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0.1 Paediatrics - RB > Gastroenterology > Flashcards

Gastroenterology Flashcards

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1
Q

What are symptoms of Abdominal Migraine?

A 
Abdominal pain >1 hour
Nausea and vomiting
Headache
Photophobia
Aura
Pallor
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2
Q

What are treatments of Abdominal Migraine?

A

Low stimulus environment

Paracetamol, Ibuprofen, Sumatriptan

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3
Q

What drug is used to prevent Abdominal Migraines? What is the mechanism of action?

A

Pizotifen, serotonin agonist

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4
Q

What medication is first-line for constipation in children?

A

Movicol, osmotic laxative

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5
Q

What does a “ribbon stool” suggest?

A

Anal stenosis

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6
Q

What two conditions are associated with Meconium Ileus?

A

Cystic Fibrosis, Hirschprung’s disease

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7
Q

What ABG result would you expect in Pyloric Stenosis?

A

Hypochloraemic, Hypokalaemic metabolic alkalosis (with high bicarbonate levels)

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8
Q

What are the two associations with Pyloric stenosis?

A

Macrolide antibiotic use

Turner’s Syndrome

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9
Q

What is the typical history from a patient with Pyloric Stenosis? How is it diagnosed? How is it treated?

A

Normal birth, but in first few weeks starts to project non-bilious vomit 30mins after feeding. Olive shaped mass palpable in RUQ, and observable peristalsis in abdomen

Diagnosed by abdominal ultrasound, which shows a thickened pylorus

Treated by a laparoscopic pyloromyotomy (Ramstedt operation)

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10
Q

What is the most common cause of obstruction in children?

A

Intussusception

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11
Q

What is the typical history from a patient with Intussusception?

A

Severe colicky abdominal pain, with a redcurrant jelly stool. RUQ sausage shaped mass, and patient will draw knees up to their chest

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12
Q

What age group does Intussusception occur in?

A

Aged 6 months to 2 years old

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13
Q

How is Intussusception diagnosed? What is the sign to look for?

A

By Abdominal Ultrasound: Target Bull’s eye lesion

By contrast Enema

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14
Q

How is Intussusception managed?

A
  • Therapeutic enema with air sufflation
  • Surgical reduction if enema fails
  • Surgical resection if bowel is gangrenous
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15
Q

What is Hirschprung’s Disease?

A

A congenital condition where parasympathetic ganglionic cells of the Meissners and Myenteric plexus are absent from the distal bowel and rectum which controls peristalsis

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16
Q

What are symptoms of Hirschprung’s Disease?

A

Failure to pass meconium within 48 hours, chronic constipation, FTT, abdominal pain, poor weight gain, vomiting

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17
Q

What two ways is Hirschprung’s Disease diagnosed?

A
  • Abdominal X-Ray

- Rectal suction biopsy of mucosa + submucosa

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18
Q

What is Hirschprung’s Disease associated with?

A

Down’s Syndrome
Neurofibromatosis
Waardenburg Syndrome
Men Type II

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19
Q

What is the definitive treatment for Hirschprung’s Disease?

A

Resection of aganglionic bowel, anorectal pull through

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20
Q

What is Oesophageal Atresia associated with?

A

VACTERL association, Polyhydramnios

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21
Q

What does VACTERL stand for?

A 
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal anomalies
Limb abnormalities
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22
Q

What is Oesophageal Atresia? When does it occur during development?

A

Where the oesophageal tube is interrupted, becoming a blind-end pouch. Occurs during Week 4 of development

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23
Q

What are symptoms of Oesophageal Atresia?

A

Increased oral secretions, regurgitation, choking, cyanotic spells

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24
Q

What is Duodenal Atresia associated with?

A

Down’s Syndrome, polyhydramnios

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25
What is the main finding on AXR for Duodenal Atresia? How do we treat Duodenal Atresia?
Double bubble sign | Duodenoduodenostomy
26
What is the main symptom of Duodenal Atresia?
Bilous vomiting
27
What is the most common cause of Gastroenteritis in children?
Rotavirus
28
What are the features of Gastroenteritis?
Diarrhoea for 5-7 days, and vomiting for 1-2 days
29
What is the electrolyte abnormality associated with Gastroenteritis? What are symptoms of it?
Hypernatraemia Jittery movements, drowsiness, coma, hypertonia, hyperreflexia, convulsions
30
What is Traveller's Diarrhoea defined as? What is it caused by?
3 loose stools or more in 24 hours, associated with fever, cramps, nausea, vomiting Most commonly caused by E. Coli in developed world, but in Southeast Asia is caused by Campylobacter
31
How do manage a child with Gastroenteritis?
- Barrier nursing / infection control - Stay off school 48 hours until symptoms improve - Microscopy, culture, sensitivities on stool sample - Fluid challenge: 20ml / kg 0.9% NaCl - Rehydration solutions i.e. Dioralyte
32
E. Coli producing Shiga toxin is associated with which condition?
Haemolytic Uraemic Syndrome
33
Haemolytic Uraemic Syndrome is a triad of..?
- Haemolytic anaemia - Acute kidney injury - Thrombocytopenia
34
What is the incubation period of E. Coli?
12-48 hours
35
What is the incubation period of Campylobacter jejuni? What is a complication of gastroenteritis cause by this bacteria? How is it treated?
48-72 hours Guillin-Barre syndrome Azithromycin, Ciprofloxacin
36
What is the incubation period of Shigella?
48-72 hours
37
What is the incubation period of Salmonella?
12-48 hours
38
What is the incubation period of Giardiasis?
> 7 days
39
What is the incubation period for Amoebiasis?
> 7 days
40
What microbes have the longest incubation period?
Giardiasis and Amoebiasis
41
What is the incubation period for Bacillus cereus?
1-6 hours for vomiting subtype | 6-14 for diarrhoea subtype
42
What is the incubation period for Staph aureus?
1-6 hours
43
What is a complication of Yersinia Enterocolitica?
Lymphadenopathy -> Mesenteric Adenitis (mimics appendicitis)
44
What are the symptoms / signs associated with Biliary Atresia?
``` Jaundice Dark urine, pale stools Hepatopmegaly Splenomegaly Growth disturbances ```
45
What test results might suggest Biliary Atresia?
Total Billirubin = Normal Total Conjugated Billirubin = Increased LFTs, Bile acids, Aminotransferases = May increase
46
What is the surgical procedure for Biliary Atresia?
Kasai Portoenterostomy
47
What is Mesenteric Adenitis caused by? How is it treated?
Yersinia Enterocolitica | No management required
48
What are the symptoms of Necrotising Enterocolitis?
Poor feeding, bloody stools, abdominal distension
49
What investigation is ordered for Necrotising Enterocolitis? What is seen?
Abdominal X-Ray Dilated bowel loops, bowel wall oedema, pneumatosis intestinalis, portal venous gas, pneumoperitoneum, Rigler's sign, Football sign
50
How is a Malrotation treated?
Ladd's procedure
51
What is Malrotation?
Arrest of normal gut as it rotates around the Superior Mesenteric Artery
52
What are the symptoms of Malrotation?
Billous vomiting, abdominal pain, abdominal distension, bloody stools
53
How is Malrotation diagnosed? What may be present?
GI Contrast Study: Corkscrew sign | Ultrasound
54
What are two differentials for Billous Vomiting?
- Duodenal atresia | - Malrotation
55
What is a sign on ultrasound might suggest a Volvulus?
Whirlpool sign
56
What is Sandifer's syndrome? How does it resolve?
Gastro-oesophageal reflux Torticolis + Dystonia Will resolve once the reflux improves
57
What is McBurney's point?
One-third of the distance from the anterior superior iliac spine to the umbilicus
58
What dermatological condition is associated with Coeliacs? What is it?
Dermatitis Herpetiformis | Itching, vesicular, blistering skin rash on abdomen and extensor surfaces
59
What anaemias are associated with Coeliacs?
Iron, B12 and folate | Folate > B12 deficiency
60
What is the first-line investigation for Coeliacs?
IgA-TTG | However must check for IgA deficiency, as it would give a false result if low
61
What changes are observed on a Jejunal Biopsy in a patient with Coeliacs who has re-introduced gluten?
- Villous atrophy - Crypt hyperplasia - Increase in intraepithelial lymphocytes - Lamina Propria infiltration with monocytes
62
What is the name given to the classification of Coeliac Disease severity?
Marsh Classification
63
What are complications of Coeliacs if untreated?
``` Iron, B12, Folate deficiency Hyposplenism Osteoprosis, Osteomalacia Lactose intolerance EATL of small bowel Oesophageal cancer (rare) ```
64
What is the term referring to Coeliac's Disease patients who have not responded well to 6-12 months of a Gluten free diet? What is the treatment?
Refractory sprue Treatment: Glucocorticoids, restriction of Soy
65
What is the definitive management for Ulcerative Colitis?
Panproctocolectomy + Ileostomy / J-pouch
66
What is the Truelove and Witts Criteria for Ulcerative Colitis?
Mild: 4 or less stools with no systemic disturbance, normal CRP / ESR Moderate: 4-6 stools with minimal systemic disturbance Severe: 6 or more stools with blood, systemic disturbance
67
What is the difference in histology between Crohn's and Ulcerative Colitis?
Crohn's: Transmural (mucosa to serosa) + goblet cells + granulomas Ulcerative Colitis: Mucosa to submucosa + crypt abscesses
68
What are the radiological signs associated with Crohn's Disease?
String sign, rose thorn ulcers, fistulae
69
What are the radiological signs associated with Ulcerative Colitis?
Loss of haustrations, drainpipe colon
70
Gallstones are more common in which IBD?
Crohn's Disease
71
Pseudopolyps are common in which IBD?
Ulcerative Colitis
72
What is the first-line management for a Crohn's patient to INDUCE remission during a flare-up?
Oral Prednisolone or IV Hydrocortisone
73
What is the second-line management for a Crohn's patient to INDUCE remission during a flare-up?
``` Azathioprine Mercaptopurine Methotrexate Infliximab Adalimumab ```
74
Smoking makes which IBD worse and which IBD better?
Smoking makes Crohn's Disease worse | Smoking makes Ulcerative Colitis better
75
What is the first-line management for a Crohn's patient to MAINTAIN remission?
Azathioprine | Mercaptopurine
76
What is the first-line management for a Ulcerative Colitis patient to INDUCE remission during a MILD/MODERATE flare-up? What is second-line?
First-line: Rectal Masalazine (+ Oral Mesalazine) Second-line: Corticosteroids
77
What is the first-line management for a Ulcerative Colitis patient to INDUCE remission during a SEVERE flare-up? What is second-line?
First-line: IV Corticosteroids Second-line: IV Ciclosporin
78
What is the first-line management for a Ulcerative Colitis patient to MAINTAIN remission?
Aminosalicyclates Azathioprine Mercaptopurine
79
Methotrexate is used in treatment regimes for which IDB?
Crohn's Disease only

0.1 Paediatrics - RB (16 decks)

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