Year 4 GI Flashcards
viral causes of gastroenteritis
norovirus
adenovirus
rotavirus
bacterial causes of gastroenteritis
e. coli
c. diff
campylobacter
salmonella
cryptosporidium
management of gastroenteritis
trial of oral rehydration with dioralyte
ondansetron
advise loose stools can continue for a couple of weeks
define diarrhoea
> 3 stools a day
which conditions can have malabsorption?
Coeliac's Crohn's CF food allergies lactose intolerance
what is toddler’s diarrhoea?
benign condition due to colonic immaturity
tends to improve around age 5-6
presentation of toddler’s diarrhoea
up to 10 stools a day
no abdo symptoms
thriving child
management of toddler’s diarrhoea
reduce excessive fruit juice
increase fat
keep fibre normal
may need loperamide for toilet training
what symptoms must be present for a diagnosis of constipation?
present for1 month
<3 defecations per week
one episode per week faecal incontinence
history of excessive retentions, painful/ hard movements and obstruction to toilet
RF for constipation
low fibre low fluid excessive dairy lack of exercise obesity problems with toilet training
diagnosis for constipation
AXR rectal biopsy (Hirschsprung's) TFTs calcium allergy testing
management of constipation
softeners e.g. laxido, movicol
may need stimulants e.g. docusate or senna
what is infant dyschezia?
problems learning to defacate with poor coordination of straining on stool and opening of external anal sphincter
presentation of infant dyschezia
babies appear in pain when trying to pass stool and settle once it is passed
what is Hirschsprung’s
nerves do not form correctly in the colon
presentation of Hirschsprung’s
explosive passage of stool following examination
delayed passage of meconium
acute bowel obstruction
complex constipation
diagnosis of Hirschsprung’s
rectal biopsy
AXR
management of Hirschsprung’s
excision or bypass of ganglionic intestine (interval colsotomy)
management of GORD
thicken feeds e.g. gaviscon or carobel PPIs/H2RA domperidone assess for overfeeding, CMPA nissen fundoplication
complications of GORD
pulmonary aspiration
oesophageal stricture
presentation of pyloric stenosis
projectle vomiting
dehydration
3-8 weeks
olive mass
blood gas result in pyloric stenosis
hyperchloraemic hypokalaemic metabolic alkalosis
diagnosis of pyloric stenosis
USS
management of pyloric stenosis
NBM, rehydration, NG tube
pyloromotomy (Ramstedt’s operation)
diagnosis of Coeliac’s
TTG x10 and anti-EMA antibodies
endoscopy with duodenal biopsy
iron, ferritin, CRP, FBC, stool cultures, calprotectin
associations with Coeliac disease
T1DM AI thyroid disease juvenile chronic arthritis Down's Turner's William's
complications of Coeliac disease
OP anaemia short stature delayed puberty female infertility intestinal malignancies (small bowel lymphoma)
what score is used in paediatric Crohn’s disease?
wPCDAI score (weighted paediatric Crohn’s activity index)
MILD UC
distal colon only <3 stools/day little blood no fever no weight loss
MODERATE UC
3-5 stools/day bloody abdo pain/cramp low grade fever mild anaemia weight loss
SEVERE UC
>5 stools a day frank blood fever anaemia leucoytosis hypoalbuminaemia pain risk of toxic megacolon perforation
complications of UC
long-term risk of colon cancer
extra-intestinal manifestations of UC
growth failure arthropathy episcleritis skin (erythema nodosum/ pyoderma gangrenosum) AI liver disease (PSC)
typical histology of UC
polymorph nuclear leukocytes near base of crypts
crypt abscesses
no granulomas
management of UC
steroids to induce remission
maintenance= mesalazine, azathioprine + infliximab/ adalimumab
colectomy
what is toxic megacolon?
transverse colon diameter >5cm on AXR
management of toxic megacolon?
drip and suck
IV antibiotics with early surgical review
what is hypernatraemic dehydration?
sodium level very high due to difficult breast feeding or profuse watery diarrhoea
babies are drowsy
presentation of abdominal migraine?
abdominal pain
headache
pallor
management of abdominal migraine
same as for migraine
prevention with pizotifen (withdraw slowly as associated with depression, anxiety, poor sleep and tremor)
UTI presentation
fever
vomiting
irritability
abdominal pain
diagnosis of UTI
clean catch urine for dipstick
can do USS, MAg3 and DMSA scan
structural renal abnormalities
renal agenesis horseshoe kidney pelvic kidney duplex system (bifid, duplication) hypospadias undescended testes (9 months send for surgical exploration) posterior urethral valves
what is biliary atresia?
gall bladder ducts are either small or absent causing bile to not be secreted so bilirubin is not broken down
presentation of biliary atresia?
prolonged jaundice (>2 weeks)
pale stools
dark urine
hepatosplenomegaly
diagnosis of biliary atresia
raised ALP raised bilirubin USS radioisotope scan liver biopsy
management of biliary atresia
Kasai procedure (hepatoportoenterostomy) or liver transplant
what does a ribbon stool indicate?
anal stenosis
