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Gastrointestinal Flashcards

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1
Q

What is the duration for constipation to be chronic?

A

Over 8 weeks

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2
Q

Encoperesis - what is it?

A

Soiling

Usually due to overflow diarrhoea

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3
Q

Red flag symptoms for constipation (+ conditions this indicates)

A

Failure to pass meconium = CF, Hirschprungs

FTT = CF, coeliac, hypothyroidism

Distension = Hirschsprungs

Sacral dimple above natal cleft = spina bifida

Perianal fistulae/ abscesses = Crohns

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4
Q

Constipation medical management

A

Disimpaction = macrogol laxatives

Escalating dose for 1-2 weeks

Add stimulant laxative after 2 weeks

Maintenance = lower dose macrogol

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5
Q

Gastroenteritis organisms, S+S

A

Usually rotavirus (infant) or noravirus (all kids), campylobacter (severe abdominal pain), shigella + salmonella (blood + mucus in stool)

Sudden onset

Fever Abdo pain Vomiting Shock

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6
Q

Gastroenteritis - investigations

A

Bloods, ABG if in shock

Stool sample if blood/ mucus in stools

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7
Q

Gastroenteritis management

A

Oral rehydration solution or fluid therapy 20mls per kg of NaCl = for bolus

UNLESS DKA, head injury, congenital heart problems (give 10mls per kg)

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8
Q

Gastroenteritis complications

A

Haemolytic uraemic syndrome = complication of E coli

IV fluids can cause decreased sodium concentration = cerebral oedema + seizures

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9
Q

Other causes of diarrhoea

A

Coeliac, IBS, IBD + toddlers diarrhoea

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10
Q

GORD - how common, when does it present, what causes it

A

Disease = only if symptomatic

40% of infants experience reflux

First 2 weeks of life

Due to incompetence of sphincter

Better with age due to solid food, time spent upright + strengthening sphincter

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11
Q

GORD S+S

A

Presenting as ‘vomiting’ - non-forceful regurg

Feeding difficulties - distress after feeding

Irritability

Resistance + arching with feeding

Usually put on weight gain fine - can get FTT

Apnoeas + cough + stridor

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12
Q

GORD complications

A

Oesophagitis = haematemesis, anaemia

Resp symptoms = cough, wheeze, aspiration pneumonia - can be life threatening FTT

Sandifers syndrome = associated with dystonic neck movements

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13
Q

GORD management

A

Conservative: avoid overfeeding, sit up (cot slanted, burping after)

Milk thickeners (for bottle fed) Gaviscon (for breast fed)

H2/ PPIs - can increase risk of NEC in preterms

Surgical - for kids with neuro problems

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14
Q

GORD investigations

A

Diagnosis is clinical

Potential investigations (for older kids) :

FBC - check for anaemia

24hr oesophageal pH study

Endoscopy - if oesophagitis suspected

Mamometry - assesses oesophageal motility + sphincter function

Barium meal

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15
Q

Vomiting in distal v proximal obstruction

A

Proximal = more bile stained vomit + more forceful

Distal = more abdo distension

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16
Q

Causes of vomiting

A

Feeding errors - faulty technique, dietary restrictions

Infections - GI, appendicitis, paraenteral

Obstruction

Raised ICP - meningitis, encephalitis, space occupying lesion

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17
Q

12 vomiting red flags (+ conditions they are associated with)

A

Bile stained = intestinal obstruction (duodenal atresia)

Haematemesis = oesophagitis, ulcers

Projectile = pyloric stenosis

Vomiting after coughing = whooping cough

Abdo tenderness = surgical abdo

Abdo distension = intestinal obstruction, inguinal hernia

Hepatosplenomegaly = liver disease

Blood in stool = intusseception, gastroenteritis

Severe dehydration = systemic infection, DKA

Bulging fontanelle/ seizures = raised ICP

FTT = reflux, coeliac

LOC = meningitis, infection

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18
Q

Causes of acute abdo pain in newborns

A

Intestinal obstruction (Hirschprungs, volvulus, pyloric stenosis)

Hernia

Necrotising enterocolitis

Reflux

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19
Q

Vomiting - medical reasons

A

Gastroenteritis, reflux, infection, intolerance, ulceration, migraine

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20
Q

Vomiting - surgical reasons

A

Intestinal obstruction, pyloric stenosis, duodenal atresia, intusseception, malrotation, volvulus, Hirschprungs

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21
Q

Causes of acute abdo pain in infants (<2)

A

Constipation Hernia Volvulus Intussusception Colic UTI

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22
Q

Causes of acute abdo pain in children 2-18 y/o

A

Appendicitis DKA Henoch-Schnolein Purpura UTI Mesenteric adenitis Gastritis Constipation Intestinal obstruction

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23
Q

Causes of acute abdo pain in adolescents

A

Dysmenorrhoea PID Ovarian torsion Testicular torsion Pregnancy

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24
Q

7 abdo pain red flags (+ conditions this indicates)

A

Bloody stool = UC, necrotising entercolitis, constipation, intussesception

Haematemesis = ulcers, gastritis

Bilious emesis = bowel obstruction

Jaundice = hepatic/ biliary obstruction

Joint pain = IBD, HSP

Skin lesions = IBD, HSP, liver disease

SOB = pneumonia

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25
3 recurrent abdo pain causes
Pain lasting more than 3 months Usually due to IBS, abdo migraine or functional dyspepsia IBS: explosive stools, bloating, feeling of incomplete defecation, constipation, abdo pain Abdo migraine = headaches + abdo pain Functional dyspepsia = bloating, early satiety, reflux
26
Functional dyspepsia management (+ H pylori treatment)
H pylori = amoxicillin + metronidazole PPIs
27
Appendicitis - S+S, investigations + management
Vomiting McBurnys point - RIF pain + guarding Rovsing's sign - pressure in L side gives pain in R side Faecalith = preschool children = blocks appendix USS Appendicectomy
28
Coeliac disease - pathology, presentation, investigations, management, complications
Gluten provokes damaging response in proximal small intestinal mucosa Villi become shorter and absent, leaving flat mucosa HLA-DQ2/8 Presents as malabsorption at 8-24 months Loose stools, FTT, abdominal distension, short stature, anaemia Serology testing - IgA tissue transglutaminase antibodies Endoscopy + biopsy = villous atrophy, crypt hypertrophy Associated w/ Downs, Turners + T1DM Gluten free diet Complications: anaemia, osteoporosis, malignancy
29
Undescended testicles - types, management
Normally descend on 36th week Retractile = testis can be manipulated into the scrotum but then retract Palpable = testis can be palpated in groin Impalpable = no testis felt Review at 6-8 weeks Review at 3 months - If still undescended - do orchidopexy
30
Inguinal hernia - cause, S+S, management
Usually indirect - due to patent processus vaginalis Common in premature babies S+S: intermittent swelling in groin, firm and tender Opioid analgesia + compression Surgery after 24-48 hours
31
Intussusception pathology + causes
Invagination of proximal bowel into distal segment Commonly = ileum passing into caecum Causes: change in diet, viral infection Causing hypertrophy of Peyer's patches - causes obstruction + ischaemia
32
Intussusception S+S + who does it commonly affect?
Colicky paroxysmal pain Pale, draws legs up Refusing feeds Vomiting - may be bile stained Redcurrent jelly stool Commonl boys, 5-10 months
33
Intussusception investigations, management + complications
Investigations: examination = sausage shaped mass AXR (bowel dilation), then USS showing target sign NBM, NGT, rectal air insufflation/ enema DON'T DO AIR ENEMA if there is a prolonged hx (\>24hrs) or already showing signs of peritonitis = may cause perforation Complication: stretching + constriction of mesentery causing venous obstruction = leads to bowel perforation, peritonitis + gut necrosis - on AXR may have football sign
34
Causes of unconjugated jaundice
Breast milk jaundice Infection (UTI) Haemolytic anaemia Hypothyroidism High GI obstruction Crigler-Najjar obstruction
35
Causes of conjugated jaundice
Bile duct obstruction Neonatal hepatitis (Hep A)
36
S+S jaundice
Pale stools, dark urine, bleeding, FTT
37
Mesenteric adenitis - what is it, differentiation with appendicitis
Inflamed lymph glands in abdo - cause abdo pain Usually due to viral infection High fever (whereas appendicitis is low grade fever) Accompanied by URTI with cervical lymphadenopathy Resolves within 48 hours
38
Pyloric stenosis - what is it, onset, S+S, management
Hypertrophy of muscle causing gastric outlet obstruction Presents between 2-7 weeks S+S: vomiting, increasing in forcefulness Dehydration, FTT Visible peristalsis Palpable abdo mass in RUQ Hypocholoraemic metabolic alkalosis - low sodium + potassium Management: pyloromyotomy
39
Testicular torsion - RF, S+S, management
RF: high insertion of tunica vaginalis = bell clapper testis with horizontal lie S+S: sudden onset severe pain, often comes on during sport, N+V, acute swelling Surgery within 12 hours
40
Biliary atresia - what is it, S+S, management, complications
Destruction of biliary tree + ducts S+S: FTT, jaundice (prolonged), pale stools + dark urine, hepatosplenomegaly Surgically bypass fibrotic ducts (hepatoportoenterostomy = Kasai procedure) Post op complications: cholangitis, malabsorption of fats + fat soluble vitamins, portal HTN
41
Duodenal atresia - cause, S+S, investigations
Double bubble on XR Bilious vomiting Congenital
42
Hepatitis S+S
N+V Abdo pain Lethargy Jaundice Large tender liver Splenomegaly Increased liver transaminases
43
Hep A - cause, S+S, diagnosis, management
RNA virus spread by faecal oral route Common cause of childhood jaundice Prodrome (week 1) then jaundice for week 2-3 Raised bilirubin, AST + ALT Diagnose with IgM antibody to virus Give prophylaxis with immunoglobulin to close contacts or vaccinate within 2 weeks
44
Hep B - cause, transmission from mother to baby
DNA virus - usually passed on from mothers Asymptomatic carriers if infected perinatally IgM ab (anti-HBc) are +ve in acute infection +ve HBsAg = ongoing infection
45
Hep C - transmission from mother to baby
Vertical transmission - causes children to be carriers with progression to cirrhosis
46
Crohns - pathology, S+S, management
Transmural inflammatory disease with non-caseating epitheloid cell granulomata S+S: abdo pain, diarrhoea, rectal bleeding, growth failure, raised crp polymeric diet for 6-8 weeks, immunosuppressant meds
47
UC - pathology, S+S, management
Inflammatory + ulcerating disease - mucosal inflammation, crypt damage, ulceration S+S: rectal bleeding, diarrhoea, colicky pain, weight loss, growth failure Treat with aminosalicylates, steroids + immunosuppression
48
Volvulus - causes, S+S, management
Malrotation = failure of gut to rotate + return to abdo Causes obstruction with bilious vomiting + ischaemia manage surgically
49
How much milk should babies have in a day?
150ml/kg/ day
50
RF for GORD
More common in floppy babies eg Downs/ neuro problems (CP) Preterm Hypotonic Males Cows milk Obesity
51
What are the downsides of breastfeeding?
Increased frequency of feeds Less vitamin D - may need a supplement
52
What is the most common cause of PR bleeding in neonates?
Swallowing blood from CS or placental abruption Cows milk protein allergy - causes pink frothy stools
53
S+S cows milk protein allergy
D +V Abdo pain Blood in stools Hives/ eczema Wheezing, irritability, facial swelling FTT
54
What is oesophageal atresia + tracheosophageal fistula + RF?
Atresia = doesn't connect with stomach, ends in pouch Fistula = connects with trachea RF: polyhydraminos
55
What is Crigler Najjar syndrome?
Causes non-haemolytic jaundice causing high unconjugated bilirubin in neonates LFTs normal Autosomal recessive Needs liver transplant
56
What is Gilbert's syndrome?
Common cause of unconjugated high bilirubin Jaundice precipitated by illness, stress etc
57
Prolonged constipation (for years), distended bowel, faecal loading (on AXR), failure to pass meconium for a few days - what is it?
Hirschprungs
58
What is Hirschprungs?
Absence of myenteric + submucosal ganglia cells in rectum Due to failure of neural crest cells to migrate in week 8-12 Results in aganglionic section that is unable to relax
59
RF for Hirschprungs
Boys more common Downs + other inherited conditions
60
S+S of Hirschprungs
Abdo distension, vomiting, constipation, delayed meconium, FTT, poor nutrition
61
Investigations + management of Hirschprungs
AXR - faecal loading + dilated bowel Barium enema + biopsy Surgery = removal of segment with end-end anastomosis OR removal of aganglionic segment + colostomy to allow decompression of dilated bowel
62
Complications of Hirschprungs
Soiling Enterocolitis - can become life threatening - stool sample to be sent to check for viral causes Incontinence Constipation Stricture Obstruction
63
What are Peyer's patches?
Lymph nodes in bowel Commonly involved in intusseception in young children (due to recent viral illness causing inflammation of Peyer's patches)
64
What defects are tracheo-oesophageal fistulas associated with?
horseshoe kidney, AV septal defects + imperforate anus, also oesophageal atresia – common in genetic disorders
65
How does a tracheo-oesophageal fistula present?
choking + coughing during for during feeds, abdo distension + LRTIs
66
What is VACTERL?
Verterbral anomalies Anorectal anomalies Cardiac anomalies TOF + oesophageal atresia Renal tract abnormalities limb anomalies
67
What is Meckel's diverticulum, how does it present + what is the rule of 2s? What scan is diagnostic?
Vitelline duct remnant Rule of 2s – 2% of people, 2cm long, 2ft from end of gut Can cause rectal bleeding, discharge from umbilicus + bowel obstruction/ intussecption in older children. Presents like appendicitis. T99 scan is diagnostic
68
When should you repair umbilical hernias by?
4-5 years
69
What is a torted hydatid?
testicular pain, pea sized blue swelling
70
What is a hydrocele?
Fluid in the scrotum leading to swelling
71
What is phimosis?
Tight foreskin
72
What is epididymitis?
inflammation causing pain, dysuria, frequency + scrotal pain, swelling – STI related
73
What is epispadias?
urethral meatus on dorsal aspect
74
What is priapism?
Painful + prolonged erection
75
What is cryptorchidism?
Undescended testes - common in preterms Should descend by 6 months - if not, fix by 1 year
76
What is the coffee bean sign?
Large bowel obstruction that folds itself double

Paediatrics (19 decks)

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