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Year 3- Paediatrics > Upper GI > Flashcards

Upper GI Flashcards

1
Q

What are the different types of vomiting?

A

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting
Haematemesis

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2
Q

What symptoms are seen in the pre-ejection phase of vomiting?

A

Pallor
Nausea
Tachycardia

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3
Q

Upon a blood gas, what would be seen in a patient with pyloric stensosi?

A

Metabolic alkalosis

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4
Q

If you suspect pyloric stenosis, what should be done?

A

Refer to surgeons, they will carry out Ramstedt’s pyloromyotomy

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5
Q

In which age group does pyloric stenosis occur in?

A

Babies 4-12wks

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6
Q

What type of vomiting is seen in pyloric stenosis?

A

Projectile non-bilious vomiting

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7
Q

What symptoms are seen in pyloric stenosis?

A

Projectile non-bilious vomiting
Weight loss
Dehydration +/- shock

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8
Q

What is the characteristic electrolyte disturbance seen in pyloric stenosis?

A

Metabolic alkalosis
Hypochloraemia
Hypokalaemia

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9
Q

Bilious vomiting should always ring alarm bells.

What is bilious vomiting until proved otherwise?

A

Intestinal obstruction

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10
Q

What are some of the causes of intestinal obstruction, and therefore bilious vomiting?

A

Intestinal atresia
Malrotation
Intussusception
Crohns disease with structures

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11
Q

Investigations for bilious vomiting to rule out intestinal obstruction?

A

Abdominal x-ray
Consider contrast meal
Surgical opinion e.g. exploratory laparotomy

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12
Q

What is effortless vomiting almost always caused by?

A

Gastro-oesophageal reflux

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13
Q

What is the treatment for gastro-oesophageal reflux and effortless vomiting?

A

Resolves on its own in most cases

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14
Q

What are the situations where gastro-oesophageal reflux will not resolve by itself?

A

Cerebral palsy
Progressive neurological problems
Oesophageal atresia
Generalised GI motility problem

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15
Q

How long after birth does gastro-oesophageal reflux tend to occur?

A

2 weeks after birth

->can get worse for four to six months

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16
Q

Investigations for gastro-oesophageal reflux?

A

History and examination usually sufficient

Can do barium swallow, pH studies. oesophageal impedance monitoring, endoscopy

17
Q

What is done in terms of feeding for infants with gastro-oesophageal reflux?

A

Thickeners for liquids
Feeding position- propped up after feeds

->bigger teat in bottle required

18
Q

What is done in terms of nutrional support for infants with gastro-oesophageal reflux?

A

Calorie supplements
Exclusion diet- milk
NG tube
Gastrotomy

19
Q

Medical treatment of GORD?

A

Feed thickener
Prokinetic drugs
Acid suppressing drugs e.g. PPI

20
Q

What are some of the indications for surgery in GORD?

A

Failure of medical treatment
Persistent failure to thrive, aspiration, oesophagitis

21
Q

What colour will the vomit be if it is bilious?

A

Green

->not yellow. Green.

22
Q

What is meant by chronic diarrhoea?

A

4 or more stools per day for 4wks

23
Q

What is meant by osmotic diarrhoea?

A

Movement of water into the bowel to equilibrate osmotic gradient

->usually a feature of malabsorption

24
Q

What is osmotic diarrhoea generally accompanied by?

A

Macroscopic and microscopic intestinal injury

25
Q

What is secretory diarrhoea associated with?

A

Toxin production from Virbio cholerae and E.Coli

26
Q

Which type of diarrhoea is always pathological?

A

Nocturnal diarrhoea

27
Q

If there is fat malabsorption, and fat is appearing in stools, what may be the cause?

A

Hepatobiliary disease-chronic liver disease, cholestasis

Pancreatic disease-diarrhoea due to lack of lipase, cystic fibrosis

28
Q

Which genes mean there is genetic susceptibility to coeliac disease?

A

HLA DQ2, DQ4

28
Q

Symptoms of coeliac disease in children?

A

Bloating
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpatiformis

29
Q

Okay to check you were paying attention…
Which skin change can be observed in coeliac disease?

A

Dermatitis herpatiformis

30
Q

If a child has coeliac disease, which condition are they screened for every two years?

A

Type 1 diabetes

31
Q

Gold standard investigation to diagnose coeliac disease?

A

Duodenal biopsy

->but not done in everyone, if the anti TTG is more than ten times the upper limit of normal and the anti-endomysial is positive, diagnosis is made without the biopsy

32
Q

Which other tests are useful in the diagnosis of coeliac disease?

A

Anti-tissue transglutaminase
Serum IgA
Anti-endomysial
Genetic testing for HLA DQ2, DQ4

33
Q

Histological findings of coeliac disease?

A

Villous atrophy
Crypt hyperplasia

34
Q

Treatment of coeliac disease?

A

Gluten free diet for life

Year 3- Paediatrics (24 decks)

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