Gastroenterology Flashcards
(122 cards)
1
Q
What foods should be avoided if weaning <6m?
A
Wheat
Fish
Eggs
Food high in: salt/sugar/honey (risk of botulism)
2
Q
What is mild Failure to Thrive classed as? + severe?
A
Mild = cross 2 centile lines Severe = cross 3 centile lines
3
Q
List some non-organic (env/psych) causes of Failure to Thrive (5)
What % of cases are due to non-organic causes?
A
Feeding probs/lack of food Low socioeconomic status/maternal education Abuse Poor bond with child Maternal depression
> 95% due to non-organic causes
4
Q
List some organic causes of Failure to Thrive (6)
A
Impaired suck/swallow (cleft) Impaired retention (vom, severe GORD)
Malabsorption (Coeliac, CF, CMP, NEC, Short gut, Cholestatic liver disease)
Chronic illness (Crohn’s, CF Chronic renal failure, liver disease)
Failure to utilise nutrients (IUGR, Premature, Down’s Infection, metabolic disorders)
High requirements (thyrotoxicosis, congenital heart, malignancy, chronic infection)
5
Q
What things should be asked about in Failure to Thrive (5)
A
Detailed Hx + food diary Social Hx probs Feeding probs Symptoms (Vom, Diarrhoea) Illness
6
Q
What Ix can be done in Failure to Thrive (7)
A
FBC Urinalysis + culture U&E + creatinine LFTs + TFTs Coeliac screen Sweat test Prealbumin (nutritional marker)
7
Q
When is hosp admission in failure to thrive indicated? (3)
A
<6m
Severe FTT
Requiring active refeeding
8
Q
What is the outcome like for FTT with non-organic cause?
A
Non-organic / continued underrating → lasting deficit
If due to developmental impairment → short term
9
Q
When might acute constipation be caused by?
How is it managed?
A
e.g. febrile illness
Self-limiting / mild laxatives + extra fluid
10
Q
What is a complication of long term constipation?
A
Rectum can over distend → lose feeling to defacate → involuntary soiling
11
Q
What are some common causes of constipation? (6)
A
Dehyration
Reduced fluid intake
Anal fissure → pain
In older, related to:
Toilet training
Unpleasant toilets
Stress
12
Q
What are the red flag symptoms for constipation?
A
Failure to pass meconium in 1st 24hrs Abdo distension Failure to Thrive Bruising/Fissures (abuse) Abnormal lower limb neurology (lumbosacral pathology) Sacral dimple (spina bifida occulta)
13
Q
How is constipation managed if faeces are not palpable?
+ if palpable?
A
→ Balanced diet + fluids + mild laxatives
→ Mild laxatives (movicol)
If spontaneous stools: maintain balanced diet + fluids
If not → stimulant laxatives (senna) ± osmotic laxative (lactulose)
Still unsuccessful: enema (± sedation)/ manual evacuation
14
Q
What types of milk are recommended + for how long?
A
Breast/formula recorded for 12m (wean after 6m)
+ pasteurised cow’s milk may be given after 12m
15
Q
What may specialised formulas be used for? (5)
A
Cow's milk protein (CMP) allergy/intol Lactose intol CF Neonatal cholestatic liver disease After intestinal resection
16
Q
Why should soya milk not be used in <6m?
A
High aluminium content + phytoestrogens
17
Q
What are the different types of hydrolysed formula milks + when are they used?
A
Partially hydrolysed (longer peptide chains):
Used for CMP prophylaxis (reduces risk allergy where FH)
Not suitable when have allergy (adverse reaction)
Extensively hydrolysed: for those with CMP allergy (amino acid formula - not v tasty)
18
Q
What are the features of CMP enteropathy (12)
A
Cutaneous:
Urticaria
Atopic + contact dermatitis
Angioedema
GI: N+D+V Constipation Colic + colitis Transient enteropathies
Resp/ENT: Asthma/wheeze Otitis media Rhinoconjunctivitis Laryngeal oedema Anaphylaxis
19
Q
Describe the symptom latency (which Sx + when) of CMP enteropathy
A
Immediate → rash + resp probs
Hrs → GI
24hrs → cough/wheeze
20
Q
What Ix can be done into CMP allergy? (3)
A
Hx - FH atopy common
Skin prick test for CMP
IgE (specific for CMP) blood test
21
Q
How is CMP allergy managed?
A
If breast fed:
Eliminate CMP + eggs from mum’s diet + req Ca supplements
If formula-fed: change to amino acid formula
22
Q
What types of food allergies are common in infants?
+ in older children
A
Infants: milk, eggs, peanuts
Older: peanuts, tree nuts, fish/shellfish
23
Q
How may IgE mediated + non-IgE mediated food allergies present differently?
A
IgE mediated (T1HS): allergy symps
Urticaria / Facial swelling / Anaphylaxis
10-15mins after ingestion
Non-IgE mediated (T2HS): = intolerance
GI symps (N+D+V + abdo pain + FTT) / Colic / Eczema
Sometimes present w. bloody stools in 1st wks life
Hrs after ingestion
24
Q
How are food allergies/intolerances Dx?
A
Skin prick test
Specific IgE blood tests
Poss need intestinal biopsy to support Dx
Gold standrd: oral food challenge (double blind placebo)
25
How are food allergies/intolerances managed?
Avoid allergen food completely
Plan/training in case of incident
```
For mild (no cardioresp Sx) → oral antihistamines
For severe → epipen
```
26
What is functional encoperesis / how does it occur?
| What are the RFs (4)
Retain stools to prevent pain
→ lose more water in colon → more painful
→ colon distension → loss of defacate sensation
→ rectal sphincter distends → stools force way out
No toilet training
Toilet phobia
Manipulative soiling
IBS
27
List some support sources for child soiling/encoporesis (4)
GP
Many referred to paed gastroenterologists
Psychological / parental help
Online info / Encoporesis support groups
28
What is soiling/encopresis defined as?
Child >4 (previously toilet trained) soiling self w/wo constipation/overflow
29
What is the incidence/prevalence of gastroenteritis in children in UK? + commonest causative pathogen?
10% of <5s
| Rotavirus
30
How does gastroenteritis generally present?
| What are the main RFs (ask in Hx) (3)
Sudden stool change → loose/watery
OR
Onset of vomiting
Recent contact with acute D+V
Exposure to known source
Recent travel abroad
31
What symptoms may make you think of an alternative Dx to gastroenteritis (8)
```
Temp >38 ( in <3m) or >39 (in >3m)
SOB/Tachypnoea
Severe abdo pain
Abdo distension /rebound tenderness
Blood/mucus in stools
Bilious vomiting
Meningism signs (stiff neck/ fontanelle/ purpuric rash)
Altered consciousness
```
32
What situations are Ix done in gastroenteritis?
Stool sample
- if blood/mucus
- if immunocompromised
- if suspect sepsis
Microbiology:
- recent travel
- diarrhoea not improved in 7d
33
What is mesenteric adenitis? What is it caused by?
Inflamed lymph glands in abdo
Common cause of abdo pain in <16s
Usually viral - self-resolves
34
What are the features of mesenteric adenitis? (4)
Abdo pain - central/RIF
Nausea + diarrhoea
Fever + malaise
Preceding sore throat/ coryzal symptoms
35
What are the DDx of mesenteric adenitis (2) + poss Ix (4)
Ectopic preg
Appendicitis
Bloods (CRP/ESR)
Preg
Poss PR
Occasionally laparotomy
36
What is the incidence + age onset of colic?
40% babies
| Occurs in 1st weeks of live + resolves by 4m
37
What are the features of colic?
Paroxysmal
Inconsolable crying
Excessive flatulence (esp in evenings)
Often accompanied with drawing up the knees
38
What may severe / persistent colic be due to? (2)
→ May be due to CMP allergy / reflux
39
How is infantile colic managed? (3)
Support + reassurance
Gripe water recommended (unproven benefit)
If suspect CMP: 2wk trial of hydrolysed formula
→ Then trial anti-reflux Tx
40
How much of food intake is used in growth in infants/children?
at 4m → 30% intake for growth
| at 1yr → 5%
41
What are some S+S of overfeeding (3)
Increased GI reflux
Obesity
Lactose overload (cramps, gas, crying, watery stools)
42
List some of the features of clinical dehydration (14) + of which of these indicate shock (5/13)
Tachycardia
Tachypnoea
```
Hypotension (indicates shock)
Weak periph pulses (shock)
Cold peripheries (shock)
Pale/mottled skin (shock)
Prolonged CRT (shock)
```
Reduced skin turgor
Dry mucous membs
Sunken eyes
Sunken fontanelle
Reduced urine output
Sudden wt loss
Altered responsiveness (loss consciousness = shock)
43
What are the RFs for dehydration in (7)
```
<1yr (esp <6m)
Low birth weight infants
6+ diarrhoeas in 24hrs
3+ vomits in 24hrs
Signs malnutrition
Stopped breastfeeding during illness
Unable to have fluids before presentation
```
44
What factors would make you suspect hypernatraemia (3)
Jittery / convulsions
Increased tone / hyperreflexia
Drowsiness/coma
45
What management measures should be taken (4) if assessed for dehydration + confirm NOT dehydrated
Continue breast
Encourage fluid intake
Discourage fruit juices/ carbonated
Use ORS
46
How is clinical dehydration (not shock) initially managed?
Fluid deficit replacement (50ml/kg) over 4hrs
Continue breast
Use ORS small/often
If poor intake use ORS+ other fluids
If vomiting: consider NG
47
How is severe dehydration/shock initially managed?
0.9% saline ± 5% dextrose:
Fluid deficit replacement:
100ml/kg if initially shocked
50ml/kg if later shocked)
Maintenance fluids:
100ml/kg/day for first 10kg
50ml/kg/day for next 10kg
20ml/kg/day for remainder kg (or 4:2:1 per hour)
Continue breast if poss
Monitor U&Es / creatinine / glucose
48
What is the management after rehydration (following dehydration/shock) (4)
Full strength milk / Reintroduce usual solids
Avoid fruit juices/carbonated
Advise parents on good hygiene
No return to school until 48hrs after last episode
49
What drugs are NOT routinely given in dehydration?
Abx
| Anti-diarrhoeals
50
In what cases of dehydration would Abx be given? (3)
Suspect sepsis
Immunocompromised
Bacterial infection (salmonella/ C.diff)
51
What is post-gastroenteritis syndrome
| + how is it managed?
Introducing normal diet after
→ watery diarrhoea + temporary lactose intolerance
Confirmed with +ve 'Clinitest' result (presence of non-absorbed sugar in stools)
Use ORS 24hrs / continue reintro normal diet
52
Why is GORD so common in infants?
Functional immaturity of lower oesophageal sphincter
Fluid diet
Horizontal posture
Short intra-abdo length of oesophagus
53
What are the features of GORD? (4)
Recurrent regurgitation / vomiting
Post-feed
Regurgitate 1/3rd-1/2 of food
Putting wt on normally + otherwise well
CLINICAL DX OF REFLUX
54
When are Ix indicated for GORD? (3)
| What Ix may this include? (4)
Atypical Hx
Failed Tx response
Complications:
Aspiration / ALTEs / FTT / Dystonic neck / Oesophagitis
24hr pH oesophageal monitoring
24hr impedance monitoring (freq/food-related onset)
Endoscopy + biopsy
Contrast studies
55
How is reflux managed in uncomplicated cases? (4)
in more severe cases?
if failure to respond to treatment?
Parental reassurance
Adding inert thickeners to feeds
30degree head-up position after feeds
Feeding smaller amounts more often
In signif: H2R antag (ranitidine) / Domperidone / PPI
If failure to respond Tx: consider DDx CMP allergy
56
When/what surgical management can be done in reflux?
If complications/ unresponsive to intense medical Tx / oesophageal strictures
Nissen fundoplication (abdo/laparoscopic)
57
What are the complications that can occur from reflux? (7)
FTT (from severe vomiting)
Oesophagitis (haematemesis/ Fe defc anaemia/ heartburn/ feeding discomfort)
Dystonic neck posture
Aspiration (pneumonia/ cough/wheeze/ apnoea)
ALTEs
SIDS (rare)
Barrett's oesophagus (rare)
58
Describe the conjugation process of bilirubin
Hb + haem prot breakdown → unconj bilirubin // albumin
Normally conj in liver + excreted in bile (dark urine/stools)
XS conj → albumin saturated → unconj crosses BBB
→ Basal ganglia damage (kernicterus)
59
In infants, what might alter bilirubin resorption in the gut?
Reduced milk intake → increased bilirubin resorption
60
List some causes of jaundice from unconj bilirubin (6)
```
Breast milk jaundice
Haemolytic anaemia
Hypothyroidism
Infection
High GI obstrn
Crigler-Najjar syndrome (bilirubin metab disorder)
```
61
List some causes of jaundice from conj bilirubin (3)
Bile duct obstrn (choledochal cyst)
Intrahepatic biliary hypoplasia (atresia)
Neonatal hepatitis syndrome:
(CF / a1-antitrypsin defc / congenital inf / inborn error)
62
What % of newborns get physiological jaundice?
| Why does it occur
>50%
Shorter RBC lifespan + RBC breakdown
Liver bilirubin metabolism less efficient in 1st few days life
63
What are the features of physiological jaundice of the newborn? (4)
Jaundiced sclera/gums/skin
Dark urine + pale stools (= unconj; water soluble)
Hepatomegaly
Poor wt gain
64
What Ix can be done for jaundice?
If visible jaundice → transcutaneous bilirubinometer
(unless <24hrs old / <35/40) → if over 250 → test serum
Measure/6hrs whilst on Tx until sub-threshold/stable
65
What are the features of kernicterus? (4)
Lethargy / irritability
Poor feeding
Increased muscle tone
Arched back
66
What are the complications of kernicterus? (3)
Choreoathetoid (dyskinetic) cerebral palsy
Learning difficulties
Sensorineural deafness
67
List the possible causes for neonatal jaundice if <24hrs (5)
if 2d-2wks (4)
if >2wks (>3wks preterm) (4)
```
<24hrs:
Haemolytic disorders (Rh, ABO, spherocytosis, G6PD)
Congenital infection
IUGR
Hepatosplenomegaly
ITP
```
```
2d-2wks:
Physiological jaundice of newborn
Breast milk jaundice
Infection
Dehydration
```
```
>2-3wks:
Breast milk jaundice
Infection
Congenital hypothyroidism
Biliary atresia (conj)
```
68
How is neonatal jaundice managed if bilirubin not extremely high?
+ if dangerously high
```
Single phototherapy (w. breaks/feeds/hydration)
→ If falls then stop // If not then continuous (no interrupt)
→ If falls then single
```
Exchange transfusion with donor blood (2x circ vol)
Check levels /2hrs
→ then continuous phototherapy
69
What is the incidence of biliary atresia?
| What may it progress too if no surgical intervention?
1 in 14,000
| can → chronic liver failure + death
70
What are the features of biliary atresia?
FTT (normal birth wt)
Jaundice (conj - dark urine/pale stools (post-meconium))
Hepatosplenomegaly (portal HT → spleno)
Bruising
71
What Ix may be done into biliary atresia? (4)
LFTs useless
Fasting abdo USS
Radioisotope scan w. TIBIDA (shows liver uptake/ no excr)
Liver biopsy (NB overlap features w. neonatal hepatitis)
Dx by laparotomy
72
What is the surgical treatment for biliary atresia?
Use jejunum loop + join onto porta hepatis
73
What is Coeliac disease?
| What is its incidence in Europe?
Gluten → damaging immune response in proximal SI mucosa
1 in 3000
74
What is the classical presentation of Coeliac disease? (6)
```
8-24m
Failure to thrive
Abdo distension
Buttock wasting
Abnormal stools
Irritability
```
75
How may Coeliac disease present in older children? (5)
```
Failure to Thrive / unexpected wt loss
Prolonged fatigue
Persistent/unexplained GI symps (D+V)
Recurrent abdo pain
Unexplained Fe defc anaemia
```
76
How is Coeliac disease investigated?
If on gluten diet AND S/s or Associated conditions
→ serological tests
If been off gluten, must have 1+ gluten meal /day/6wks
→ Serological tests
IgA -ve → check IgA defc / exclude DDx / poss biopsy
IgA +ve → intestinal biopsy (Dx)
77
How is Coeliac disease managed?
Gluten free diet for life
| UNLESS <2y/o → gluten challenge later in life
78
Which tissue/site of the bowel is affected in Crohn's
Transmurual IBD
Commonly affecting distal ileum/ prox colon
Inflamm/thickening → strictures + fistulae
79
How may Crohn's disease present in children?
| What are the possible presenting features (7)
Older children
Lethargy + malaise (not necessarily with GI symps)
```
Abdo pain
Diarrhoea
Fever
Growth failure
Wt loss
Delayed puberty
```
80
What are the extra-systemic manifestations of Crohn's? (FACE U POO)
```
Fe defc anaemia
Arthralgia
Clubbing
Erythema nodosum
Uveitis
Perianal skin tags
Oral lesions
Osteoporosis
```
81
How is Crohn's Dx?
Endoscopy/biopsy - non-caseating granulomata
| AXR - small bowel irregs/fissures/narrowing
82
Describe the management of Crohn's (5)
Nutritionally (whole prot feeds every 6-8wks)
→ effective in 75%
Ineffective → systemic steroids
+ immunosuppressants (prevent relapse)
Steroids ineffective → MABS
Longterm enteral supplement (overnight NG/gastrostomy)
→ to correct growth failure
Surgery: if severe localised unresponsive / complications
83
Which tissue of the bowel is affected in UC?
Colon mucosa
84
What are the features of UC (4)
Rectal bleeding
Diarrhoea
Colicky pain
Growth failure (not as bad as Crohn's)
85
What are the extra-systemic manifestations of UC (MADAME UC)
```
Mouth ulcers
Ank spon
DVT
Arthralgia (sero -ve)
M: erytheMa nodusuM
Episcleritis
```
Uveitis
Clubbing
86
How is UC Dx?
Endoscopy/Biopsy
AND
Exclusion of gastroenteritis
87
How is UC in children different to adults?
Adults usually confined to distal rectum
| Children: 90% have pancolitis
88
Describe the management of UC (5)
Aminosalicylates (for mild) → remission/maintenance
Extensive/exac → systemic steroids + immunosupps
Confined to rectum/sigmoid → topical steroids
Fulminant = emergency (risk toxic mega/ bad chronic)
→ IV steroids/fluids
→ colectomy/ileostomy + ileorectal pouch
Bowel cancer screening 10yrs post-Dx
89
Describe the features of functional/recurrent abdo pain (4)
Characteristically periumbilical
Child otherwise well
Interrupts normal activities
Lasts >3m
90
List the usual causes of functional/recurrent abdo pain (4)
IBS**
Abdo migraine
Functional dyspepsia
Stress/anxiety related
91
What must the Ex/basic Ix include in a child presenting with functional/recurrent abdo pain (4)
Assess growth
Abdo palpation (exclude gall stones / PUJ obstrn)
Inspect perineum (anal fissures)
Urine MC+S (UTI DDx)
92
How is functional/recurrent abdo pain discussed with the parents?
Reassure parents (10% school aged children)
Explain that aim to find any serious cause without unnecessary Ix
Explain diff b/wn serious/dangerous
(serious = signify time out of school, not dangerous)
93
What causes IBS?
Altered GI motility + abnormal sensation
Often post-GI infection / FH
Also psychosocial factors (stress + anxiety)
94
What are the symptoms of IBS (ABCEF)
```
Abdo pain: worse before/relieved by defacating
Bloating
Constipation (b/wn normal/loose)
Explosive/loose/mucousy stools
Feeling of incomplete defacation
```
95
What are some causes of gastritis / peptic ulcer in children? (3)
H.Pylori (usually silent/asymp infection in children)
Infection
Pernicious anaemia
Bile reflux
96
List the symptoms of gastritis in children (3)
Nausea
Vomiting
Abdo pain (frequent complaints)
97
List the symptoms of peptic ulcers in children (3)
Gnawing/burning in epigastrium
Pain relieved by eating/antacids/milk
Bleeding → haematemesis/malaena
98
How is H.Pylori / gastritis / peptic ulcer managed?
```
Triple therapy (H.Pylori): amoxi + metro/clarithro + PPI
Lifestyle factors (for older children):
avoid irritant foods / alc / smoking / NSAIDs
```
99
What are the features of Toddler Diarrhoea? (4)
Vary in consistency (well formed → loose/explosive)
Often contain undigested vegetables
Paler + smellier than usual
Well + thriving
100
What advice can be given to parents in terms of managing Toddler Diarrhoea?
Investigations not usually necessary as v v common
Can relieve a bit by ensuring enough fat/fibre in diet
Maintain hydration
101
What reassuring info can be given to parents regarding Toddler Diarrhoea
Due to gut motility immaturity
NOT malabsorption
Other more serious diseases (Coeliac/ Gastroenteritis/ Lactose intol/ malabsorption) would not be well/thriving
102
How does Malabsorption manifest? (3)
Abnormal stools
Failure to thrive
Specific nutrient defc
103
List the diff types of malabsorption syndromes (8)
Coeliac
Food allergy/intolerance
Exocrine panc dysfunc
Cholestatic liver disease / Biliary atresia → fat/fat-sols
Short bowel syndrome (congenital/NEC)
Loss of terminal ileum → defective Bile/B12 absorption
Lymphatic leakage/obstrn
Small-intestinal mucosal disease (Coeliac, enzyme defects e.g. lactase post-GI, transporter defects)
104
How is malabsorption investigated?
```
Dietician review (may just be poor calorific intake)
Stool sample (pH-carb/bile acids/prots/infection)
Urinalysis (transporter defects)
Various bloods/endoscopy/biopsy (dep on what DDx)
```
105
What are some causes/RFs of malnutrition in MEDCs/UK (7)
```
Chronic illness - esp at risk:
Preterm
Congenital heart disease
IBD/Chronic GI conditions
Malignancy
Renal failure
Cerebral palsy
```
Eating disorders
106
How is malnutrition assessed?
Food diary
Nutritional status index e.g. BMI/ tricep skin fold thickness/ mid-upper arm circumf
Biochem/immunological tests (less important)
107
What are the complications of malnutrition? (3)
Multi-system disorder
Impaired immunity / wound healing
Permanent delay in intellectual development
108
What diff types (2) of nutritional support can be given in malnutrition + when is each used?
Enteral - when digestive tract functioning
(safe + maintains gut func)
Via NG/gastrostomy - continuous feeds overnight
Parenteral - exclusively/or as adjunct
Cannula (short term)/ central venous (long-term)
109
Describe the MUST tool for malnutrition (5 steps)
```
Step 1: BMI
Step 2: % unplanned wt loss
Step 3: acute disease effect
Step 4: add scores from steps 1-3
→ gives overall risk malnutrition
Step 5: use guidelines/local policy to make care plan
```
110
What are some diff measurement indexes of assessing nutritional status? (3)
Wt for ht (BMI) - acute malnutrition/wasting
Severe = 3SDs (<70%) below median
MUAC (mid-upper arm circumference)
Severe = <115mm
Ht for age - chronic malnutrition/stunting
111
Define + describe the 2 diff types of severe protein-energy malnutrition
Marasmus - no oedema
Severe low BMI / MUAC / skin fold thickness (wasting)
Kwashiorkor - generalised oedema/severe wasting
Wt loss not as severe due to oedema
112
What are the features of Kwashiorkor (9)
```
Flaky rash/ hyperkeratosis
Dry/brittle hair
Angular stomatitis
Diarrhoea
Abdomen distension
Enlarged liver
Hypotension/Bradycardia
Hypothermia
Low plasma albumin/Mg/K/glucose
```
113
When might you see Kwashiorkor in UK/MEDCs? (2)
When not weaned off breast until 12m (high-starch diet)
| After acute inter-current infection e.g. measles/gastroenteritis
114
What are the features of viral hepatitis (5 common + 2 less common)
What will be seen on LFTS?
```
Lethargy
Abdo pain / tenderness
Nausea
Vomiting
Hepatomegaly
```
Jaundice (only 50%)
Splenomegaly
Transaminases v elevated + Coag normal
115
How is HepA transmitted?
What is the prognosis of its progression to chronic liver disease?
How Dx?
How treated/managed?
Faecal-oral
Does not progress to chronic liver disease
IgM Antibodies confirm Dx
Self-resolves + Contact prophylaxis
116
How is HepB transmitted
What is the prognosis of its progression to chronic liver disease?
How Dx?
How treated/managed?
Viral: perinatally/sexually/blood
>90% become chronic carriers (+10% → cirrhosis)
Anti-HBc (acute infection) + HBsAg (ongoing/carriers)
Maternal +ve → babies need Ig Vx (5% req further dose)
117
How is HepB transmitted
| What is the prognosis of its progression to chronic liver disease?
Viral: mainly blood (IVDUs)/ vertical (risk if HIV)
Most → chronic carriers (20-25%→ cirrhosis/carcinoma)
118
What are some symptoms of acute liver failure? (5)
Jaundice
Coagulopathy
Encephalopathy*
Hypoglycaemia + electrolye disturbances*
*Irritability / confusion / aggression
119
What is the commonest type of parasite infection in children?
What other types of parasitic infection may be seen? (2)
Worms
Giardia lambia
Cryptosporidium
120
How does parasitic infection of worms present?
| How must it be treated
Usually asymp
Anal/vaginal itching
Esp at night
Treat whole household: hygiene/ mebendazole/piperazine
121
How does giardia lambia transmit?
| What are the features (5)
Faecal-oral
```
Travellers diarrhoea >10d
Nausea
Abdo pain
Anorexia / wt loss / FTT
Dehydration
```
122
How does cryptosporidium transmit?
| What are the features (3)
From animals/ infected indivs (nursery/food/water)
Low grade fever
Malaise
Sudden onset watery diarrhoea
