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Paediatrics > Paediatric Gastroenterology > Flashcards

Paediatric Gastroenterology Flashcards

1
Q

4 presentations of vomiting

A

Vomiting with retching
Projectile vomiting
Effortless vomiting
Bilious vomiting

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2
Q

Symptoms of vomiting pre-ejection phase

A

Pallor
Tachycardia
Nausea

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3
Q

Stimuli of vomiting centres

A 
Enteric pathogens
Intestinal inflammation
Metabolic derangement
Infection
Head injury
Visual stimuli
Middle ear stimuli
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4
Q 
Differentials for case
6 week old baby
3 week history of vomiting after every feed
Bottle fed 6 ounces hourly
Vomit - large volume, mikly/curdy, projectile
Irritable, crying
Not gaining any weight
Dehydrated
A

Gastrooesophageal reflux
Overfeeding
Pyloric stenosis

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5
Q

Signs of pyloric stenosis with further examination/investigation

A

Test feed
Palpation of olive tumour
Visible gastric peristalsis

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6
Q

Investigations for pyloric stenosis

A

Blood gas

Ultrasound

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7
Q

Management of pyloric stenosis

A

Fluid resuscitation

Ramstedts pyloromyotomy

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8
Q

Which group of patients does pyloric stenosis commonly present in?

A

Babies 4-12 weeks

More common in boys

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9
Q

Symptoms of pyloric stenosis

A

Projectile non-bilious vomiting, particularly 30 minutes after feed
Dehydration
Weight loss
Shock

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10
Q

Electrolyte disturbance characteristic of pyloric stenosis

A

Hypochloraema
Hypokalemia
Metabolic alkalosis

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11
Q

Why does bilious vomiting occur?

A

Intestinal obstruction until proven otherwise

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12
Q

Cases of bilious vomiting

A 
Malrotation
Intussusception
Atresia
Ileus
Crohns with strictures
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13
Q

Investigations of bilious vomiting

A

Abdominal x-ray
Contrast meal
Laparotomy

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14
Q

Most common cause of effortless vomiting

A

Gastrooesophageal reflux

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15
Q

Prognosis of effortless vomiting due to GOR

A

Usually self-limiting

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16
Q

Exceptions to self-limiting effortless vomiting/reflux

A

Cerebral palsy
Progressive neurological problems
Oesophageal atresia +/- TOF operated
Generalised GI motility

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17
Q

Presenting symptoms of gastrooesophageal reflux

A

Vomiting
Haematemesis

Feeding problems
Failure to thrive

Apnoea
Cough
Wheeze
Chest infections

Sandrifer’s syndrome

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18
Q

What is sandrifer’s syndrome?

A 
Neurological disorder - movement associated
Nodding
Rotation of head
Spastic torticollis
Dystonic movement

Movement could be to ease discomfort

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19
Q

Assessment of gastrooesophageal reflux

A 
History
Examination
Radiology - video fluoroscopy / barium swallow
pH study
Oesophageal impedance monitor
Endoscopy
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20
Q

4 elements of treatment for Gastrooesophageal reflux

A

Feeding Advice
Nutritional support
Medical
Surgical

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21
Q

Management of feeding in gastrooesophageal reflux

A

Using thickeners for liquids
Looking at food textures and amounts
Behavioural programme - oral stimulation, remove aversive stimuli
Feeding position

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22
Q

Nutritional management of gastrooesophageal reflux

A

Calorie supplements
Exclusion diet
NG tube
Gastrotomy

23
Q

Medical management of gastrooesophageal reflux

A

Food thickeners - gaviscon
Prokinetic drugs
Acid suppressing drugs - PPIs, H2R blockers

24
Q

Indications for surgery in gastrooesophageal reflux

A

Failure to thrive
Aspiration
Oesophagitis

25
Q

Surgical interventions for gastrooesophageal reflux

A

Nissens fundoplication

26
Q

Complications of nissen fundoplication

A

Post op in cerebral palsy - bloating, dumping |(sweating and diarrhoea) and retching

May unmask other GI motility issues

27
Q

Definition of chronic diarrhoea

A

Greater than 4 stools per day for weeks

28
Q

Causes of diarrhoea

A

Motility disturbance - toddlers diarrhoea, IBS
Active secretion - acute infective, inflammatory bowel disease
Malabsorption of nutrients - Coeliac, food allergy, cystic fibrosis

29
Q

4 types of diarrhoea

A

Osmotic
Secretory
Motility
Inflammatory

30
Q

Causes of motility diarrhoea

A

Toddlers
IBS
Congenital hyperthyroidism
Chronic intestinal pseudo obstruction

31
Q

Cause of secretory diarrhoea

A

Enterotoxigenic e coli
Vibrio cholerae
Active chloride secretion by CFTR

32
Q

Clinical approach to assessing child with diarrhoea

A 
History 
- Age of onset
= Abrupt/gradual onset
- Family history
-Nocturnal defecation

Weight of child and growth
Faeces analysis - stool culture

33
Q

What does nocturnal defecation in a child presenting with diarrhoea indicate?

A

Organic cause

34
Q

Causes of fat malabsorption

A

Pancreatic disease

Hepatobiliary disease - chronic liver disease, cholestasis

35
Q

Signs and symptoms of coeliac disease

A 
Abdominal bloatedness
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpatiformis
36
Q

Screening for coeliac disease

A

Serology
Duodenal biopsy
Genetic testing

37
Q

Which serological tests are carried out for coeliac disease?

A

Anti-tissue transglutaminase
Anti endomysial
Antigliadin

38
Q

What deficiency can result in false negatives in serological testing for coeliac disease?

A

IgA

39
Q

Which genes are tested for coeliac disease?

A

HLA DQ2

DQ 8 Positive

40
Q

How might a child be diagnosed with coeliac without performing a duodenal biopsy>

A

Symptomatic
Anti TTG > times 10 of normal upper limit
Positive anti endomysial antibodies
HLA DQ2 DQ8 positive

41
Q

Treatment for coeliac disease

A

Gluten free diet for life
( cannot exclude gluten prior to diagnosis)
Can rechallenge and rebiopsy in children who present under 2 years of age

42
Q

Leaving coeliac disease untreated can result in what condition

A

Greater risk of rare small bowel lymphoma

43
Q

What percentage of infants experience regurgitation?

A

40%`

44
Q

When is regurgitation and gastrooesophageal reflux most likely to present?

A

Around 2 weeks

45
Q

Define regurgitation

A

Passing of stomach contents beyond the oesophagus

46
Q

Risk factors for GOR/GORD in infantsq

A

Prematurity
Parental history of heartburn or acid regurgitation
Obesity
Hiatus hernia
History of (repaired) congenital diaphragmatic hernia
History of (repaired) congenial oesophageal atresia
Neurodisability (eg. cerebral palsy)

47
Q

Example of a full feeding history

A

Check position, attachment, technique, duration, frequency and type of milk.
Calculate the volume of milk being given as babies can be over-fed and therefore have gastric over-distension.
Ask about frequency and estimated volume of vomits
Find out the relationship of symptoms to feeds.

48
Q

Symptoms to enquire about related to episodes of GORD

A

Distressed behaviour (eg. excessive crying, unusual neck postures, back-arching)
Unexplained feeding difficulties (refusing feeds, gagging, choking)
Hoarseness and/or chronic cough in children
A single episode of pneumonia
Faltering growth
If child is able to they may report retrosternal or epigastric pain

49
Q

Other differentials for GORD

A

Pyloric stenosis: Frequent, forceful (projectile) vomiting in <2 month olds
Intestinal obstruction: bile-stained (green or yellow-green) vomit, such as malrotation volvulus
Any acute surgical abdominal issue: abdominal distension, tenderness, or palpable mass
Upper gastrointestinal bleed: haematemesis (beware swallowed blood from cracked nipple if breastfeeding or patient with epistaxis)
Sepsis: altered responsiveness, severe prolonged vomiting, petechial rash, bulging fontanelle if central nervous system involvement
Raised intracranial pressure: rapidly increasing head circumference (>1cm per week), persistent headache and vomiting following periods of recumbence (eg. in morning)
Blood in stool: consider bacterial gastroenteritis, cow’s milk protein allergy.
Chronic diarrhoea, especially if atopic: consider cow’s milk protein allergy.
Urinary tract infection especially if associated with lower urinary tract symptoms
If onset is >6 months of age or symptoms persist beyond 1 year then reflux is unlikely

50
Q

Conditions related with coeliac disease

A

Type 1 diabetes
Down syndrome
Turner syndrome
Other autoimmune diseases, such as thyroid disease, rheumatoid arthritis & Addison’s disease.

51
Q

Histological changes in biopsy for coeliac

A

Crypt hyperplasia

Villous atrophy

52
Q

Differential diagnosis for coeliac disease

A 
Tropical sprue
Cystic fibrosis
Inflammatory bowel disease
Post – gastroenteritis
Autoimmune enteropathy
Eosinophilic enteritis
53
Q

Classification of duodenal biopsy for coeliac disease

A

Stage Definition
0 Normal
1 Increased intraepithelial lymphocytes
2 Increased inflammatory cells and crypt hyperplasia
3 All of the above plus mild to complete villous atrophy – specific to coeliac disease

54
Q

Complications of coeliac disease

A

anaemia
osteopenia/ osteoporosis
refractory coeliac disease( symptoms persist despite diet, my need treatment with steroids)
malignancy
fertility problems/ adverse events during pregnancy
depression/ anxiety (11, 12)

Paediatrics (10 decks)

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