surgery later with regular monitoring

27
Q

what is intussusception?

A

invagination of proximal bowel into distal segment often ileum into caecum

28
Q

common presenting age of intussusception

A

2m-3y

29
Q

features of intussusception

A

colicky pain severe. during pain legs drawn to chest, crying, pallor, after pain lethargic
distended abdo, peritonitis if perforation, shock, redcurrent jelly stool late sign, bile stained vomit
on examination- sausage mass in abdo

30
Q

management of intussuception

A

don’t delay treatment
if unsure AXR- distended bowel loops, no air in distal colon or rectum
USS confirms response to treatment
IV fluids!! prophylaxis antibiotic for perforation risk
if no perforation –> radiologist try air insufflation
if doesn’t work or peritonitis or shock–> surgery operate

31
Q

what is meckel diverticulum

A

ectopic gastric mucosa or pancreatic tissue at ileal remnant of vitello -intestinal duct

32
Q

features of meckel diverticulum

A

range from asymptomatic to life threatening rectal bleeding, intussusception, volvus, diverticulitis

33
Q

management of meckel diverticulum

A

technetium scan shows uptake by gastric mucosa

surgical resection

34
Q

what is a hernia and types

A 
abdomen lining or section of bowel bulges through weak area in abdo muscle wall
inguinal
hiatus
epigastric
umbilical
incisional
35
Q

features of hernia and treatment and complication

A

lump, bigger on straining or standing
pain tender sometimes
persistent crying in baby

complication- strangulation
rx- surgery to avoid strangulation

36
Q

features of strangulated hernia

A

nausea, vomiting, abdo distended, bulge enlarges and redder

37
Q

describe inguinal hernia

A

direct- tissue push out of weak section in abdo muscle wall
indirect- inguinal canal fail to close before birth, tissue passes through
most common

38
Q

umbilical hernia describe

A

more common in <6m

umbilical cord exit fails to close

39
Q

epigastric hernia describe

A

more in boys

protrusion through abdo muscles between chest and umbilicus

40
Q

hiatal hernia describe

A

upper part of stomach bulges out of diaphragm, may have heart burn chest pain

41
Q

incisional hernia describe

A

after surgery abdo

42
Q

describe abdominal migraine

A

associated with abdo pain, headaches, vomiting, pallor face

personal or family hx of migrains

43
Q

describe IBS what and features

A

irritable bowel syndrome
altered GI motility, abnormal sensation of intra-abdominal events
abdo pain often worse before defecation
explosive loose stool, mucous stool, constipated, alternates with normal stool, varying levels of diarrhoea vs constipation
bloating, feeling of incomplete defecation
symptoms are chronic >6m

44
Q

investigations for IBS

A

exclude other causes
stool culture if lots of diarrhoea
b12/folate levels
anti-endomysial antibodies

45
Q

red flags in ibs hx to make sure you exclude other causes

A

bloody stool
weight loss
pain or diarrhoea waking up at night
mouth ulcer

46
Q

rx of IBS

A 
healthy diet (fibre, caffiene, fizzy drinks, fructose, lactose, wheat some things that make it worse)
treat any psychosocial issues
depending on main symptoms:
constipation: bisacodyl
diarrhoea: loperamide
bloating: mebeverine
47
Q

gastroenteritis common causative agents

A

GI infection
viral>bacterial in kids
rotavirus (most common in developed countries esp <2y), adenovirus, norovirus, coronavirus
bacterial- campylobacter jejuni, shigella, salmonella, e.coli, cholera

48
Q

features of gastroenteritis

A

change to loose stools
vomiting fever
recent contact w person w symptoms or travel hx
complication is dehydration and shock

49
Q

why is gastroenteritis so worrying in children

A

dehydration and shock complication

50
Q

why is dehydration more risk in children

A

high insensible losses
300ml/m2/day or 15-17ml/kg/day
higher basal fluid requirements 100-120ml/kg/day

51
Q

who is more at risk of dehydration from gastroenteritis

A 
<6m
>6 diarrhoeal stool in 24h
>3 vomiting in 24h
no extra fluids given
malnutrition
52
Q

when is clinically detectable dehydartion and shock seen, i.e. how much body weight loss

A

5-10% clinical dehydration

>10% shock

53
Q

investigations with gastroenteritis

A

measure degree of weight loss, hsock hx and examination
stool sample and culture if septic, bloody or mucus diarrhoea, immunocompromised child, unimproved diarrhoea
check UE, creatine, glucose, blood cultures if giving antibiotic

54
Q

dehydration types in gastroenteritis and why

A

isonatraemic
hyponatraemic- given lots of hypotonic solution so greater net loss of Na than water)
hypernatraemic- high insensible loss due to fever or hot environment or low sodium diarrhoea)

55
Q

what happens in hyponatraemic dehydration

A

water moves extra to intracelllar space
increased brain volume
seizure, worsening shock

56
Q

what happens in hypernatraemic dehydartion

A

water moves intra to extracellular space
cerebral shrinkage, depressed fontanelle, increased muscle tone, hyperreflexia, altered consciousness, transient hyperglycaemia

Paediatric (6 decks)

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