Gastro Flashcards
(106 cards)
1
Q
when should you breastfeed/formula feed until
A
6months
2
Q
when should you start weaning
A
6 months
3
Q
why is unmodified cows milk inappropriate
A
too much protein/electrolytes, deficient in iron, vitamins A,C,D
4
Q
when can you give cows milk
A
after 12m
5
Q
when to use specialised infants formula feed
A
cows milk protein allergy/intolerance, lactose intolerance, CF, intestinal resection
6
Q
advantages of breastfeeding for baby
A
transfer IgA, lactoferrin and interferon reduces chance of gastroenteritis; lower chance atopy; good supply Fe and Ca; good supply protein and fat
7
Q
advantages of breastfeeding for mother
A
reduced incidence breast cancer, improved relationship with baby
8
Q
disadvantages of breastfeeding for baby
A
breast milk jaundice; transmission viruses/drugs; deficient in vitamin K; poor weaning practise
9
Q
disadvantages of breastfeeding for mother
A
emotional, time consuming
10
Q
what hormone is in the anterior pituitary
A
prolactin
11
Q
what does prolactin do
A
stimulates milk reflex
12
Q
what hormone is in the posterior pituitary
A
oxytocin
13
Q
what does oxytocin do
A
contraction of myoepithelial cells in alveoli forcing milk into the larger ducts
14
Q
bile stained vomit
A
intestinal obstruction
15
Q
causes of haematemesis
A
oesophagitis, peptic ulceration, oral/nasal bleeding
16
Q
projectile vomiting in first few weeks of life
A
pyloric stenosis
17
Q
vomit at end of paroxysmal coughing
A
whooping cough (pertussis)
18
Q
abdominal distension in vomiting
A
lower intestinal obstruction
19
Q
hepatosplenomegaly
A
chronic liver disease, storage diseases
20
Q
blood in stool in vomiting
A
gastroenteritis
21
Q
bulging fontanelle or seizures in vomiting child
A
increased ICP
22
Q
vomiting and failure to thrive
A
gastro oesophageal reflux, coeliac
23
Q
what is Gastro oesophageal reflux
A
involuntary passage of gastric contents into oesophagus due to the lower oesophageal sphincter being inappropriately relaxed
24
Q
why is GOR common in infants
A
fluid diet, horizontal posture, short intra abdominal length
25
presentation of GOR
recurrent regurgitation and vomiting, put on weight normally
26
complications of GOR
failure to thrive if severe vomiting, oesophagitis leading to haematemesis, pulmonary aspiration, apparent life threatening events, dystonic neck posturing
27
investigations in GOR
24h oesophageal PH monitoring (gold standard), 24h impedance monitoring, endoscopy and biopsy, contrast studies
28
management GOR
thickening agents added to feeds, position at 30 degree head prone after feeds, if more serious add ranitidine and PPIs (omeprazole), surgery last resort Nissen fundoplication
29
what is pyloric stenosis
hypertrophy of the pyloric muscle leading to gastric outlet obstruction
30
when does pyloric stenosis present
2-7 weeks
31
how does pyloric stenosis present
vomiting, hunger after vomiting, weight loss, hypochloraemic metabolic alkalosis with low Na and K
32
diagnosis pyloric stenosis
test feeds, waves of peristalsis, pyloric mass RUQ (feels like an olive), ultrasound
33
management
IV fluids to correct fluid and electrolytes, pyloromyotomy
34
recurrent abdominal pain how do they present
usually central pain (periumbilical) and otherwise well
35
RAP- what do you need to check
urine for UTI
36
RAP- gastro causes
IBS, abdominal migraine, constipation, non ulcer dyspepsia, gastritis and peptic ulceration
37
RAP- gynae causes
dysmenorrhoea, ovarian cysts, PID
38
RAP-psych causes
bullying, abuse, stress
39
RAP-hepato/biliary causes
hepatitis, gall stones, pancreatitis
40
RAP- urinary tract
UTI, pelvi-ureteric junction obstruction
41
symptoms in recurrent abdominal pain that suggest organic disease
epigastric pain at night, haematemesis, diarrhoea, weight loss, growth failure, vomiting (pancreatitis), jaundice, dysuria, bilious vomiting and distension
42
definition of recurrent abdominal pain
limiting activities lasting within 3 months
43
if suspect ulcer what do you do
PPI, eradication- amoxicillin + clarithromycin or metronidazole. if doesnt respond then functional dyspepsia
44
causes of constipation- what to consider in babies
Hirschsprung, anorectal abnormalities, hypothyroid, hypercalcaemia
45
causes constipation
not enough fibre and fluids, hypothyroid, hypercalcaemia, bowel disorder, stress, fear
46
why does soiling occur
contraction of full rectum inhibits internal sphincter leading to overflow
47
what is used in disimpaction regime
Movicol- polyethylene glycol + electrolytes which acts as a stool softener- escalating dose over 1-2 weeks until impaction resolves. if unsuccessful- use stimulant laxative
48
last resort in constipation
enema or manual evacuation under anaesthetic
49
what is Hirschsprungs
absence of gangluin cells from myenteric and submucosal plexuses in large bowel leading to narrow contracted segment
50
what % of pts with hirsch affects entire bowel
10%, 75% are rectosigmoid
51
presentation Hirschsprungs
neonatal- failure to pass meconium in first 24h of life, abdominal distension, vomiting
childhood- chronic constipation, abdominal distention, growth failure
52
diagnosis Hirschsprung
suction rectum biopsy- absence of ganglion cells and presence of Ach +ve nerve trunks. barium studies
53
management Hirschsprung
colostomy, anastomose normal bowel to anus
54
what is coeliac
gliadin portion of gluten stimulates an immunological response
55
what part of the bowel does coeliac affect
proximal small intestine mucosa
56
what happens to the villi in coeliac
become shorter then absent
57
classical presentation coeliac
malabsorption at 8-24m when wheat is introduced, failure to thrive, abnormal stools, irritable, buttock wasting, abdominal distention
58
if coeliac presents later in childhood what does it present with
GI symptoms, anaemia, growth failure
59
diagnosis coeliac
anti IgA TTG antibodies, anti endomysial antibodies, flat mucosa on jejunal biopsy
60
complications coeliac
increased small bowel malignancy, associated with dermatitis herpetiformis
61
management coeliac
remove wheat, rye, barley from diet
62
what is the main cause of gastroenteritis
rotavirus
63
if there is blood in the stool what is the cause of gastroenteritis
bacteria
64
bacterial cause of gastroenteritis with severe pain
campylobacter jejuni (most common bacterial)
65
bacterial cause gastroenteritis with dysenteric presentation (blood and pus)
shigella and salmonella
66
bacterial cause gastroenteritis with profuse and dehydrating diarrhoea
e coli and cholera
67
most serious complication of diarrhoea
dehydration leading to shock
68
signs of dehydration
tachycardic, tachypnoeic, decreased urine output, dry mucous membranes, decreased skin turgor, sunken eyes
69
signs of shock
lethargy, sunken fontanelle, dry mucous membranes, eyes sunken, tachypnoea, tachycardia, increased cap refill, weak peripheral pulses, decr tissue turgor, sudden weight loss, decr urine output, pale/mottled skin, hypotension, cold extremities
70
how does hyponatraemic dehydration occur
drinking a lot of water so more Na lost than water
71
what can hyponatraemic dehydration lead to
cerebral oedema and convulsions
72
how does hypernatraemic dehydration occur
high water losses so more water lost than Na
73
what can hypernatraemic dehydration lead to
jittery, increased muscle tone with hyperreflexia, altered conciousness, seizures, cerebral haem
74
what is mild dehydration defined by and what is the management
75
what is moderate dehydration defined by and what is the management
6-10% body weight loss. oral rehydration solution- 100ml/kg over 6h. if no improvement then IV rehydration
76
what is severe dehydration defined by and what is the management
>10% body weight loss. IV rehydration. bolus fluids if shocked- rapid infusion NaCl 0.9%.
77
what can happen post gastroenteritis
can develop a temporary lactose intolerance- confirm by non absorbed sugar in stools- positive Clinitest result- return to ORS for 24h
78
causes of chronic diarrhoea
coeliac, IBD, transient dietary protein intolerance, toddler diarrhoea
79
features of transient dietary protein intolerance
diarrhoea +- vomiting with failure to thrive, eczema, acute colitis, migraine, occasional acute anaphylaxis
80
which condition is IgE mediated- coeliac or transient dietary protein intolerance
transient dietary
81
what is the most common food for transient dietary protein intolerance
cows milk protein
82
differentiate transient dietary protein intolerance from coeliac
jejunal biopsy- patchy enteropathy with eosinophilsrather than flattened villi
83
diagnosis transient dietary protein intolerance
most children have eosinophilia, positive RAST test, high IgE in plasma
84
manage transient dietary protein intolerance
dietician, complete antigen exclusion, cows milk use hydrolysate based formula
85
when do most children grow out of transient dietary protein intolerance
by 2 years
86
what is toddler diarrhoea
chronic non specific diarrhoea- caused by functionally immature bowel leading to minor malabsorption
87
features of toddler diarrhoea
stools varying consistency, presence of undigested vegetables, child well and thriving, no precipitating factors
88
classical presentation of Crohns
25%- abdominal pain, weight loss, diarrhoea
89
presentation of Crohns
growth failure, delayed puberty, abdominal pain, weight loss, diarrhoea, general ill health, extra intestinal manifestations- oral lesions, perianal fissures, uveitis, arthralgia, erythema nodosum
90
where is the most common site affected in Crohns
distal ileum, proximal colon
91
what happens to the bowel in Crohns
acutely inflamed, thickened bowel. strictures and fistulae form
92
what is the histological in Crohns
non caseating epithelioid cell granulomata
93
investigations in crohns
upper GI endoscopy, ileocolonoscopy, small bowel imaging
94
how is remission induced in crohns
nutritional therapy- replace normal diet by whole protein modular feeds (polymeric diet), if not effective- steroids
95
what drugs can be used in Crohns
steroids, immunosuppressants- azathioprine, methotrexate, anti tumour necrosis factor agents- infliximab, adalimumab.
96
surgery necessary for what complications in Crohns
obstruction, fistulae, abscesses
97
local symptoms of UC
rectal bleeding, colicky pain, diarrhoea
98
systemic symptoms UC
weight loss, growth failure, arthritis, erythema nodosum
99
what % of children in UC have pancolitis
90%
100
diagnosis UC
biopsy, colonoscopy, crypt damage, ulceration
101
treatment for mild UC
aminosalicylates- mesalazine, balsalazide. or topical steroids
102
treatment for severe UC
systemic steroids
103
complication of UC in severe fulminating disease
toxic megacolon- inflammation causes impaired gut motility leading to acute distension of the colon. increased abdominal pain and shock
104
how is toxic megacolon treated in UC
emergency- ciclosporin, IV fluids, steroids. if not responsing- colectomy
105
when is surgery implicated in UC
colectomy with ileostomy or ileorectal pouch in toxic megacolon or in chronic poorly controlled.
106
what are you at increased risk of in UC
adenocarcinoma of colon in adults- regular screening after 10 years
