Gastroenterology Flashcards
(102 cards)
1
Q
What is possetting?
A
throwing up small amounts of milk together with a burp (swallowed air)
2
Q
What is regurgitation
A
larger, more frequent losses
3
Q
what is vomiting
A
forceful ejection of gastric contents
4
Q
What does intestinal obstruction lead to?
A
vomioting
the more proximal the obstruction, the more prominent and bile stained the vomiting is
5
Q
what is gastro-oesophageal reflux
A
involuntary passage of gastric contents into the oesophagus
6
Q
why does gastro-oesophageal reflux occur
A
immaturity of lower oesophageal sphincter causing insufficient relaxation
7
Q
what are baby factors contributing to reflux
A
fluid diet
horizontal posture
short intra-abdominal length off oesophagus
8
Q
What are investigations for GOR?
A
24h oesophageal pH monitoring
24h impedance monitoring
endoscopy
upper Gi contrast study
9
Q
what is management for GOR?
A
If breast-feeding:
- Breastfeeding assessment by midwife
- Alginate therapy
If formula fed:
- Review feeding hx (trial smaller, frequent feeds)
- Thickened formula
- alginate therapy
- PPI
10
Q
What causes pyloric stenosis?
A
hypertrophy of pyloric muscle
causes gastric outlet obstruction
11
Q
When does pyloric stenosis present?
A
2-8 weeks of age
irrespective of gestational age
12
Q
what are features of pyloric stenosis?
A
Vomiting +
Hunger after vomiting
WL
13
Q
what is management of pyloric stenosis
A
IV fluid resus
Ramstedt pyloromyotomy
14
Q
What is a colic
A
common symptom complex
- typical pattern of symptoms: paroxysmal, inconsolable crying > drawing up of knees > passing excessive flatus
15
Q
What is the cause of colic
A
GI
but no firm evidence
16
Q
how do you manage colic?
A
reassure patients it is a common problem and resolves by 6m
sources for information / support: NHS Choices leaflet, health vitsitor
Strategies to soothe a crying infant
Look after yourself
17
Q
What is the commonest cause of abdominal pain in babies
A
Mostly UNDIAGNOSED
18
Q
What are surgical causes of abdo pain
A
acute appendicitis intestinal obstruction (including insussception) inguinal hernia peritonitis Meckel diverticulum Pancreatitis Trauma
19
Q
What are medical causes of abdo pain
A
gastroenteritis pyelonephritis hydronephrosis renal calculus Henoch-Shonlein purpura
20
Q
what are extra abdominal causes of abdo pain
A
URTI
Lower lobe pneumonia
testicular torsion
hip and spine
21
Q
what are symptoms of acute appendicitis
A
anorexia
vomiting
abdo pain (initially central, colicky > then RIF)
22
Q
what are signs of acute appendicitis
A
flushed face, oral fetter fever pain aggravated by movement persistent tenderness guarding in RIF (McBurney's point)
23
Q
What occurs to guarding in retrocaecal appendix
A
absent
24
Q
what is a risk in appendicitis in children and why
A
PERFORATUON
because omentum is less well developed and fails to guard the appendix
25
What are ix for diagnosing appendicitis
USS (shows thickened, non compressible appendix with increased blood flow and possible complications e.g. absess, perforation, appendix mass)
26
what is management for appendicitis
NBM
IV fluid
appendicectomy
27
what is mesenteric adenines
enlarged mesenteric lymph nodes
| normal appendix
28
What is insussception?
Invagination of proximal bowel into distal segment
29
What part of the GI tract is most commonly involved in insussception?
The ileum (when it passes into the caecum at the ileocaecal value)
30
What is the most common cause of intestinal obstruction in neonates?
insussception
31
What is the presentation of insussception
paroxysmal, severe colicky pain
Pallor during the colicky pAIN
Refusing feeds
Vomiting (may be bile stained depending on location)=
Passage of redcurrant jelly stool (blood stained mucous)
32
What are findings of abdominal exam in insussception
Sausage shaped mass palpable (in RIF)
| Abdominal distensions
33
What are investigations for insussception
```
X ray (distended bowel with no gas)
Abdo USS
```
34
What is management of insussception
- Rectal air insufflation (if no signs of peritonitis)
OR
- contrast enema
- fluid resus
- broad spec antibiotics
SECOND LINE: SURGICAL REDUCTION + broad spec anti bionics
35
What is meckel's diverticulum=
The ideal remnant of the omphalomesenteric duct
36
What is the omphalomesenteric duct
Long narrow tube joining the yolk sac to midgut lumen of foetus
Made up of either gastric mucosa / pancreatic tissue
37
How does meckel's diverticulum present?
severe rectal bleeding
obstruction
perforation / peritonitis if severe
38
How do you investigate meckel's diverticulum
Technetium scan (shows increased uptake by ectopic gastric mucosa)
39
What is management for meckel's diverticulum
Asymptomatic - no tx
Symptomatic - excision of diverticulum, lysis of adhesions
Perforation / peritonitis
40
What is another word for GI malrotation in neonate?
VOLVULUS
41
What are presentations of GI malrotation in neonate?
bilious vomitng
abdo pain
tenderness
42
What is management for GI malrotation
```
Ladd procedure (detort bowel, surgically divide Ladd bands) - done laparoscopically if non-urgent, open laparotomy if urgent
+ antibiotics (cefazolin)
```
43
What is abdominal migraine'
abdominal pain and headaches
pain is usually midline and associated with vomiting and facial pallor
44
How do you treat abdominal migraine?
anti migraine medication
45
What does IBS present as
```
Non specific abdo pain
explosive, loose, mucous stool
bloating
incomplete defecation
constipation
```
46
How do you manage IBS
reassure
encourage pt to reduce stress
eliminate food that trigger sx
47
what are main causes of gastroenteritis in developed countries?
ROTAVIRUS
Other (bacterial):
- campylobacter jejune
Shigella
48
What is important to assess for in gastroenteritis?
DEHYDRATION for fluid replacement
49
What further investigation must you do for gastroenteritis
stool sample analysis
50
What causes coeliac disease
immunological response to gliadin
51
What occurs to the GI system in coeliac
Villi become shorter and then absent, leaving a flat mucosa
52
Whjat is classical presentaation of coeliac in children
profound malabsorption art 8-24m of age
after introduction of wheat containing food
- faltering growth
- abdo distension
- buttock wasting
- abnormal stools
- general irritability
53
How do you manage coeliac?
Eliminate all products containing wheat, rye, barley
Monitor body weight, height, BMI
Give calcium, vit D suppllement, conssider iron
Refer to dietician if necessary
ARRANGE ANNUAL REVIEW
54
What is Hirschprung disease?
Absence of ganglion cells in myenteric and submucosal plexuses in large bowel
Results in a narrow and contracted segment of large bowel
55
What is the presentation of Hirschprrung disease?
Neonatal: intestinal obstruction, unable to pass meconium
Childhood: chronic constipation, abdo distension, bile stained vomiting, growth failure
56
What occurs in PR exam for Hirschprrung disease?
Narrowed segment
| Gush of liquid stool Shen removing the finger
57
How do you diagnose Hirschprung disease?
Full thickness rectal biopsy
| Anorectal mamometry
58
How do you manage Hirschprung disease
Initially bowel irrigation
then SURGICAL - ANORECTAL PULL THROUGH
initial colostomy
then anastomose normally innervated bowel to anus
59
What is the cause fo regurgutation
GOR
| Due to immaturity of LOS
60
What must you exclude if baby is projectile vomiting?
pyloric stenosis
61
How do you investigate pyloric stenosis?
Abdo exam (palpable pyloric mass in RUQ)
Perform test feed
USS
U&E (electrolyte disturbance, dehydration)
62
What sign do you see on abdomen ultrasound for insussception?
TARGET SIGN (double lumen)
63
What is eosinophilic oesophagitis?
INFLAMMATION OF OESOPHAGUS
| DUE To Activation of eosinophils within mucosa/submucosa of oesophagus
64
Who is eosinophilic oesophagitis common in?
Children with atopy
65
What are symptoms of eosinophilic oesophagitis
vomiting
discomfort when swallowing
bolus dysphagia
66
How do you diagnose eosinophilic oesophagitis
By ENDOSCOPY
| - linear furrows and trachealisation of oesophagus
67
How do you manage eosinophilic oesophagitis
oral corticosteroids (fluticasone / viscous budosenide)
68
How do you. measure dehydration in children'
By looking at degree of WL during diarrhoea illness
- <5% body weight = not clinically detectable
- 5-10% body weight = clinical dehydration
- >10% body weight = shock
69
What are maintenance fluids that are appropriate for children?
```
0-10kg = 100ml/kg
10-20kg = 1L + 50ml/kg for every kg over 10
20+kg = 1500 + 20ml/kg for every kg over 20
```
70
What fluids do you give to a child with shock?
Rapid infusion of 0.9% NaCL
71
what is the normal frequency of defecation in children?
Varies with age
infants: 4x day in 1 week
1 year old: 2x day
72
What is the definition of constipation
infrequent passage of dry, hardened faces accompanied by straining, pain, bleeding, and associated with hard stools
73
What factors precipitate constipation
dehydration
reduced fluid intake
anal fissures
anxiety /psycholocial factors
74
What are primary causes for constipation to exclude
hiaschprung disease
Lower SC problems
anorectal abnormalities s
Hypothyroidism, hypercalcaemia
Coeliac's
75
Should you do DRE in a child
NO
76
How do you assess impaction in a baby
abdo palpation
| will reveal small hard mass usually in LIF
77
How do you manage constipaation with no impaction
Maintenance laxatives - Movicol
+/- stimulant
Consider behavioural changes
78
What is movicol
Polyethylene glycol + electrolytes
79
How do you manage constipation with impaction
Movicol Paediatric Plain (2 week escalating dose)
| +/- stimulant
80
What are behavioural changes to consider for constipation
- scheduled toileting
- bowel diary
- positive reward system
81
What is cow milks protein allergy
Allergic reaction of the immune system to protein in cows milk
82
What are symptoms in cow milks protein allergy
D&V
rash
wheezing
faltering growth
83
What is management for cow milks protein allergy
Breast: mother to avoid cows milk
Formula: hypoallergenic formula
+ monitor growth
84
How do you investigate for pyloric stenosis
1. Abdo exam:; visible peristalsis, pyloric mass (like an olive) in RUQ
2. Perform test feed
3. USS + U&E
85
What are the two top causes of peptic ulceration ?
H pylori
| NSAIDS
86
What is presentation of a peptic ulcer
- epigastric pain (wakes them up at night, radiates to back)
- bloating
- belching
- vomiting
- haematemesis
- perforation
87
What is the difference in presentation between gastric ulcer and duodenal ulcer
Gastric ulcer = pain worse on eating (presence of food increaases HCl production)
Duodenal ulcer = pain better on eating
88
How do you investigate peptic ulcer from H pylori
TEST before you TREAT
C-13 breath test (as H pylori produces urease)
OR
Stool antigen in children
89
What is mx for H pylori
Omeprazole + eradication therapy (amox + clary/metronidazole)
90
What is toddler's diarrhoea
benign condition
due to fast transit of food through digestive system
often contains undigested foods
91
How do you manage toddler's diarrhoea
no need
| just plot centiles
92
What part of GI tract does Chron's affect
Distal ileum / proximal colon
93
What is the histological hallmark of Chrons
Non-caseating epithelioid cell granulomata
94
What are the 4 PILLARS of treatment (medical management) for Chrons
- Steroids (predinisolone)
- immunosuppressants (azathioprine, methotrexate)
- Biological therapies (infliximab)
- aminosalicates (mesalazine)
95
What part of the GI tract does UC affect
COLON mucosa
96
What are histological fts of UC
Mucosal inflammation
Crypt damage
Ulceration
97
What are extra intestinal fts of UC
Mucosal inflamm
Crypt damage
Ulceration
98
How do you assess UC severity in children
PUCAI
| Paediatric Ulcerative Colitis Activity Index
99
How do you manage UC
Aminosalicylate
| Steroids
100
how do you manage anal fissure in children
Advise :
- against stool withholding
- on importance of anal hygene
Ensure stool are soft
- increase fibre
- increase fluid intake
- consider stool softener
Manage pain:
- glyceryl trinitrate intra-anally
- simple analgesia
- sit in a shallow warm bath to help relieve pain
101
What must you do in the annual review for coeliac disese
- check height, weight, BMI
- review symptoms
- review adherence to diet (IgA-tTG titre every 3m until normalised, and then yearly)
- consider blood tests (coeliaac serology, FBC, TFT; LFT, vit D, B12, folate, calcium, U&E)
102
when do you give oral vs IV fluids for rehudration
ORAL REHYDRATION is mainstay
| only give IV fluids if in shock/dehydration/vomiting
