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Phase 3a Paeds > GI > Flashcards

GI Flashcards

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1
Q

In paeds IBD, what is the ratio M:F and which type of IBD is MC?

A

M>F (2:1)
crohns > UC

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2
Q

What are the causes of chronic paediatric diarrhoea?

A

5Cs
CF
CMPI
Crohns
Colitis
Coeliacs

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3
Q

What is Ulcerative colitis?

A

Autoimmune colitis, associated with HLA B27 gene (either have gene or don’t) + pANCA

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4
Q

RF for UC?

A

FHx
jewish
smoking = protective
Associated with PSC

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5
Q

where does UC affect?

A

Colon only
starts at rectum (proctis) to sigmoid to proximal colon

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6
Q

Where is the inflammation in UC?

A

confined to mucosa (+ submucosa)

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7
Q

Sx of UC?

A

Colonic
LLQ pain
Tenesmus (rectal defecation pain - feel need to pass stool when bowel empty)
Bloody mucusy diarrhoea
extra intestinal Sx

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8
Q

What are the extra intestinal Sx?

A

Aphthous mouth ulcers
uveitis/epicleritis
Erythema nodosum
spondylarthritis

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9
Q

Dx of UC?
what score is used in UC?
what is it out of and what is severe to no disease?

A

FIT + fecal elastase (non specific)
pANCA +ve
Colonoscopy + biopsy

PUCAI (paediatric UC activity index)
measures disease activity
severe = >65/85
mod = 64-35
mild = 34-10
no disease = <10

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10
Q

what would be seen on colonoscopy and biopsy in UC?

A

submucosal continuous goblet cell depletion + ulceration

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11
Q

Tx for acute UC (induce remission)?

A
  1. PO/rectal ASA (aminosalicyclate) eg. mesalazine, sulfasalazine
  2. corticosteroid
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12
Q

Tx for long term UC ?

A

ASA, azathioprine, mercaptopurine
Surgery

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13
Q

Tx for severe UC?

A
  1. IV corticosteroids
  2. IV Ciclosporin
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14
Q

What surgery can be done for UC?

A

Panproctocolectomy = colonic removal = ilio-anal asantamoses (J Pouch)

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15
Q

complication of UC?

A

toxic megacolon

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16
Q

What is crohns?

A

Not autoimmune
defect in epithelial barrier allows bacteria through and immune system activated therefore inflammation and destruction deep in mucosa, forming GRANULOMAS.

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17
Q

RF for crohns?

A

fHx
jewish
Smoking (2x more likely)

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18
Q

where does crohns affect?

A

Whole git (from mouth to anus)
esp terminaal ilium + proximal colon (usually rectum spared)

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19
Q

How deep does inflammation occur?

A

transmural
(all 4 layers, mucosa, submucosa, muscle, serosa)

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20
Q

Sx of crohns?

A

Whole git

RLQ Pain

mucusy diarrhoea

Malabsorption - B12, Folate, Fe deficiency (as small intestine involved, colon = only H2O absorption)

Gallstones

Less extra intestinal Sx but *more mouth ulcers

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21
Q

Dx of Crohns?
what score is used and what is a significant score?

A

FIT + fecal elastase
ASCA +ve
Endoscopy and biopsy

Score = PCDAI (Paediatric crohns disease activity index)
>30 = significant

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22
Q

what is seen in the endoscopy and biopsy in crohns?

A

Endoscopy = transmural skip lesions, granulomatous, cobble stoning (inflammation is patchy, normal gut in-between)

Biopsy = transmural inflammation with non caveating granulomas

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23
Q

what is the Tx for crohns flares?

A

PO prednisolone or IV hydrocortisone

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24
Q

Tx for crohns remission?

A

Azathioprine
methotrexate
influximab

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25
can surgery be used as a Tx for crohns?
No
26
Complications of crohns?
weight loss fistulas strictures short bowel syndrome
27
What is coeliacs? RF?
autoimmune Type 4 hypersensitivity reaction vs alpha gliadin (in gluten) = inflammation of epithelial cells HLA DQ2+8 Autoimmunity (T1DM, Thyroid, downs and turner's)
28
Sx of coeliacs?
Bloating Fatigue mouth ulcers Malabsorption (haematinic deficiency - Fe, B12, folate) - anemia Steatorrhoea - increased fat excretion in stool (not absorbed) Weight loss + failure to thrive (FTT) 2 or less centile weights or fall 2+ centile Dermatitis hepetiformis
29
what is dermatitis herpetiformis?
Red bumpy skin rash on shins + knees due to IgA skin deposit
30
Dx of coeliacs?
On gluten diet: 1. Anti ttg Ab (best, most specific) High total Ig A (may get false negative in IgA deficient Px) 2. EMA (endomysial Ab) GS = Biopsy
31
what would be found in a biopsy in coeliacs?
villous atrophy + crypt hypoplasia
32
Tx of coeliacs?
Stop eating gluten PCV 5y booster
33
complication of coeliacs?
EATL lymphoma
34
what is appendicitis? what ages does it affect? due to?
10-20y Medical emergency due to Faecolith (impacted faeces blocking appendix) or filial worms
35
Sx of appendicitis?
Umbilical pain that's migrated to RIF pain Rosving (palpate LLQ and pain on RLQ) obturator Psoas sign Rebound tenderness Fever, N+V
36
Dx of appendicitis?
FBC = High WCC + CRP Abdo Xray/USS = Faecolith Young female = pregnancy test bhCG GS = CT abdo
37
If the investigations of appendicitis come back negative but the Sx indicate appendicitis then what should be done?
laparoscopy
38
Tx for appendicitis?
Abx Appendectomy
39
Ddx of appendicitis? why?
-Mesenteric adenitis (inflammation of mesenteric LN) No rosving, systemically well -Ectopic
40
Complications of appendicitis?
gangrene rupture peritonitis
41
what is intussusception? What ages does it affect? M or F MC?
1-2y/o Invaginating/telescoping bowel (folds in on itself) M>F
42
what are the RF of intussusception?
Meckel diverticulum URTI Henoch Schonlein Purpura CF
43
Sx of intussusception?
Infantile colic (severe) abdo pain Pale, unwell + lethargic Recurrent jelly stools (Late) RUQ Sausage mass (palpation) Knees to chest Inconsolable crying Intestinal obstruction (N+V, Constopation, distension)
44
Dx of intussusception? what is seen?
1. Abdo USS = target sign (hyper - o - echogenicity) Abdo Xray = distended Contrast enema
45
Tx of intussusception?
Rectal air insufflation Surgical if not working
46
Complications of intussusception?
Gangrenous bowel Obstruction Perforation Peritonitis
47
What is hirschprung?
Congenital condition - aganglionic bowel No parasympathetic ganglion cells - failed ganglion migration so no nerve cells of myenteric plexus In distal bowel + rectum = uncoordinated peristalsis = large bowel
48
RF of hirschprung? M or F MC?
M>F (3:1) MEN 2A/B Downs newborns
49
what part of the colon does hirschprung usually affect ?
rectosigmoid colon
50
Sx of hirschprung?
Failure to pass meconium <24/48hr (even with gastriflin) Abdo pain + distension billows vomiting FTT
51
What sign is seen in hirschprung? What is it?
Squirt sign DRE = Forceful expulsion of stool and gas
52
Dx of hirschprung? what is seen?
1. Abdo Xray with barium contrast = dilated bowel loops and fluid level GS. Rectal suction biopsy - absence off ganglionic cells
53
Tx of hirschprung?
Manual evacuation with bowel imaging then surgery (Swenson procedure)
54
Complications of hirschprung?
HAEC (superinfection with C.diff + severe diarrhoea - IV fluid, electrolyte balance and IV Vancomycin) SBP
55
what is the MC GI tract congenital abnormality?
Meckels diverticulum
56
What is Meckels diverticulum?
Remanent of omphalomesenteric duct, congenital diverticulum of small intestine
57
what is the rule of 2 is meckels?
2% population 2ft from ileocoecal valve 2 inches long 2y/o
58
Sx of meckels?
Severe, painless dark red PR bleeding (ulcers due to 2-3x tissue types - pancreatic, gastric) Commonest cause of painless massive GI bleeds in infants
59
Dx of meckels?
Technetium 99m scan
60
Tx of meckels?
surgical resection +/- transfusion if severe haemorrhage
61
complications of meckels?
Intussusception Volvulus Diverticulitis
62
What is intestinal malrotation?
Congenital abnormality, mesentery is not fixed/shorter = abnormal rotation +/- Ladd band formation = intestines settle incorrectly
63
Sx of intestinal malrotation?
1st week of life bilous vomiting, constipation + abdo distension
64
Dx of intestinal malrotation?
1. Abdo USS GS. Urgent GI contrast study
65
Tx of intestinal malrotation?
Surgery, laparotomy LADD procedure
66
What is pyloric stenosis?
hypertrophy of pyloric sphincter - prevents food travelling to duodenum
67
what gender and age experience pyloric stenosis?
5:1 M>F 2-7 weeks, around 1 month most
68
Sx of pyloric stenosis?
First few weeks: FTT, thin, pale, dehydrated PROJECTILE non bilous vomiting Olive mass in RUQ Visible peristalsis post feed
69
Dx of pyloric stenosis? what is seen?
Abdo USS = Thickened pylorus (target, astral rupple) VBG = Low Cl- + K+, metabolic alkalosis
70
Tx of pyloric stenosis? 1st and GS?
1st = fluids and electrolytes GS = Laparoscopic Ramstedt pyloromyotomy
71
what is the MC cause of infant vomiting?
GOR
72
what is Gastro oesophageal Reflux (GOR)?
immature functional oesophageal LOS - Inappropriate relaxation of LOS, reflux into oesophagus
73
RF for GOR? what age does it usually occur?
cerebral palsy! Prematurity! Laryngimalacia <8 weeks
74
Sx of GOR?
Chronic milky vomit/regurgitation (worse lying flat/after feed) Gain weight normally Problematic reflux = Chronic cough, hoarse cry, distress post feeding, reluctance to feed, FTT
75
Dx of GOR?
Clinical + 24hr pH monitor +/- endoscopy + biopsy
76
Tx of GOR? 1st, 2nd and 3rd?
1st = small meals, keep upright breastfed = gaviscon bottle = thickener 2nd = Alginate (thickener) 3rd = 4 wk PPI/H2-R Antacid Nissen procedure
77
Complication of chronic vomiting in GOR?
Torticollis Sandifer syndrome (neuro Sx = acute dysarthria, seizures, CN4 Palsy)
78
What is cows milk protein allergy (CMPA)? RF?
allergy / intolerance to cows milk RF = Formula feed, personal / FHx of atopy
79
when does cows milk protein allergy present? age?
Child weened from breast milk to formula feed Presents around <1y/o Intolerance = 3y allergy = 5y
80
what is cows milk protein ALLERGY and Sx?
T1 hypersensitivity to protein in cows milk - IgE mediated = Rapid <2hr response Flushing, Hives, angioedema, Rhinorrhoea, urticaria, Cough/wheeze, eczema +/- anaphylaxis
81
what is cows milk protein INTOLERANCE and Sx?
Non allergy / IgE = over several days Abdo pain, loose stools, poor sleep, dry skin/rashes, colic, perianal redness
82
Dx of cows milk protein allergy?
Clinical IgE skin prick test (RAST) GS = Elimination test
83
Ddx of cows milk protein allergy?
Lactose intolerance allergy to lactose sugar CMPA sufferers do not have an allergy to lactose
84
If a baby is having cows milk <1y/o, what are they at risk of?
Fe deficiency anemia
85
Tx of cows milk protein allergy?
Extensively hydrolysed feed (if breastfeeding = lower maternal dairy intake) Milk ladder reintroduction: Biscuit - muffin - pancake - cheese - yogurt - milk
86
What is gastroenteritis?
Inflammation. of stomach (gastritis - N+V) to intestines (enteritis - diarrhoea)
87
what causes gastroenteritis in developing and developed countries?
Developing = Bacteria from contaminated food Developed = viral, hydration
88
what are the causative organisms of gastroenteritis?
MC = Viral: Rotavirus (kids) Norovirus (adults) Bacterial: E.coli (traveller with HUS) C.Jejuni MC (undercooked BBQ + GBS) Salmonella (undercooked chicken) Bacillus cenus = rice
89
what does E.Coli 0157 cause?
Abx = increased risk HUS (Haemolytic uremic syndrome)
90
Sx of gastroenteritis?
N+V Abdo pain diarrhoea (+/- bloody)
91
Dx of gastroenteritis?
FBC, ESR/CRP, U+E, stool MC+S, travel Hx Assess dehydration
92
Tx of gastroenteritis?
Isolation of Px in hospital, school isolation until ASx >48hrs Dehydration = PO fluids, discourage fruit juices / carbonated drinks - dehrdration = 50ml/kg ORS
93
what is toddler diarrhoea? Sx? age it occurs? RF?
Functional GI immaturity Chronic loose stools (pees, carrot appearance), systemically well, no FTT 5 years old or less Premature
94
Causes of constipation?
1^ = idiopathic, functional, Opiates, over enthusiastic potty training 2^ = Hypothyroid, Hirschprung, LD, CF, CMPI, S.C lesions, abuse, anal stenosis
95
what is the ROME III criteria for paediatric functional constipation?
<2 defacation / week painful hard stool rectal fecal mass Can result in overflow diarrhoea (involuntary watery encopresis in pants)
96
Tx of Constipation?
1st = Movicol 2nd = Senna +/- lactulose 3rd = Enema or manual evacuation
97
what are threadworms caused by? Sx? Dx? Tx?
Enterobius vermicularis (pinworm) Itchy bum with white things in stool perianal sellotape MC+S Mebenazole to all household >6m + hygiene advice

Phase 3a Paeds (14 decks)

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