Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Paediatrics > Paediatric Gastroenterology > Flashcards

Paediatric Gastroenterology Flashcards

1
Q

4 presentations of vomiting

A

Vomiting with retching
Projectile vomiting
Effortless vomiting
Bilious vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of vomiting pre-ejection phase

A

Pallor
Tachycardia
Nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stimuli of vomiting centres

A 
Enteric pathogens
Intestinal inflammation
Metabolic derangement
Infection
Head injury
Visual stimuli
Middle ear stimuli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signs of pyloric stenosis with further examination/investigation

A

Test feed
Palpation of olive tumour
Visible gastric peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations for pyloric stenosis

A

Blood gas

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of pyloric stenosis

A

Fluid resuscitation

Ramstedts pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which group of patients does pyloric stenosis commonly present in?

A

Babies 4-12 weeks

More common in boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms of pyloric stenosis

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Electrolyte disturbance characteristic of pyloric stenosis

A

Hypochloraema
Hypokalemia
Metabolic alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why does bilious vomiting occur?

A

Intestinal obstruction until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cases of bilious vomiting

A 
Malrotation
Intussusception
Atresia
Ileus
Crohns with strictures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations of bilious vomiting

A

Abdominal x-ray
Contrast meal
Laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most common cause of effortless vomiting

A

Gastrooesophageal reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Prognosis of effortless vomiting due to GOR

A

Usually self-limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Exceptions to self-limiting effortless vomiting/reflux

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Presenting symptoms of gastrooesophageal reflux

A

Vomiting
Haematemesis

Feeding problems
Failure to thrive

Apnoea
Cough
Wheeze
Chest infections

Sandrifer’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Assessment of gastrooesophageal reflux

A 
History
Examination
Radiology - video fluoroscopy / barium swallow
pH study
Oesophageal impedance monitor
Endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

4 elements of treatment for Gastrooesophageal reflux

A

Feeding Advice
Nutritional support
Medical
Surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Surgical interventions for gastrooesophageal reflux
Nissens fundoplication
26
Complications of nissen fundoplication
Post op in cerebral palsy - bloating, dumping |(sweating and diarrhoea) and retching May unmask other GI motility issues
27
Definition of chronic diarrhoea
Greater than 4 stools per day for weeks
28
Causes of diarrhoea
Motility disturbance - toddlers diarrhoea, IBS Active secretion - acute infective, inflammatory bowel disease Malabsorption of nutrients - Coeliac, food allergy, cystic fibrosis
29
4 types of diarrhoea
Osmotic Secretory Motility Inflammatory
30
Causes of motility diarrhoea
Toddlers IBS Congenital hyperthyroidism Chronic intestinal pseudo obstruction
31
Cause of secretory diarrhoea
Enterotoxigenic e coli Vibrio cholerae Active chloride secretion by CFTR
32
Clinical approach to assessing child with diarrhoea
``` History - Age of onset = Abrupt/gradual onset - Family history -Nocturnal defecation ``` Weight of child and growth Faeces analysis - stool culture
33
What does nocturnal defecation in a child presenting with diarrhoea indicate?
Organic cause
34
Causes of fat malabsorption
Pancreatic disease | Hepatobiliary disease - chronic liver disease, cholestasis
35
Signs and symptoms of coeliac disease
``` Abdominal bloatedness Diarrhoea Failure to thrive Short stature Constipation Tiredness Dermatitis herpatiformis ```
36
Screening for coeliac disease
Serology Duodenal biopsy Genetic testing
37
Which serological tests are carried out for coeliac disease?
Anti-tissue transglutaminase Anti endomysial Antigliadin
38
What deficiency can result in false negatives in serological testing for coeliac disease?
IgA
39
Which genes are tested for coeliac disease?
HLA DQ2 | DQ 8 Positive
40
How might a child be diagnosed with coeliac without performing a duodenal biopsy>
Symptomatic Anti TTG > times 10 of normal upper limit Positive anti endomysial antibodies HLA DQ2 DQ8 positive
41
Treatment for coeliac disease
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
Leaving coeliac disease untreated can result in what condition
Greater risk of rare small bowel lymphoma
43
What percentage of infants experience regurgitation?
40%`
44
When is regurgitation and gastrooesophageal reflux most likely to present?
Around 2 weeks
45
Define regurgitation
Passing of stomach contents beyond the oesophagus
46
Risk factors for GOR/GORD in infantsq
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
Example of a full feeding history
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
Symptoms to enquire about related to episodes of GORD
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
Other differentials for GORD
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
Conditions related with coeliac disease
Type 1 diabetes Down syndrome Turner syndrome Other autoimmune diseases, such as thyroid disease, rheumatoid arthritis & Addison’s disease.
51
Histological changes in biopsy for coeliac
Crypt hyperplasia | Villous atrophy
52
Differential diagnosis for coeliac disease
``` Tropical sprue Cystic fibrosis Inflammatory bowel disease Post – gastroenteritis Autoimmune enteropathy Eosinophilic enteritis ```
53
Classification of duodenal biopsy for coeliac disease
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
Complications of coeliac disease
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions