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PAEDS SC1 > Gastro > Flashcards

Gastro Flashcards

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1
Q

Dx pyloric stenosis

A

Abdo US– hypertrophy of sphincter

Barium- string sign, pyloric beak

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2
Q

Tx pyloric stenosis

A
  1. Fluid and electrolytes

2. Pyloromyotomy- Ramstedt (old), lapro

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3
Q

PC meckels

A

Incidental

Acute intermittent rectal bleeding

OB V I

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4
Q

Dx Meckels

A

Tc 99– ectopic gastric mucosa

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5
Q

Tx Meckels

A

Surgical excision– if it’s bleeding from surrounding ulceration

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6
Q

Associated with pyloric stenosis

A

M-E-T

Maternal history

Erythromycin

TEF

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7
Q

Associated with hirschsprungs

A

DOWNS

MEN 2

WAARDENBERG syndrome

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8
Q

PC hirschsprungs

A

Failure to pass meconium

FTT
billious vomiting

Abdo distension

Empty vault on DRE

Explosive stool discharge

Abnormal sphincter tone

Chronic constipation if older kid

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9
Q

Dx Hirschsprungs

A
  1. Barium enema
  2. PFA
  3. Anorectal manometry
    - failure of internal sphincter to relax
  4. Rectal suction bx
    - absence Meissner and Auerbach
    - hypertrophied nerve endings with AChE stain
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10
Q

Tx hirschsprungs

A

TWO STEPS:

  1. Diverting colostomy
  2. Definitive pull through
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11
Q

MCC bowel obstruction in first two years of life

A

Intussusception

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12
Q

Risk factors intussusception

A

Polyp
Lymphoma

Rotavirus
Adenovirus
Parasites

HSP
CF
Celiac
Meckels

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13
Q

PC intussusception

A

SUDDEN COLICKY abdo pain

Sausage mass in RUQ

Vomiting

Currant jelly stools (later)

Absence bowel RLQ

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14
Q

MC site intussusception

A

Ileocecal

Proximal into distal

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15
Q

Dx intussusception

A
  1. PFA- obstruction, perforation, mass

2. US- target sign

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16
Q

Tx intussusception

A
  1. Volume and electrolytes and CBC
  2. NG tube decompression
  3. Air contrast barium enema- insuffulation
    - diagnostic> therapeutic
  4. Surgery- reduction and resection of gangrenous bowel
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17
Q

Sites of malrotation

A

DJ

IC

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18
Q

PC malrotation and volvulus

A

FIRST MONTH of life
- bilious vomiting

Cramps abdo pain
Distension
Bloody / mucus diarrhea

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19
Q

Dx malrotation and volvulus

A
  1. AXR- bird beak and air fluid levels
  2. Abnormal lig of treitz
  3. US
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20
Q

Tx malrotation and volvulus

A
  1. NG tube decompression
  2. IV fluids
  3. Sx repair ER– gastric volvulus
  4. Sx repair or endoscopy – intestinal volvulus
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21
Q

PC NEC

A

Preme

First few days of life

Feeding intolerance

Bloody stools

Delayed gastric emptying

Abdo distension

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22
Q

Dx NEC

A
  1. LABS
  2. PFA
    Dilation/ portal venous has/ free air/ pneumatosis intestinalis
  3. US
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23
Q

Tx NEC

A

Supportive

Surgery – ileostomy with mucus fistula

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24
Q

PC pyloric stenosis

A

Little boy
3 weeks old, becomes projectile vomiting non bilious

Palpable olive like mass = visible peristalsis

HINGRY – malnourished and dehydrated

HypoK hypoCl met alkalosis

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25
CB jaundice
1. Extra hepatic- Bili atresia, choledochal cysts 2. Intra hepatic - IEM: tyrosinemia, AAT, galactosemia - neonatal hepatitis - TPN cholestasis 3. Dubin Johnson 4. Rotor 5. TORCH
26
UCB jaundice
Physiologic - increase Hct, enterohepatic circulation - decrease rbc life span, gluc transferase - patent ductus venous
27
UCB pathological
- BREAST milk - Criggler - Gilbert's - increase enterohepatic - sepsis - haemolysis
28
BREAST milk jaundice
Steroids and Esterfied Fatty acids - inhibit conjugation - activate enterohepatic circulation
29
Definition jaundice levels
> 5mg/dL
30
NB Hx points jaundice
- diet - drug exposure intrauterine - familial Hb / rbc problems
31
Exam jaundice
1. Hb - pallor - EHA- HM - bruising- Petechiae, cephalohematoma 2. Hepatic/ GI - abdo distension - delayed MEC passage - light stools dark urine 3. Infection signs
32
Dx jaundice
``` 1. BLOOD smears DCT Bili levels Blood typing ``` 2. LIVER US, HIDA 3. Levels and IEM
33
Tx jaundice
1. Underlying 2. UCB - photo tx - exchange transfusion 3. Phenobarbital - Gilbert's - type 2 gluc transferase def
34
SE's photo tx
Decrease intestinal motility Dehydration, hyperthermia Decrease maternal time Retinal damage
35
SE's exchange transfusion
``` Death Thrombocytopenia NEC PCT GvHd Infection Electro ```
36
Jaundice
Haemolysis - UCB Congenital infection- CB
37
Jaundice 24hrs- 2 weeks
``` Physiologic BREAST milk Jaundice Haemolysis Infection Criggler Bruising Pgcythemia ```
38
Jaundice > 2 weeks
CB - bile duct obs - neonatal hepatitis ICB - physio or breast - infection - hypothyroidism - HA - high GIT obstruction
39
Kasai procedure
hepato-porto-enterostomy
40
MCC OLT in paeds
biliary atresia
41
Choledochal cysts definition
= extrahepatic biliary tree cysts
42
PC choledochal cysts
``` 25%= IFNANTS= CHOLESTASIS Older kids: - jaundice - abdo pain - abdo mass - cholangitis ```
43
Dx biliary atresia
1. fasting US 2. HIDA/ TIBIDA 3. liver bx 4. liver lapro
44
Dx choledochal cysts
1. US | 2. Radionucleide scan
45
Dx of AAT deficiency
ANTENATAL - levels of AAT - phenotype
46
Prognosis of AAT
``` 50%= good 50%= OLT ```
47
Dx of galactosemia
1. reducing sugar in urine | 2. enzyme in RBC
48
Tx of galactosemia
galactose free diet= protective to liver STILL... - developmental delay and - OVARIAN FAILURE
49
In born errors of bile acid synthesis
increase in cholenoic acid bile acids NORMAL GGT
50
PC inborn errors of bile acid synthesis
CHOLESTASIS
51
PC progressive familial intrahepatic cholestasis
- jaundice - itching - diarrhoea with FTT - rickets / CLD
52
Progressive familial intrahepatic cholestasis
RECESSIVE-- bile acid transporter problem DECREASE GGT
53
Dx of inborn errors of bile acid synthesis
Mass spectrometry
54
Tx of inborn errors of bile acid synthesis
Ursofalk= ursodeoxycholic acid
55
Biopsy of neonatal hepatitis syndromes
NON-specific, | GIANT CELL hepatitis
56
4 complications of acute liver failure
Cerebral edema Haemorrhage Pancreatitis Sepsis
57
2 things a/w reyes
Aspirin Medium Chain Acyl dehydrogenase deficiency
58
Liver work up
- bilirubin - transaminases - ALP - coagulation screen - plasma ammonia - acid base balance - blood glucose - EEG - CT
59
Tx acute liver failure
- IV dextrose - antibiotics and antifungals - coag: FFP, vit K, H2 ant, PPI's - OLT - cerebral edema: mannitol and fluid restriction
60
poor prognosis acute liver failure
shrinking liver increase bilirubin with decrease transaminases worsening coagulopathy coma
61
fibropolycystic kidney disease
= liver disease a/w ADPCKD and ARPCKD
62
causes of chronic liver disease in kids
1. chronic infection 2. autoimmune hepatitis 3. wilsons disease 4. CF 5. fibropolycystic liver disease 6. alpha 1 AT 7. neonatal liver disease 8. bile duct lesions 9. NAFLD
63
diagnosis of cirrhosis
transaminases ALP bilirubin PT
64
Tx cirrhosis
1. nutrition 2. pruritus 3. encephalopathy 4. OLT
65
nutrition cirrhosis
ADEK high protein/ carbs/ long chain FA's NG TPN
66
pruritus cirrhosis
``` loose clothes emollients cholestyramine phenobarbitol ursodeoxycholic acid ```
67
encephalopathy cirrhosis tx
protein restriction lactulose rifaxamin
68
OLT cirrhosis indications
FTT severe complications despite tx poor QoL severe malnutrition
69
6 RED FLAG SIGNS OF SHOCK/DEHYDRATION
1. eyes shrunken and tearless 2. decreased skin turgor 3. tachypnea 4. tachycardia 5. irritable/lethargic 6. deteriorating
70
risk factors for dehydration
- low BW or 6 stools past 24hrs - vomit 3x/1 day - unable to tolerate XS fluids - malnutrition
71
prevention of dehydration
breast/formula increase fluids ORS
72
clinical dehydration
``` ORS**** breast/formula normal fluids ------> IV: 0.9% saline if vomiting + IV vit K + breast ```
73
SHOCK
IV 0.9% NaCl and PICU
74
after rehydration mgmt
reintroduce solids hygiene NO carbonated drinks NO fruit juices NO school until 48hours after last episode
75
Clinitest
presence of non-absorptive sugar in stools ---> return to ORS 24hrs......then reintroduce normal diet for post-gastroenteritis syndrome --- give TPN until mucosa recovered
76
Toddler diarrhear= Chronic Nonspecific Diarrhea treatment
``` 4F's Fibre Fluids Fat (35-40%) Fruit juice XS AVOID ```
77
Gluten free diet--- avoid....
``` BROW Barley Rye Oats Wheat ```
78
Rome 3 criteria for constipation
>1 fecal incont toilet/week
79
risk factors for hemorrhagic disease of the newborn
perinatal asphyxia maternal anticonvulsants breast fed preme
80
risk factors for haemolytic disease of newborn
miscarriage abortion amnionitis bleeding during pregnancy previous
81
when do babies present with hemorrhagic disease of newborn
day 2-4 | weeks 1-8
82
Kleihauer test
checking for fetal Hb in maternal blood | [anaemia]
83
4 ways to protect from jaundice in newborn
1. RhoGAM 2. feeding 3. breast 4. metaloporphyrins: inhibit haemoxygenase
84
drugs causing acute liver failure
paracetamol halothane INH amantia phalloides
85
phenobarbitol in treatment of jaundice
type 2 glucuronysl transferase def gilberts syndrome

PAEDS SC1 (13 decks)

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