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Paediatrics > Paediatric Gastroenterology > Flashcards

Paediatric Gastroenterology Flashcards

1
Q

Diagnosis 4-12 wk old presenting with projectile, non-bilous vomiting?

A

Pyloric stenosis

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2
Q

What is the vomit like in PS?

A

White curd-like

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3
Q

What are other symptoms of PS?

A

Weight loss
Not feeding
Shock
DEHYDRATION

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4
Q

Investigation for PS?

A

Test feed

  • Examing abdomen that distends as it reaches pylorus
  • USS
  • Bloods
  • Blood gases
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5
Q

What will be seen on USS in PS?

A

Long thickened pylorus

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6
Q

What blood gas results will be seen in PS?

A

Metabolic alkalosis

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7
Q

What may be seen on bloods in PS?

A

Hypochloreamia

Hypokalaemia

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8
Q

Treatment PS?

A

Fluids replacement

Pyloric myotomy

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9
Q

3 causes of effortless vomiting?

A

Relaxation in LOS
Hiatus hernia
Neuromuscular disorder

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10
Q

What is sanifer’s syndrome?

A

Spastic torticollis

Dystonic movements

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11
Q

Investigation for effortless vomiting?

A

Barium swallow if dysphagia

Gold standard = pH study

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12
Q

Management of effortless vomiting?

A

Thickened feed
Oral stimulation
Exclusional diet if support fails - may be sensitivity
NG feeding - serious

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13
Q

What surgery can be done for effortless vomiting if it is causing failure to thrive or aspiration?

A

Nissen fundoplication

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14
Q

What is CMPA?

A

Cow’s milk protein allergy

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15
Q

% of CMPA?

A

2-5%

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16
Q

What does not mediate CMPA?

A

IgE

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17
Q

What is thought to mediate CMPA?

A

T cells

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18
Q

What are the symptoms of CMPA?

A 
Slow developing
Over hours and day
Diarrhoea and vomiting
Poor feeding
Reflux

Failure to thrive

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19
Q

What symptom may be present if it is IgE CMPA?

A

Eczema

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20
Q

Investigation for CMPA?

A

Exclusion trial diet for 6 months (mother)

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21
Q

Treatment for CMPA?

A

Formula - extensively hydrolysed formula

Exclude cows milk from mothers diet

Dietetics referral

Calcium supps

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22
Q

What can be tried at 6 months or 1year?

A

Milk challenge

  • Baked milk
  • Cooked milk
  • Yoghurt
  • Solids
  • Normal milk
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23
Q

What are the symptoms of an IgE allergy?

A 
Reaction within 2 hours
Urticaria
Angiodema
Pruritis
Conjunctivitis
Wheeze/stridor

Anaphylaxis

24
Q

What are causes of BILOUS vomiting?

A 
Intestinal atresia
Malrotation causing a volvulus
Intussiception
Ileus
Crohns - strictures
25
Q

What is green vomit always caused by?

A

Pathology

26
Q

What is investigation for bilous vomiting?

A

AxR
- Intussiception = target sign

Contrast meal

Surgical opinion

27
Q

What are causes of chronic constipation/soiling?

A 
Poor diet
Bad potty training 
Illness
Medication
Psychological
28
Q

What can chronic constipation lead to/withholding

A

Bowel impaction

- Large hard stool

29
Q

What are signs of bowel impaction?

A

Diarrhoea - watery

30
Q

Treatment of bowel impaction?

A

Laxatives high dose
Fluids
Totally empty colon then slowly wean off treatment

31
Q

Investigations of chronic constipation?

A

History

AxR if red flags

32
Q

3 types of laxatives?

A

Osmotic - lactulose
Stimulant - senna
Isotonic - movicol

33
Q

Treatment of Crohns?

A

5-ASA
Azothioprine
Methotrexate
Infliximab

34
Q

What are the 3 main causes of diarrhoea in kids?

A

MOTILITY DISTURBANCE
SECRETORY
OSMOTIC/MALABSORPTIVE

35
Q

What are the motility disturbance causes of diarrhoea?

A

IBS

Toddler diarrhoea

36
Q

What are the secretory causes of diarrhoea?

A

Infection
IBD
Congenital hypothyroidism

37
Q

What are the osmotic/malabsorptive causes of diarrhoea?

A

CF
Chronic liver disease (lack of bile)
Coeliac
Food allergy

38
Q

What is the pathology of secretory diarrhoea?

A

Driven by Cl- CFTR channels

39
Q

What is the pathology of osmotic diarrhoea?

A

Movement of water across the bowel to equalise equilibrium

40
Q

What is a red flag in the history?

A

Nocturnal defecation

41
Q

Define acute

A

<1 week

42
Q

Define persistent

A

2-4 weeks

43
Q

Define chronic

A

> 4 weeks

More than 4 stools per day

44
Q

Investigation for diarrhoea?

A

Faeces analysis

- Define type of diarrhoea

45
Q

What will faeces analysis show with secretory diarrhoea?

A

Large volume

Continues with fasting

46
Q

What will faeces analysis show with osmotic diarrhoea?

A

Small volume

Stops with fasting

47
Q

What genes cause coeliac?

A

HLA - DQ2/DQ8

48
Q

What is coeliac?

A

Gliadin sensitivity

49
Q

Investigations coeliac?

A

Anti - TTG
Anti-endomysial

Duodenal biopsy

50
Q

What may cause false positive anti-TTG?

A

IgA deficiency

51
Q

What should be tested if IgA is low?

A

Anti-endomysial Ab

52
Q

What levels of anti-TTG mean a duodenal biopsy is unnessesary?

A

10x normal with normal IgA

53
Q

Tx coeliac?

A

Gluten free diet for life

54
Q

What does untreated coeliac increase risk of?

A

Small bowel lymphoma

55
Q

What would be seen on duodenal biopsy in coeliac?

A

Crypt hypertrophy
Villous atrophy
Lyphocytic infiltration

Paediatrics (8 decks)

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