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Year 4 Paediatrics > Paediatric Gastroenterology > Flashcards

Paediatric Gastroenterology Flashcards

1
Q

Red flags for abdominal pain

A 
Persistent or bilous vomiting 
Severe chronic diarrhoea 
Fever 
Rectal bleeding 
Weight loss or failure to thrive 
Dysphagia 
Nocturnal pain 
Abdominal tenderness
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2
Q

Abdominal migraine features

A

Migraine associated with central abdominal pain lasting more than 1 hour

May have:

  • nausea and vomiting
  • anorexia and pallor
  • photophobia
  • aura
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3
Q

Management of abdominal migraines

A
  • low stimulus environment - dark, quiet room
  • paracetamol or NSAIDs
  • Sumatriptans
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4
Q

Management of recurrent abdominal migraines

A

Prophylaxis - propanolol or pizotifen (serotonin agonist)

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5
Q

Secondary causes of constipation

A

Hirschprung’s disease
Cystic fibrosis
Hypothyroidism
Intususseption

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6
Q

Constipation history

A
  • Frequency - normal vs now - less than 3 per week
  • consistency
  • blood or mucous in stool
  • abdominal pain
  • passed meconium
  • straining
  • diet and hydration
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7
Q

Red flags for constipation

A

Not passing meconium within 48 bours of birth
Neurological signs/ symptoms in lower limbs
Vomiting
Ribbon stool - anal stenosis
Failure to thrive
Acute severe abdo pain and bloating

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8
Q

Management of constipation

A
  • increase fibre in the diet
  • increase hydration
  • increase physical activity
  • movicol first line
  • praise toilet visits
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9
Q

Causes of reflux

A 
Physiological 
GORD 
CMPA
Overfeeding 
Pyloric stenosis - non bilous 
Intersusseption - bilous vomiting
Intestinal obstruction 
UTI 
Appendicitis
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10
Q

Signs of secondary reflux

A 
Chronic cough 
Hoarse cry 
Distress after feeding 
Reluctance to feed 
Pneumonia 
Failure to thrive
Dehydration - not wetting nappies
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11
Q

Red flags for reflux

A 
Not keeping down any food - pyloric stenosis
Projectile fomiting - pyloric stenosis 
Bilous - intestinal obstruction 
Haematemesis or maleana - peptic ulcer 
Abdominal distension - obstruction
Reduced consciousness - meningitis 
Resp symptoms - aspiration 
Blood in stools - CMPA or gastroenteritis 
Rash - CMPA
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12
Q

Reflux advice

A

Small frequent meals
Burping regularly
Not over feeding
Keep baby upright after feeding

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13
Q

Management of reflux

A

Gaviscon
Thickened milk or specific formulas
PPI and omeprazole

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14
Q

Sandifer’s syndrome

A

Condition causing brief episodes of abnormal movements associated with reflux

  • torticollis - forceful contraction of the neck muscles causing twisting
  • dystonia - twisting and arching of the back or unusual postures
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15
Q

Pathophysiology of pyloric stenosis

A

Hypertrophy of the pylorus causing stenosis

After feeding, there is powerful peristalsis which causes projectile vomiting

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16
Q

Presentation of pyloric stenosis

A

Projectile vomiting
Failure to thrive
Olive like mass on abdo examination

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17
Q

Blood gas result for pyloric stenosis

A

Hypochloric hypokalaemic metabolic alkalosis

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18
Q

Investigations for pyloric stenosis

A

USS abdomen

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19
Q

Treatment of pyloric stenosis

A

Laparoscopic pyloromyotomy - Ramstedt’s operation

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20
Q

Gastroenteritis pathophysiology

A

Inflammation of the stomach and intestines commonly due to a viral infection

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21
Q

Gastroenteritis presentation

A 
Nausea 
Vomiting 
Diarrhoea 
Dehydration
Abdominal cramps
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22
Q

Causative organisms of gastroenteritis and method of infection

A

Rotavirus
Norovirus

E.coli
Campylobacter jejuni - travellers diarrhoea, unpasterised milk
Shigella - faecal contamination
Salmonella - raw eggs and poultry
Bacillus cereus - uncooked food - fried rice
Yersinia enterocolitica - pigs, rats and rabbits

Giardiasis (parasite)

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23
Q

Why should antibiotics be avoided in gastroenteritis caused by E.Coli?

A

E.Coli produces shiga toxin which can cause haemolytic ureamic syndrome. Antibiotics can increase the risk of HUS

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24
Q

Which bacterial cause of gastroenteritis causes lymphadenopathy

A

Yersinia enterocolitica - mesenteric lymphadenitis can mimic appendicitis

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25
Management of gastroenteritis
Good hygiene Isolation Stay of school for 48 hours after symptoms have resolved Hydration - fluid challenge and dioralyte Antibiotics - may not be required
26
Investigations of gastroenteritis
Stool sample - microscopy, culture and sensitivity
27
Coeliac disease pathophysiology
Autoimmune reaction to gliadin factor present in gluten which targets epithelial cells of the intestines and causes atrophy
28
Investigations for coeliac disease
Remain on gluten diet: - Bloods - Anti TTG and anti endomysial A antibodies - endoscopy and biopsy - crypt hypertrophy and villous atrophy - IgA levels - rule out IgA deficiency
29
Conditions associated with Coeliacs disease
``` Type 1 diabetes Thyroid disease Autoimmune hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis Down’s syndrome Dermatitis herpetiformis ```
30
Presentation of coeliacs disease
``` Failure to thrive Abdominal distention Diarrhoea Fatigue Weight loss Mouth ulcers Anaemia - B12 deficiency Dermatitis herpetiforms ```
31
Genetic associations for coeliacs disease
HLA - DQ2 | HLA - DQ8
32
Complications of untreated coeliacs disease
``` Vitamin deficiency - vit B12 Anaemia Osteoporosis Ulcerative jejunitis Non hodgkins lymphoma Small bowel adenocarcinoma Enteropathy associated T cell lymphoma (EATL) ```
33
Treatment of coeliacs disease
Lifelong gluten free diet
34
Features of Crohns disease
- entire GI tract can be affected - skip lesions - terminal ileum most affected and transmural inflammation - strictures and fistulas - smoking exacerbates condition
35
Features of ulcerative colitis
- continuous inflammation - rectum always involved - superficial mucosa affected - smoking is protective - blood and mucous in stools - associated with primary sclerosing cholangitis
36
Presentation of inflammatory bowel disease
Abdominal pain Diarrhoea Weight loss Anaemia
37
Extra intestinal manifestations of inflammatpry bowel disease
``` Finger clubbing Erythema nodosum Pyoderma gangrenosum Iritis and episcleritis Inflammatory arthritis ```
38
Investigations for inflammtory bowel disease
Bloods - FBC (anaemia), TFTs, LFTs, U+Es Faecal calprotectin Endoscopy and biopsy CT abdomen
39
General management of inflammatory bowel disease
MDT | Monitor growth and pubertal development
40
Inducing remission in Crohns
1. Steroids - oral prednisolone or IV hydrocortisone 2. Add azathioprine, mercaptopurine or methotrexate 3. Infliximab
41
Maintaining remission in Crohns
1. Azathioprine or mecaptopurine 2. Methotrexate 3. Infliximab 4. Surgical resection of the terminal ileum
42
Inducing remission in ulcerative colitis
Mild to moderate - aminosalicylate e.g. mesalazine or 2nd line - prednisolone Severe - IV hydrocortisone or IV ciclosporin
43
Maintaining remission in ulcerative colitis
1. Aminosalicylates - mesalazine 2. Azothioprine 3. Mercaptopurine 4. Panproctocolectomy
44
Pathophysiology of Hirschsprung’s disease
Absence of the parasympathetic ganglion cells in the form of myenteric plexus nerve cells in the distal portion of the bowel and rectum therefore lack of peristalsis
45
Total colonic aganglionosis
Entire colon lacks parasympathetic ganglion cells
46
Conditions associated with Hirschsprung’s disease
Downs syndrome Neurofibromatosis Multiple endocrine neoplasia type II
47
Presentation of Hirschsprungs disease
``` Delay in passing meconium - more than 24 hours Chronic constipation since birth Abdominal pain and distention Vomiting Failure to thrive ```
48
Hirschsprung associated enterocolitis
Inflammation and obstruction associated with hirschsprungs disease causing fever and features of sepsis Can cause toxic megacolon and perforation Requires urgent abx, fluid resuscitation and decompression
49
Investigations for hirschsprungs disease
Rectal biopsy | Abdominal xray
50
Management of hirschsprungs disease
Fluid resuscitation NGT IV antibiotics are required if there is HAEC Surgical removal of the aganglionic section of the bowel
51
Intussusception pathophysiology
Bowel invaginates into itself, narrowing the lumen of the bowel and causes obstruction
52
Who does intussusception commonly present in
Infants 6 months - 2 years old boys
53
Conditions associated with intussusception
``` Concurrent viral illness Henoch Schonlein purpura Cystic fibrosis Intestinal polyps Meckel diverticulum ```
54
Presentation of intussusception
``` Severe colicky abdominal pain Pale, lethargic and unwell child Redcurrant jelly stool Sausage shaped mass in right upper quadrant Vomiting Intestinal obstruction ```
55
Investigations for intussusception
Abdominal USS
56
Management of intussusception
Therapeutic enemas - contrast, water, air | Surgical reduction
57
Complications of intussusception
Obstruction Gangrenous bowel Perforation Death
58
Pathophysiology of appendicitis
Inflammation of the appendix caused by infection or impacted faecolith
59
Peak incidence of appendicitis
Between the ages of 10 - 20 years old
60
Presentation of appenditis
RIF pain and tenderness Fever Nausea and vomiting Loss of apetite Rovsings sign Guarding Rebound tenderness
61
Investigations for appendicitis
Bloods - FBC, CRP Abdominal USS If symptomatic but investigations are negative - diagnostic laparoscopy
62
Management of appendicitis
Emergency admission | Appendicectomy

Year 4 Paediatrics (19 decks)

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