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Paediatrics > Paeds GI 2 > Flashcards

Paeds GI 2 Flashcards

1
Q

Why is reflux v common in infancy?

A

oes sphincter isn’t mature

fluid diet, horizontal posture

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2
Q

Gastro-oesophageal reflux is v common in infancy, often resolves by 12 months. What symptoms alongside reflux make it into gastro-oesophageal reflux DISEASE?

A
  • faltering growth
  • oesophagitis
  • pulm aspiration
  • Sandifer syndrome
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3
Q

What might be the signs of oesophagitis as part of GORD?

A

haematemesis, feeding discomfort

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4
Q

What might be some signs of pulm aspiration as part of GORD?

A

cough, wheeze, pneumonia!

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5
Q

What is Sandifer syndrome?

A

dystonic neck posturing in association with GORD

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6
Q

Name two groups for whom GORD is more common.

A

preterms

neurodisability (cerebral palsy)

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7
Q

Are investigations used to diagnose GORD?

A

no
if complex / atypical - 24hr oes pH monitoring

(or suspect other cause eg urine dip)

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8
Q

Name some risk factors for GORD.

A 
prematurity
neurodisability (CP)
obesity
hiatus hernia
FHx
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9
Q

If breastfed with frequent regurgitation causing marked distress, what should you give immediately after feeds?

A

alginate (eg. Gaviscon) mixed with water

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10
Q

Management of GORD if formula fed?

A
  1. Little and often feeds
  2. Add Thickener to formula
  3. Add Alginate to formula instead
  4. RANITIDINE OR OMEPRAZOLE
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11
Q

If thickener and alginate (Gavsicon) don’t work, what medications can be used to treat GORD?

A

ranitidine (anti-histamine)

omeprazole (proton pump inhibitor)

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12
Q

What is the DEFINITIVE treatment for GORD?

A

Nissen’s fundoplication

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13
Q

Nissen’s fundoplication is surgery for…

A

GORD

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14
Q

What are two uncommon complications of GORD

A

recurrent aspiration pneumonia

recurrent otitis media

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15
Q

Acute abdo pain could be caused by all sorts of GI stuff - appendicitis, obstruction, trauma, peritonitis, IBD, gastroenteritis, constipation, Meckel’s. What haem stuff could also cause abdo pain?

A

lead poisoning
sickle cell
Henoch Schonlein purpura

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16
Q

What groin stuff could cause acute abdo pain?

A

inguinal hernia
testicular torsion

pregnancy / ectopic
ovarian torsion

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17
Q

What kidney stuff could cause acute abdo pain?

A

acute pyelonephritis
UTI
hydronephrosis
renal calculus

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18
Q

Apart from GI stuff, haem stuff, groin stuff, kidney stuff, what else could cause acute abdo pain?

A

RESP - lower lobe pneumonia
MSK - hip + spine

also hepatitis, pancreatitis, DKA.

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19
Q

What age group most commonly get intussusception?

A

under 2yrs

20
Q

Define intussusception

A

invagination of proximal into distal

21
Q

What part of bowel is intussusception usually?

A

ileum into caecum

22
Q

Give me the 4 BASIC SYMPTOMS of intussusception.

A

paroxysmal colicky abdo pain + pallor
vomiting
sausage shaped abdo mass
redcurrant jelly stool

23
Q

How does intussusception cause shock?

A

distension – venous obstruction – bleeding into bowel – fluid pools in gut – HYPOVOL.
… perforation, peritonitis :/

24
Q

What investigations for intussusception?

A

abdo US

AXR

25
Q

What would abdo US show in intussusception?

A

distended small bowel

no gas in colon

26
Q

Treatment for intussusception?

A

IV fluid resusc

RECTAL AIR INSUFFLATION - pop it out!

27
Q

What is “rectal air insufflation” the treatment for?

A

intussusception

PLUS DONT FORGET IV FLUID RESUSC

28
Q

Remnant of vitello-intestinal duct in ileum in 2% of pop. What’s this?

A

Meckel’s diverticulum

29
Q

What is Meckel’s diverticulum?

A

remnant of vitello-intestinal duct in ileum in 2% pop - it’s weird tissue and it bleeds

30
Q

Most Meckel’s diverticulum are asymptomatic. But can cause what bad stuff can happen?

A

PR bleeding
acute drop in Hb
diverticulitis / intussusception / volvulus

31
Q

What is the treatment for Meckel’s diverticulum?

A

surgical resection

32
Q

When does malrotation present?

A

first 1-3 days of life

33
Q

Tell me about anatomy and malrotation.

A 
it's when the gut grows weird in the womb
have abnormalities like:
- narrow stalk-like mesentery
- Ladd bands
- small bowel over on the right

so twists around causing VOLVULUS

34
Q

What happens in volvulus?

A

obstruction +/- compromised blood supply

bilious vom, acute abdo

35
Q

What is the investigation for malrotation + volvulus?

A

URGENT upper GI contrast study

36
Q

Suspected malrotation + volvulus, with signs of COMPROMISED BLOOD SUPPLY. Don’t faff around with upper GI contrast study, do what?

A

urgent laparotomy

untwist volvulus, widen mesentery

37
Q

“Recurrent” abdo pain counts as how long?

A

> 3 months; disrupts activities

38
Q

In what % of recurrent abdo pain is no structural cause identified?!

A

90%!

39
Q

Name some LADY causes of RECURRENT abdo pain.

A

dysmenorrhoea
ovarian cysts
PID

40
Q

Name some KIDNEY causes of RECURRENT abdo pain.

A

UTI

PUJ obstruction

41
Q

Name some GI causes of RECURRENT abdo pain

A 
functional dyspepsia
eosinophilis oesophagitis
IBS
constipation
gastritis + peptic ulcer
IBD
42
Q

Name some liver-ish causes of recurrent abdo pain.

A

hepatitis
gallstones
pancreatitis

43
Q

Child has recurrent abdo pain, with food sticking in her throat and vomiting for over 3 months. PMH of asthma, eczema and hayfever. What do you suspect and how confirm?

A

eosinophilic oesophagitis!

endoscopy

44
Q

What is treatment for eosinophilic oesophagitis?

A

oral fluticasone

corticosteroid

45
Q

Child presents with recurrent abdo pain, headaches and facial pallor. She gets episodes of midline pain lasting 48hrs at a time. On social Hx you find she is stressed and being bullied at school. Suspect?

A

abdominal migraine

  • TOPIRAMATE
46
Q

What is treatment for abdominal migraine?

A

TOPIRAMATE

Paediatrics (14 decks)

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