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Flashcards in Gastro Deck (106):
1

when should you breastfeed/formula feed until

6months

2

when should you start weaning

6 months

3

why is unmodified cows milk inappropriate

too much protein/electrolytes, deficient in iron, vitamins A,C,D

4

when can you give cows milk

after 12m

5

when to use specialised infants formula feed

cows milk protein allergy/intolerance, lactose intolerance, CF, intestinal resection

6

advantages of breastfeeding for baby

transfer IgA, lactoferrin and interferon reduces chance of gastroenteritis; lower chance atopy; good supply Fe and Ca; good supply protein and fat

7

advantages of breastfeeding for mother

reduced incidence breast cancer, improved relationship with baby

8

disadvantages of breastfeeding for baby

breast milk jaundice; transmission viruses/drugs; deficient in vitamin K; poor weaning practise

9

disadvantages of breastfeeding for mother

emotional, time consuming

10

what hormone is in the anterior pituitary

prolactin

11

what does prolactin do

stimulates milk reflex

12

what hormone is in the posterior pituitary

oxytocin

13

what does oxytocin do

contraction of myoepithelial cells in alveoli forcing milk into the larger ducts

14

bile stained vomit

intestinal obstruction

15

causes of haematemesis

oesophagitis, peptic ulceration, oral/nasal bleeding

16

projectile vomiting in first few weeks of life

pyloric stenosis

17

vomit at end of paroxysmal coughing

whooping cough (pertussis)

18

abdominal distension in vomiting

lower intestinal obstruction

19

hepatosplenomegaly

chronic liver disease, storage diseases

20

blood in stool in vomiting

gastroenteritis

21

bulging fontanelle or seizures in vomiting child

increased ICP

22

vomiting and failure to thrive

gastro oesophageal reflux, coeliac

23

what is Gastro oesophageal reflux

involuntary passage of gastric contents into oesophagus due to the lower oesophageal sphincter being inappropriately relaxed

24

why is GOR common in infants

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