Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Upper GI Disorders > Flashcards

Upper GI Disorders Flashcards

1
Q

Types of vomiting in children

A

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Phases of vomiting with retching

A

Pre-ejection phase:

  • pallor
  • nausea
  • tachycardia

Ejection phase:

  • retch
  • vomit

Post-ejection phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stimulants of vomiting centre

A 
Enteric pathogens
Intestinal inflammation
Metabolic derangement 
Infection
Head injury
Visual stimuli
Middle ear stimuli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
Differential diagnosis of case:
6 week old baby 
Vomiting after every feed
Vomit is large volume, projectile, millk or curdy 
Irritable and crying 
Not gaining weight
A

Gastroesophageal reflux
Overfeeding
Pyloric stenosis
Cows milk allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Presentation of pyloric stenosis (5)

A 
Visible gastric peristalsis
Projectile non bilious vomiting 
Weight loss
Dehydration +/- shock
Electrolyte disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of pyloric stenosis

A

Fluid resuscitation
Surgeon referral
-Ramstedts pyloromyotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Electrolyte disturbance in pyloric stenosis

A

Metabolic alkalosis (increase pH)
Hypochloraemia (decreased Cl)
Hypokalaemia (decrease K)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Typical age and gender of pyloric stenosis

A

Babies 4-12 weeks

Boys > Girls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of bilious vomiting (6)

A

Intestinal obstruction

Intestinal atresia (in newborns only)
Malrotation +/- volvulus
Intussusception
Ileus
Crohns disease with strictures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Investigations for bilious vomiting (3)

A

Abdominal xray
Consider contrast meal
Surgical exploratory laparotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most common cause of effortless vomiting

A

Gastro-oesophageal reflux

Self limiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Other than gastro-oesophageal reflux other causes of effortless vomiting

A

Cerebral palsy
Progressive neurological problems
Oesophageal atresia +/- TOF operates
Generalised GI motility problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gastro-oesophageal reflux presentaion (9)

A

GI:

  • vomiting
  • haematemesis

Nutritional:

  • Feeding problems
  • Failure to thrive

Respiratory:

  • Apnoea
  • Cough
  • wheeze
  • Chest infection

Neurological:
-Sandifer’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is sandifer’s syndrome

A

gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations for gastrooesophageal reflux (6)

A 
History and examination (normally enough)
Video fluoroscopy
Barium swallow 
pH study
Oesophageal impedance monitoring 
Endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can a barium swallow detect

A 
Dysmotility 
Hiatus hernia 
Reflux
Gastric emptying 
Strictures
17
Q

Problems of barium swallow

A

Aspiration

Inadequate contrast taken (NG tube)

18
Q

Pros and cons of pH study

A

Pro
-Detects acid reflux missed by barium

Con

  • Only detects acid reflux
  • May be uncomfortable for the child
19
Q

Pros and cons of endoscopy for detecting GOR

A

Pros

  • Best test for osophagitis
  • Can be combined with pH+impedance study

Cons
-Need anaesthetic

20
Q

Pros and Cons of trial of feeding test for GOR

A

Pro
-May be best discriminator if child needs surgery

Con

  • NG tube required
  • Needs 2-3 days in hospital
21
Q

Treatment for gastrooesophageal reflux

A

Feeding advice:

  • Thickeners for liquids
  • Appropriateness of foods (texture, amount)
  • Behavioural programme (oral stimulation, removal of aversive stimuli)
  • Feeding position

Nutritional advice:

  • Calorie supplements
  • Exclusion diet (milk free)
  • Nasogastric tube
  • Gastrostomy

Medical treatment:

  • Feed thickener (Gaviscon)
  • Prokinetic drugs
  • Acid suppressing drugs

Surgery:
-Nissen fundoplication

22
Q

Indications for surgery in GOR

A

Persistent:

  • Failure to thrive
  • Aspiration
  • Oesophagitis
23
Q

Chronic diarrhoea definition

A

4 or more stools per day
For more than 4 weeks

<1 week: acute diarrhoea
2-4 weeks: persistent diarrhoea
>4 weeks: chronic diarrhoea

24
Q

Causes of diarrhoea

A

Motility disturbance:

  • Toddler diarrhoea
  • IBS

Active secretion (secretory):

  • Acute infective diarrhoea
  • IBD

Malabsorption of nutrients (osmotic):

  • Food allergy
  • Coeliac disease
  • CF
25
Q

Types of diarrhoea?

A

Osmotic
Secretory
Motility
Inflammatory

26
Q

Define osmotic diarrhoea

A

Movement of water into bowel to equilibrate osmotic gradient

Normally a feature of malabsorption

  • Enzymatic defect
  • Transport defect

Generally accompanied by macroscopic and microscopic intestinal injury

Clinical remission with removal of causative agent

27
Q

Define secretory diarrhoea

A

Classically associated with toxin production from vibrio cholerae and enterotoxigenic ecoli

Intestinal fluid secretion predominantly driven by active Cl- secretion via CFTR

28
Q

Define inflammatory diarrhoea

A

“Mixed” bag
Malabsorption due to intestinal damage
Secretory effect of cytokines
Altered transit time in response to inflammation
Protein exudate across inflamed epithelium

29
Q

Red flag for organic pathology to diarrhoea

A

Nocturnal defecation

30
Q

Difference between osmotic and secretory diarrhoea

A

Stool volume:
Osmotic-Small
Secretory-Large

Response to fasting:
Osmotic- stops
Secretory- continues

Osmotic gap:
Osmotic- >135m0sm/l
Secretory- <50m0sm/l

Stool sodium:
Osmotic- <70mmol/l
Secretory- >70 mmol/l

Stool potassium:
Osmotic- <30mmol/l
Secretory- >40mmol/l

Stool chloride:
Osmotic- <35mmol/l
Secretory- >40mmol/l

Stool pH:
Osmotic- <5.5
Secretory- >6

Stool reducing substance:
Osmotic- Positive
Secretory- Negative

31
Q

Fat malabsorption stools (steatorrhoea) causes

A 
Pancreatic disease (due to lack of lipase)
Eg CF

Hepatobiliary disease
Eg chronic liver disease, cholestasis

32
Q

What is coeliac disease

A

Gluten-sensitive enteropathy

33
Q

Presentation of coeliac disease (7)

A 
Abdominal bloatedness
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpatiformis
34
Q

Screening tests for coeliac diseases

A

Serological screens:

  • Anti-tissue transglutaminase
  • Anti-endomysial
  • Anti-gliadin
  • IgA

Duodenal biopsy

Genetic testing
-HLA DQ2, DQ8

35
Q

According to ESPGHAN guidelines what are the criteria for coeliac disease

A

Symptomatic
Anti TTG >10 times upper limit of normal
Positive anti endomysial antibodies
HLA DQ2, DQ8 positive

If not all present diagnose with biopsy
If all present dont need biopsy

36
Q

Treatment for coeliac disease

A

Gluten free diet

Risk of small bowel lymphoma if continue to have gluten

Paediatrics (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions