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YEAR 4 PAEDS > GI > Flashcards

GI Flashcards

1
Q

Acute and Chronic causes of diarrhoea?

A

Acute:
* Gastroenteritis
* Nectrotizing entercolitis
* Intusseseption
* Volulus
Chronic
* Toddlers Diarrhoea
* Coeliacs
* IBD
* Allergies- non IgE mediated

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2
Q

A toddler presents with diarrhoea. What are your differentials?

A
  • Gastroenteritis
  • Any infection e.g. viral URTIs, Chest infections, otitis media, UTI
  • Antibiotic use

Chronic:
Lactose intolerance
Toddlers diarrhoea

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3
Q

A 4 year old presents with diarrhoea. What are your differentials?

A
  • Toddlers diarrhoea
  • Parasites
  • Overflow dirrhoea in constipation
  • Lactose intolerance
  • Coeliac disease
  • Cystic fibrosis
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4
Q

13 year old presents with diarrhoea. What are your differentials?

A
  • Coeliacs disease
  • Lactose intolerance
  • IBD
  • IBS
  • Psychosocial- anxiety
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5
Q

Main complication of diarrhoea in young children and babies?

A
  • Dehydration
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6
Q

Causes of dehydration?

A
  • Inability to drink e.g. tonsillitis
  • Excessive sweating: high fever, hot climate, cystic fibrosis
  • Vomiting: Pyloric stenosis, viral infections, gastroenteritis
  • Acute diarrhoea: viral/ bacterial gastroenteritis, food poisoning, antibiotics, any acute infection
  • Burns
  • Post surgery
  • Polyuria- diabetes mellitus, diabetes insipidus
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7
Q

Signs of severe dehydration in a baby/ child ?

A
  • Sunken fontanelle- baby
  • Sunken eyes
  • Dry lips and mouth
  • Thirst +++
  • Tachycardia
  • Delayed cap refill time
  • Reduced skin turgor
  • Reduced urine output
  • Weight loss
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8
Q

What is Coeliacs disease?

A
  • Autoimmune condition caused by sensitivity to protein in gluten
  • Repeated exposure leads to villous atrophy–> malabsorption
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9
Q

What conditions are associated with Coeliacs?

A
  • dermatitis herpetiformis
  • Autoimmune disorders e.g. T1DM and autoimmune hepatitis
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10
Q

What genes are associated with Coeliacs?

A
  • HLA-DQ2
  • HLA-DQ8
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11
Q

Complications of Coeliacs disease?

A
  • anaemia: iron, folate and vitamin B12 deficiency (folate deficiency is more common than vitamin B12 deficiency in coeliac disease)
  • hyposplenism
  • osteoporosis, osteomalacia
  • lactose intolerance
  • enteropathy-associated T-cell lymphoma of small intestine
  • subfertility, unfavourable pregnancy outcomes
  • rare: oesophageal cancer, other malignancies
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12
Q

When should you think about investigating for Coeliacs disease?

NICE 2009- suggested

A

Signs and symptoms:
* Chronic or intermittent diarrhoea
* Failure to thrive or faltering growth in children
* Persisten or unexplained GI symptoms incl N&V
* Prolonged fatigue
* Reccurent abdo pain, cramping or distension
* Sudden or unexpected weight loss
* Unexplained iron- deficiency anaemia, or other unspecified anaemia
Conditions
* Autoimmune thyroid disease
* Dermatitis herpetiformis
* IBS
* Type 1 diabetes
* First degree relatives with coeliacs

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13
Q

What investigations would you do for coealiacs?

A

Serology:
* tissue transglutaminase (TTG) antibodies (IgA) are first-choice according to NICE
* endomyseal antibody (IgA)
needed to look for selective IgA deficiency, which would give a false negative coeliac result
* anti-casein antibodies are also found in some patients

Endoscopic intestinal biopsy- duodenum, usually in children you use jejunal biopsy showing subtotal villous atrophy
May see the following:
* Crypt hyperplasia
* Increase in intraepithelial lymphocytes
* Lamina propria infiltration with lymphocytes

* anti-gliadin antibody (IgA or IgG) tests are not recommended by NICE

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14
Q

Management of Coeliacs?

A
  • Gluten- free diet
  • Patients with coeliac disease often have a degree of functional hyposplenism-all patients with coeliac disease are offered the pneumococcal vaccine
  • Coeliac UK recommends that everyone with coeliac disease is vaccinated against pneumococcal infection and has a booster every 5 years
  • Currrent guidelines suggest giving the influenza vaccine on an individual basis.
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15
Q

What contains gluten?

A
  • wheat: bread, pasta, pastry
  • barley: beer
  • whisky is made using malted barley. Proteins such as gluten are however removed during the distillation process making it safe to drink for patients with coeliac disease
  • rye
  • oats- although GF, some react to them, also usually made in factory that is not GF so cannot have

rice
potatoes
corn (maize)
are GLUTEN FREE

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16
Q

Acute and Chronic causes of constipation?

A

Acute:
* Dehydration
* Bowel obstruction
Chronic
* Functional constipation
* Hirschsprung’s disease
* Secondary to other conditions e.g. hypothryroidism, coeliac disease, CF

Idiopathic is the most common cause

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17
Q

Signs of constipation in children < 1 year old ?

A

Stool pattern:
* Fewer than 3 complete stools per week (type 3 or 4 on Bristol Stool Form Scale) (this does not apply to exclusively breastfed babies after 6 weeks
of age)
* Hard large stool
* ‘Rabbit droppings’ (type 1)
Symptoms associated with defecation
* Distress on passing stool
* Bleeding associated with hard stool
* Straining
History
* Previous episode(s) of constipation
* Previous or current anal fissure

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18
Q

Presentation of constipation of child > 1 year?

A

Stool Pattern:
* Fewer than 3 complete stools per week (type 3 or 4)
* Overflow soiling (commonly very loose, very smelly, stool passed without sensation)
* ‘Rabbit droppings’ (type 1)
* Large, infrequent stools that can block the toilet
Symptoms associated with defecation:
* Poor appetite that improves with passage of large stool
* Waxing and waning of abdominal pain with passage of stool
* Evidence of retentive posturing: typical straight-legged, tiptoed, back arching posture
* Straining
* Anal pain
History
* Previous episodes of constipation
* Previous or current anal fissure
* Painful bowel movements and bleeding associated with hard stools

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19
Q

What points to idiopathic constipation as opposed to more serious condition?

Think Timing, Growth and Diet

A

Timing:
* starts after a few weeks of life
* Obvious precipitating factor e.g. fissure, change of diet, timing of potty/toilet training or acute events such as infections, moving house, starting nursery/school, fears and phobias, major change in family, taking medicines
Passage of meconium < 48 hours
Growth:
* Generally well, weight and height within normal limits, fit and active
Neuro/locomotor
* No neuro problems in legs and normal locomotor development
Diet:
* Changes in infant formula
* Weaning
* insufficient fluid intake or poor diet

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20
Q

Red flags in children with constipation?

A

Timing:
* Reported from birth or first few weeks of life
Failure to pass meconium w/in <48 hours
Stool pattern:
* Ribbon stools
Growth:
* faltering growth is amber flag
Abdomen:
* Distension (+/- vomiting)
Other:
* Disclosure or evidence that raises concerns over possibility of child maltreatment

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21
Q

What is a necessity to assess for in a child with constipation?

A

FAECAL IMPACTION
Suggestive features incl:
* symptoms of severe constipation
* overflow soiling
* faecal mass palpable in abdomen

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22
Q

Managment of constipation if there is faecal impaction?

A
  • polyethylene glycol 3350 + electrolytes (Movicol Paediatric Plain) using an escalating dose regimen as the first-line treatment
  • add a stimulant laxative if Movicol Paediatric Plain does not lead to disimpaction after 2 weeks
  • substitute a stimulant laxative singly or in combination with an osmotic laxative such as lactulose if Movicol Paediatric Plain is not tolerated
  • inform families that disimpaction treatment can initially increase symptoms of soiling and abdominal pain
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23
Q

Conservative management of constipation in children?

A
  • Reward charts e.g. star charts
  • Increased dietary fibre
  • Adequate hydration/fluids
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24
Q

Treatment of constipation (w/o faecal impaction)

A
  • first-line: Movicol Paediatric Plain
  • add a stimulant laxative if no response
  • substitute a stimulant laxative if Movicol Paediatric Plain is not tolerated. Add another laxative such as lactulose or docusate if stools are hard
  • continue medication at maintenance dose for several weeks after regular bowel habit is established, then reduce the dose gradually
  • DR LUYT: duration for the same as symptoms have been there e.g. 3 weeks of symptoms- 3 weeks of treatment
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25
Q

How to treat children < 6 mnths for constipation?

A
  • bottle-fed infants: give extra water in between feeds. Try gentle abdominal massage and bicycling the infant’s legs
  • breast-fed infants: constipation is unusual and organic causes should be considered
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26
Q

Management of constipation of infants who are or have been weaned?

A
  • offer extra water, diluted fruit juice and fruits
  • if not effective consider adding lactulose
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27
Q

What shoudl you ask in Hx when child comes in with constipation?

A
  • Infrequent but normal stools are not indicators of constipation
  • Ask about: hardness of stool, painful defecation, crampy abdo pain and blood on the stool or toilet
  • Hx of anal fissure is significant
  • Preciptating events
  • Ask about diet
  • Soiling
  • Abdo pain
  • Developmental milestones
  • Ask about pregnancy, birth and meconium passage
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28
Q

Examination in constipation?

A
  • Growth: review growth chart as Hirschprungs disease accompanied by failure to thrive
  • Abdo exam- may be able to feel stool in LLQ
  • Anorectal examination: anal fissures may be present. Do not perform DRE
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29
Q

What is the commonest cause of vomitting in infancy?

A
  • GORD
  • Around 40% infants regurgitate their feeds to a certain extend so degree of overlap w normal physiological processes
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30
Q

RF for GORD?

A
  • Preterm delivery
  • Neuro delivery
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31
Q

Features of GORD in infants?

A
  • typically develops before 8 weeks
  • Vomiting/regurgitation
  • Milky vomits after feeds
  • May occur after being laid flat
  • Excessive crying, esp while feeding
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32
Q

Management of GORD in infants?

2015 NICE

A
  • advise regarding position during feeds - 30 degree head-up
  • infants should sleep on their backs
  • ensure infant is not being overfed (as per their weight) and consider a trial of smaller and more frequent feeds
  • a trial of thickened formula (for example, containing rice starch, cornstarch, locust bean gum or carob bean gum)
  • a trial of alginate therapy e.g. Gaviscon. Alginates should not be used at the same time as thickening agents
  • NICE do not recommend a proton pump inhibitor (PPI) to treat overt regurgitation in infants and children occurring as an isolated symptom. A trial of one of these agents should be considered if 1 or more of the following apply:
  • unexplained feeding difficulties (for example, refusing feeds, gagging or choking)
  • distressed behaviour
  • faltering growth

If severe complications and medical treatment does not work: consider fundoplication

prokinetic agents e.g. metoclopramide should only be used with specialis

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33
Q

Complications of GORD in infants?

A
  • Distress
  • Failure to thrive
  • Aspirtion
  • frequent otitis media
  • In older children: erosion may occur
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34
Q

A 6 week year old infant presents with worsening vomitting for the last 2 weeks. What are your differentials?

A
  • Pyloric stenosis
  • Milk allergy
  • Overfeeding
  • GORD
  • Gastroenteritis
  • Gastric volvulus
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35
Q

What is Gastroenteritis?

DL tutorial

A
  • Sudden onset of diarrhoea, with or without vomitting
  • Most cases due to an enteric virus; can be caused by bacteria or protozoa
  • V common- 10% of children present annually
  • Usually self- limiting not needing medical attention but can be life threatening
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36
Q

What to ask in hx for suspected GE?

A
  • Diet
  • Blood in stools and recent bowel habits
  • Presence of fever
  • Anyone around him unwell
  • Immunisations
  • Travel hx
  • Rest of hx: PMH, Dhx, Shx, Fhx, ICE

DL tutorial

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37
Q

What to ask in hx for suspected GE?

A
  • Diet
  • Blood in stools and recent bowel habits
  • Presence of fever
  • Anyone around him unwell
  • Immunisations
  • RF for dehydration
  • Urine output, fluid intake and are they floppy?
  • Travel hx
  • Rest of hx: PMH, Dhx, Shx, Fhx, ICE

DL tutorial

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38
Q

What are the RF for dehydration in GE?

A
  • 5 or more stool in 24 hours
  • 3 or more vomits in 24 hours
  • Age < 12 months ( < 6 months is worse)
  • Intake (worse if not breast feeding)
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39
Q

Examination to assess for hydration?

A
  • Cap refill
  • Skin tugor
  • Mucus membranes
  • Fontanelles
  • Urine output
40
Q

How do you diagnose Gastroenteritis?

A

Clinical: suspect if sudden change in stool consitency to loose/ watery and/or sudden onset of vomiting

Stool microbiology if:
* septicaemia is suspected
* Blood and/or mucus in stools
* Child is immunocompromised
* Recent travel abroad
* Diarrhoea has not improved after 7 days
* Diagnosis of GE uncertain
And then treat accordingly
* Assess dehydration and shock

DL tut

41
Q

What clinical features would lead to you consider other diagnoses other than GE in a pt with diarrhoea and/or vomitting?

A
  • Fever > 38 if less than 3 mnths; > 39 if older
  • Dyspnoea/tachypnoea
  • Altered LOC, bulging fontanelle, non-blanching rash
  • Bilious vomiting; blood/ mucus in stool
  • Severe/localised pain, rebound tenderness, abdo distension
42
Q

How to assess for dehydration and shock?

What to ask about, look out for, red flags and hypernatraemia

A

Consider RF
Ask about:
* Appear unwell
* altered responsiveness (irritable or lethargic)
* Decreased urine output
* Pale, mottled skin, cold extremities
Look for:
* Altered responsiveness
* Skin colour changes, extremity temperature
* Mucous membranes
* Sunken eyes
* Tissue turgor
* Tachypnoea, tachycardia, cap refill, BP
Red flags:
* Altered level of consciousness
* Tachycardia
* Tachypnoea
* Sunked eyes, reduced tissue turgor
Consider hypernatraemia if:
* Jittery
* Increased muscle tone
* Hyperreflexic
* Convulsions
* Drowsiness
* Coma

43
Q

Management of GE?

A

Fluid management
GE without dehydration:
* continue breast feeding and other milk feeds
* Encourage fluid intake
* Discourage fruit juices/ fizzy drinks
* Offer ORS as a supplement if at risk of dehydration

GE WITH dehyrdation incl hypernatraemia:
* Use low osmolality ORS for oral rehydration
* GIve 50ml/kg for fluid deficit over 4 hours as well as maintenance fluid
* GIve ORS frequently and in small amounts
* Consider supplementation with usual feeds if ORS refused (if no red flags)
* Monitor response to ORS with regular clinical assessment

Use IV fluids if:
* Shock suspected or confirmed
* Child with red flag symptoms/ signs despite ORS
* Persistent vomiting of ORS

44
Q

What are the points to remember if using IV for rehydration in GE?

A
  • Use isotonic solution (0.9% NaCl +/- 5% glucose) for rehydration and maintenance
  • For those with suspected/ confirmed shock- give 100ml/kg bolus
  • For those without shock- add 50ml/kg for fluid deficit (or the deficit is weight in kg x % dehydration)
  • Measure U&Es and glucose regularly
  • Consider IV potassium supplementation when plasma potassium is known
  • If hypernatraemic dehyration- give over 48 hours to avoid cerebral odema
45
Q

The child with GEhas now been rehydrated. How would you manage their nutrition?

A
  • Give full strength milk straight away
  • Reintroduce child’s usual solid foods
  • Avoid fruit juices/carbonated drinks until diarrhoea has settled
46
Q

What advice would you give to a parent of a child who has GE?

(hygiene, school return)

A
  • Wash hands with soap (liquid) and warm water
  • Wash hands after going to the toilet (for children) or changing nappies (parents/carers) or before handling any food
  • Towels used by infected children should not be shared
  • Child not to attend school or childcare whilst they have D or V
  • Child not to go back to school until at least 48 hours after last D/V
  • Child not to swim for 2 weeks after last episode of diarrhoea
47
Q

What is Ulcerative colitis?

A
  • Diffuse mucosal inflammation or the rectum, extending proximally
  • Subdivision into distal (proctitis and proctosigmoiditis) and extensive disease (left-sides or extensive colitis and pancolitis)
48
Q

What is Crohn’s disease?

A
  • Patchy transmural inflammation affecting one or several segements of the intestinal tract
  • Defined by anatomically location or pattern of disease
49
Q

History that would make you suspect IBD? Differentiate between UC and Crohns.

A
  • Adolescent or young adult
  • Abdominal pain
  • frequent Diarrhoea e.g. 5 or more a day
  • Weight loss
  • Lethargy
  • Ulcers
  • Joint pain
  • Fhx of IBD
  • Erythema nodosum
  • Waking up at night to use the toilet

Crohn’s:
* Weight loss
* Smoking makes it worse
* Perianal disease
* Less likely to have blood in stools
* Low grade fever
* Mildly anaemia

UC:
* Blood in stools
* Mucus in stools
* No perianal disease

50
Q

Histology in Crohns?

A
  • Fissuring ulcers
  • Non-caseating granuloma
  • Lymphoid and neutrophil aggregates
51
Q

Endoscopy findings Crohns?

A
  • Apthous ulcer
  • Cobblestone appearance
52
Q

Xray in Crohn’s?

A
  • Tapering at hepatic flexure
53
Q

Investigations in IBD?

A
  • Bloods: Hb (anaemia), Increased ESR/ CRP, hemanitics (folate and B12), LFTs (for primary sclerosisng cholangitis), albumin
  • Microbiology: Stool culture- rule out infective causes and faecal calprotection (raised in IBD)
  • Imaging: Xray, Endoscopy, Barium enema (Crohns) or Double contrast enema (UC)
54
Q

Endoscopy findings for UC?

A
  • Decreased goblet cells
  • Crypt abcesses
55
Q

Endoscopy findings for UC?

A
  • Decreased goblet cells
  • Crypt abcesses
56
Q

Xray findings in UC?

A
  • mucosal odema
  • Thumbprinting
57
Q

Double contrast enema findings in UC?

A
  • Lead pipe colon
58
Q

Mangagment of Crohns disease?

A
  • Liquid diet- induces remission (not sure why)
  • Can use steroids to induce remission too
  • Maintenance with azthioprine or mercaptourine
59
Q

Mangement of UC?

A

Aminosalicylates for induction of remission for mild/moderate disease
IV steroids for induction of severe disease

Aminosalicylates for maintenance

60
Q

Associations of IBD?

A

Crohns:
* Arthritis
* Episcelritis
* Asymmetric erythema nodosum
UC:
* Arthiritis
* Primary sclerosing cholangitis
* Uveitis

61
Q

What is the aetiology of Acute liver failure in children?

A

Damage to hepatocytes by:
* Infection: acute viral hep (A,B); EBV may precipitate mononucleosis hepatitis
* Drugs/ inadvertent poinsoning: paracetamol, isoniazid, halothane, poisonous mushrooms
* Reye syndrome: <14 years old is associated with an acute non-inflammatory encephalopathy with associated liver damage (esp w concomitant vericella infection)

62
Q

How can acute liver failure present?

A
  • May present within hours
  • Jaundice
  • Encephalopathy
  • Coagulopathy
  • Hypoglycaemia
  • Other elctrolyte disturbances
63
Q

How may encephalopathy present?

A
  • Young children: alternating periods of irritability and confusion with drowsiness
  • Older children: aggression and being unusually difficult
64
Q

Investigations in acute liver failure?

A

Bloods: LFTs: Increased bilirubin (although may be normal in the early stages),increased ALT, AST,ALP, Coag- deranged clotting, increased plasma ammonia and decreased glucose
ABG: frquently associated with acid/base imbalance
Viral serology: detect hepatitis
Imaging: CT/MRI brain: may show cerebral oedema in encephalopathy
EEG: may show acute hepatic encephalopathy

65
Q

Managment of acute liver failure?

A

Treatment of complications:
Hypoglycaemia: Dextrose infusion
Sepsis: broad spec abx
Coagulation defect: FFP and PPI to prevent gastric bleeding. Vit K not usually indicated- if needed then usually indication for liver transplantation
Cerebral oedema: fluid restriction and diuresis with mannitol

Liver transplant: prothrombin time is the best marker of liver failure

66
Q

Complications of acute liver failure?

A
  • Cerebral oedema
  • Haemorrhage from gastritis or coagulopathy
  • Sepsis
  • Pancreatitis
67
Q

Poor prognostic signs for acute liver failure?

A
  1. Liver starting to shrink in size
  2. Rising bilirubin with falling transaminases
  3. Increase coagulation defect
  4. Progression to encephalopathy and coma
68
Q

What hepatitis viruses have vertical transmission?

A
  • B
  • C
69
Q

How is Hep A spread?

A
  • Faeco-oral route
70
Q

Epidemiology of Hep B?

A
  • Most common cause of hepatitis globally
  • High prevalence regions include sub-Saharan Africa, Asia and the Pacific Islands.
  • Decline of disease in children and adolescents in the UK is due to routine vaccination
  • Incubation period usually 60-90 days.
71
Q

Features of Hep B Infection?

A
  • Only 5% of children have jaundice and severe symptoms, but the majority cannot clear the infection and develop chronic disease.
  • 30-50% of adults experience jaundice, fever, malaise, and darkening of urine and lightening of stool. Some develop fulminant liver failure with decompensation (ascites, encephalopathy etc.). Risk of developing chronic disease is low (<5%).
72
Q

Serology of Hep B?

A
  • HBsAg is detected 3-5 weeks after infection. If present for >6 months: Chronic disease (5-10% of infections).
  • Anti-HBs implies immunity- negative in chronic disease
  • Anti-HBc: previous or current infection. In current infection IgM raised for about 6 months, after will be IgG
  • HbeAg- marker of infectivity
73
Q

Management of chronic Hep B?

A
  • Pegylated interferon-alpha
  • Antivirals: tenofovir, entercavir and telbivudine
74
Q

Features of Hep C?

A

Only 30% of people will develop features e.g.:
* transient rise in serum aminotransfereases/ jaundice
* fatigue
* arthralgia

75
Q

Investigations for Hep C?

A
  • HCV RNA is the investigation of choice to diagnose acute infection
  • whilst patients will eventually develop anti-HCV antibodies it should be remembered that patients who spontaneously clear the virus will continue to have anti-HCV antibodies
76
Q

What % of patients will go on to have chronic hep C?

A
  • 55-85%
77
Q

What is chronic Hep C?

A
  • Persistence of HCV RNA in the blood for 6 months
78
Q

Complications of chronic hep C?

A
  • rheumatological problems: arthralgia, arthritis
  • eye problems: Sjogren’s syndrome
  • cirrhosis (5-20% of those with chronic disease)
  • hepatocellular cancer
  • cryoglobulinaemia: typically type II (mixed monoclonal and polyclonal)
  • porphyria cutanea tarda (PCT): it is increasingly recognised that PCT may develop in patients with hepatitis C, especially if there are other factors such as alcohol abuse
  • membranoproliferative glomerulonephritis
79
Q

Management of chronic Hep C?

A
  • treatment depends on the viral genotype - this should be tested prior to treatment
  • the management of hepatitis C has advanced rapidly in recent years resulting in clearance rates of around 95%.
  • the aim of treatment is sustained virological response (SVR), defined as undetectable serum HCV RNA six months after the end of therapy
  • currently a combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used
80
Q

Complications of Chronic Hep C treatment?

A

ribavirin - side-effects: haemolytic anaemia, cough. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic

interferon alpha- no longer recommned - side-effects: flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia

81
Q

What is Hep A?

A

Hepatitis A is typically a benign, self-limiting disease, with a serious outcome being very rare.

82
Q

Features of Hep A?

A
  • flu-like prodrome
  • abdominal pain: typically right upper quadrant
  • tender hepatomegaly
  • jaundice
  • deranged liver function tests
83
Q

Vaccination programme for Hep A?

A

an effective vaccine is available
after the initial dose a booster dose should be given 6-12 months later

84
Q

Who should get vaccinated for Hep A?

A
  • people travelling to or going to reside in areas of high or intermediate prevalence, if aged > 1 year old
  • people with chronic liver disease
  • patients with haemophilia
  • men who have sex with men
  • injecting drug users
  • individuals at occupational risk: laboratory worker; staff of large residential institutions; sewage workers; people who work with primates
85
Q

Causes of acute abdo pain in children + supporting features?

A
  • Acute appendicitis: anorexia, central pain localising to RIF, peritonism, tachycardia
  • Henoch-schonlein purapura: purpuric rash on legs, joint pain
  • UTI: dysuria, frequency, back pain, bedwetting, vomiting
  • Constipation: hard or infrequent stool, mass in LIF
  • Intestinal obstruction: bile stained vomting, abdo distension
  • Intussusception: intermittent screaming/colic, shock, redcurrent jelly stool, 3-24 months
  • DKA
  • Lower lobe pneumonia: signs of pneumonia
  • Peptic ulcer: pain at night, relief with milk
  • Renal calculi: symptoms of hydronephrosis
  • Gastroenteritis: D&V
  • Hepatitis
  • Mesenteric adenitis
86
Q

Ddx for recurrent abdo pain?

A
  • IBS/IBD
  • Idiopathic constipation
  • Coeliacs
  • Psychogenic
  • Sickle cell
  • Gynae problems e.g. ovarian cyst or dysmenorrhoea
87
Q

Examination for abdo pain?

A
  • General observations
  • Abdo exam- signs of peritonism, rebound tenderness, guarding
  • Mesenteric adenitis: often palpable lymphadenopathy elsewhere
88
Q

Investigations in abdo pain?

A

Bedside:
* urine dip for UTI
* BM: DKA
Bloods/Lab:
* FBC: WCC count
* CRP: high in infection/ IBD
* U&Es: any metabolite abnomalities/ AKI for dehydration
* LFTs: to rule out hepatitis
* Urine MC&S
Imaging:
* Axr: dilated bowel loops in obstruction, faecal loading in constipation, abnormal gas pattern in intussuception
* USS of abdo: exclude renal tract abnormality
* Pelivc USS: any gynae causes
* Barium enema: for inussusception or UC (double contrast), Crohns
* Barium swallow and follow-through: oesophagitis and reflux, peptic ulcers
* Endoscopy: oesophagitis and reflux, peptic ulcer and IBD

89
Q

Causes of vomiting in newborns and infants? Mention some distinguishing factors.

A
  • Overfeeding
  • GORD: may cause apnoea and failure to thrive, positional vomiting
  • Pyloric stenosis: 4-6 weeks old, projectile vomiting after feed, hungry after vomiting, palpable ‘olive’ in abdo
  • Whooping cough: paroxysmal cough
  • Small bowel obstruction e.g. congenital atresia or malrotation: bile stained vomit, presents soon after birth, may have distension
  • Constipation
  • Systemic: Menigitis, UTI/ pyelonephritis
90
Q

Causes of vomiting in older children?

A
  • Gastroenteritis: usually have diarrhoea, dehydration
  • Migraine
  • Raisied ICP: effortless vomiting, neuro signs, papilloedema
  • Bulimia
  • Toxic ingestion or medications
  • Pregnancy
91
Q

Examination in child who is vomiting?

A
  • Check for dehydration esp if presenting with GE
  • Abdo exam: feel for mass in neonates ‘olive’: pyloric stenosis, check for abdominal distension: intestinal obstruction
  • Neuro exam incl checking for papilloedema and HTN in cases of suspected raised ICP
  • Brudzinski and kernigs sign if suspecting meningitis
92
Q

Investigations in vomiting?

A

Bedside: Urine dip- rule out UTI, ECG- may have electrolyte disturbances that can cause arrythmias, BM- check for DKA, CBG- metabolic disturbances

Bloods: FBC- raised WCC for infection, U&Es- assess electrolyte disturbances and dehydration, CRP- for inflammation

Imaging: pH monitoring and barium swallow-may show significant GORD, upper GI contrast study- if bilious vomiting in newborn- to exclude malrotation, USS of pylorus- if pyloric stenosis is suspected

93
Q

Lightning learning Hirschprung’s disease

A
94
Q

lightning learning viral gastroenteritis

A
95
Q

lightning learning billous vomiting

A

YEAR 4 PAEDS (19 decks)

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