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Gastroenterology Flashcards

1
Q

Red Flags in patient with constipation?

A

not passing meconium within 48hrs
neuro signs or symptoms
vomiting
ribbon stool
abnormal anus
abnormal lower back or buttocks
failure to thrive
acute severe abdo pain or bloating

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2
Q

Complications of chronic constipation?

A

pain
reduced sensation
anal fissures
haemorrhoids
overflow and soiling
psychosocial morbidity

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3
Q

Mx of idiopathic constipation?

A

correct reversible RFs
high fibre diet
good hydration
laxatives (Movicol first line)
may require faecal disimpaction regime initially
scheduling visits, bowel diary, star charts

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4
Q

Causes of constipation?

A

idiopathic
Hirschprung’s disease
cystic fibrosis
hypothyroidism
spinal cord lesions
sexual abuse
obstruction
anal stenosis
CMPA

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5
Q

What is Gastro-Oesophageal Reflux?

A

when contents from the stomach reflux through the lower oesophageal sphincter into the oesophagus

v common in babies due to immature oesophageal sphincter (up to 1 yr)

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6
Q

Red flags in GOR?

A

chronic cough
hoarse cry
distress, crying after feeding
reluctance to feed
pneumonia
poor weight gain

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7
Q

Causes of vomiting?

A

overfeeding
GORD
pyloric stenosis
gastroenteritis
appendicitis
infections (UTI, tonsillitis, meningitis)
intestinal obstruction
bulimia

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8
Q

Mx of GORD?

A

small, frequent meals
keep baby upright after feeding
don’t overfeed
Gaviscon
thickened milk or formula
PPIs

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9
Q

What is pyloric stenosis?

A

hypertrophy and narrowing of the pyloric muscle in between the stomach and the duodenum

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10
Q

Presentation of pyloric stenosis?

A

first few weeks of life
hungry baby
failure to thrive
projectile vomiting
firm, round mass in abdomen
hypochloric metabolic alkalosis

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11
Q

Diagnosis of pyloric stenosis?

A

abdo US

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12
Q

Mx of pyloric stenosis?

A

laparoscopic pyloromyotomy (Ramstedt’s)

excellent prognosis

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13
Q

Causes of diarrhoea?

A

infection (gastroenteritis)
IBD
lactose intolerance
coeliac disease
cystic fibrosis
toddler’s diarrhoea
IBS
meds (antibiotics)

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14
Q

Causes of gastroenteritis?

A

viral:
norovirus
rotavirus
adenovirus
bacterial:
E coli (HUS)
campylobacter jejuni (traveller’s diarrhoea)
Shigella (HUS)
salmonella
bacillus cereus
yersinia enterocolitica
staph aureus toxin
giardia

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15
Q

Mx of gastroenteritis?

A

isolation
faeces for culture, sensitivity and microscopy
hydration
avoid antidiarrheal meds

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16
Q

Complications post-gastroenteritis?

A

lactose intolerance
IBS
reactive arthritis
Guillain-Barré syndrome

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17
Q

Antibodies in coeliac disease?

A

anti-TTG
anti endomysial

(always test IgA too for context)

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18
Q

Presentation of coeliac disease?

A

often asymptomatic
failure to thrive
diarrhoea
fatigue
weight loss
mouth ulcers
anaemia (iron, B12, folate)
dermatitis herpetiformis
neuro symptoms (peripheral neuropathy, cerebellar ataxia, epilepsy)

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19
Q

Who should always be tested for coeliac disease?

A

T1DM

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20
Q

Genetic associations in coeliac disease?

A

HLA-DQ2
HLA-DQ8

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21
Q

Diagnosis of coeliac disease?

A

must continue eating gluten for investigations

antibodies
endoscopy (villous atrophy, crypt hypertrophy)

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22
Q

Findings on endoscopy in coeliac disease?

A

villous atrophy
crypt hypertrophy

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23
Q

Associated diseases with coeliac disease?

A

T1DM
thyroid disease
autoimmune hepatitis
PBC
PSC
Down’s syndrome

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24
Q

Complications of coeliac disease?

A

vitamin def.
anaemia
osteoporosis
ulcerative jejunitis
enteropathy-associated T- cell lymphoma
Non-Hodgkin lymphoma
small bowel adenocarcinoma

25
Q

Mx of coeliac disease?

A

lifelong gluten free diet

26
Q

What is biliary atresia?

A

congenital condition where a section of the bile duct is either absent or narrowed

prevents the excretion of conjugated bilirubin

27
Q

Mx of biliary atresia?

A

surgical management
Kasai portoenterostomy
liver transplant

28
Q

Causes of intestinal obstruction?

A

meconium ileus
Hirschsprung’s disease
oesophageal atresia
duodenal atresia
intussusception
imperforate anus
malrotation with volvulus
strangulated hernia

29
Q

Presentation of intestinal obstruction?

A

persistent vomiting (may be bilious)
abdo pain and distension
obstipation
absent bowel sounds (may be tinkling initially)

30
Q

Diagnosis of intestinal obstruction?

A

abdo x ray -> distended loops of bowel, absence of air in rectum

31
Q

Mx of intestinal obstruction?

A

‘drip and suck’
definitive mx based on cause

32
Q

What is Hirschsprung’s disease?

A

congenital condition where the parasympathetic ganglion cells of the myenteric plexus are absent in the distal bowel and rectum

33
Q

Presentation of Hirschsprung’s Disease?

A

acute intestinal obstruction
failure to pass meconium
chronic constipation since birth
abdo pain and distension
vomiting
poor weight gain and failure to thrive

34
Q

Associated conditions with Hirschsprung disease?

A

Down’s syndrome
neurofibromatosis
Waardenburg syndrome
MEN 2

35
Q

What is Hirschsprung-associated enterocolitis?

A

HAEC -> inflammation and obstruction, occurs in 20% of neonates with Hirschsprung
2-4wks of birth with fever, abdo distension, bleeding
can lead to toxic megacolon and perforation

36
Q

Mx of Hirschsprung’s Disease?

A

fluid resuscitation and management of obstruction
antibiotics, fluids and decompression in HAEC

definitive mx is removal of affected bowel

37
Q

Diagnosis of Hirschsprung’s Disease?

A

abdo x-ray for obstruction and HAEC
rectal biopsy gold standard (absence of ganglionic cells)

38
Q

What is intussusception?

A

a condition where the bowel ‘telescopes’ into itself
leading to palpable mass in the abdomen and obstruction

39
Q

Who gets intussuscpetion?

A

6months - 2yrs
more common in boys

40
Q

Associated conditions with intussusception?

A

concurrent viral illness
HSP
cystic fibrosis
intestinal polyps
Meckel’s diverticulum

41
Q

Presentation of intussusception?

A

severe, colicky abdo pain
pale, lethargic, unwell
redcurrant jelly stool
sausage-shaped mass
vomiting
obstruction

42
Q

Diagnosis of intussusception?

A

US abdo

43
Q

Mx of intussusception?

A

air insufflation
surgical reduction
surgical resection if gangrene or perforation

44
Q

Complications of intussuception?

A

obstruction
gangrene
perforation
death

45
Q

What is a congenital diaphragmatic hernia?

A

occurs in 1 in 2000
herniation of the abdominal viscera into the thoracic cavity due to incomplete formation of the diaphragm
causes pulmonary hypoplasia and HTN
only 50% survive

46
Q

Distinguishing features of Crohn’s Disease?

A

NESTS
no blood or mucous
entire GI tract
skip lesions
transmural inflammation, terminal ileum most affected
smoking is RF

more associated with weight loss, strictures, fistulas, gallstones

47
Q

Distinguishing features of ulcerative colitis?

A

CLOSE-UP
continuous inflammation
limited to colon and rectum
only superficial mucosa
smoking is protective
excrete blood and mucus
use aminosalicylates
PSC

48
Q

Presentation of IBD?

A

diarrhoea
abdominal pain
blood and mucus
tenesmus
weight loss
anaemia
mouth ulcers (Crohns)
systemically unwell during flares

49
Q

Extra-intestinal manifestations of IBD?

A

finger clubbing
erythema nodosum
pyoderma gangrenosum
episcleritis, scleritis, irisitis
inflammatory arthritis
PSC (UC)
gallstones (Crohns)

50
Q

Investigations for IBD?

A

bloods (anaemia, infection, thyroid, kidney, liver function)
raised CRP
faecal calprotectin
endoscopy gold standard
imaging with US, CT, MRI to look for fistula, abscesses, strictures

51
Q

General Mx of IBD?

A

MDT
monitor for growth and development
induce and maintain remission

52
Q

Medical Mx of Crohn’s?

A

inducing remission:
steroids first-line
consider adding azathioprine, mercaptopurine, methotrexate, infliximab, adalimumab

maintaining remission:
may not be necessary
first-line:
azathioprine
mercaptopurine
alternatives:
methotrexate
infliximab
adalimumab

sx intervention if only affecting distal ileum
sx to treat strictures or fistulae

53
Q

Medical Mx of UC?

A

inducing remission:
mild-moderate:
aminosalicylate (mesalazine PO or PR)
corticosteroids
severe:
corticosteroids
IV ciclosporin

maintaining remission:
aminosalicylate (mesalazine PO or PR)
azathioprine
mercaptopurine

Sx:
panproctocolectomy
permanent ileostomy or ileo-anal anastomosis J-pouch

54
Q

Presentation of appendicitis?

A

central abdominal pain that migrates to RIF
tenderness at McBurney’s point
anorexia
N&V
Rovsing’s sign
peritonism (guarding, rebound tenderness, percussion tenderness)

55
Q

Diagnosis of appendicitis?

A

clinical diagnosis
inflammatory markers
CT can be used to confirm
US to rule out gynae
definitive diagnosis on laparoscopy

56
Q

DDx of appendicitis?

A

ectopic pregnancy
ovarian cysts
meckel’s diverticulum
mesenteric adenitis
appendix mass

57
Q

Mx of appendicitis?

A

appendectomy (open or laparoscopic)

58
Q

Complications of appendectomy?

A

bleeding, infection, pain, scars
damage to bowel, bladder, other structures
removal of normal appendix
anaesthetic risks
VTE

Paeds (16 decks)

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