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Gastro Flashcards

1
Q

Define Constipation

A

Decrease in frequency of bowel movements characterised by passage of stools which may be large and associated with straining/pain

Termed chronic if lasting more than 8 weeks

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2
Q

What is the normal Bowel Frequency in children?

A

<4 weeks - QTS
1y - BD
4y - Adult frequency (3 per day to 3 per week)

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3
Q

Name some causes of Constipation in children

A

Inadequate fluid/fibres
Psychosocial issues
Impaired mobility (Cerebral Palsy)
Neurodevelopmental (Downs)

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4
Q

Diagnosis of Constipation requires Atleast two of:

A

<3 complete stools a week
Hard large stool
Rabbit droppings
Overflow soiling

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5
Q

What is Retentive Posturing?

A

Straight legged
Tip toes
Arched back

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6
Q

Name three red flags for Constipation in children

A

Symptoms occurring from birth (?Hirschsprungs)
Abdominal Distension (?Hirschsprungs)
Ribbon stool pattern (?Anal Stenosis)

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7
Q

What suspected diagnoses with constipation would require a non urgent referral?

A

Coeliac
Hypothyroidism
CMPA

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8
Q

How is Constipation disimpacted?

A

Macrogol using escalating dose regimen (increasing dose until soft stools form)

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9
Q

Describe maintenance therapy in constipation

A

Movicol in escalating dose (normally half the dose required for disimpaction)

Can add Senna if required

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10
Q

What general advice should you give parents whose child is constipated?

A 
Scheduled toiletting
Bowel diary
Star chart
Adequate fibre and fluids
Don’t stop laxatives abruptly
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11
Q

Name four organic causes of Abdominal Pain

A

Constipation
Coeliac
Mesenteric Adenitis
Abdominal Migraine

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12
Q

Give three red flags in an Abdominal Pain presentation

A

Persistent vomit
Fever
Rectal bleeding

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13
Q

What initial investigations should be done in Abdominal Pain?

A

FBC, CRP, TTG, Urine Dipstick

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14
Q

Define Recurrent Abdominal Pain

A

Abdominal pain occurring Atleast four times a month, over Atleast two months which limits child’s activity and can’t be attributed to another cause
Believed to be due to dysregulation of visceral nerve pathways

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15
Q

How can recurrent abdominal pain be managed?

A

Encourage distraction and school

Peppermint Oil, Antispasmodics, Antidiarrhoeals

CBT

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16
Q

What are the different patterns of vomiting?

A

Acute (discrete episodes of moderate to high intensity)
Chronic (low grade daily pattern)
Cyclic (severe discrete episodes with pallor/lethargy/pain)

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17
Q

Give three causes of newborn vomiting

A

Pyloric Stenosis
Duodenal Atresia
Intestinal Malrotation

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18
Q

What diagnoses for vomiting would you consider after the newborn period?

A

GOR
Intussusception
Allergies

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19
Q

Give four Non GI causes of vomiting

A

Meningitis
Pyelonephritis
Migraines
Raised ICP

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20
Q

Give three causes of cyclical vomiting

A

Abdominal migraine
Cyclical vomiting syndrome
Intermittent obstruction

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21
Q

What features in a vomiting history could help differentiate the cause?

A

Bilious vs Non Bilious
Bloody vs Non Bloody
Projectile vs Non Projectile
Febrile vs Non Febrile

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22
Q

What investigations are required in acute vomiting?

A

Bloods
Stool Culture
AXR
Abdominal USS if projectile

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23
Q

What investigations are required in chronic vomiting?

A

H.Pylori testing
Coeliac AB screen
Urinalysis
?Imaging

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24
Q

What investigations are required in cyclical vomiting?

A

Serum Amylase
Serum Lipase
Serum Ammonia

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25
Management of vomiting is supportive and treat underlying cause. What complications could occur?
Dehydration Electrolyte Disturbance Mallory Weiss
26
If no underlying organic cause for vomiting, what diagnosis should be considered?
Psychogenic
27
Define Diarrhoea
Change in consistency and frequency of stools, with enough loss of fluids and electrolytes to cause illness
28
Give 5 causes of Diarrhoea in children
``` Infective Gastroenteritis Food Hypersensitivity Drugs (Antibiotics) HSP Intussusception ```
29
How would you manage mild to moderate diarrhoea?
No tests necessary Replace fluids and electrolytes with oral glucose and electrolytes
30
How would you manage severe diarrhoea?
IV Fluids and electrolytes Full range of bloods, ABG, Stool Culture, USS Anti motility not recommended
31
What is Chronic Diarrhoea?
Diarrhoea persisting for more than 14 days Can be due to reduced absorption (coeliac), osmotic (lactase deficiency), inflammatory (UC), or secretory (VIP secreting tumour)
32
What is Toddler’s Diarrhoea?
Occurring from 6 months to 5 years Colicky intestinal pain, distension and undigested food Managed with increased fibre and occasional loperamide
33
What stool tests could you do in chronic diarrhoea?
``` Microscopy Leukocytes Fat Culture pH Elastase Calprotectin ```
34
Other than Stool, Blood and Radiological investigations, what else can be done in Chronic Diarrhoea?
H2 breath (Lactose Intolerance) Biopsy (Coeliac/IBD) Sweat (CF)
35
Coeliac is an autoimmune response to gluten. Describe the pathophysiology
Combination of immunological responses to an an environmental factor (gliadin) and genetic factors (HLA DQ2/DQ8) Epithelial destruction and follows atrophy via antitissue transglutaminase and anti endomysial
36
Describe the classical presentation of Coeliac
Presenting at 9-24 months with features of malabsorption, failure to thrive, weight loss, loose stools
37
Describe the atypical presentation of Coeliac
``` Osteoporosis Peripheral Neuropathy Anaemia Dermatitis Herpetiformis Dental Enamel Hypoplasia ``` Positive serology only
38
What would the classic histology show in Coeliac?
Crypt Hyperplasia | Villous Atrophy
39
Describe the latent presentation of Coeliac
Predisposing genes Normal mucosa Possible positive serology
40
Describe the silent presentation of Coeliac
Damaged small intestine Positive Serology No symptoms
41
How is suspected Coeliac investigated?
Patient has to be eating gluten at time and for Atleast 6 months before Total IgA then tTG IgA Duodenal biopsy if positive serology
42
Describe the staging of Coeliac biopsy
0 - normal 1 - Increased intraepithelial lymphocytes 2 - Increased inflammatory cells and crypt hyperplasia 3 - all of the above plus mild to complete villous atrophy
43
State four complications of Coeliac
Anaemia Osteopenia Osteoporosis Malignancy
44
Define GORD
Gastro-Oesophageal reflux is the passage of gastric contents into the oesophagus Becomes known as GORD when it is symptomatic
45
What is Posseting?
Reflux of contents beyond oesophagus, and can be normal in infants Eg after feeding
46
Why are children predisposed for reflux?
Reduced LOS tone Short Oesophagus Liquid diet Significant periods recumbent
47
Give three risk factors for GORD
Prematurity Obesity Hiatus Hernia
48
How does GORD present?
Excess crying Back arch Chronic cough Faltering growth
49
What should you establish in a GORD history in relation to feeding?
Position and technique Volume given (?over distension) Frequency/Volume of vomits Relationship to feeds
50
GORD is a clinical diagnosis. Give three differentials
Pyloric Stenosis (Projectile) Malrotation (Bile Stained) CMPA (Blood in stool)
51
How should you manage breast fed infants with GORD?
Alignate with water immediately post feed
52
How should you manage formula fed infants with GORD?
1) Ensure not overfed (150ml/kg/d total) 2) Decrease feed volume and increase frequency 3) Use feed thickener 4) Stop thickener and add alignate
53
If GORD doesn’t improve with alignates, what can be used?
PPI | H2 Antagonist
54
The features of Crohns can be remembered by the mnemonic NESTS, describe this
``` No blood or mucous Entire GI tract Skip Lesions Terminal Ileum/Transmural Smoking is a risk factor ```
55
The features of UC can be remembered by the mnemonic CLOSE UP, describe this
``` Continuous inflammation Limited to colon/rectum Only superficial mucosa Smoking is protective Excrete blood and mucous ``` Use Aminosalicyclates PSC association
56
Give four extraintestinal features of IBD
Clubbing Erythema Nodosum Pyoderma Gangrenosum Iritis
57
How is IBD investigated in children?
Faecal Calprotectin OGD and colonoscopy with biopsy AXR/Small Bowel MRI/CT for complications
58
How is remission induced in Crohns?
First line - Oral Prednisolone/IV Hydrocortisone Second Line - Azathioprine, Infliximab
59
What is the maintenance treatment in Crohns?
Azathioprine/Mercaptopurine first line Surgery for complications
60
How is remission induced in UC?
Mild to Moderate - Aminosalicyclate first line, Prednisolone second line Severe - IV Hydrocortisone or IV Ciclosporin
61
What is the maintenance treatment for UC?
Aminosalicyclate or Azathioprine Panprotocolectomy is curative (either Ileostomy or J Pouch)
62
Describe the different types of viral hepatitis
``` A- Faecal Oral B - Blood Products, IVDU, Sex, Vertical C - Same as above, mostly chronic D - Coinfection for Hep B E - Faecal Oeal G - IV ``` (+ EBV,HIV, CMV)
63
What are the non viral causes of Hepatitis?
Metabolic Disease (Wilson’s) Autoimmune Reye Syndrome
64
What is Reye’s Syndrome?
Acute Encephalopathy associated with aspirin therapy and fatty liver infiltration Nausea and vomiting, Hypoglycaemia, Abdo Pain
65
Hepatitis can present in various ways in children. Describe some
Asymptomatic Fulminant (Encephalopathy, Coagulopathy) Fever, fatigue, anorexia, RUQ pain, jaundice
66
Give five investigations for Hepatitis
``` LFTs Blood Glucose Viral Serology Serum Immunoglobulins Serum Copper ```
67
Hepatitis is normally managed supportively with the avoidance of alcohol. How is Fulminant Hepatitis managed?
PICU | Liver Transplant
68
Hepatitis is normally managed supportively with the avoidance of alcohol. How is Reyes Syndrome managed?
Maintain glucose >4mmol/l | Prevent sepsis
69
Give four causes of CHRONIC hepatitis in Children
Chronic Hepatitis NAFLD A1 Antitrypsin Biliary Atresia
70
Biliary Atresia results in conjugated jaundice. How is it managed?
Kasai Portoenterostomy (attaching small intestine to liver opening)
71
How could Chronic Hepatitis present in Children?
Jaundice Pruritus Anaemia Developmental Delay
72
What investigations could you do for Chronic Hepatitis that are different to those from Acute?
Sweat Test A1 Antitrypsin Level Serum/Urinary Copper Liver Biopsy
73
How is Autoimmune Hepatitis treated?
Prednisolone and Azathioprine
74
How is Chronic Viral Hepatitis treated?
Interferon Alpha and Ribavirin
75
How is Hepatitis due to Wilson’s disease treated?
Penicillamine
76
Peptic Ulcers present similarly in children as adults. How could it be investigated?
Breath Test for H.Pylori
77
How are Peptic Ulcers managed?
Omeprazole If H.Pylori add Amoxicillin and Metronidazole
78
Give five causes of Gastritis in Children
``` H.Pylori Irrational introduction of adult foods Unbalanced food composition Poor chewing Too Cold/Very Hot food ```
79
Describe the pathophysiology of Gastritis
Some foods may cause formation of oedema cells and enhance acid synthesis Inflammation and blood circulation to wall increases, altering nervous regulation (alters contractions)
80
How would you investigate Gastritis in Children?
Full range of bloods Faecal Culture and Analysis H.Pylori
81
How would you manage Gastritis in children?
Diet - mashed/puréed food without spices or additives, exclude roughage and carbonated drinks PPIs Antispasmodics
82
What is the normal milk requirement in an infant?
150ml/kg/d
83
Name four different types of formula milk
Cows Milk - early weeks are whey based, later weeks are casein based Soya milk - now not recommended due to photo-oestrogens Hydrolysed Cows Milk (CMPA) Elemental Formula (Severe CMPA)
84
When should solids be introduced to a child’s diet? What should the be?
Not recommended until 6 months Baby rice, fruit and vegetables No low fat products Supplementary Vit ACD
85
When should breast formula feeding be continued until?
1y
86
Why should children avoid excess juices/fizzy drinks?
Cause of Toddler’s Diarrhoea
87
How is Parenteral Nutrition given?
Via central or peripheral lines
88
What are the two components of Parenteral Nutrition?
Lipid component (fat and fat soluble vitamins over 20h) Aqueous component (Carbohydrate, protein, electrolytes, minerals over 24h)

Year 4 Paediatrics (15 decks)

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