Gastroenterology Flashcards
(20 cards)
True or false: Treatment and investigation of uncomplicated
gastroesophageal reflux (GER) in an otherwise well child is often unnecessary
True
What are the red flags for treatment in a child with GERD?
1) Feed aversion
2) Poor weight gain
3) Pain and discomfort during feeds
4) Signs of aspiration (esp in neurologic impairment/ poor airway protective mechanisms)
What is the first line treatment of acute GE?
Rehydration (oral or IV)
What is bilious vomiting indicative of?
Mechanical obstruction
- distal to ligament of Trietz
What are 4 causes of mechanical obstruction in a child?
1) Malrotation/volvulus
2) Strangulated hernias
3) Intestinal adhesions (? prior surgery)
4) Intussusception
What is the clinical definition of chronic diarrhoea?
1) Duration >2-4 weeks
2) ↑Frequency/fluidity
What is the most common cause of prolonged diarrhoea after an acute episode of gastroenteritis?
Secondary lactose intolerance (temporary reduction in intestinal lactase activity)
- worse AFTEr a meal
What are 3 organic causes of constipation?
1) Hypothyroidism
- development delay, FTT
2) Hirschsprung disease
- chronic abdominal distension, constipation started early in life
3) Spina bifida/ spinal cord lesions
- LL reflexes, LUT symptoms
What are 3 causes of abdominal pain of out proportion to appearance in children?
1) Intestinal obstruction
- intussuception
2) Acute appendicitis
- rovsings, mcburney’s sign
3) Mesenteric ischaemia
- only if dengue shock syndrome/ haemorrhagic fever
What are 4 red flags for recurrent abdominal pain?
1) Nocturnal diarrhoea/ abdominal pain
2) Weight loss
3) Pallor
4) Constitutional symptoms
What are 3 differentials for mucoid diarrhoea?
1) Infective colitis
- giardiasis, shigella, campylobacter
2) Crohn’s disease
3) Ulcerative colitis
What are 4 causes of unconjugated prolonged jaundice in children?
1) Breast milk jaundice
2) Hypothyroidism
3) Hemolysis (G6PD)
4) Metabolic defects of conjugation
What are 4 causes of conjugated prolonged jaundice in children?
1) UTI
2) Neonatal hepatitis
3) Choledochal cyst
4) Biliary atresia
5) Septicemia
6) TPN
7) Metabolic (Citrin deficiency, Galactosaemia, Hereditary fructose intolerance, tyrosinaemia)
What are the most important components of a jaundice history for a child?
1) Stool colour
2) Gestational age
3) Birth weight, cord TSH, G6PD
4) Perinatal events (maternal flu-like symptoms/rash)
5) feeding Hx (check siblings)
6) Weight gain
What is the clinical biochemical definition of cholestatic jaundice in an infant?
Conjugated >20% of total
How does low bilirubin affect the bilirubin test interpretation?
If the total bilirubin level is already low (< 85 umol/L)1,
cholestasis is only defined when the absolute conjugated bilirubin is > 20 umol/L (> 1mg/dl )
What 4 differences between breast milk and breast feeding jaundice?
Weight gain
- milk: good
- feeding: poor
Feeding
- milk: well fed
- feeding: limited intake
Hydration
- milk: hydration
- feeding: dehydration
Urine output
- milk: good
- feeding: poor
True or false: A pigmented stool colour is enough to exclude a conjugated jaundiced.
False: MUST do fractionated bilirubin
- conjugated/direct is ALWAYS pathological
What are 3 causes of jaundice with hepatomegaly?
1) Viral hepatitis
- recent travel/ contact Hx
- ACUTE with infective symptoms
2) Leukaemia/ haemonco
- splenomeg
- pallor
- lymphadenopathy
3) CHF
- deviated apex
- bi-basal creps
- pedal edema
What are the measures for liver synthetic function?
1) PT
2) Albumin
3) Glucose
