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Year 5 Paediatrics > Gastroenterology > Flashcards

Flashcards in Gastroenterology Deck (30):
1

Red flags of vomiting

 

What are the red flags of vomiting in children what are they assoicated with?

  1. Bile stained vomit
  2. Haematemesis
  3. Projectile vomiting, in first few weeks of life
  4. Vomiting at the end of paroxysmal coughing 
  5. Abdominal tenderness/Abdo pain on movement
  6. Abdominal distension
  7. Hepatosplenomeglay
  8. Blood in the stool
  9. Severe dehydration, shock
  10. Bulging frontanelle or seizures
  11. Failure to thrive

Haematemesis: can also be oesophageal variceal bleeding. 

Hepatosplenomegaly: can also be due to inborn error of metabolism

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2

Normal stool patterns

 

What are the normal stool patterns for: 

  1. 0 to 4 months (breast and bottle fed)
  2. 4 months to 1 year
  3. After 1 year

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3

Investigations to consider

 

What are the main investigations, indications and expected findings in Acute Diarrhoea?

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4

Diarrhoea Diagnosis clues

 

What are the ages, stool features, pain (?), fits (?), vomiting (?), high fever (?) and typical season for: 

  1. Rotavius
  2. Shigella
  3. E.Coli
  4. Salmonella
  5. Campylobacter

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5

Acute Diarrhoea

 

What are the common causes of Acute Diarrhoea?

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6

Chronic Diarrhoea

 

What are the common causes of Chronic Diarrhoea?

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7

Blood, stool and other investigations

 

What are the key blood, stool and other investigation, their findings and significance?

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8

Causes of Vomiting

 

What are the main causes of vomiting in Infants, Preschool children and school age children?

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9

Gastroenteritis

 

What is the ateiology, symptoms, complications and investigations of Gastroenteritis?

Ateiology:

  1. There are 3 main causes: 
    1. Viral
    2. Bacterial
    3. Protazoan: Giardia and Cryptosporidium

Investigations: 

  1. Usually none reqired 

Treatment: 

  1. Clincal Dehydration: Give ORS often and in small amounts 

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10

Gastroenteritis

 

What is the management of Gastroenteritis?

Short hand version: 

  1. No clincal dehydration = Feed more/ORS
  2. Clincal Dehydration = ORS 50ml/kg over 4 hours & maintenance fluids
  3. Shock = IV Bolus 20ml/kg
    1. If still in shock > PICU
    2. If shock resolves > IV Saline 100ml/kg over 4 hours & maintenance fluids

Maintenance fluids = (100ml/kg/24hrs for 1st 10 kg), (50ml/kg/24hrs for 2nd 10 kg), (20ml/kg/24hrs up to 50kg) 

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11

Gastroenteritis

 

Outline the features of: No clinical dehydration, Clinical Dehydration and Shock including: 

  1. General appearnace
  2. Concious level 
  3. Urine output
  4. Skin colour
  5. Extermities
  6. Eyes
  7. Mucous membranes
  8. HR
  9. Breathing 
  10. Peripheral pulses
  11. Capilliary refil time
  12. Skin Turgour
  13. BP

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12

Appendicitis

 

Outline the symptoms, ateiology, complications, investigastions and management of Appendicitis

Symptoms: 

  • Abdo pain: initially central, then RIF
  • Oral fetor = unpleasant odour from mouth
  • Gaurding: particularly in the RIF, McBernie's point

Investigstions: 

  • USS: also can identify abscess, abdominal mass or perforation

Management: 

  • Complicated (perforation, abdo mass or abcess) or uncomplicated 

 

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13

Pyloric Stenosis:

 

Outline the symptoms, ateiology, complications, investigations and management of Pyloric stenosis

 

 

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14

Molrotation/Volvus

 

Outline the symptoms, ateiology, complications, differentials, investigations and management of Molrotation/Volvus

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15

Mesenteric Adenitis

 

Outline the symptoms, ateiology, complications, differentials, investigations and management of Mesenteric Adenitis

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16

Urinary Tract Infection

 

Outline the symptoms, ateiology, complications and differentials of Urinary Tract Infection

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17

Urinary Tract Infection

 

Outline the investigations and management of Urinary Tract Infection

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18

Recurrent Abdominal Pain

 

Outline the symptoms, ateiology, complications, differentials, investigations and prognosis of Recurrent Abdominal Pain

Definition: 

Defined as pain sufficient to interrupt normal activiteis for more than 3 months

Aetiology: 

Lots of different causes, can be psychosomatic, stress, constipation

Investigations:

  1. History and Exam (exam perineum for anal fissures) and ask about stress
  2. Growth chart
  3. Urine microscopy and culture: manditory since UTI can present with just Abdo pain
  4. Abdo Ultrasound: good for galls stones and suspected urinary obstruction
  5. Coeliac antibodies and TFTs: any other investigations need a clinical indication to do

Prognosis:

  • 1/2 of cases resolve quickly 
  • 1/4 resolve in a few months
  • 1/4 long term issues: such as abdominal migraine, IBS or functional dyspepsia

19

Recurrent Abdominal Pain

 

Outline the symptoms, investigations and management for non resolving recurrent abdominal pain, including: 

  1. Abdominal Migraine
  2. IBS
  3. Peptic Ulceration
  4. Nodular Antral Gastritis
  5. Functional Dyspepsia 
  6. Eosinophilic Oesophagitis

Abdominal Migraine: 

Symptoms: Associated withe headaches, long periods that are fine then 12 to 48 hours of non specific abdo pain

Management: Migraine medication (sumatriptan)

 

IBS: 

Classic IBS presentation, psychogeneic. Often assocaited with Coeliac which is why its tested for.

 

Peptic Ulceration:

(casued by H.Pylori)

Symtpoms: Uncommonin children, should be considered when they have epigastric pain, waking them up in the night and radiates to the back.

Investigations: Stool antigen for H.Pyloti

Management: 

  1. PPI (Omeprazole) if Peptic ulceration is suspected
  2. If H.Pylori is suspected, give Amoxicillin and Metronidazole or Clarithromycin

 

Nodular Antral Gastritis:

Symptoms: Associaed with abdo pain and nausea

Investigations: 

  1. Gastric antral biopsy: H.Pylori produces Urease that is detected on biopsy
  2. Stool antigen for H.Pylori
  3. 13 C breath test: (given 13 C labelled Urea by mouth)

Management: Same as Peptic Ulercation

 

Functional Dyspepsia:

If treatment fails then do an endoscopy, if it is normal they have Functional Dyspepsia. Very similar to IBS. May benefit from a Hypoallergenic diet.

 

Eosinophilic oesophagitis: 

Inflammatory condition, often presents with "food being stuck in the chest". Associated with Asthma and Eczema.

Investigations: Endoscopy, showing macroscopic linear furrows and trachalization of the oesphagus.

Management: Corticosteriods in the form of fluticasone or viscous badesonide.

20

Possible causes of Abdominal Pain

 

What are the possible causes of recurrent abdominal pain? 

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21

Constipation in Children: 

 

What are the NICE guidelines on diagnosing constipation in Children for those under and over 1 year? 

Include: 

  1. Stool pattern
  2. Symptoms associated with defecation 
  3. History

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22

Constipation in Children: 

 

What are the possible causes of constipation in Children? 

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23

Constipation in Children: 

 

What is the management of constipation in Children? 

General points: 

  • Faeces are palpable = faecal impaction 
  • Stools passing spontaneously = disimpaciton
  • Don't use dietary changes as first line alone, but make sure the child is well hydrated
  • Maintenance Therapy: First line is Movicol Paediatric plain. Continue for several weeks until symptoms have subsided. 

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24

Constipation in Children: 

 

What are the red flags of constipation? What do they indicate?

Include:

  1. Timing
  2. Passage of Maeconium
  3. Stool Pattern
  4. Growth
  5. Neuro 
  6. Abdomen
  7. Diet
  8. Other

 

  • Failure to pass meconium > Hirschprung disease
  • FTT > Hypothyroidism, Coeliac disease, other
  • Ribbon stools > blood is never good, IBD, UC, Crohn's
  • Lower limb deformity > Lumbosacral pathology
  • Abdominal distension > Inestinal obstruction
  • Evidence of maltreatment > safegaurding 

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25

Intussusception

 

Outline the symptoms, ateiology, complications, differentials, investigations and management of Intussusception

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26

Overview of Gastrointestinal issues

 

Give the brief details of: 

  1. Pyloric stenosis 
  2. Acute appendicitis
  3. Mesenteric Adenitis
  4. Intussuception
  5. Malrotation
  6. Hirchsprung's disease
  7. Oesophageal atresia
  8. Meconium ileus
  9. Biliary atresia
  10. Nectrotising enterocolitis

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27

Anal fissure

 

Outline the symptoms, aetiology, investigations and management of Anal fissure

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28

Crohn's Disease

 

Outline the symptoms, aetiology, investigations and management of Crohn's Disease

Aetiology:

  • Increase in prevalence over the last 2 decades
  • Unlike in adults, Crohn's is more prevalent in children than ulcerative colitis.

Other Investigations: 

  1. Platelet count
  2. ESR
  3. C reactive protein
  4. Iron deficiency anaemia
  5. Low serum albumin

 

Management: 

  1. Remission induction
  2. Maintain remission:
    1. Anti TNF agents: Infliximab and adalimumab may be needed if conventional immunosupressants fail.
  3. Complications

 

Prognosis: 

Good, most patients live normal lives despite the occasional relapse.

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29

Ulcerative Colitis

 

Outline the symptoms, aetiology, investigations and management of Ulcerative Colitis

Investigations: 

  • Endoscopy: 
    • 90% of children have pancytosis
  • Histology: 
    • Crypt damage includes: 
      • Cryptitis
      • Architechtural abnormalities
      • Abscesses
      • Crypt damage

Managment: 

  • Aggressive disease: 
    • ​Immunomodulatory drugs include
      • ​Azathioprine
      • Methotrexate
    • Anti TNF, such as Ifliximab are also an option for treatment resistant UC. Ciclosporin is also an option.

 

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30

Merkle Diverticulum

 

Outline the symptoms, aetiology, investigations and management of Merkle Diverticulum

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