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3a > Paeds GI > Flashcards

Paeds GI Flashcards

1
Q

How is transient synovitis managed ?

A
  • Simple analgesia

- Safety net to attend A&E if symptoms worsen or they develop a fever !

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2
Q

What are the symptoms of an appendicitis ?

A
  • Umbilical pain that spreads to the RIF
  • Anorexia
  • N&V
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3
Q

What are the signs of an appendicitis ?

A
  • > Tenderness and guarding over McBurney’s point
  • > Rovsing’s sign : palpation in LIF causes pain in the RIF
  • > Fever
  • > Abdo pain aggravated my movement
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4
Q

Give 2 signs of peritonitis

A
  • Rebound tenderness : increased pain following quick release of pressure of RIF
  • Percussion tenderness
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5
Q

Give 3 complications of an appendicitis

A
  • Rupture -> peritonitis
  • Abscess
  • Appendix mass
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6
Q

Define biliary atresia

A
  • Section of the bile duct is either narrowed or absent
  • This leads to cholestasis, where bile cannot be transported from the liver to the bowel
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7
Q

How does biliary atresia present

A
  • Persistent jaundice shortly after birth
  • Dark urine, pale stools
  • Hepatosplenomegly
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8
Q

Define prolonged jaundice in term and premature babies

A
  • Term : 14 days
  • Premature : 21 days
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9
Q

What investigations are used in biliary atresia ?

A

Raised levels of conjugated bilirubin

- > There will be a high proportion of conjugated bilirubin (the liver can process it but not excrete it)

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10
Q

How is biliary atresia managed?

A
  • > Kasai portoenterostomy : attaching a section of the small intestine to the opening of the liver where the bile duct normally attaches.
  • > Often require a liver transplant in later life
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11
Q

Explain the pathophysiology behind coeliac disease

A
  • Gliadin in gluten provokes a damaging immunological response in the proximal small intestinal mucosa
  • > Anti-TTG and anti-EMA antibodies target epithelial cells and cause inflammation
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12
Q

How does coeliac disease present ?

A
  • Failure to thrive
  • Diarrhoea
  • Fatigue
  • Weight loss
  • Mouth ulcers
  • Iron an/or folate deficiency anaemia
  • Growth failure
  • Dermatitis herpetiformis
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13
Q

What bloods are done in coeliac disease ?

A
  • First check IgA levels to exclude IgA deficiency
  • Raised anti-TTG
  • Raised anti-EMA
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14
Q

What is seen on an endoscopy + biopsy in coeliac disease ?

A
  • Jejunum is most affected
  • Crypt hypertrophy
  • Villous atrophy
  • Increased intraepithelial lymphocytes
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15
Q

Define crohns disease

A

-Transmural granulomatous chronic inflammation of the GI tract

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16
Q

How does crohns disease present ?

A
  • Abdo pain, diarrhoea, weight loss
  • Growth failure due to malabsorption
  • Delayed puberty
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17
Q

What are the extraintestinal symptoms of crohns?

A
  • Oral lesions or perianal skin tags
  • Uveitis
  • Arthralgia
  • Erythema nodosum
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18
Q

What bloods are seen in crohns ?

A
  • Raised faecal calprotectin
  • Raised plts, ESR and CRP
  • IDA due to malabsorption
  • low serum albumin
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19
Q

What is seen on endoscopy + biopsy in crohns

A
  • Skip lesions
  • Non-caseating granulomas
  • Transmural damage, terminal ileum most severe
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20
Q

How is remission induced in crohns ?

A
  • Nutritional therapy for 6-8 wks

- Systemic steroids if necessary (oral pred, IV hydrocortisone)

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21
Q

How is remission maintained/relapse treated in crohns?

A
  • Immunosuppressant medication : azathioprine, mercaptpurine, methotrexate
  • Infliximab, adalimumab if necessary
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22
Q

Give 3 complications of crohns

A
  • Bowel strictures leading to obstruction
  • Fistulae
  • Abscess formation
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23
Q

What causes GORD ?

A
  • Inappropriate relaxation of the lower oesophageal sphincter due to functional immaturity
  • Most spontanesouly resolves by 12mnths of age and put on weight normally despite symptoms
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24
Q

Give 4 serious causes of GORD

A
  • Cerebral palsy
  • Other neurodevelopmental disorders
  • Preterm infants
  • Following surgery for oesopheal atresia or diaphragmatic hernia
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25
Q

What investigations are done for GORD ?

A
  • Usually clinic
  • 24hr oesophageal pH monitoring to assess degree of acid reflux
  • Endoscopy with oesophageal biopsy
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26
Q

How is uncomplicated GORD managed ?

A

-Inert thickening agents to feeds and position upright after meals

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27
Q

How is more severe GORD managed?

A
  • Acid suppression with ranitidine or PPI

- Severe : surgical fundoplication

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28
Q

Give 4 complications of GORD

A
  • Failure to thrive in severe vomiting
  • Oesophagitis
  • Recurrent pulmonary aspiration
  • Sandifer’s syndrome
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29
Q

What is sandifer’s syndrome ?

A

-Rare condition causing brief episodes of abnormal movements assocaited with GORD in infants

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30
Q

Give 2 characteristics of sandifer’s syndrome

A
  • Torticollis : forceful contraction of the neck muscles
  • Dystonia
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31
Q

Define Hirschsprung disease

A

-Congenital condition where the nerve cells in the myenteric plexus are absent (aganglionic) in the rectum and variable distance of the colon

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32
Q

Give 4 presenting signs of Hirschsprung

A
  • Failure to pass meconium in the first 24 hrs of life
  • Abdominal distention
  • Later : bile-stained vomit
  • If presentation is later in life : profound chronic constipation, abdo distention and growth failure
33
Q

How is Hirschsprung diagnosed ?

A

-Suction rectal biopsy

34
Q

How is Hirschsprung managed ?

A
  • Initially : rectal washouts/irrigation to prevent enterocolitis
  • Surgically : initial colostomy with removal of the aganglionic section, followed by anastomosing normally innervated bowel the the anus -> swenson
35
Q

What is a severe complication of Hirschsprung disease ?

A

-Hirschsprung-Associated Enterocolitis (HAEC)

36
Q

What can cause HAEC and how does it present ?

A
  • C.diff
  • Fever, abdo distention, diarrhoea (often bloody) and features of sepsis
37
Q

How is HAEC managed ?

A
  • IV antibiotics
  • Fluid resus
  • Decompression of obstructed bowel
38
Q

Define ulcerative colitis

A

-Recurrent, inflammatory and ulcerating disease involving the mucosa of the colon

39
Q

How does UC present ?

A
  • Rectal bleeding, diarrhoea and colicky abdo pain
  • Weight loss
  • Growth failure
40
Q

Give 3 extraintestinal signs of UC

A
  • Arthritis
  • Erythema nodosum
  • Primary sclerosing cholangitis
41
Q

Give 3 signs of UC on endoscopy + biopsy

A
  • Continuous inflammation
  • Begins in the rectum and travels proximally
  • Possible crypt abscesses
42
Q

How is remission induced in UC ?

A
  • Mild : aminosalicylates (e.g. mesalazine) or corticosteroids
  • More severe : IV corticosteroids or IV ciclosporin
43
Q

How is remission maintained in UC

A
  • Aminosalicylate
  • Azathioprine
  • Mercaptopurine
44
Q

What is a complication of UC ?

A

-Increased risk of adenocarcinoma of the colon in adulthood

45
Q

What is malrotation ?

A

-Malrotation of the small bowel during foetal life

46
Q

How does malrotation present ?

A
  • Bilious vomiting in the first few days of life
  • can lead to volvus formation leading to an obstruction and ischaemic bowel
  • Abdo pain and tenderness from peritonitis or ischaemic bowel
  • Associated with exomphalos & hernia
47
Q

How is malrotation diagnosed ?

A

-Abdo USS : whirlpool sign

48
Q

How is malrotation managed ?

A

-Surgery to untwist the bowel : Ladd’s

49
Q

What is intussusception and when does it occur?

A
  • Invagination of proximal bowel into a distal segment
  • Usually occurs between 6mnths and 2 yrs of age
50
Q

How does intussusception present

A
  • Concurrent viral illness !
  • Severe colciky pain and pallor causing a child to draw their legs up
  • Redcurrant jelly stool
  • Palpable sausage shaped mass in the abdomen
  • Intestinal obstruction : vomiting, constipation, abdo distention.
51
Q

What is associated with intussusception

A
  • Meckel diverticulum
  • Henoch-Schonlein purpura
  • Cystic fibrosis
  • Intestinal polyps
52
Q

What is Meckels diverticulum and how does it present ?

A
  • Ileal remnant of the vitello-intestinal duct
  • Presents with severe rectal bleeding
  • Diverticulitis micking appendicitis
  • Treated with surgical resection
53
Q

How is intussusception diagnosed ?

A
  • USS : target sign

- Contrast enema

54
Q

How is intussusception managed ?

A
  • Rectal air insufflation : therapeutic enema
  • Surgery if reduction of air is ineffective
55
Q

How is intussusception managed if there are signs of peritonitis ?

A
  • Surgery
56
Q

Give 4 complications of intussusception

A
  • Obstruction
  • Gangernous bowel
  • Perforation
  • Death
57
Q

What is pyloric stenosis ?

A

-Hypertrophy of the pyloric muscle leading to narrowing and oulet obstruction

58
Q

Give 4 clinical features of pyloric stenosis

A
  • Projectile vomit
  • Hunger after vomiting
  • Failure to thrive
  • Olive shaped mass in upper abdomen
59
Q

What would a blood gas show in pyloric stenosis ?

A

Hypochloric metabolic alkalosis with low plasma sodium and potassium due to vomiting stomach contents

60
Q

When does pyloric stenosis present ?

A
  • First few weeks of life
61
Q

What can be seen on abdo exam in pyloric stenosis ?

A
  • Pyloric mass in RUQ (olive like )

- Gastric peristalsis seen as a wave moving from left to right across the abdomen

62
Q

How is pyloric stenosis diagnosed ?

A
  • Test feed
  • USS
63
Q

How is pyloric stenosis managed ?

A
  • Ramstedt’s pyloromyotomy

- Correct fluid and electrolyte disturbance with IV fluids

64
Q

Give 3 mechanical consequences of vomiting

A
  • Mallory-Weiss tear
  • Boerhaave’s syndrome
  • Tears of the short gastric arteries resulting in shock and hemoperitoneum
65
Q

Give 5 signs of more severe GORD

A
  • Faltering growth
  • Oesophagitis +/-stricture
  • Apnoea
  • Aspiration, wheezing, hoarseness
  • Seizure like events
66
Q

Give 3 common causes of viral gastroenteritis

A
  • Rotavirus
  • Norovirus
  • Adenovirus -> less common, more subacute diarrhoea
67
Q

How would E.coli present if causing gastroenteritis

A
  • Abdo cramps, D&V
  • The shiga toxin leads to HUS
  • Abx should be avoided due to increased risk of HUS
68
Q

What is the most common bacterial causes of gastroenteritis worldwide ?

A
  • Campylobacter jejuni -> gram neg
  • Abdo cramps, bloody diarrhoea, vomiting, fever
  • Raw poultry, untreated water, unpasteurised milk
  • Abx : azithromycin, ciprofloxacin
69
Q

How would shigella gastroenteritis present ?

A
  • Faeces contaminated food and water
  • Bloody diarrhoea, abdo cramps, fever
  • Shiga toxin -> HUS
  • Severe : azithromycin or ciprofloxacin
70
Q

Explain salmonella causes of gastroenteritis

A
  • Raw eggs, poultry
  • Watery diarrhoea
  • Abx only in severe cases
71
Q

How does bacillus cereus as a cause of gastroenteritis present ?

A
  • Fried rice eaten at room temp
  • Cereulide toxin produces abdo cramping and vomiting withing 5 hrs
  • Diarrhoea within 8 hrs
  • Resolves within 24
  • Gram positive rod
72
Q

Give a parasitic cause of gastroenteritis

A
  • Giardia lamblia

- Tx with metronidazole

73
Q

What are the principles of gastroenteritis management

A
  • Barrier nursing
  • Stool microscopy, culture and sensitivities
  • Hydration -> attempt fluid challenge. Dioralyte can be used to rehydrate or IV fluid is needed
74
Q

How can intestinal obstruction present and how is it diagnosed ?

A
  • Persistent, possibly bilious vomiting
  • Abdo pain and distention
  • Failure. topass stool or wind
  • Abnormal bowel sounds : high pitched ‘tinkling’, absent later
  • XRAY : dilated bowel proximal and collapsed loops distal + absence of air in rectum
75
Q

Define encopresis

A
  • Faecal incontinence -> pathological at 4 yrs
  • Chronic constipation causes the rectum to stretch and lose sensation.
  • Only loose stool can bypass blockage and leak out
76
Q

How is constipation managed if faecal impaction is present ?

A
  • Movicol peadiatric plan
  • Add stimulant after 2 wks if no change
  • Add osmotic laxative (lactulose)
77
Q

How is general constipation managed

A
  • Movicol
  • Add stimulant
  • Add osmotic laxative
  • Continue for several weeks after refulat bowel habit.
78
Q
A

3a (45 decks)

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