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Phase 3a conditions list flashcards > Paediatrics - GI > Flashcards

Paediatrics - GI Flashcards

1
Q

What are some common medical causes of abdominal pain in children (9)?

A
  • Non-specific abdominal pain/ unknown/ functional
  • Constipation
  • UTI/ pyelonephritis
  • Gastroenteritis
  • IBD
  • Diabetic ketoacidosis
  • Gynaecological causes
  • Henoch Schonlein purpura
  • Abdominal migraine
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2
Q

What are some common surgical causes of abdominal pain (5)?

A
  • Appendicitis
  • Intussusception
  • Bowel obstruction
  • Hernias
  • Pancreatitis
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3
Q

What are some extra-abdominal causes of abdominal pain?

A
  • Lower lobe pneumonia
  • Testicular torsion
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4
Q

What has been suggested to be a cause of non-specific abdominal pain in children?

A

Mesenteric adenitis
often occurs together with an URTI - causing enlarged lymph nodes

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5
Q

What are some common causes of diarrhoea in children (6)?

A
  • Gastroenteritis
  • IBD/IBS
  • Coeliacs
  • Chronic non-specific diarrhoea/ toddlers diarrhoea
  • Cow’s milk protein allergy/ lactose intolerance
  • Liver (or pancreatic) disease
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6
Q

What are the most common causes of constipation (7)?

A
  • Idiopathic/ lifestyle = MC
  • Hirschprungs
  • CF
  • Hypothyroidism
  • Anal stenosis
  • Intestinal obstruction
  • Cow’s milk intolerance
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7
Q

What would be the presentation of a child with constipation (6)?

A
  • Less than 3 stool per week
  • Hard, difficult to pass stools
  • Abdo pain
  • Holding abnormal posture
  • Overflow diarrhoea
  • Rectal bleeding
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8
Q

What is the term for faecal incontinence?

A

Encopresis

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9
Q

What may cause encopresis in children (5)?

A
  • Constipation
  • Hirschprungs disease
  • Learning difficulties
  • Cerebral palsy
  • Stress/ abuse
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10
Q

When is encopresis considered abnormal?

A

Past the age of 4

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11
Q

What viscous cycle can occur that makes constipation progressively worse?

A

Impacted stool in the rectum –> stretched rectum –> desensitisation of rectum –> urge to defecate less frequently –> further impacted stool

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12
Q

How should constipation be managed in children (3)?

A
  • Lifestyle advice/ factors
  • Laxatives
  • Schedule visits to toilet/ keep bowel diary
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13
Q

What laxatives should be used to treat constipation in children (3)?

A
  • Macrogols (osmotic laxatives) e.g. movicol = 1st line
  • Stimulant laxative e.g. Senna (for impacted stool)
  • Lactulose (osmotic laxative)
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14
Q

What are the typical signs/ symptoms of appendicitis (8)?

A
  • Central abdo pain, localising to McBurneys point
  • Anorexia
  • Nausea/ vomiting
  • Fever
  • Rosvings sign
  • Guarding
  • Rebound/ percussion tenderness (peritonitis)
  • Psoas + obturator sign
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15
Q

How is appendicitis diagnosed (3)?

A
  • Raised CRP/ESR
  • Ultrasound/ CT (sometimes used)
  • Diagnostic laparoscopy
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16
Q

What are some differential diagnoses for diarrhoea in children (6)?

A
  • Gastroenteritis
  • IBD/IBS
  • Coeliacs
  • Lactose intolerance
  • Toddlers diarrhoea
  • Medications
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17
Q

What is the most common cause of gastroenteritis in children?

A

Rotavirus
Norovirus most common in adults

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18
Q

What are some other viral causes of gastroenteritis other than rotavirus in children (2)?

A
  • Norovirus
  • Adenovirus
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19
Q

What are the most common causes of bacterial diarrhoea (4)?

A
  • C. jejuni = MC
  • E. coli (most strains don’t cause infection)
  • Shigella
  • Salmonella
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20
Q

What symptom may point more towards bacterial gastroenteritis?

A

Bloody diarrhoea

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21
Q

What are two parasitic causes of gastroenteritis?

A
  • Gardia
  • Cryptosporidium
    mostly water born
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22
Q

What is the main risk associated with gastroenteritis?

A

Dehydration - the very old, young or vulnerable may need to be admitted for IV fluids

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23
Q

What are signs of dehydration in an infant (7)?

A
  • Hypotension
  • Cold extremities
  • Reduced skin turgor
  • Tachypnoea/ tachycardic
  • Slow cap refill
  • Sunken fontanelle
  • Dry mucous membranes
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24
Q

How long should a child stay off school with gastroenteritis?

A

48 hours post diarrhoea/ vomiting

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25
Q

What are some post gastroenteritis complications (4)?

A
  • GBS
  • IBS
  • Lactose intolerance
  • Reactive arthritis
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26
Q

What is coeliacs disease?

A

Autoimmune reaction where exposure to gluten causes an immune reaction creating inflammation in the intestines

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27
Q

What are the signs/ symptoms of coeliacs in children (6)?

A
  • Failure to thrive
  • Diarrhoea
  • Abdo pain
  • Fatigue
  • Weight loss
  • Dermatitis herpetiformis
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28
Q

What other parts of the body (other than intestines) may be affected in those with coeliacs disease (2)?

A
  • Brain - ataxia, epilepsy
  • Skin - dermatitis herpetiformis
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29
Q

What part of the bowel is particularly affected by coeliac’s disease?

A

Jejunum

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30
Q

What genes are associated with coeliacs disease (2)?

A
  • HLA-DQ2 (90%)
  • HLA-QD8
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31
Q

What is the first line investigation for coeliacs disease?

A
  • anti TTG-IgA
  • Total IgA
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32
Q

What antibody can also be tested for if anti TTG is inconclusive for coeliacs disease?

A

EMA-IgA

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33
Q

If there is IgA deficiency how can coeliacs be tested for?

A
  • anti TTG-IgG
  • anti EMA-IgG
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34
Q

How is a diagnosis of coeliacs disease confirmed?

A

Duodenal biopsy

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35
Q

What would a duodenal biopsy show in those with coeliacs (2)?

A
  • Crypt hypertrophy
  • Villous atrophy
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36
Q

What is important for those suspected of coeliac to carry on doing during investigation for coeliacs?

A

They must continue to eat a gluten diet

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37
Q

For which conditions is a serological screen for coeliacs disease indicated (3)?

A
  • T1DM
  • Autoimmune thyroid disease
  • Downs syndrome
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38
Q

What are some complications of coeliacs disease (4)?

A
  • Malabsorption
  • Anaemia
  • Osteoporosis
  • Small intestine cancers (rarer)
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39
Q

How is coeliacs treated?

A

Gluten free diet

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40
Q

What is inflammatory bowel disease?

A

Inflammation of the walls of the GI tracts, with periods of remission and exacerbation

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41
Q

What age children are usually affected by IBD?

A

15+ year olds

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42
Q

What is the general presentation of a child/ teen with IBD (7)?

A
  • Diarrhoea
  • Abdo pain
  • Bleeding
  • Weight loss
  • Anaemia
  • Fever
  • Dehydration
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43
Q

What are some extra-intestinal manifestations of IBD (6)?

A
  • Finger clubbing
  • Arthritis
  • Aphthous mouth ulcers (mostly crohns)
  • Primary sclerosing colangitis (UC only)
  • Erythema nodosum
  • Episcleritis + uveitis
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44
Q

What is the first line test for IBD?

A

Faecal calprotectin

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45
Q

What is the gold standard test for IBD?

A

OGD/ colonoscopy with biopsy

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46
Q

What other investigation can be done to investigate IBD?

A

Imaging (US/CT/MRI) to look for fistulas, abscesses and strictures

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47
Q

How is a flare of Crohns treated (3)?

A
  1. Steroids (oral prednisolone or IV hydrocortisone)
  2. Mesalazine
  3. (+ azathioprine, mercaptopurine, infliximab)
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48
Q

How is crohns remission maintained (2)?

A
  1. Azathioprine or mercaptopurine
  2. Methotrexate, infliximab, adalimumab
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49
Q

How is a mild - moderate flare of UC treated (2)?

A
  1. Aminosalicylate (mesalazine - oral or rectal)
  2. Oral steroids
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50
Q

How is a sever flare of UC treated (2)?

A
  1. IV hydrocortisone
  2. IV ciclosporin
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51
Q

How is remission maintained in UC (2)?

A
  1. Aminosalicylate (mesalazine)
  2. Azathioprine/ mercaptopurine
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52
Q

What other treatment as well as medication can be offered to those with IBD?

A

Surgery

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53
Q

What is a common cause of diarrhoea in toddlers?

A

Toddlers diarrhoea/ chronic non-specific diarrhoea (maybe a form of IBS)

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54
Q

What is the prognosis for chronic non-specific diarrhoea?

A

Most children usually grow out of it

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55
Q

What are some causes of vomiting in children (8)?

A
  • Overfeeding
  • GORD
  • Pyloric stenosis
  • Gastroenteritis
  • Other infections e.g. UTI + meningitis
  • Intestinal obstruction
  • Bulimia nervosa
  • Cows milk protein allergy
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56
Q

What are some red flag symptoms associated with vomiting in babies (5)?

A
  • Not keeping any food down
  • Projectile vomiting
  • Bile stained vomit
  • Haematemesis
  • Abdominal distension
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57
Q

What age are children commonly affected by GORD?

A

Under 1 year

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58
Q

Why are children under 1 year commonly affected by GORD?

A

They have an underdeveloped/ immaturity of the lower oesophageal sphincter

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59
Q

What is the presentation of GORD in those under 1 (6)?

A
  • Chronic cough
  • Hoarse voice
  • Distress/crying/ unsettled after feed
  • Reluctance to feed
  • Pneumonia
  • Poor weight gain
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60
Q

How can GORD typically be managed in babies (4)?

A
  • Small frequent meals
  • Burping regularly
  • Not overfeeding
  • Keeping baby upright after meals
61
Q

What can be used to treat more problematic cases of GORD in babies (3)?

A
  • Gaviscon mixed with feed
  • Thickened milk or formula
  • PPIs
62
Q

What is a worrying syndrome associated with GORD in babies?

A

Sandifers syndrome

63
Q

What are the symptoms of Sandifers syndrome?

A

Episodes of abnormal movements and muscles spasms particularly in the back and neck

64
Q

What is the prognosis for Sandifers syndrome?

A

The outcome is good, however other conditions need to be ruled out such as infantile spasms and epilepsy

65
Q

What are the symptoms of cows milk protein allergy (4)?

A
  • Regurg/ vomiting
  • Diarrhoea
  • Uticaria
  • ‘Colic’ symptoms
66
Q

How common is cows milk protein allergy?

A

3-6% of children

67
Q

What is a severe complication of cows milk protein allergy?

A

Anaphylaxis - if IgE mediated allergy is suspected (rapid onset, angioedema, wheeze)

68
Q

Which group of children and what age does cows milk protein allergy typically occur in?

A

Formula fed infants in first 3 months of life
can occasionally occur in breast fed infants, when mother has cows milk in diet

69
Q

What are the symptoms of lactose intolerance (4)?

A
  • Flatulence
  • Diarrhoea
  • Abdo pain
  • Nausea
70
Q

When does lactose intolerance usually present?

A

Past age 5 when our bodies stop making lactase

71
Q

What is pyloric stenosis?

A

Hypertrophy of the pyloric sphincter

72
Q

How does pyloric stenosis present (2)?

A
  • Projectile vomiting after feeding
  • Failure to thrive
73
Q

What age does pyloric stenosis usually present?

A

Within the first few weeks of life

74
Q

What is the pathophysiology of projectile vomiting in pyloric stenosis?

A

Increasingly strong peristaltic waves in the stomach eventually overcome the LOS and project food out of the mouth

75
Q

What would a blood gas analysis show on a baby with pyloric stenosis?

A

Hypochloric metabolic alkalosis

76
Q

Why does pyloric stenosis cause hypochloric metabolic alkalosis?

A

Baby is vomiting HCl therefore this causes an alkalosis and low chlorine

77
Q

What may be seen on examination of a baby with pyloric stenosis (2)?

A
  • Round mass in upper abdomen
  • Visible peristalsis
78
Q

How is pyloric stenosis diagnosed?

A

Abdominal ultrasound

79
Q

How is pyloric stenosis treated?

A

Laparoscopic pyloromyotomy (surgery to cut/ widen pyloric sphincter)

80
Q

What is the most common hernia in children?

A

Inguinal hernia

81
Q

What type of inguinal hernia occurs in children?

A

Indirect hernia
direct more common in adults

82
Q

What is the pathophysiology of an indirect inguinal hernia compared to a direct?

A
  • Indirect - passes through the inguinal canal
  • Direct - bulge through abdominal wall in weak spot
83
Q

What are the symptoms of an inguinal hernia in a child (2)?

A
  • Bulge/ swelling in the groin/ scrotum
  • Discomfort/ pain –> crying
    sometimes it appears the child is crying because of the hernia, but in reality the normal crying causes the hernia to bulge
84
Q

What are 2 features suggestive of hernias?

A
  • Lump protrudes on coughing/ straining/ crying
  • Lump reducible
85
Q

How are inguinal hernias treated in children?

A

Open/ laparoscopic surgery shortly after diagnosis

86
Q

Who do inguinal hernias occur more frequently in?

A

Boys

87
Q

What is a differential diagnosis for an inguinal hernia in children?

A

Hydrocele

88
Q

What is the cause of a hydrocele in a newborn?

A

Collection of fluid around the testicle that enters via a small opening in the inguinal canal, but not large enough opening for bowel to protrude through

89
Q

What is the second most common hernia in children?

A

Umbilical hernia

90
Q

Where do umbilical hernias occur?

A

A bulge/ lump around the belly button

91
Q

How are umbilical hernias managed in children?

A

Small umbilical hernias usually close on their own. If large or no improvement by age 3-5, surgical repair can be performed.

92
Q

What is a severe congenital type of hernia?

A

Diaphragmatic hernia

93
Q

What is a diaphragmatic hernia?

A

Protrusion of the abdominal organs through an abnormal opening in the diaphragm into the chest

94
Q

What causes a diaphragmatic hernia?

A

Malformation of the diaphragm during foetal development

95
Q

What are the symptoms of a diaphragmatic hernia (3)?

A
  • Respiratory distress immediately after birth
  • Cyanosis
  • Sunken abdomen (due to displacement of organs into chest)
96
Q

How is a diaphragmatic hernia usually diagnosed?

A

Usually prenatally through ultrasound

97
Q

How is a diaphragmatic hernia usually managed (2)?

A
  • Stabilisation
  • Surgical repair
98
Q

What are some other hernias that can occur in children (other than inguinal, umbilical and diaphragmatic) (3)?

A
  • Epigastric - midline between umbilicus and sternum
  • Incisional - through surgical scar
  • Hiatal - stomach protrudes into chest
99
Q

What are some possible complications of hernias in children (3)?

A
  • Strangulation
  • Obstruction (bowel)
  • Incarceration (irreducible)
100
Q

What are some risk factors for hernias in children (3)?

A
  • Low birth weight
  • Genetics/ race
  • Gender (inguinal more common in boys)
101
Q

What is hirschprungs disease?

A

Nerve cells of the myenteric plexus are absent in the distal bowel and rectum

102
Q

What is the pathophysiology of hirschprungs disease?

A

Parasympathetic ganglion cells travel down the gut during development they do not reach the end of the gut in hirschprungs disease leaving a portion without innervation

103
Q

What is a risk factor for hirschprungs disease?

A

A number of genetic conditions including downs syndrome, neurofibromatosis

104
Q

What are the symptoms/ signs of hirschprungs disease (6)?

A
  • Acute intestinal obstruction
  • Delayed meconium
  • Chronic constipation
  • Abdo pain + distension
  • Vomiting
  • Poor weight gain/ failure to thrive
105
Q

What is a severe complication of hirschprungs?

A

Hirschprungs associated enterocolitis

106
Q

What are the symptoms of hirschprungs associated enterocolitis (3)?

A
  • Fever
  • Abdo distension
  • Diarrhoea
    +sepsis symptoms
107
Q

How is hirschprungs disease diagnosed?

A

Rectal biopsy = absence of ganglionic cells

108
Q

What other investigation is useful for hirschprungs disease?

A

Xray - look for signs of HAEC, obstruction

109
Q

How is hirschprungs treated?

A

Surgical removal of the aganglionic section of the bowel

110
Q

What is meckels diverticulum?

A

Outpouching of the embryological remnant of the midgut toward to umbilicus 1 meter from the end of the ileum

111
Q

How common is meckels diverticulum?

A

2% of people have it

112
Q

What is intussusception?

A

Telescoping of the bowel into itself

113
Q

What age does intussusception usually occur?

A

6 months to 2 years

114
Q

What are some associated conditions with intussusception (5)?

A
  • Concurrent viral illness
  • CF
  • Meckels diverticulum
  • Intestinal polyps
  • Henoch Schonlein purpura
115
Q

What are the signs/ symptoms of intussusception (6)?

A
  • Redcurrant jelly stool
  • Severe colicky abdo pain
  • RUQ mass (sausage-shaped mass)
  • Vomiting
  • Intestinal obstruction
  • Pale lethargic child
116
Q

How is intussusception investigated (2)?

A
  • Ultrasound scan
  • Contrast enemas
117
Q

How is intussusception managed (2)?

A
  • Therapeutic enema (air or water pumped in)
  • Surgical reduction
118
Q

What are some complications of intussusception (3)?

A
  • Obstruction
  • Gangrenous bowel
  • Perforation
119
Q

What should be suspected in an infant with green bilious vomiting?

A

Intestinal obstruction (particularly malrotation + volvulus)
*other causes include atresia, meconium ileus, necrotising enterocolitis)

120
Q

What are the signs/ symptoms of intestinal malrotation with volvulus (6)?

A
  • Green bilious vomiting
  • Distended abdomen
  • Painful abdomen
  • Infrequent bowel movements
  • Lethargy
  • Poor appetite
121
Q

What is a volvulus?

A

Twisted intestine that obstructs passage of faeces through it

122
Q

How is intestinal malroatation investigated?

A
  • USS
  • Upper GI contrast study
123
Q

What age does malrotation usually present?

A

Within first year of life

124
Q

How is malrotation treated?

A

Surgery (laparotomy)

125
Q

What disease is caused by a deficiency in protein intake?

A

Kwashiorkor

126
Q

What are the signs/ symptoms of Kwashiorkor (5)?

A
  • Failure to thrive
  • Fatigue
  • Muscle waisting
  • Oedema
  • Immunodeficiency
127
Q

What is a key blood finding for those with kwashiorkor?

A

Hypoalbuminaemia

128
Q

What disease is caused by a deficiency in all macronutrients?

A

Marasmus

129
Q

What are the key macronutrients deficient in those with marasmus (3)?

A
  • Protein
  • Carbohydrates
  • Fats
130
Q

What are the signs/ symptoms of marasmus (4)?

A
  • Failure to thrive
  • Low BMI/ weight loss
  • Brittle hair
  • Immunodeficiency
131
Q

What is the key difference between marasmus and kwashiorkor in terms of presentation?

A

Marasmus does not cause oedema, kwashiorkor does

132
Q

What is colic?

A

Frequent, prolonged episodes of crying in a healthy infant

133
Q

What ages does colic usually occur between?

A

2 weeks to 4 months (first year of life)

134
Q

What is important to do in babies with colic?

A

Rule out other causes of colic e.g. GORD, milk protein allergy

135
Q

What disease may affect the bile ducts of children?

A

Choledochal cysts

136
Q

What is a choledochal cyst?

A

A congenital cystic dilation of bile ducts (intra or extra hepatic)

137
Q

What is the key triad of symptoms suggestive of a choledochal cyst?

A
  • Jaundice
  • Abdominal pain
  • Abdominal (RUQ) mass
138
Q

What are some other symptoms of choledochal cyst (other than the triad of symptoms) (3)?

A
  • Nausea
  • Vomiting
  • Fever
139
Q

What age do choledochal cysts usually present?

A

Usually in early childhood, < 5 years
However they can go undiagnosed until adulthood

140
Q

How is a choledochal cyst investigated (3)?

A
  • Ultrasound
  • MRCP/ ERCP
  • CT
141
Q

How are choledochal cysts treated?

A

Surgical removal + reconstruction

142
Q

What are some complications of choledochal cysts (3)?

A
  • Stone formation
  • Pancreatitis
  • Increased risk of cholagiocarcinoma
143
Q

What are the causes of acute liver failure in children (4)?

A
  • Viral hepatitis (hep A-G/ other viruses)
  • Paracetamol overdose
  • Wilsons
  • Autoimmune hepatitis
144
Q

What are the causes of chronic liver disease in children (8)?

A
  • Postviral hepatitis
  • Autoimmune hepatitis + PSC
  • Wilsons
  • CF
  • Drug induced (e.g. NSAIDs)
  • NAFLD
  • A1ATD
  • Idiopathic (may be an unidentified viral infection)
145
Q

What virus other than hep A-G commonly causes hepatitis?

A

EBV

146
Q

What are the symptoms of liver disease in children (7)?

A
  • Jaundice
  • Vomiting
  • Lethargy
  • Abdo pain
  • Confusion
  • Increased bruising/ bleeding
  • Failure to thrive
147
Q

What are some GI causes of failure to thrive in children (10)?

A
  • GORD
  • Poor feeding
  • Pyloric stenosis
  • IBD
  • Coeliacs
  • Nutritional deficiencies (e.g. marasmus/ kwashiorkor)
  • Food intolerance/ allergy
  • Liver disease
  • CF
  • Chronic diarrhoea/ constipation
  • Hirschprungs
148
Q

What is a key differential for failure to thrive?

A

Normal growth variation in healthy children (due to parents being short for example)

149
Q

What are some important causes of poor feeding in babies (9)?

A
  • GI disorders e.g. GORD, coeliacs, constipation, food intolerance/ allergy
  • Neurological disorders e.g. cerebral palsy
  • Congenital/ structural e.g. cleft lip, tongue tied
  • Endocrine e.g. hypothyroidism
  • Congenital heart disease
  • Chronic lung disease
  • Infection
  • Behavioural disorders e.g. ASD
  • Neglect/ abuse/ poverty

Phase 3a conditions list flashcards (25 decks)

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