Gastrointestinal Flashcards
(50 cards)
What questions should be asked regarding passage of stool in GI conditions?
- How often
- How hard
- Is it painful
- Has there been a change?
What is normal stool frequency?
Very variable - from 4 per day to 1 a week
Depending on age + diet
What are the advantages of stool softening medication in constipation?
- Non invasive
- Can be given by parents
What are the disadvantages of stool softening medication in constipation?
- Non compliance
- Side effects
What treatment is used for impaction?
- Empty impacted rectum
- Empty colon
- Maintain regular stool passage
- Slow weaning off treatment
What may be investigated in history and examination in suspected IBD?
- Intestinal symptoms
- Extra-intestinal manifestations
- Exclude infection
- Family History
- Growth and sexual development
- Nutritional status
List types of vomiting in children
- Vomiting with retching
- Projectile vomiting
- Bilious vomiting
- Effortless vomiting
How may a child present in pre-ejection phase of vomiting with retching?
- Pallor
- Nausea
- Tachycardia
List some stimulants of the vomiting centre in children
- Enteric pathogens
- Intestinal inflammation
- Metabolic derangement
- Infection
- Head injury/tumour
- Visual stimuli
- Middle ear stimuli
What are the causes of bilious vomiting?
Intestinal atresia (in newborns) Malrotation +/- volvulus Intussuception Ileus Crohn's disease w strictures
What investigations may be done for bilious vomiting?
- Abdominal xray
- Contrast meal
- Surgical opinion re exploratory laparotomy
What are the causes of effortless vomiting?
Almost always - GORD
Cerebral palsy, Progressive neuro problems, Oesophageal atresia +/- TOF operated, Generalised GI motility problem
What can barium swallow be useful in the diagnosis of?
- Dysmotility
- Hiatus hernia
- Reflux
- Gastric emptying
- Strictures
What feeding advice may be given in reflux?
- Fluid thickeners
- Appropriateness of foods
- Behavioural programme (Oral stimulation/Remove adverse stimuli)
- Feeding position
What nutritional advice may be given in reflux?
- Calorie supplements
- Exclusion diet (milk free)
- Nasogastric tube
- Gastrostomy
What medical treatment may be given in reflux?
-Feed thickener
Gaviscon
Thick & Easy
-Prokinetic drugs
-Acid suppressing drugs
H2 receptor blockers
Proton pump inhibitorsWhat are some indications for surgery in reflux?
-Failure of medical treatment
Persistent - Failure to thrive/Aspiration/Oesophagitis
What are the functions of the small intestine?
Enormous surface area of small intestine
-For absorption - Folds, Villi
Essential secretory component
- Water for fluidity/enzyme transport/absorption
- Ions e.g. duodenal HCO3-
- ? Defence mechanism against pathogens/harmful substances/antigens
What usually causes osmotic diarrhoea?
Malabsorption
Allergy, Coeliac, CF
What usually causes secretory diarrhoea?
Toxin production eg from Cholera and enterotoxigenic E. coli
Can be inflammatory - IBD
What are causes of motility diarrhoea?
- Toddler’s diarrhoea
- IBD, Congenital hyperthyroidism, Chronic intestinal pseudo-obstruction
How can you tell the difference between osmotic and secretory diarrhoea?
If you make the patient NBM -
Osmotic diarrhoea will stop. If it doesn’t - most likely secretory.
What types of condition can cause fat malabsorption?
-Pancreatic Disease
(Diarrhoea due to lack of lipase. Ie CF)
-Hepatobiliary Disease
(Chronic liver disease, cholestasis)
List some liver function tests (LFTs)
- Bilirubin (Total/Split - conjugated/unconjugated)
- ALT/AST (alanine aminotransferase/aspertate aminotransferase)
- Alkaline phosphatase
- Gamma glutamyl transferase (GGT)
