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Upper and lower GI Flashcards

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1
Q

What are the different types of vomiting?

A

Vomiting with retching
Projectile vomiting
Bilious vomiting
Effortless vomiting

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2
Q

What are the three phases of vomiting with retching?

A

Pre-ejection phase
Ejection phase
Post-ejection phase

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3
Q

What are the signs of the pre-ejection phase of vomiting with retching?

A

Pallor
Nausea
Tachycardia

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4
Q

What are the parts of the ejection phase of vomiting with retching?

A

Retch

Vomit

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5
Q

What can stimulate the vomiting centre of the brain?

A 
Enteric pathogens
Intestinal inflammation
Metabolic derangement
Infection
Head injury
Visual stimuli
Middle ear stimuli
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6
Q 
CS:
6wk boy, 3wk Hx vomiting after every feed, bottle fed 6oz 3hrly, vomitus: large volume, milky/curdy, mostly projectile
Irritable/crying
Not gaining weight adequately
O/E: slightly dehydrated

What are the differential diagnoses?

A

Gastro-oesophageal reflux
Overfeeding
Pyloric stenosis

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7
Q

What is an olive tumour?

A

Olive-shaped mass in abdomen in upper left quadrant of epigastric region

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8
Q

What is a visible sign of pyloric stenosis?

A

Visible gastric peristalsis

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9
Q

What is an olive tumour indicative of?

A

Pyloric stenosis

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10
Q

What is the vomiting like with pyloric stenosis?

A

Projectile non bilious vomiting

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11
Q

What is the management of pyloric stenosis?

A 
Fluid resuscitation (for dehydration)
Refer to surgeons
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12
Q

What is the surgery for pyloric stenosis?

A

Ramstedts pyloromyotomy

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13
Q

What age does pyloric stenosis usually present?

A

4-12 weeks

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14
Q

Does pyloric stenosis usually present in boys or girls more?

A

Boys

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15
Q

What is the characteristic electrolyte disturbance of pyloric stenosis?

A

Metabolic alkalosis (↑ pH)
Hypochloraemia (↓Cl)
Hypokalaemia (↓K)

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16
Q

What are the signs of physical signs pyloric stenosis?

A

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

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17
Q

What is bilious vomiting usually due to unless proven otherwise?

A

Intestinal obstruction

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18
Q

What are the main causes of bilious vomiting?

A 
Intestinal atresia
Malrotation +/- volvulus
Intussusuception
Ileus
Crohn's disease with strictures
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19
Q

What is a volvulus?

A

When a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction

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20
Q

What is ileus?

A

Lack of movement somewhere in the intestines that leads to a buildup and potential blockage of food material

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21
Q

What is intussusception?

A

One segment of intestine “telescopes” inside of another, causing an intestinal obstruction (blockage)

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22
Q

What are the investigations for bilious vomiting?

A 
Abdominal XR
Contrast meal
Surgical opinion (exploratory laparotomy)
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23
Q

What is effortless vomiting usually due to?

A

Gastro-oesophageal reflux

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24
Q

What are the cases when gastro-oesophageal reflux may not spontaneously resolve?

A

Cerebral palsy
Progressive neuro problems
Oesophageal atresia +/- TOF operated
Generalised GI motility problem

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25
What are the presenting symptoms of reflux?
``` Vomiting Haematemesis Feeding problems Failure to thrive Apnoea Cough Wheeze Chest infections Sandifer's syndrome ```
26
What is Sandifer's syndrome?
Neurological: involves spasmodic torsional dystonia with arching of the back and rigid opisthotonic posturing, mainly involving the neck, back, and upper extremities, associated with symptomatic gastroesophageal reflux, esophagitis, or the presence of hiatal hernia
27
What is the medical assessment for reflex?
``` History and exam Video fluroscopy Barium swallow pH study Oesophageal impedance monitoring Upper GI endoscopy ```
28
What problems can be identified on barium swallow?
``` Dysmotility Hiatus hernia Reflux Gastric emptying Strictures ```
29
What are the problems with barium swallow?
Aspiration | Inadequate contrast taken
30
What are the positive points of videofluroscopy and barium meal?
May detect aspiration | Defines anatomy well
31
What are the negative points of videofluroscopy and barium meal?
May miss reflux | Radiation
32
What are the positive points of pH study?
Detects acid reflux missed by barium
33
What are the negative points of pH study?
Only detects acid reflux | May be unpleasant for child
34
What are the positive points of endoscopy?
Best test for oesophagitis | Can be combined with pH+ impedance study
35
What are the negative points of endoscopy?
Needs anaesthetic
36
What are the positive points of trial feeding?
Most physiological test | May be best discriminator if child needs surgery
37
What are the negative points of trial feeding?
NG tube required | Needs 2-3 days in hospital
38
What is the treatment for gastro-oesophageal reflux?
Feeding advice Nutritional support Medical treatment Surgery
39
What is the feeding advice for gastro-oesophageal reflux?
Thickeners for liquids Appropriateness of foods: texture/amount Behavioural programme: oral stimulation/removal of aversive stimuli Feeding position
40
What nutritional support can be given to babies with gastro-oesophageal reflux?
Calorie supplements Exclusion diet (milk free) NG tube Gastrostomy
41
What medical treatment can be given for gastro-oesophageal reflux?
Feed thickener: Gaviscon Prokinetic drugs Acid suppressing drugs: H2 receptors blockers/PPI
42
What are the indications for surgery in gastro-oesophageal reflux?
Failure of medical treatment | Persistent: failure to thrive, aspiration, oesophagitis
43
What is Nissan fundoplication?
A surgical procedure that corrects GERD by creating an improved valve mechanism at the bottom of the oesophagus - it is meant to prevent the flow of acids upward
44
For which group of patients might surgery be more complication for those with GOR?
Cerebral palsy
45
What is the definition of chronic diarrhoea?
4 or more stools a day | >4 weeks
46
What is the definition of acute diarrhoea?
4 or more stools a day | <1 week
47
What is the definition of persistent diarrhoea?
4 or more stools a day | 2-4 weeks
48
What are the three main groups of causes of diarrhoea?
Motility disturbance Active secretion (secretory) Malabsorption of nutrients (osmotic)
49
What conditions come under osmotic diarrhoea?
Food allergy Coeliac disease CF
50
What is the management of osmotic diarrhoea?
Removal of causative agent
51
What conditions come under secretory diarrhoea?
Acute infective diarrhoea | IBD
52
What is secretory diarrhoea associated with?
Toxin production
53
What conditions can cause motility diarrhoea?
Toddler's diarrhoea IBS Congenital hyperthyroidism Chronic intestinal pseudo-obstruction
54
What is inflammatory diarrhoea?
Malabsorption due to intestinal damage | Accelerated transit time in response to inflammation
55
Which type of diarrhoea has a larger volume: osmotic or secretory?
Secretory
56
Which type of diarrhoea stops in response to fasting?
Osmotic
57
Which diseases cause fat malabsorption and diarrhoea?
``` Pancreatic disease (CF) Hepatobiliary disease ```
58
What are the signs and symptoms of coeliac disease?
``` Abdominal bloatedness Diarrhoea Failure to thrive Short stature Constipation Tiredness Dermatitis herpatiformis ```
59
What are the screening tests for coeliac disease?
Serological screens Duodenal biopsy Genetic testing
60
What are the serological screens for coeliac disease?
Anti-tissue transglutaminase Anti-endomysial Anti-gliadin IgA dependent test
61
How would you diagnose children with coeliac disease with the ESPGHAN guidelines?
Symptomatic Anti TTG >10 times upper limit of normal Positive anti-endomysial antibodies HLA DQ2, DQ8 positive
62
What is the treatment for coeliac disease?
Gluten-free diet for life
63
What questions should you ask about constipation?
How often? How hard? Is it painful? Has there been a change?
64
What type on the Bristol stool chart are constipated?
Type 1 & 2
65
What are other signs/symptoms of constipation?
``` Poor appetite Irritable Lack of energy Abdominal pain/distention Withholding or straining Diarrhoea ```
66
Why do children become constipated?
``` Social: - Poor diet, too many fluids/milk - Potty training/school toilet Physical - Intercurrent illness - Medication FH Psychological Organic ```
67
What diet measures can treat constipation?
Increase fibre, fruit, vegetables, fluids | Decrease milk
68
What psychological factors can treat constipation?
Reduce aversive factors - height, cold, school | Reward good behaviour
69
What are the different types of laxative that soften stool and stimulate defecation?
Osmotic laxatives - lactulose Stimulant laxatives - senna, picolax Isotonic laxatives - movicol
70
What is the treatment of impaction?
Empty impacted rectum/colon Maintain regular stool passage Slow weaning off treatment
71
What are more common presenting symptoms in UC than Crohn’s?
Diarrhoea and rectal bleeding
72
What are symptoms of Crohn’s and UC?
``` Diarrhoea Rectal bleeding Abdo pain Fever Weight loss Growth failure Arthritis ```
73
What are more common presenting symptoms in Crohn’s than UC?
Weight loss | Growth failure
74
What are the investigations for IBD?
FBC & ESR Stool calprotectin CRP
75
What are you looking for the in FBC of someone with IBD?
``` Anaemia Thrombocytosis Raised ESR Raised CRP Low albumin Raised calprotectin ```
76
What are imaging investigations for IBD?
MRI Barium meal Endoscopy
77
What are the aims of treatment in IBD?
Induce and maintain remission Correct nutritional deficiencies Maintain normal growth and development
78
What the methods of treatment for IBD?
``` Medical: - anti-inflammatory - immuno-suppressive - biologicals Nutritional: - immune modulation - nutritional supplementation Surgical ```

Paedriatrics (19 decks)

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