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Finals > Paeds: Gastro > Flashcards

Paeds: Gastro Flashcards

1
Q

Intussusception

what is it

A

bowel invaginates or telescopes into itself

palpable mass in the abdo and obstruction to the passage of faeces through the bowel

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2
Q

Intussusception

epidemiology

A

6m - 2y

more common in boys

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3
Q

Intussusception

associated conditions

A
  • concurrent VIRAL ILLNESS
  • Henoch-Schonlein purpura
  • cystic fibrosis
  • intestinal polyps
  • Meckel diverticulum
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4
Q

Intussusception

presentation

A
  • REDCURRANT JELLY STOOL
  • SAUSAGE SHAPED mass in RUQ on palpation
  • severe, colicky abdo pain
  • pale, lethargic + unwell child
  • vomiting
  • intestinal obstruction
  • URTI preceding the illness
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5
Q

Intussusception

initial inx

A

US

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6
Q

Intussusception

mnx

A
  • therapeutic enemas: contrast, water or air are pumped into the colon to force the folded bowel out
  • 2nd line: surgical reduction if bowel becomes gangrenous or perforated
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7
Q

Intussusception

complications

A
  • obstruction
  • gangrenous bowel
  • perforation
  • death
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8
Q

Biliary atresia

what is it

A

congenital condition where a section of the bile duct is narrowed or absent

results in cholestasis: bile cannot be transported from liver to bowel

conjugated bilirubin cannot be excreted

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9
Q

Biliary atresia

presentation

A
  • shortly after birth

- persistent jaundice >14d

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10
Q

Biliary atresia

initial inx

A

conjugated and unconjugated bilirubin

high conjugated = biliary atresia

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11
Q

Biliary atresia

mnx

A

surgery: the Kasai portoenterostomy

some may need a full liver transplant to resolve the condition

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12
Q

Biliary atresia

what is involved in the Kasai portoenterostomy

A

involves attaching a section of the small intestine to the opening of the liver, where the bile duct normally attaches

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13
Q

Pyloric Stenosis

what is the pyloric sphincter

A

a ring of smooth muscle that forms the canal between the stomach and the duodenum

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14
Q

Pyloric Stenosis

what is it

A

hypertrophy and therefore narrowing of the pylorus

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15
Q

Pyloric Stenosis

how does projectile vomiting occur

A

after feeding, there is increasingly powerful peristalsis in the stomach as it tries to push food into the duodenum

it ejects the food into the oesophagus out of the mouth and across the room

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16
Q

Pyloric Stenosis

features

A
  • projectile vomiting
  • presents in the 1st few weeks of life
  • failure to thrive
  • round mass felt in upper abdo that feels like a large olive
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17
Q

Pyloric Stenosis

what is the mass felt

A

hypertrophic muscle of the pylorus

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18
Q

Pyloric Stenosis

what will blood gas analysis show

A

hypochloric (low Chloride)

metabolic alkalosis

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19
Q

Pyloric Stenosis

dx

A

abdominal US to visualise thickened pylorus

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20
Q

Pyloric Stenosis

trx

A

laparoscopic pyloromyotomy aka Ramstedt’s operation

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21
Q

Pyloric Stenosis

what is Ramstedt’s operation?

A

laparoscopic pyloromyotomy

an incision is made i the smooth muscle of the pylorus to widen the canal

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22
Q

Gastroenteritis

what is acute gastritis

A

inflammation of the stomach and presents with N + V

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23
Q

Gastroenteritis

what is enteritis

A

inflammation of the intestines and presents with diarrhoea

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24
Q

Gastroenteritis

what is gastroenteritis

A

inflammation from the stomach to the intestinges and presents with N + V + diarrhoea

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25
Q

Gastroenteritis

the most common cause

A

viral : rotavirus and norovirus

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26
Q

Gastroenteritis

main concern

A

dehydration

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27
Q

Gastroenteritis

what does steatorrhoea mean

A

greasy stools with excessive fat content

suggests a problem with digesting fats e.g. pancreatic insufficiency (CF?)

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28
Q

Gastroenteritis

Ddx of diarrhoea in children

A
  • infection (gastroenteritis)
  • IBD
  • lactose intolerance
  • coeliac
  • CF
  • toddler’s diarrhoea
  • IBS
  • medications (e.g. abx)
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29
Q

Gastroenteritis

less common cause presenting with subacute diarrhoea

A

adenovirus

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30
Q

Gastroenteritis

how is Escherichia coli spread

A

through contact with infected faeces, unwashed salads or contaminated water

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31
Q

Gastroenteritis

pathogenesis of E.coli

A

E.coli 0157 produces the Shiga toxin –> abdo cramps, bloody diarrhoea + vomiting

the Shiga toxin destroys blood cells and leads to haemolytic uraemic syndrome

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32
Q

Gastroenteritis

why should abx be avoided if E.coli gastroenteritis is considered

A

they increase the risk of haemolytic uraemic syndrome

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33
Q

Gastroenteritis

most common cause of bacterial gastroenteritis worldwide

A

Campylobacter Jejuni

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34
Q

Gastroenteritis

common cause of travellers diarrhoea

A

Campylobacter Jejuni

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35
Q

Gastroenteritis

what does Campylobacter mean and what is it?

A

‘curved bacteria’

a gram -ve bacteria that has a curved or spiral shape

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36
Q

Gastroenteritis

how is Campylobacter spread?

A
  • raw or improperly cooked poultry
  • untreated water
  • unpasteurised milk
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37
Q

Gastroenteritis

incubation period for Campylobacter

A

2-5d

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38
Q

Gastroenteritis

Campylobacter symptoms

A
  • abdo cramps
  • diarrhoea often with blood
  • vomiting
  • fever

symptoms resolve after 3-6d

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39
Q

Gastroenteritis

Campylobacter: when can abx be considered

A

after isolating the organism where pts have severe sx or other RFs (HIV or HF)

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40
Q

Gastroenteritis

Campylobacter abx choice

A

azithromycin or ciprofloaxin

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41
Q

Gastroenteritis

how is Shigella spread

A

by faeces contaminating drinking water, swimming pools + foods

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42
Q

Gastroenteritis

shigella: incubation period

A

1-2d

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43
Q

Gastroenteritis

shigella: when do sx resolve

A

within 1w

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44
Q

Gastroenteritis

shigella: sx

A
  • watery diarrhoea that can be associated with mucus or blood
  • abdo pain
  • vomiting
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45
Q

Gastroenteritis

shigella: when to use abx

A

only in severe cases guided by stool culture and sensitivities

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46
Q

Gastroenteritis

Bacillus Cereus

A

gram positive rod

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47
Q

Gastroenteritis

Bacillus Cereus: how is it spread

A

through inadequately cooked food

it grows well on food not immediately refrigerated after cooking

typically fried rice left out at room temp

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48
Q

Gastroenteritis

Bacillus Cereus: how does it cause abdo cramping and vomiting

A

whilst growing on food it produces a toxin called cereulide

abdo cramping and V within 5hrs of ingestion

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49
Q

Gastroenteritis

Bacillus Cereus: how does it cause watery diarrhoea

A

it arrives in the intestine and produces a different toxin

> 8h after ingestion

50
Q

Gastroenteritis

Bacilius Cereus: when do sx resolve

A

within 24h

51
Q

Gastroenteritis

Yersinia Enterocolitica

A

gram negative bacillus

52
Q

Gastroenteritis

Yersinia Enterocolitica: what can cause infection

A

eating raw or undercooked pork as pigs are carriers of Yersinia

also spread through contamination with the urine or faeces of other mammal such as rats and rabbits

53
Q

Gastroenteritis

Yersinia Enterocolitica presentation

A
  • most freq affects children
  • water or bloody diarrhoea
  • abdo pain
  • fever
  • LYMPADENOPATHY

can last 3w or more

54
Q

Gastroenteritis

Yersinia Enterocolitica: incubation

A

4-7d

55
Q

Gastroenteritis

Yersinia Enterocolitica: why can older children or adults present with right sided abdo pain

A

due to mesenteric lymphadenitis (inflammation in the intestinal lymph nodes)

can give the impression of appendicitis

56
Q

Gastroenteritis

Yersinia Enterocolitica: mnx

A

abx are only necessary in severe cases and shold be guided by stool culture and sensitivities

57
Q

Gastroenteritis

Staphylococcus Aureus produces what

A

enterotoxins when growing on food such as eggs, dairy and meat

58
Q

Gastroenteritis

S.Areus enterotoxin causes what?

A

small intestine inflammation (enteritis)

59
Q

Gastroenteritis

S.Aureus enterotoxin sx

A
  • diarrhoea
  • perfuse vomiting
  • abdo cramps
  • fever
60
Q

Gastroenteritis

S.Aureus enterotoxin: sx onset

A

within hours of ingestion and settle within 12-24 hours

61
Q

Gastroenteritis

what is Giardia lamblia

A

a type of microscopic parasite that lives in the small intestines of mammals

62
Q

Gastroenteritis

how do Giardia lamblia infect a new host

A

it releases cysts in the stools of infected mammals

the cysts contaminate food or water and are eaten, infecting a new host

faecal-oral transmission

63
Q

Gastroenteritis

Giardiasis sx

A
  • many not cause any

- chronic diarrhoea

64
Q

Gastroenteritis

Giardiasis dx

A

stool microscopy

65
Q

Gastroenteritis

Giardiasis trx

A

metronidazole

66
Q

Gastroenteritis

principles of mnx

A
  1. good hygiene
  2. immediately isolate to prevent spread: barrier nursing and infection control.
  3. establish causative organism with faecal MC+S
  4. Fluid challenge
67
Q

Gastroenteritis

should children stay off school

A

yes, until 48hrs after the sx have completely resolved

68
Q

Gastroenteritis

what is a fluid challenge

A
  • record a small volume of fluid given orally every 5-10min to esnure they can tolerate
  • if they can, they can be hydrated at home
69
Q

Gastroenteritis

should you take medications such as loperamide and metoclopramide

A

no, not recommended

antidiarrheal medications are particularly avoided in e.coli 0157 and shigella infections and where there is bloody diarrhoea or high fever

70
Q

Gastroenteritis

post gastroenteritis complications

A
  • lactose intolerance
  • IBS
  • reactive arthritis
  • Gullain-Barré syndrome
71
Q

Hirschsprung’s Disease

what is it

A

a congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum

72
Q

Hirschsprung’s Disease

what is the myenteric plexus

A

aka Auerbach’s plexus

forms the enteric nervous system. It is the brain of the gut

runs all the way along the bowel

a complex web of neurones, ganglion cells, receptors, synapses and neurotransmitters.

responsible for stimulating peristalsis of the large bowel.

73
Q

Hirschsprung’s Disease

key pathophysiology

A

the absence of parasympathetic ganglion cells at a section at the end of the colon

74
Q

Hirschsprung’s Disease

what is total colonic aganglionosis

A

When the entire colon is affected, without innervation

75
Q

Hirschsprung’s Disease

what causes the bowel to become distended and full

A

The aganglionic section of colon does not relax, causing it to becomes constricted

This leads to loss of movement of faeces and obstruction in the bowel.

so proximal to the obstruction the bowel becomes distended and full.

76
Q

Hirschsprung’s Disease

what greatly increases the risk of it

A

a FH

77
Q

Hirschsprung’s Disease

what other syndromes is it associated with (4)

A
  • Downs syndrome
  • Neurofibromatosis
  • Waardenburg syndrome (a genetic condition causing pale blue eyes, hearing loss and patches of white skin and hair)
  • Multiple endocrine neoplasia type II
78
Q

Hirschsprung’s Disease

presentation

A
  • acute intestinal obstruction shortly after birth if lots of bowel affected
  • delay in passing meconium (24hrs)
  • chronic constipation since birth
  • abdo pain + distention
  • vomiting
  • poor weight gain and failure to thrive
79
Q

what is Hirschsprung-Associated Enterocolitis (HAEC)

A

inflammation and obstruction of the intestine occurring in around 20% of neonates with Hirschsprung’s disease

80
Q

how does Hirschsprung-Associated Enterocolitis typically present

A

within 2-4 weeks of birth with:

  • fever
  • abdominal distention
  • diarrhoea (often with blood)
  • features of sepsis.

life threatening and can lead to toxic megacolon and perforation of the bowel.

81
Q

mnx of Hirschsprung-Associated Enterocolitis

A

urgent antibiotics, fluid resuscitation and decompression of the obstructed bowel.

82
Q

Hirschsprung’s Disease

definitive mnx

A

surgical removal of the aganglionic section of bowel

83
Q

Hirschsprung’s Disease

confirm dx

A

Rectal biopsy

histology will show an absence of ganglionic cells.

abdo xray can be helpful

84
Q

GOR

why do babies suffer from it

A

there is immaturity of the lower oesophageal sphincter

allowing stomach contents to easily reflux into the oesophagus

it is normal and normally stops by 1 yr

85
Q

GOR

signs of problematic reflux (6)

A
  • chronic cough
  • hoarse cry
  • distress, crying or unsettled after feeding
  • reluctance to feed
  • pneumonia
  • poor weight gain
86
Q

GOR

how may children over 1yr present

A
  • heartburn
  • acid regurg
  • epigastric pain
  • bloating
  • nocturnal cough
87
Q

possible causes of vomiting

A
  • overfeeding
  • GOR
  • pyloric stenosis
  • gastritis or gastroenteritis
  • appendicitis
  • infections: UTI, tonsilitis, meningitis
  • intestinal obstruction
  • bulimia
88
Q

red flags in a vomiting hx

A
  • not keeping down any feed
  • projectile
  • bile stained
  • haematemesis or melaena
  • abdominal distention
  • reduced consciousness, bulging fontanelle or neuro signs
  • resp sx
  • blood in stool
  • signs of infection
  • rash, angioedema + other signs of allergy
  • apnoeas
89
Q

vomiting

not keeping down any feed may suggest what

A

pyloric stenosis or intestinal obstruction

90
Q

bile stained vomit may suggest what

A

intestinal obstruction

91
Q

vomiting

haematemesis or malaena may suggest what

A

peptic ulcer, oesophagitis or varices

92
Q

vomiting

resp sx may suggest what

A

aspiration or infection

93
Q

vomiting

blood in stool may suggest what

A

gastroenteritis or cows milk protein allergy

94
Q

vomiting

rash, angioedema and other signs of allergy may suggest what

A

cows milk protein allergy

95
Q

GOR

what to advise parents in simple cases

A
  • small, frequent meals
  • burping regularly to help milk settle
  • not over feeding
  • keep baby upright after feeding
96
Q

GOR

trx for more problematic cases

A
  • Gaviscon mixed with feeds
  • thickened milk or formula
  • Ranitidine
  • Omeprazole where ranitidine is inadequate
97
Q

AXR shows double bubble. Infant billious vomiting since birth. What is it

A

duodenal atresia

98
Q

whom are duodenal atresias more common in

A

Down’s

99
Q

trx of duodenal atresia

A

Duodenoduodenostomy

100
Q

Mesenteric adenitis

presentation

A

history of pain in the right iliac fossa, usually following an acute viral illness

101
Q

Mesenteric adenitis

mnx

A
  • exclude appendicitis

- monitored overnight to look for worsening of their clinical status

102
Q

Constipation

what is idiopathic/functional constipation

A

not a significant underlying cause other than simple lifestyle factors.

103
Q

Constipation

secondary causes

A
  • Hirschsprung’s disease
  • cystic fibrosis
  • hypothyroidism
104
Q

Constipation

typical features

A
  • <3 stools/week
  • Hard stools that are difficult to pass
  • Rabbit dropping stools
  • Straining and painful passages of stools
  • Abdominal pain
  • Holding an abnormal posture (retentive posturing)
  • Rectal bleeding assc w/ hard stools
  • Faecal impaction causing overflow soiling, with incontinence of particularly loose smelly stools
  • Hard stools may be palpable in abdomen
  • Loss of the sensation of the need to open the bowels
105
Q

Constipation

what is the term for faecal incontinence

A

encopresis

106
Q

Constipation

when is encopresis considered pathological

A

4y

107
Q

Constipation

usual cause of encopresis

A

chronic constipation where the rectum becomes stretched and looses sensation

Large hard stools remain in the rectum and only loose stools are able to bypass the blockage and leak out, causing soiling

108
Q

Constipation

rarer causes of encopresis

A
  • Spina bifida
  • Hirschprung’s disease
  • Cerebral palsy
  • Learning disability
  • Psychosocial stress
  • Abuse
109
Q

Constipation

what is faecal impaction

A

a large, hard stool blocks the rectum

110
Q

Constipation

what is desensitisation of the rectum

A

Often patients develop a habit of not opening their bowels when they need to and ignoring the sensation of a full rectum. Over time they loose the sensation of needing to open their bowels,

111
Q

Constipation

red flags: what could not passing meconium within 48h of birth indicate

A

cystic fibrosis or Hirschsprung’s disease

112
Q

Constipation

red flags: what could neuro signs indicate

A

cerebral palsy or spinal cord lesion

113
Q

Constipation

red flags: what could vomiting indicate

A

intestinal obstruction or Hirschsprung’s disease

114
Q

Constipation

red flags: what could ribbon stool indicate

A

anal stenosis

115
Q

Constipation

red flags: what could an Abnormal anus indicate

A

anal stenosis, inflammatory bowel disease or sexual abuse

116
Q

Constipation

red flags: what could an Abnormal lower back or buttocks indicate

A

spina bifida, spinal cord lesion or sacral agenesis

117
Q

Constipation

red flags: what could failure to thrive indicate

A

coeliac disease, hypothyroidism or safeguarding

118
Q

Constipation

red flags: what could acute severe abdominal pain and bloating indicate

A

obstruction or intussusception

119
Q

Constipation

complications (6)

A 
Pain
Reduced sensation
Anal fissures
Haemorrhoids
Overflow and soiling
Psychosocial morbidity
120
Q

Constipation

mnx

A
  • Correct reversible contributing factors: high fibre diet + good hydration
  • laxatives (movicol)
  • Faecal impaction may require a disimpaction regimen with high doses of laxatives at first
  • Encourage and praise visiting the toilet. This could involve scheduling visits, a bowel diary and star charts.
121
Q

Constipation

what is first line laxatives

A

movicol

Finals (47 decks)

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