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Finals > Paediatric gastroenterology > Flashcards

Paediatric gastroenterology Flashcards

1
Q

What is pyloric stenosis ?

A

-Hypertrophy of the pyloric muscle leading to narrowing and oulet obstruction

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2
Q

Give 4 clinical features of pyloric stenosis

A
  • Projectile vomit
  • Hunger after vomiting
  • Failure to thrive
  • Olive shaped mass in upper abdomen
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3
Q

What would a blood gas show in pyloric stenosis ?

A

Hypochloric metabolic alkalosis with low plasma sodium and potassium due to vomiting stomach contents

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4
Q

When does pyloric stenosis present ?

A
  • First few weeks of life
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5
Q

What can be seen on abdo exam in pyloric stenosis ?

A
  • Pyloric mass in RUQ (olive like )
  • Gastric peristalsis seen as a wave moving from left to right across the abdomen
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6
Q

How is pyloric stenosis diagnosed ?

A
  • Test feed
  • USS
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7
Q

How is pyloric stenosis managed ?

A
  • Ramstedt’s pyloromyotomy
  • Correct fluid and electrolyte disturbance with IV fluids
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8
Q

Define biliary atresia

A
  • Section of the bile duct is either narrowed or absent
  • This leads to cholestasis, where bile cannot be transported from the liver to the bowel
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9
Q

How does biliary atresia present

A
  • Persistent jaundice shortly after birth
  • Dark urine, pale stools
  • Hepatosplenomegly
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10
Q

Define prolonged jaundice in term and premature babies

A
  • Term : 14 days
  • Premature : 21 days
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11
Q

What investigations are used in biliary atresia ?

A
  • Raised levels of conjugated bilirubin
  • There will be a high proportion of conjugated bilirubin (the liver can process it but not excrete it)
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12
Q

How is biliary atresia managed?

A
  • > Kasai portoenterostomy : attaching a section of the small intestine to the opening of the liver where the bile duct normally attaches.
  • > Often require a liver transplant in later life
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13
Q

Define Hirschsprung disease

A

-Congenital condition where the nerve cells in the myenteric plexus are absent (aganglionic) in the rectum and variable distance of the colon

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14
Q

Give 4 presenting signs of Hirschsprung

A
  • Failure to pass meconium in the first 24 hrs of life
  • Abdominal distention
  • Later : bile-stained vomit
  • If presentation is later in life : profound chronic constipation, abdo distention and growth failure
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15
Q

How is Hirschsprung diagnosed ?

A

-Suction rectal biopsy

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16
Q

How is Hirschsprung managed ?

A
  • Initially : rectal washouts/irrigation to prevent enterocolitis
  • Surgically : initial colostomy with removal of the aganglionic section, followed by anastomosing normally innervated bowel the the anus -> swenson
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17
Q

What is a severe complication of Hirschsprung disease ?

A

-Hirschsprung-Associated Enterocolitis (HAEC)

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18
Q

What can cause HAEC and how does it present ?

A
  • C.diff
  • Fever, abdo distention, diarrhoea (often bloody) and features of sepsis
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19
Q

How is HAEC managed ?

A
  • IV antibiotics
  • Fluid resus
  • Decompression of obstructed bowel
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20
Q

what conditions is hirschsprung’s associated with ?

A
  • Down’s
  • Waardenburg
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21
Q

What is intussusception and when does it occur?

A
  • Invagination of proximal bowel into a distal segment
  • Usually occurs between 6mnths and 2 yrs of age
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22
Q

How does intussusception present

A
  • Concurrent viral illness !
  • Severe colciky pain and pallor causing a child to draw their legs up
  • Redcurrant jelly stool
  • Palpable sausage shaped mass in the abdomen
  • Intestinal obstruction : vomiting, constipation, abdo distention.
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23
Q

What is associated with intussusception

A
  • Meckel diverticulum
  • Henoch-Schonlein purpura
  • Cystic fibrosis
  • Intestinal polyps
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24
Q

What is Meckels diverticulum and how does it present ?

A
  • Ileal remnant of the vitello-intestinal duct
  • Presents with severe rectal bleeding : most common cause of painless massive GI bleeding requiring transfusion between the ages of 1 and 2.
  • Diverticulitis micking appendicitis.
  • Often haemadynamically unstable due to the bleeding.
  • Treated with surgical resection
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25
Q

How is intussusception diagnosed ?

A
  • USS : target sign
  • Contrast enema
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26
Q

How is intussusception managed ?

A
  • Rectal air insufflation : therapeutic enema
  • Surgery if reduction of air is ineffective
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27
Q

How is intussusception managed if there are signs of peritonitis ?

A
  • Surgery
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28
Q

Give 4 complications of intussusception

A
  • Obstruction
  • Gangernous bowel
  • Perforation
  • Death
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29
Q

What are the symptoms of an appendicitis ?

A
  • Umbilical pain that spreads to the RIF
  • Anorexia
  • N&V
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30
Q

What are the signs of an appendicitis ?

A
  • > Tenderness and guarding over McBurney’s point
  • > Rovsing’s sign : palpation in LIF causes pain in the RIF
  • > Fever
  • > Abdo pain aggravated my movement
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31
Q

Give 2 signs of peritonitis

A
  • Rebound tenderness : increased pain following quick release of pressure of RIF
  • Percussion tenderness
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32
Q

Give 3 complications of an appendicitis

A
  • Rupture -> peritonitis
  • Abscess
  • Appendix mass
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33
Q

What is malrotation ?

A

-Malrotation of the small bowel during foetal life

34
Q

How does malrotation present ?

A
  • Bilious vomiting in the first few days of life
  • can lead to volvus formation leading to an obstruction and ischaemic bowel
  • Abdo pain and tenderness from peritonitis or ischaemic bowel
  • Associated with exomphalos & hernia
35
Q

How is malrotation diagnosed ?

A
  • Upper GI contrast study
  • Abdo USS : whirlpool sign
36
Q

How is malrotation managed ?

A

-Surgery to untwist the bowel : Ladd’s

37
Q

how will an intestinal obstruction present

A
  • Persistent vomiting. This may be bilious, containing bright green bile.
  • Abdo pain and distention
  • Failure to pass stools or wind
  • Abnormal bowel sounds. These can be high pitched and “tinkling” early in the obstruction and absent later
38
Q

What are the differentials of intestinal obstruction in a child

A
  • Meconium ileus
  • Malrotation with volvus formation
  • Hirchsprung’s
  • Intussusception
  • Oesophageal atresia
  • Duodenal atresia
  • Imperforate anus
  • Strangulated hernia
39
Q

What is mesenteric adenitis and how does it present

A
  • Inflammation of the lymph nodes in the abdomen
  • Central abdominal pain and concurrent URTI
40
Q

How are simple cases of GORD in children managed ?

A
  • Small, frequent meals
  • Burping regularly to help milk settle
  • Not over-feeding
  • Keep the baby upright after feeding (i.e. not lying flat)
41
Q

How can more problematic cases of GORD in children be managed ?

A
  • Gaviscon mixed with feeds
  • Thickened milk or formula
  • PPI : if -> faltering growth, distressed behaviour
42
Q

What is Sandifer’s syndrome ?

A
  • Episodes of abnormal movement associated with GORD in infants
43
Q

What are the key features of sandifer’s syndrome

A
  • Torticollis: forceful contraction of the neck muscles causing twisting of the neck
  • Dystonia: abnormal muscle contractions causing twisting movements, arching of the back or unusual postures
44
Q

Exam question : child <5 presents with watery loose stools containing bits of vegetables up to 10 times a day. What is the diagnosis ?

A

Toddler’s diarrhoea

45
Q

what are the genetic associations with coeliac disease ?

A

HLA-DQ2 gene (90%)
HLA-DQ8 gene

46
Q

what auto-antibodies are seen in coeliac disease and what damage do they cause

A
  • Anti-tissue transglutaminase (anti-TTG)
  • Anti-endomysial (anti-EMA)
  • Target the epithelial cells leading to inflammation -> causing atrophy of the intestinal villi and crypt hypertrophy. Particularly in the jejnum
47
Q

How can coeliac disease present in children?

A
  • Failure to thrive
  • Diarrhoea
  • Fatigue
  • Weight loss
  • Mouth ulcers
  • Anaemia
  • Dermatitis herpetiformis on the abdomen
48
Q

what neurological symptoms can rarely be seen in coeliac disease

A

Peripheral neuropathy
Cerebellar ataxia
Epilepsy

49
Q

what needs to be tested before looking at the antibodies involved in coeliac screening ?

A
  • Total IgA levels
  • If total IgA is low the coeliac test will be negative even when they have the condition as anti-TTG and anti-EMA are IgA antibodies
50
Q

what 3 malignancies are recognised complications of untreated coeliac disease ?

A
  • Enteropathy-associated T-cell lymphoma (EATL) of the intestine
  • Non-Hodgkin lymphoma (NHL)
  • Small bowel adenocarcinoma (rare)
51
Q

Define crohns disease

A

-Transmural granulomatous chronic inflammation of the GI tract

52
Q

How does crohns disease present ?

A
  • Abdo pain, diarrhoea, weight loss
  • Growth failure due to malabsorption
  • Delayed puberty
53
Q

What are the extraintestinal symptoms of crohns?

A
  • Oral lesions or perianal skin tags
  • Uveitis
  • Arthralgia
  • Erythema nodosum
54
Q

What bloods are seen in crohns ?

A
  • Raised faecal calprotectin
  • Raised plts, ESR and CRP
  • IDA due to malabsorption
  • low serum albumin
55
Q

What is seen on endoscopy + biopsy in crohns

A
  • Skip lesions
  • Non-caseating granulomas
  • Transmural damage, terminal ileum most severe
56
Q

How is remission induced in crohns ?

A
  • Nutritional therapy for 6-8 wks

- Systemic steroids if necessary (oral pred, IV hydrocortisone)

57
Q

How is remission maintained/relapse treated in crohns?

A
  • Immunosuppressant medication : azathioprine, mercaptpurine, methotrexate
  • Infliximab, adalimumab if necessary
58
Q

Give 3 complications of crohns

A
  • Bowel strictures leading to obstruction
  • Fistulae
  • Abscess formation
59
Q

Define ulcerative colitis

A

-Recurrent, inflammatory and ulcerating disease involving the mucosa of the colon

60
Q

How does UC present ?

A
  • Rectal bleeding, diarrhoea and colicky abdo pain
  • Weight loss
  • Growth failure
61
Q

Give 3 extraintestinal signs of UC

A
  • Arthritis
  • Erythema nodosum
  • Primary sclerosing cholangitis
62
Q

Give 3 signs of UC on endoscopy + biopsy

A
  • Continuous inflammation
  • Begins in the rectum and travels proximally
  • Possible crypt abscesses
63
Q

How is remission induced in UC ?

A
  • Mild : aminosalicylates (e.g. mesalazine) or corticosteroids
  • More severe : IV corticosteroids or IV ciclosporin
64
Q

How is remission maintained in UC

A
  • Aminosalicylate
  • Azathioprine
  • Mercaptopurine
65
Q

What is a complication of UC ?

A

-Increased risk of adenocarcinoma of the colon in adulthood

66
Q

Give 3 common causes of viral gastroenteritis

A
  • Rotavirus
  • Norovirus
  • Adenovirus -> less common, more subacute diarrhoea
67
Q

How would E.coli present if causing gastroenteritis

A
  • Abdo cramps, bloody diarrhoea, vomiting.
  • The shiga toxin leads to HUS
  • Abx should be avoided due to increased risk of HUS
68
Q

What is the most common bacterial causes of gastroenteritis worldwide ?

A
  • Campylobacter jejuni -> gram neg
  • Abdo cramps, bloody diarrhoea, vomiting, fever
  • Raw poultry, untreated water, unpasteurised milk
  • Abx : azithromycin, ciprofloxacin
69
Q

How would shigella gastroenteritis present ?

A
  • Faeces contaminated food and water
  • Bloody diarrhoea, abdo cramps, fever
  • Shiga toxin -> HUS
  • Severe : azithromycin or ciprofloxacin
70
Q

Explain salmonella causes of gastroenteritis

A
  • Raw eggs, poultry
  • Watery diarrhoea with possible mucus or blood
  • Abx only in severe cases
71
Q

How does bacillus cereus as a cause of gastroenteritis present ?

A
  • Fried rice eaten at room temp
  • Cereulide toxin produces abdo cramping and vomiting withing 5 hrs
  • Diarrhoea within 8 hrs
  • Resolves within 24
  • Gram positive rod
72
Q

Give a parasitic cause of gastroenteritis

A
  • Giardia lamblia
  • Chronic diarrhoea
  • Tx : metronidazole

- Tx with metronidazole

73
Q

What are the principles of gastroenteritis management

A
  • Barrier nursing
  • Stool microscopy, culture and sensitivities
  • Hydration -> attempt fluid challenge. Dioralyte can be used to rehydrate or IV fluid is needed
74
Q

How can intestinal obstruction present and how is it diagnosed ?

A
  • Persistent, possibly bilious vomiting
  • Abdo pain and distention
  • Failure to pass stool or wind
  • Abnormal bowel sounds : high pitched ‘tinkling’, absent later
  • XRAY : dilated bowel proximal and collapsed loops distal + absence of air in rectum
75
Q

Define encopresis

A
  • Faecal incontinence -> pathological at 4 yrs
  • Chronic constipation causes the rectum to stretch and lose sensation.
  • Only loose stool can bypass blockage and leak out
76
Q

How is constipation managed if faecal impaction is present ?

A
  • Movicol peadiatric plan
  • Add stimulant after 2 wks if no change (e.g. bisacodyl, senna)
  • Add osmotic laxative (lactulose)
77
Q

How is general constipation managed

A
  • Movicol paediatric plan
  • Add stimulant
  • Add osmotic laxative
  • Continue for several weeks after refulat bowel habit.
78
Q
  • Bacteria most commonly affecting children
  • Causes watery or blood diarrhoea, abdo pain, fever and lymphadenopathy
  • Can mimic appendicitis by causing mesenteric lymphadenitis in older children
  • Caused by raw or undercooked pork
A

Yersinia enterocolitica

79
Q

What is an abdominal migraine

A
  • Episodes of central abod pain, lasting >1 hr
  • Possible associated : Nausea and vomiting, Anorexia, Pallor, Headache, Photophobia, Aura
80
Q

How are acute attacks of abdominal migraines managed ?

A
  • Low stimulus environment (quiet, dark room)
  • Paracetamol
  • Ibuprofen
  • Sumatriptan
81
Q

What is the main preventer used in abdominal migraines ?

A

Pizotifen -> serotonin agonist

82
Q
A

Finals (92 decks)

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