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3A REVISION > PAEDIATRICS 2 > Flashcards

PAEDIATRICS 2 Flashcards

1
Q

What is the prevalence of asthma in children?

A

15-20%, 20 deaths a year

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2
Q

What is transient early wheeze in preschool children likely to be?

A

Episodic viral wheeze, due to tendency of airways to narrow and inflame with viruses

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3
Q

What is persistent wheeze likely to be?

A

IgE response to allergens

Recurrent wheeze associated with evidence of allergy is atopic asthma

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4
Q

What is the pathophysiology of asthma?

A

Environmental triggers/allergens lead to bronchial inflammation (oedema, mucous) and hyperresponsiveness, leading to airway narrowing an symptoms of cough/wheeze/SoB/tightness

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5
Q

What are the causes of asthma?

A 
Genetic predisposition (family history)
Atopy
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6
Q

Symptoms of asthma? (7)

A 
Wheeze
Symptoms worse at night and in early morning
Cough
Shortness of breath
Triggered by allergens/environment
Interval symptoms between exacerbations
Positive response to therapy
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7
Q

Signs of asthma? (3)

A

Chest hyperinflation
Eczema
Harrison’s sulcus

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8
Q

How is asthma diagnosed? (5)

A 
Clinically
Skin prick test for common allergies
CXR to exclude other 
Peak expiratory flow rate recording - diurnal pattern
Check if response to bronchodilator
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9
Q

Management of asthma? (6)

A

Allergen avoidance
1 - inhaled SHORT acting beta 2 agonist (salbutamol)
2 - ADD an inhaled STEROID (beclometasone, budenoside)
3 - ADD a leukotriene receptor antagonist LTRA (montelukast)
4 - Stop LTRA, refer if under 5, if over 5 add LABA (formeterol)
5 - increase ICS dose
6 - Trial of theophylline

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10
Q

What is the management of acute asthma? (4)

A

Salbutamol
Oral prednisolone/IV hydrocortisone
Nebulised ipratropium bromide
Oxygen

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11
Q

What is the most common cause of pneumonia in younger and older children?

A

Viruses in younger children, bacteria in older

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12
Q

Common causative organisms of pneumonia in the newborn?

A

Group B strep, enterococci

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13
Q

Common causative organisms of pneumonia in infants/young children?

A

Respiratory syncytial virus
Strep pneumoniae
H.influenzae
Staph aureus is serious

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14
Q

Common causative organisms of pneumonia over 5 years?

A

M.pneumoniae

Strep pneumoniae

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15
Q

What vaccines are there to prevent pneumonia in children?

A

Strep pneumoniae

H.influenzae type b

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16
Q

Symptoms of pneumonia? (6)

A 
Fever
Difficulty breathing
Cough
Lethargy
Poor feeding
Chest/abdo/neck pain
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17
Q

Signs of pneumonia? (4)

A

Tachypnoea
Nasal flaring
Chest recession
End inspiratory crackles

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18
Q

What is pneumonia usually preceded by?

A

URTI

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19
Q

Investigations for pneumonia? (4)

A

CXR
Nasophyaryngeal aspirate to identify cause
FBC
Acute reactants

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20
Q

What may be seen on CXR in pneumonia?

A

Lobar consolidation
Effusion
Empyema

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21
Q

General management of pneumonia? (5)

A 
Admit if severe
Oygen
Analgesia
IV fluids
Abx
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22
Q

What antibotics are used for newborns with pneumonia?

A

Broad spectrum IV

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23
Q

What antibiotics are used for older children with pneumonia?

A

Oral amoxicillin

Co-amoxiclav if complicated

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24
Q

Why are children mostly not infectious for TB?

A

Disease is paucibacillary

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25
Q

How to children commonly catch TB?

A

From an infected adult in same household, more likely to progress to active disease than in adults
Mycobacterium tuberculosis

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26
Q

Why do 50% of infants and 90% of children show minimal signs of TB?

A

Inflammation limits progression of disease so it remains latent

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27
Q

What are symptoms of TB? (5)

A 
Fever
Anorexia, weight loss
Cough
CXR changes i.e. hilar lymphadenopathy
Older children: fatigue, night sweats, chest pain, bloody sputum
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28
Q

What is the primary Ghon complex and what may it lead to in TB?

A

Lesion of lung calcification and regional nodes
May lead to bronchial obstruction, lung collapse, pleural effusion
May involve gut, skin

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29
Q

What is post primary TB?

A

Asymptomatic or symptomatic infections may become dormant and reactivate to post primary TB
May be widely disseminated

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30
Q

What is a complication of post primary TB in infants

A

Wide dissemination with CNS involvement leading to meningitis

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31
Q

How is TB diagnosed? (5)

A 
Sputum culture
Urine sample
CSF sample
CXR
Lymph node excision
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32
Q

Management of suspected TB?

A

Mantoux test - if positive, treat

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33
Q

Management of TB

A

Quadruple therapy with rifampicin, isoniazid, pyrazinamide, ethambutol (6 months)
Rifampicin and isoniazid only after 2 months
Longer course if disseminated/meningitis

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34
Q

What is a side effect of isoniazid and how is it prevented? Which TB drug causes red urine? Which can cause visual problems?

A

Weekly pyridoxine after puberty to prevent peripheral neuropathy
Red urine - rifampicin
Visual - ethambutol

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35
Q

What is prevention of TB?

A

BCG vaccine at birth for high risk groups

Screen contacts

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36
Q

What is bronchiolitis?

A

Most common serious respiratory infection of infancy

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37
Q

When are children commonly affected by bronchiolitis?

A

1-9 months

Winter

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38
Q

What is the most common pathogen for bronchiolitis?

A

Respiratory syncytial virus in 80%

Others - parainfluenza, rhinovirus

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39
Q

Symptoms of bronchiolitis? (5)

A 
Coryzal features
Dry cough
Increasing breathlessness
Feeding difficulty
Recurrent apnoea
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40
Q

Signs of bronchiolitis? (7)

A 
Tachypnoea
Sub and intercostal recession
Hyperinflation
End-inspiratory crackles
Wheeze
Tachycardia
Pallor/cyanosis
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41
Q

Diagnosis of bronchiolitis?

A

Clinical

Virus on PCR of nasopharyngeal swab

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42
Q

Management of bronchiolitis?

A

Supportive - humidified oxygen nasal cannulae

IV fluids

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43
Q

Prevention of bronchiolitis?

A

Palivuzumab for high risk - preterm infants, CF

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44
Q

What is the proper name for croup and what is it?

A

Laryngotracheobronchitis - mucosal secretions and inflammation affecting the airway, and oedema of the subglottic area which can result in critical narrowing

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45
Q

What is the most common cause of croup?

A

Parainfluenza viruses

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46
Q

When does croup occur?

A

From 6 months-6 years
Peak at 2 years
Autumn

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47
Q

Symptoms of croup? (5)

A 
Barking cough
Harsh stridor
Hoarseness
Usually preceded by fever/cold
Worse at night
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48
Q

How is croup treated?

A 
Oral dexamethasone (/prednisolone/nebulised budenoside)
If severe, nebulised adrenaline and oxygen
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49
Q

What is bacterial tracheitis?

A

Similar to severe croup but high fever and rapid obstruction

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50
Q

What causes bacterial tracheitis?

A

Staph aureus

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51
Q

How is bacterial tracheitis treated?

A

IV antibiotics - penicillin

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52
Q

What is epiglottitis?

A

Emergency - obstruction risk due to intense epiglottal swelling, associated with septicaemia
DO NOT EXAMINE THROAT

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53
Q

What causes epiglottitis?

A

H influenzae type B

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54
Q

Symptoms of epiglottitis? (4)

A 
Acute onset
High fever
Drooling
Soft stridor
NO COUGH
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55
Q

Treatment of epiglottitis?

A

Intubated
IV cefuroxime

rifampicin for close contacts

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56
Q

What is cystic fibrosis?

A

Most common life limiting (average life expectancy 30-40s) autosomal recessive condition in the Caucasian population

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57
Q

What is the cause of cystic fibrosis?

A

Defective protein of the cystic fibrosis transmembrane conductance regulator (CFTR) on chromosome 7

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58
Q

What are some risk factors that may moderate severity of cystic fibrosis?

A

Passive smoking
Social deprivation
Modifier genes

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59
Q

What features does the defective protein in cystic fibrosis cause? (6)

A

Impaired ciliary function
Increased retention of secretions
Chronic bronchial infection - psued aerug
Thick meconium in infants - meconium ileus
Blocked pancreatic ducts leading to enzyme deficiency, malabsorption
Excessive Na and Cl in sweat

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60
Q

What is a common bronchial infection in cystic fibrosis?

A

Pseudomonas aeruginosa

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61
Q

Screening for cystic fibrosis?

A

Guthrie test - heel prick

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62
Q

How may cystic fibrosis present in infants? (5)

A 
Recurrent infections
Failure to thrive
Malabsorption
Meconium ileus
Prolonged neonatal jaundice
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63
Q

How may cystic fibrosis present in young children? (4)

A

Bronchiectasis
Nasal polyps
Sinusitis
Rectal prolapse

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64
Q

How may cystic fibrosis present in older children? (5)

A 
Diabetes
Cirrhosis
Intestinal obstruction
Pneumothorax
Male infertility
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65
Q

How is cystic fibrosis diagnosed?

A

Sweat test - elevated chloride level

Genetic testing - abnormalities in CTFR protein

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66
Q

How is cystic fibrosis managed?

A

MDT approach to suppress lung disease, maintain nutrition and growth

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67
Q

What is treatment of bacterial chest infections in cystic fibrosis? (4)

A

Physiotherapy to clear secretions
Prophylactic oral flucloxacillin with rescue antibiotics in exacerbations
Daily nebulised pseudomonal antibiotics
Nebulised DNAse/hypertonic saline

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68
Q

What is treatment of severe/end stage respiratory disease in cystic fibrosis?

A

If severe - regular IV abx, portacath

Bilateral lung transplant

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69
Q

How is pancreatic insufficiency in cystic fibrosis managed?

A

Pancreatic replacement medication after food
High calorie diet
Fat soluble vitamin supplements

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70
Q

What is the prevalence of significant cardiac malformations in infants?

A

8/1000, 1/10 stillborn

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71
Q

Give 3 left to right shunts and what the main symptom is

A

Breathless
Ventricular septal defect (most common)
Patent ductus arteriosus
Atrial septal defect

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72
Q

Give 2 right to left shunts and what the main symptom is

A

Blue
Tetralogy of Fallot
Transposition of the great arteries

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73
Q

Give an example of a common mixing heart defect and what the symptoms are

A

Breathless and blue

Atrioventricular septal defect

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74
Q

Give two types of outflow obstruction in a well child and what the symptoms are

A

Asymptomatic with murmur
Pulmonary stenosis
Aortic stenosis

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75
Q

Give a type of outflow obstruction in the sick neonate and what the symptoms are

A

Collapse with shock

Coarctation of the aorta

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76
Q

What causes congenital heart defects? (5)

A 
Rubella infection
Diabetes
SLE
Fetal alcohol syndrome
Genetics - Down's, Edwards's, Patau, Turner's
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77
Q

How does congenital heart disease present and which is most common? (5)

A 
Picked up antenatally by USS
Detection of heart murmur clinically - most common
Heart failure
Shock
Cyanosis
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78
Q

What are the hallmarks of an innocent murmur? (4)

A 
30% of children have an innoSent murmur
aSymptomatic patient
Soft blowing murmur
Systolic only
left Sternal edge
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79
Q

When are innocent (flow) murmurs often heard?

A

When a child has a fever or is anaemic, due to increased cardiac output

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80
Q

What are the two main types of atrial septal defect?

A

Secundum (80%)

Primum (partial atrioventricular septal defect)

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81
Q

What is secundum ASD?

A

Defect in the centre of the atrial septum involving the foramen ovale

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82
Q

What is partial AVSD?

A

Defect of the atrioventricular septum - either between the atrial septum and atrioventricular valves or abnormal atrioventricular valves which leak

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83
Q

What are the symptoms of atrial septal defects? (3)

A

Commonly asymptomatic
May have recurrent chest infections
Arrhythmias when adults

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84
Q

Signs of atrial septal defects? (3)

A

Ejection systolic murmur (upper left sternal edge)
Fixed, widely split second heart sound
If partial - apical pansystolic murmur

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85
Q

Investigations for atrial septal defects? (3)

A

CXR shows cardiomegaly, enlarged pulmonary arteries
ECG - partial right bundle branch block in secundum, abnornal QRS axis in primum
Echocardiography for anatomy

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86
Q

How are atrial septal defects treated if significant?

A

Secundum - cardiac catheterisation with insertion of occlusion device
Primum - surgical correction at around 3-5 years

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87
Q

What are ventricular septal defects?

A

Defect anywhere in the ventricular septum, perimembranous (next to tricuspid valve) or muscular
Categorised by size - smaller or larger than the aortic valve

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88
Q

Symptoms of small VSDs?

A

None

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89
Q

Sign of small VSDs?

A

Loud pansystolic murmur at lower left sternal edge - loud murmur = smaller defect

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90
Q

Investigations of small VSDs?

A

CXR and ECG normal

Echocardiogram shows anatomy

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91
Q

Management of small VSDs?

A

Will close spontaneously

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92
Q

Symptoms of large VSDs? (4)

A

Heart failure
Breathlessness
Failure to thrive
Recurrent chest infections

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93
Q

Signs of large VSDs? (6)

A 
Tachypnoea
Tachycardia
Hepatomegaly
Active precordium
Soft pansystolic murmur or no murmur
Apical mid-diastolic murmur
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94
Q

Investigations of large VSDs?

A

CXR shows cardiomegaly, enlarged pulmonary arteries, pulmonary oedema
ECG biventricular hypertrophy, upright T wave shows pulmonary hypertension
Echocardiogram - anatomy and pulmonary hypertension

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95
Q

Management of large VSDs?

A

Diuretics
Captopril - ACEi
Extra calories
Surgery at 3-6 months to prevent permanent damage from pulmonary hypertension and high blood flow

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96
Q

What is patent ductus arteriosus?

A

When ductus arteriosus fails to close within 1 month after due date due to a defect in constrictor mechanism of duct. Connects pulmonary artery to descending aorta so after birth blood flows from aorta to P.A.
Common in prematurity

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97
Q

Symptoms and signs (3) of patent ductus arteriosus?

A

Continuous murmur below left clavicle
Pulse pressure increased - collapsing/bounding pulse
If large, heart failure and pulmonary hypertension
Normally asymptomatic

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98
Q

Investigations of patent ductus arteriosus?

A

CXR and ECG normal - if large same appearance as VSDs

Duct identified on echocardiogram

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99
Q

Management of patent ductus arteriosus?

A

Coil or occlusion closure via cardiac catheterisation at 1 year to avoid risk of bacterial endocarditis, pulmonary vascular disease

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100
Q

What is the most common cause of cyanotic congenital heart disease?

A

Tetralogy of Fallot

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101
Q

What are the 4 features of tetralogy of fallot?

A

Large VSD
Overriding aorta
Pulmonary stenosis
Right ventricular hypertrophy

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102
Q

Symptoms of tetralogy of fallot? (4)

A

Most diagnosed antenatally or within first 2 months after a murmur identified
Severe cyanosis in first few days of life
Hypercyanotic spells later in life
Squatting on exercise later in life

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103
Q

What are hypercyanotic spells? (5)

A 
Rapid increase in cyanosis 
Irritability/crying
Hypoxia
Breathlessness
Pallor
104
Q

Signs of tetralogy of fallot?

A

Clubbing

Harsh ejection systolic murmur at left sternal edge

105
Q

Investigations for tetralogy of fallot?

A

CXR shows small heart, with uptilted apex and pulmonary artery ‘bay’
ECG normal at birth, right ventricular hypertrophy when older
Echo for anatomy
Cardiac catheterisation for anatomy

106
Q

Management of tetralogy of fallot?

A

Medical
Surgery at 6 months to close VSD
If cyanosed infant - shunt to increase pulmonary blood flow

107
Q

How are hypercyanotic spells treated? (4)

A

Sedation, pain relief, fluids
IV propranolol
Bicarbonate for acidosis
Muscle paralysis and artificial ventilation to reduce oxygen demand

108
Q

How is ductal patency maintained in the first few days of life for duct dependant cyanotic infants?

A

Prostaglandin infusion

109
Q

What is transposition of the great arteries?

A

Aorta is connected to the right ventricle
Pulmonary artery is connected to the left ventricle
Deoxygenated blood is returned to the body - incompatible with life unless there is an associated defect that allows mixing (ASD, VSD, PDA)

110
Q

Symptoms of transposition of the great arteries?

A

Cyanosis - usually day 2 after ductal closure as reduces mixing
Less severe if more mixing

111
Q

Signs of transposition of the great arteries?

A

Loud, single second heart sound

Variable systolic murmur due to increased pulmonary flow

112
Q

Investigations of transposition of the great arteries?

A

CXR - narrow upper mediastinum, ‘egg on side’ appearance of cardiac shadow, increased pulmonary vascular markings
ECG normal
Echo for anatomy and other abnormalities

113
Q

How is transposition of the great arteries managed?

A

Improve mixing
Maintain patency of ductus arteriosus - prostaglandin infusion
Balloon atrial septostomy to tear atrial septum and allow mixing
Surgery - arterial switch procedure in neonatal period (first few days of life)

114
Q

What is eisenmenger syndrome?

A

If high pulmonary blood flow due to a large left to right shunt or common mixing is not treated, pulmonary arteries become thick walled and resistance to flow increases
At about 10-15 years the shunt reverses and teenager becomes cyanosed
Progressive syndrome, death from heart failure in middle age

115
Q

How is eisenmenger syndrome treated?

A

Prevention by treating heart defects early
Transplant
Palliative pulmonary hypertension medication to delay transplantation

116
Q

What is atrioventricular septal defect?

A

Common mixing
Seen in Down’s syndrome
Defect in the middle of the heart with a common valve between the atria and ventricles, which leaks
Causes pulmonary hypertension

117
Q

Features of atrioventricular septal defect? (3)

A

Presents on fetal USS
Cyanosis at birth or heart failure after 2-3 weeks
No murmur

118
Q

Management of atrioventricular septal defect

A

Treat heart failure medically

Surgical repair at 2-3 months

119
Q

What causes heart failure in neonates?

A 
Obstructed (duct dependant) systemic circulation:
Hypoplastic left heart syndrome
Critical aortic valve stenosis
Severe coarctation of aorta
Interruption of aortic arch
120
Q

What causes heart failure in infants?

A

High pulmonary blood flow (left to right shunts):
Ventricular septal defect
Atrioventricular septal defect
Large patent ductus arteriosus

121
Q

What causes heart failure in older children?

A

Eisenmenger (right heart failure)
Rheumatic heart disease
Cardiomyopathy

122
Q

Symptoms of heart failure? (4)

A

Breathlessness
Sweating
Poor feeding
Recurrent chest infection

123
Q

Signs of heart failure? (7)

A 
Poor weight gain
Tachypnoea
Tachycardia
Heart murmur - gallop rhythm
Enlarged heart
Hepatomegaly
Cool peripheries
124
Q

Signs of right heart failure?

A

Ankle and sacral oedema
Ascites
Rare, may be seen with longstanding pulmonary hypertension or rheumatic fever

125
Q

Complications of heart failure?

A

Progressive heart failure until 3 months, when symptoms may improve due to rise in pulmonary vascular resistance but this then leads to Eisenmenger’s when the shunt reverses to right to left.

126
Q

What is sinus arrhythmia?

A

Normal cyclical change in heart rate with respiration - increasing on inspiration

127
Q

What is supraventricular tachycardia?

A

Most common childhood arrhythmia
Rapid heart rate - 250-300 bpm
Premature activation of the atrium via an accessory pathway

128
Q

How does supraventricular tachycardia present?

A

Symptoms of heart failure
Poor cardiac output
Pulmonary oedema

129
Q

Investigation of supraventricular tachycardia?

A

ECG - narrow complex tachycardia, if severe changes suggestive of myocardial ischaemia (T wave inversion)

130
Q

Management of supraventricular tachycardia?

A

Circulatory and respiratory support
Vagal stimulating manoeuvres - carotid sinus massage
IV adenosine breaks re-entry circuit
Electrical cardioversion

131
Q

What is maintenance therapy of supraventricular tachycardia?

A

Flecainide or sotalol

132
Q

What is congenital heart block?

A

Rare, related to anti-Ro or anti-La antibodies in maernal serum which prevent normal development of the electrical conduction system in the developing heart, with atrophy of the AV node

133
Q

What are the symptoms of congenital heart block?

A

May cause death in utero
May cause heart failure neonatally
Most symptom free for a few years
May develop presyncope or syncope

134
Q

What is management of congenital heart block?

A

Insertion of endocardial pacemaker

135
Q

What is coarctation of the aorta?

A

Arterial duct tissue encircling the aorta just at the point of insertion of the duct
When the duct closes the aorta constricts causing obstruction to left ventricular outflow

136
Q

How does coarctation of the aorta present if not antenatally?

A

Collapse when DA closes at 2 days
Severe heart failure and metabolic acidosis
Weak femoral pulses

137
Q

Management of coarctation of the aorta?

A

Resus
Prostaglandin infusion
Early surgical repair

138
Q

What is hypoplastic left heart syndrome?

A

Undervelopment of the entire left side of the heart, with small ascending aorta
Usually also has coarctation of the aorta

139
Q

How does hypoplastic left heart syndrome present if not antenatally?

A

Sickest of all neonates
Duct dependent systemic circulation
No flow through left heart - acidosis and quick cardiovascular collapse
Weak or absent peripheral pulses

140
Q

Management of hypoplastic left heart syndrome?

A

Resus, prostaglandin infusion

Early surgery, followed by another at 6 months and another at 3 years

141
Q

What is rheumatic fever?

A

Abnormal immune response to a preceding group A beta-haemolytic streptococcus infection
Mainly affects 5-15 year olds, most common cause of heart disease worldwide

142
Q

How does rheumatic fever present?

A 
Latent interval 2-6 weeks after pharyngeal infection
Pancarditis (endo, myo, pericarditis) 
Polyarthritis
Mild fever
Malaise
143
Q

What is chronic rheumatic fever?

A

Mitral stenosis usually occurs from long term damage and fibrosis of the valve tissue if repeated attacks of rheumatic fever with carditis
Severity of valvular disease related to number of childhood attacks

144
Q

How is acute rheumatic fever treated? (5)

A

Anti-inflammatory agents - high dose aspirin
Limit exercise
Corticosteroids if no rapid improvement
Diuretics and ACE inhibitors for heart failure
Anti-streptococcal antibiotics if persistent infection

145
Q

How is recurrence of rheumatic fever prevented?

A

Monthly benzathine penicillin injections or oral erythromycin until age of 18-21 years - possibly lifelong

146
Q

What are risk factors for infective endocarditis?

A

Congenital heart disease - VSD, coarctation of aorta, patent ductus arteriosus
Prosthetic material inserted at surgery

147
Q

Symptoms of infective endocarditis?

A 
Fever
Malaise
Raised ESR
Anaemua/haematuria
Peripheral stigmata - splinter haemorrhages, clubbig, necrotic skin lesions
Cerebral and retinal infarcts
148
Q

How is endocarditis investigated?

A

Blood cultures

Echocardiography for vegetations

149
Q

What is the common causative organism of endocarditis?

A

Streptococcus viridans (alpha haemolytic)

150
Q

Treatment of endocarditis?

A

High dose penicillin and aminoglycoside for 6 weeks

Possible removal of synthetic shunts etc.

151
Q

Prophylaxis of endocarditis?

A

Good dental hygiene

152
Q

What is oesophageal atresia?

A

Usually associated with tracheo-oesophageal fistula and with polyhdramnios in pregnancy

153
Q

How is oesophageal atresia diagnosed?

A

Antenatally

Wide feeding tube passed down and checked with X ray if it reaches the stomach

154
Q

How does oesophogeal atresia present?

A 
Antenatal USS
Salivation
Drooling
Cough/choking when fed
Cyanotic episodes
Aspiration of saliva
155
Q

How is oesophageal atresia treated?

A

Continuous suction applied to a tube passed to oesophageal pouch
Surgical repair

156
Q

What is the VACTERL association?

A 
Vertebral
Anorectal
Tracheo-Esophageal
Renal
Limb 
anomalies
157
Q

How does small bowel obstruction present? (4)

A

Antenatal USS
Vomiting, possibly bile stained
Delayed/absent stool passing
Abdominal distension

158
Q

What is bile stained vomit a sign of until proven otherwise?

A

Bowel obstruction

159
Q

What may small bowel obstruction be caused by?

A

Duodenal atresia/stenosis - associated with Down’s syndrome and other congenital malformations
Jejunal/ileal atresia/stenosis - may be atretic bowel

160
Q

How are small bowel atresia/stenosis treated?

A

Surgical repair

Correct fluid and electrolyte depletion

161
Q

What is malrotation with volvulus?

A

Type of small bowel obstruction
Loop of intestine loops around itself
May lead to infarction of large parts of bowel

162
Q

How is malrotation with volvulus treated?

A

Surgically after correction of fluids and electrolytes

163
Q

What is meconium ileus?

A

Thick meconium becomes compacted in the lower ileum - almost all affected have cystic fibrosis

164
Q

How is meconium ileus treated?

A

Dislodged using gastrografin contrast medium

165
Q

What is meconium plug?

A

Plug of thick meconium causes lower intestinal obstruction, passes spontaneously

166
Q

What causes large bowel obstruction?

A

Hirschprung’s disease

Rectal atresia

167
Q

What is rectal atresia?

A

Absence of anus at the normal site, possible fistula to bladder or vagina
Surgical repair

168
Q

What is Hirschprung’s disease?

A

Absence of the ganglion cells from the myenteric and submucosal plexuses in the large bowel results in a narrow, contracted segment
Mostly confined to rectosigmoid but in 10% whole bowel affected

169
Q

How does Hirschprung’s disease present? (4)

A

Intestinal obstruction in neonatal period
Failure to pass meconium
Abdominal distension
Bile stained vomit

170
Q

What is Hirschprung enterocolitis?

A

Severe bowel inflammation during first few weeks of life caused by Clostridium difficile infection

171
Q

How does Hirschprung’s disease present in older children? (3)

A

Chronic constipation
Abdominal distension
Growth failure

172
Q

How is Hirschprung’s disease diagnosed?

A

Absence of ganglion cells
Presence of large acetylcholinesterase positive nerve trunks on rectal biopsy
Barium studies to give length of affected segment

173
Q

How is Hirschprung’s disease treated?

A

Surgical

Colostomy then anastomosis of normal bowel to anus

174
Q

What is exomphalos?

A

(omphalocoele)
Abdominal contents protrude through umbilical ring, covered by a sac of amniotic membrane and peritoneum
Usually associated with other abnormalities

175
Q

What is gastroschisis?

A

Bowel protrudes through defect in abdominal wall adjacent to umbilicus, no covering sac
Not associated with other abnormalities

176
Q

Complications of gatroschisis?

A

Carries high risk of dehydration and protein loss

177
Q

How is gastroschisis treated?

A

Wrap abdomen in layers of clingfilm
NG tube
IV dextrose
Colloid support for lost protein

178
Q

Repair of gastroschisis and exomphalos?

A

Primary closure of abdomen if small
If large, intestine enclosed in a sac sutured to edge of abdominal wall and contents slowly returned to the peritoneal cavity

179
Q

What is intussusception?

A

Invagination of proximal bowel into a distal segment, commonly ileum into caecum

180
Q

When does intussusception present?

A

Most common intestinal obstruction after neonatal period

3 months - 2 years

181
Q

Complications of intussusception?

A

Stretching and constriction of mesentary resulting in venous obstruction and bowel perforation and necrosis

182
Q

How does intussusception present? (6)

A

Paroxsymal severe colicky pain and pallor
Refusal to feed
Vomit, may be bile stained
Mass in abdomen
Passing of redcurrant jelly stool with blood stained mucous
Abdominal distension, shock

183
Q

Investigation of intussusception?

A

X ray - Distended small bowel, no gas in distal colon or rectum, may show outline

184
Q

Treatment of intussusception?

A

Reduction by rectal air insufflation

Operative reduction if failed

185
Q

What is Meckel’s diverticulum?

A

Ileal remnant of the vitello-intestinal duct containing ectopic gastric mucosa or pancreatic tissue in 2% of infants

186
Q

Presentation of Meckel’s diverticulum? (4)

A

Most asymptomatic
Rectal bleeding
Intusssusception
Diverticulitis

187
Q

How is Meckel’s diverticulum treated?

A

Surgical resection

188
Q

How does malrotation of the bowel present?

A

Usually in first 1-3 days with obstruction

Presents at any age with volvulus causing obstruction and ischaemic bowel

189
Q

Symptoms of malrotation?

A

Bilious vomiting
Abdominal pain and tenderness from peritonitis
Ischaemic bowel

190
Q

Treatment of malrotation?

A

GI contrast study and urgent surgery

191
Q

What is pyloric stenosis?

A

Hypertrophy of pyloric muscle causing gastric outlet obstruction, presenting between 2-7 weeks and more common in eldest boys

192
Q

Symptoms of pyloric stenosis? (4)

A

Projectile vomiting
Dehydration
Loss of interest in feeding
Weight loss

193
Q

Investigations of pyloric stenosis? (3)

A

Bloods - hypochloraemic metabolis alkalosis with low sodium and potassium
Test feed - visible gastric peristalsis left to right, palpable olive shaped mass in upper right quadrant
USS

194
Q

Management of pyloric stenosis?

A

Correct fluid and electrolyte balance - IV fluids, dextrose

Surgery - pyloromyotomy

195
Q

Symptoms of constipation? (4)

A

Decreased frequency of defecation
Hard stool
Pain
Abdominal mass

196
Q

What is overflow diarrhoea?

A

Chronic constipation causes rectum to be over distended and the urge to defecate is lost
Involuntary soiling may occur of watery stool

197
Q

How is constipation treated? (4)

A

Disimpaction - evacuation of rectum with stool softeners and laxatives and electrolytes (movicol, senna if unsuccessful)
Maintenance - polyethylene glycol, reducing dose over a few months
Enema if severe
Dietary interventions, school support etc.

198
Q

How do diaphragmatic hernias present?

A

Antenatally
Failure to respond to resuscitation
Respiratory distress

199
Q

What is a congenital diaphragmatic hernia?

A

Defect in the diaphragm so bowel protrudes through and into the lung cavity, compressing the lung
Most are left sided

200
Q

Signs of congenital diaphragmatic hernia? (2)

A

Poor air entry on affected side

Apex beat displaced if left sided

201
Q

Treatment of congenital diaphragmatic hernia?

A

Surgical correction

High mortality if large pulmonary hypoplasia

202
Q

What is an inguinal hernia and what causes it?

A

Protrusion of the bowel through the inguinal canal, mostly indirect
Due to patent processus vaginalis
More common in boys, premature

203
Q

How does an inguinal hernia present? (2)

A

Groin/scrotal swelling when crying or straining

Possible scrotal oedema

204
Q

How are inguinal hernias treated?

A

Prompt surgical correction to avoid strangulation

205
Q

What is appendicitis?

A

Inflammation of the appendix, commonest cause of abdominal pain in children needing surgery

206
Q

Symptoms of appendicitis? (3)

A

Anorexia
Vomiting
Initial central colicky pain then localised to right iliac fossa

207
Q

Signs of appendicitis? (4)

A

Flushed face
Fever
Pain aggravated on movement
Tenderness and guarding at McBurney’s point

208
Q

Investigations of appendicitis?

A

FBC for inflammatory markers

USS

209
Q

How is appendicitis treated?

A

Surgery - appendicectomy

Antibiotics if perforation

210
Q

How common is recurrent abdominal pain in children?

A

10% of school age

211
Q

What are some causes of recurrent abdominal pain in children? (13)

A 
IBS
IBD
Constipation
Abdominal migraine
Ulcers or functional dyspepsia
Malrotation
Dysmenorrhoea
Ovarian cysts
PID
Hepatitis
Gallstones
UTI
Psychosocial
212
Q

What are the 3 most common of recurrent abdominal pain in children?

A

IBS
Functional dyspepsia
Abdominal migraine

213
Q

Management of recurrent abdominal pain?

A

Exclude serious causes

Reassure - 50% become asymptomatic quickly

214
Q

How common is infective diarrhoea (gastroenteritis)?

A

10% of under 5s annually

Significant cause of mortality in developing countries

215
Q

What is the most common cause of gastroenteritis in developed countries?

A

Rotavirus 60%

Adenovirus, norovirus, coronavirus

216
Q

What are bacterial causes of gastroenteritis?

A

Campylobacter jejuni

Shigella, salmonella

217
Q

Symptoms of gastroenteritis? (3)

A

Loose watery stools
Vomiting
Dehydration

218
Q

Red flags in gastroenteritis? (6)

A 
Red flags possibly indicating shock
Deteriorating 
Lethargic
Sunken eyes
Increased heart rate and respiratory rate 
Decreased skin turgor
219
Q

Investigations of gastroenteritis?

A

Usually none
Stool cultures if septic or bloody stools or if prolonged illness
Check electrolytes

220
Q

Treatment of gastroenteritis?

A

Oral rehydration solution
IV fluids if shock or ongoing illness
Antibiotics if septic, if <6 months, if salmonella or C.difficile, if immunodeficient

221
Q

What is toddler diarrhoea?

A

Commonest cause of persistent loose stools in preschool children, most grow out of it by 5 but faecal continence may be delayed

222
Q

Symptoms of toddler diarrhoea?

A

Stools of varying consistency

Children are well

223
Q

What causes toddler diarrhoea?

A

Underlying maturational delay in intestinal motility leading to intestinal hurry

224
Q

How to manage toddler diarrhoea?

A

Eat more fat and fibre

If failure to thrive, investigate for cow’s milk allergy or coeliac disease

225
Q

What is Crohn’s disease?

A

Inflammatory bowel disease, can affect everywhere from mouth to anus

226
Q

Symptoms of Crohn’s disease? (11)

A 
Growth failure
Delayed puberty
Fever
Weight loss
Abdominal pain
Oral lesions
Perianal skin tags
Uveitis
Arthralgia
Diarrhoea
Erythema nodosum
227
Q

What is erythema nodosum?

A

Swollen fat under the skin causing bumps and redness

228
Q

What is the classic triad of Crohn’s presentation?

A

Weight loss
Diarrhoea
Abdominal pain

229
Q

Investigations of Crohn’s disease? (5)

A 
Increased platelets, ESR, CRP
Decreased albumin
Iron deficiency anaemia
Colonoscopy
Histology
230
Q

3 features of Crohn’s disease?

A

Transmural
Focal - commonly distal ileum/proximal colon
Subacute or chronic

231
Q

What does colonoscopy in Crohn’s disease show? (4)

A

Areas of inflamed/thickened bowel
Strictures and fistulae
Narrowed, fissured bowel
Mucosal irregularities

232
Q

What does histology in Crohn’s disease show?

A

Non caseating epithelioid cell granulomata

233
Q

What is the treatment of Crohn’s disease?

A

Nutritional therapy - replace normal diet with protein feeds for 8 weeks
If ineffective, systemic steroids
If steroids contraindicated, budenoside or 5-ASAs

234
Q

How is relapsed Crohn’s disease treated?

A

Immunosuppressants - azathioprine, methotrexate
May need infliximab
Surgery if complicated or refractive

235
Q

What is ulcerative colitis?

A

Recurrent inflammatory ulcerating disease affecting colonic mucosa

236
Q

Symptoms of ulcerative colitis?

A 
Rectal bleeding
Diarrhoea
Colicky abdominal pain
Arthritis
Erythema nodosum
237
Q

How is ulcerative colitis diagnosed?

A

Bloods - raised inflammatory markers, anaemia
Colonoscopy shows colitis extending from rectum proximally
Histology

238
Q

What is a feature of ulcerative colitis?

A

In children, more likely to be pancolitis than confined to distal bowel in adults

239
Q

What is seen on histology in ulcerative colitis? (4)

A

Mucosal damage
Crypt loss
Abscesses
Ulceration

240
Q

How is ulcerative colitis treated? (4)

A

5-ASA (aminosalicylates)
If only rectum/sigmoid, topical steroids
Azathioprine with prednisolone for exacerbations
Colectomy if severe

241
Q

What is coeliac disease?

A

Malabsorption syndrome manifesting as abnormal stools, failure to thrive, nutrient deficiencies

242
Q

Symptoms of coeliac disease? (4)

A

Presents between 8-24 months normally, can present less acutely later on
Steatorrhoea (greasy, hard to flush, smell)
Failure to thrive
Abdominal distension
Irritability

243
Q

What causes coeliac disease?

A

Gliadin part of gluten provokes damaging immunological response in the proximal small intestine mucosa
Villu shorten leaving a flat mucosa

244
Q

How is coeliac diagnosed?

A

Biopsy of small intestine shows villous atrophy and crypt hyperplasia
Serology for IgA tissue transglutaminase antibodies, anti-endomysial

245
Q

How is coeliac treated?

A

Lifelong gluten free diet with supervision

246
Q

What is marasmus?

A

Severe protein-energy malnutrition in children, with <70% weight for height compared to average

247
Q

Symptoms of marasmus? (3)

A

Wasted, wizened appearance
Skinfold thickness and mid-arm circumference reduced
Withdrawn, apathetic

248
Q

What is Kwashiorkor?

A

Severe protein malnutrition, common in developing countries where infants are weaned late and diet is high in starch

249
Q

Symptoms of Kwashiorkor? (8)

A 
Oedema - weight not be as markedly reduced
Distended abdomen
Hepatomegaly
Angular stomatitis
Sparse hair
Hyperkeratosis, rash
Diarrhoea
Hypothermia, hypotension, bradycardia
250
Q

Management of severe malnutrition? (7)

A 
Correct hypoglyaemia
Keep warm
Correct dehydration
Correct electrolytes
Treat infection
Give vitamins
Initiate small volume feeding frequently
251
Q

What is IBS?

A

Irritable bowel syndrome, associated with altered GI motility and abnormal sensation, stronger peristaltic contractions

252
Q

Symptoms of IBS? (5)

A 
Abdo pain relieved by defecation
Explosive, loose, mucousy stools
Bloating
Feeling of incomplete defecation
Fluctuating constipation
253
Q

Treatment of IBS? (5)

A 
Fibre supplements
Laxatives
Anti-diarrhoeals
Antispasmodics - reduce pain
Antidepressants - reduce pain
254
Q

What is colic?

A

Symptom complex occuring in first few months of life, benign and self limiting

255
Q

Symptoms of colic?

A

Paroxysmal inconsolable crying/screaming
Drawing up of knees
Excessive flatus

256
Q

Causes of colic?

A

Unknown
Cows milk allergy
GORD

3A REVISION (17 decks)

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