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Paediatrics > Paediatrics - GI > Flashcards

Paediatrics - GI Flashcards

1
Q

What are the differentials of an abdominal mass in a child?

A

Wilm’s tumour, neuroblastoma, leukemia, sarcoma. hepatoblastoma
Constipation
Enlarged kidneys

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2
Q

What are some ways to treat constipation?

A

Diet
Osmotic laxatives - movical, lactulose
Stimulant laxatives - sodium picosulfate, senna, bisacodyl

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3
Q

What are some symptoms of oesophageal atrusion?

A

persisten salivation and drooling
coughing and choking on feeding
cyanotic episodes
aspiration

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4
Q

What is the difference between gastroschisis and exomphalos?

A

gastroschisis - bowel protrudes through abdominal wall with no covering sac - these is greater risk of dehydration and hypothermia

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5
Q

What do you do with umbilical hernias?

A

leave them alone!

95% resolve spontaneously

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6
Q

How would you treat necrotizing enterocolitis?

A

stop oral feeds
broad spectrum antibiotics
abdo XR
surgery if bowel perforation - surgcial review

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7
Q

How would you test for oesophagel atrusion?

A

insert wide-calibre feeding tube and see if in stomach on XR

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8
Q

What are the symptoms of necrotizing enterocolitis?

A

feed intolerance
vomiting - bile stained
disended abdo
stool-fresh blood

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9
Q

Name 2 causes of large bowel atresia

A

Hirschrung disease

rectal atresia

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10
Q

Name 3 common causes of small bowel atresia

A 
duodenal atresia/stenosis (esp Down)
Jujunual atresia/stenosis 
malnutrition with volvulus 
meconium ileus 
meconium plug
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11
Q

How do you test for and treat Hirschprung?

A

rectal exam and suction rectal biopsy

treat - surgery, colostomy

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12
Q

What is the VACTERL association?

A

vertebral, anorectal, cardiac, tracheo-oesophageal, renal, radial limb anomalies

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13
Q

What increases the incidence of necrotizing enterocolitis?

A

Hisprungs

premature - vulnerable to ischaemic injury and bacterial invasion

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14
Q

What are the symptoms of Hirschprung disease?

A 
do not pass meconium in 24-48 hours
abdominal distension 
bile stained vomiting 
chronic constipation 
growth failure 
enterocolitis
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15
Q

What is different with treating inguinal hernias in children?

A

Need more urgent repair
Neonates - within days
Infants - within weeks

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16
Q

Name symptoms of small bowel atresia

A

persistent vomiting - bile stained
no normal stool +/- meconium
abdominal distension (esp when distal)

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17
Q

What is the meconium ileus?

A

thick insipissated meconium, putty consistency becomes impacted in lower ileum - 10% of people with CF

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18
Q

What is Hirschsprung disease?

A

absence of myenteric plexus of rectum and variable distance of colon

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19
Q

How would you treat GORD?

A

anatacid, H2 blocker e.g. ranitide, PPI e.g. omeprazole

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20
Q

What are the red flags for constipation?

A

no/delayed meconium, fever, vomiting, bloody stools, failure to thrive, tight, empty rectum and palpable mass, abnormal neuro exam

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21
Q

Name 5 causes of diarrhoea

A

gastroenteritis, UTI, meningitis, food allergy, appendicitis, intussception, haemolytic uraemic syndrome

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22
Q

What are red flags of abdo pain?

A

weight loss, decreased growth, GI blood loss, vomiting, diarrhoea, fever, family history, persistent right/upper or lower quadrant pain

23
Q

Name 5 differentials for constipation

A

Hirschprung, anorectal malformation, spina bifida, neuromuscular disease, coeliac, food allergy, CF, anal fissure, hypothyroid, sexual abuse, drugs, spinal tumours

24
Q

When does pyloric stenosis present?

A

2-8 weeks

25
Q

What would you see on bloods of a child with pyloric stenosis?

A

hypochoremic metabolic acidosis

low sodium and potassium

26
Q

Name symptoms of pyloric stenosis

A

vomiting - increased frequency and forcefullness eventually projectile
hunger - until dehydration results in loss of feeding
weight loss

27
Q

What is the cause of neonatal jaundice is urgent and needs to be treated ASAP?

A

extrahepatic obstruction to bile flow
TEST - radioisotope, liver biopsy
TREAT - hepatoporto and enterostomy
Risk - liver cirrhosis

28
Q

What is a major complication of jaundice?

A

Kernictereus - bilirubin deposits in basal ganglia and brainstem nuceli
due to unconjugated bilirubin being fat soluble so can cross blood-brain barrier

29
Q

When would you be concerned about jaundice?

A

< 1 days old
dark urine
pale stools
failure to thrive

30
Q

What are some causes of jaundice?

A

congenital, infection, haemolytic, polycythaemia, physiological, breast milk, biliary atresia

31
Q

What is biliary atresia?

A

extrahepatic obstruction to bile flow = pale urine and dark stools

32
Q

What does bile stained vomit indicate?

A

Intestinal obstruction

33
Q

What does blood stained vomit indicate?

A

Peptic ulceration, gastritis, oesophageal varices

34
Q

What does projectile vomit indicate?

A

Pyloric stenosis

35
Q

What does blood in stool indicate?

A

intussusception, gastroenteritis

36
Q

How would you test for pyloric stenosis?

A

ABG - metabolic alkalosis, low potassium and chloride
Test feed - NG tube and aspiration to empty stomach, give dioralyte - if an “olive” mass is palpable on liver edge = stenosed pylorus

37
Q

What is the treatment of pyloric stenosis?

A

normalise fluid and electrolytes

Ramstedt’s pyloromytomy

38
Q

How would you treat Crohn’s disease?

A

enteral nutrition, glucocorticoid

Maintainence - azathioprine

39
Q

How would you treat UC?

A

glucocorticoids, aminosalicylates (e.g. mesalazine)

Maintainence - aminosalicylates

40
Q

What are symptoms of intussusception?

A

sudden colicky pain, drawing legs up, pale, vomiting, redcurrent jelly stools
Target sign on US

41
Q

What causes jaundice in firsts 24 hours?

A

haemolytic disease of the newborn, hereditary spherocytosis, G-6-PD deficiency, sepsis, TORCH infections

42
Q

What causes jaundice 2 weeks after birth?

A

Biliary atresia, hypothyroidism, galactosaemia, UTI, Gilbert syndrome

43
Q

What would high levels of conjugated or unconjugated bilirubin indicate?

A

Conjugated - hepatobiliary source

un-conjugated - extra-hepatic source

44
Q

What is wilson’s disease?

A

Copper accumulating in liver, kidneys, eyes and brain

Kayser-Fleischer rings, parkinsonism, vit D resistant rickets, jaundice

45
Q

How do you test and treat for Wilson’s disease?

A

24 hour urine copper assay, serum caeruloplasmin low

Treat - penicillamine, zinc, vit B6

46
Q

What is Kernicterus?

A

unconjugated bilirubin in basal ganglia = GI haem, athetosis, gaze disturbance, hearing loss, convulsions, cerebal palsy, usually in first month of life

47
Q

What is galactosaemia and some of its symptoms?

A

autosommal recessive where you lack the enzyme for galactose ingestion (in milk)
ingestion of galactose = vomiting, hepatomegaly, failure to thrive, DM, cataracts, developmental delay
transferase deficiency itself causes poor growth and problems with speech and mental development

48
Q

What is phenylketonuria?

A

they cannot digest phenylalamine (eggs, milk, meat)

leads to brain damage, epilepsy and learning difficulties

49
Q

When is phenylketonuria tested for?

A

Newborn heel prick test

50
Q

How would you manage intussception?

A

NBM
IV fluids
75% reduced by air insuffiation rectally but this risks perforation so do in theatre

51
Q

What counts as prolonged jaundice?

A

Beyond day 14 in term babies

Beyond dy 21 in preterm neonates

52
Q

What are systemic symptoms of cow’s milk allergy?

A

diarrhoea, dermatitis, rhinitis

53
Q

When does reflux start and how long does it last?

A

within first 8 weeks, peaks 3-4 months

90% resolve in one year

Paediatrics (11 decks)

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