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GI Flashcards

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1
Q

coeliac - features in kids

A

stools - pale, bulky, increased/diarrhoea
abdo - distension
systemic - fatigue, pallor
growth - weight loss + failure to thrive

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2
Q

coeliac - investigations in kids

A

diagnosis (reintroduce gluten 6wk before):
anti-TTG
jejunal biopsy - villous atrophy

plus:
FBC - microcytic anaemia
stool culture + calprotectin - rule out other

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3
Q

commonest cause of haematemesis in kids

A

mallory weiss

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4
Q

commonest cause of opening bowels at night in kids

A

colitis

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5
Q

commonest cause of blood mixed with stool in kids

A

gastroenteritis - usually bacterial

poss colitis

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6
Q

commonest cause of mucus in stool in kids

A

inflammation

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7
Q

viral GE hx - things to ask about in kids

A

dehydration risk - eating, drinking, urinating

sources - contacts, travel, animals, unusual/contaminated foods

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8
Q

IBD - symptoms in kids

A

abdo pain
stools - diarrhoea, tenesmus, mucus, blood
constitutional - fatigue, fever, weight loss
chron’s - mouth ulcers + perianal disease

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9
Q

IBD - investigations in kids

A

faecal calprotectin - marks gut damage (not IBD specific)

endoscopy:
mainstay of diagnosis - flex sig then colonoscopy if needs be

bloods:
FBC - anaemia
B12, folate + iron - deficiency in small bowel disease / aggressive colitis
LFTs - other effects of disease 
CRP - disease activity

rule out:
coeliac - anti-TTG
stool culture

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10
Q

chron’s - treatment to induce remission in kids

A

prednisolone 2-4wk → taper 4-8wk
calcium + vit D ± PPI
or
6wk enteral nutrition eg NG + gradually reintroduce food

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11
Q

UC - treatment in kids

A

mild:
mesalazine oral/suppositories

mod:
steroids 2-4wk + taper
then mesalazine

*mesalazine = 5-ASA
treatment involves inducing + maintaining remission

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12
Q

anorexia nervosa management (kids)

A 
refer psych
nutrition - vitamins (thiamine, B complex, multivits),
diet plan, dietitian
monitor - obs, bloods esp phosphate, ECG
therapy - CBT, family CBT
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13
Q

GE - investigations in kids

A

U+Es + glucose if dehydrated
blood cultures if starting abx

stool culture if BmITS:
blood/mucus
immunosuppressed
travel
?septicaemia
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14
Q

signs of dehydration in an infant

A

sunken - fontanelle + eyes
surfaces - dry membranes + reduced turgor
circulation - tachy, weak pulse, hypotn, ↑CRT
oliguria

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15
Q

severe dehydration in GE - red flags that indicate need for treatment? what is the treatment?

A

shock
persistent vomiting
hypoglycaemia
red flags

IV fluids - 1-2x bolus then maintenance

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16
Q

management + counselling of mild-mod dehydration in GE in kids

A

ORS
glucose + electrolytes
50ml/kg in 4h + maintenance

± usual fluids but not juice/fizzy
continue breast/formula
safety net

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17
Q

2 commonest pathogens that cause GE in kids

A

rotavirus

adenovirus

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18
Q

intussusception - presentation + examination finding

A 
episodes of:
severe colicky pain - legs drawn up
pallor + crying +- vomiting
recovery + lethargy
red currant jelly stool

sausage lump may be palpable

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19
Q

e coli in kids - presentation

Study These Flashcards
A

bloody diarrhoea
abdo pain, fever + lethargy
seizures
haemolytic uraemic syndrome

20
Q

how does haemolytic anaemic syndrome present?

Study These Flashcards
A

progressive:
haemolytic anaemia
low platelets
AKI (uraemia)

± jaundice

21
Q

differentials - blood in stool WITH D+V in kids

Study These Flashcards
A 
intussusception
gastroenteritis - docs to the RESCue:
Rotavirus
E coli
Shigella
Campylobacter
22
Q

vomiting in kids - RFgs

Study These Flashcards
A

3 vom - “blood, bile, projectile”:
blood - usually MW
bile - proximal BO, meconium ileus
projectile - pyloric stenosis if <2mo

3 other - 1 at the top, 1 in the middle, 1 at the bottom:
fontanelle bulging - ^ICP - meningitis
abdo distension - proximal BO
stool bloody or jelly - GE (salmonella/campy), intusussception

fever - UTI/meningitis
cough - whooping cough

23
Q

viral GE - advice for parents on home management? safety netting?

Study These Flashcards
A

48h nursery rule
continue breast/formula, must reintroduce by 24h
diarrhoea lasts 5-7d - 5ml/kg ORS after episodes

get help if:
unwell
behaviour - irritable/lethargic
looks - mottled/pale/cold
sx - vomiting > 3d + decreased urine
24
Q

diarrhoea
symptoms to ask about?
red flags for acute illness?
investigations?

Study These Flashcards
A

blood + mucus

rule out:
sepsis
dehydration/shock - consistency, frequency, duration, fluid intake/wee

send stool for microbiology if BmITS:
blood/mucus
immunocompromised
travel
?septicaemia
25
lyme disease - 3 stages | mgmt
1 - rash + nonspecific symptoms 2 - meningitis, facial palsy, arthritis, carditis 3 - neuropsych probs + fatigue cefuroxime + amoxicillin - can give based on clinical diagnosis
26
intussusception - mgmt
fluid resus if stable + no peritonitis/perf - air insufflation under radiological control if not - surgery
27
intusussception - investigation
USS - target-like mass
28
constipation - examination + mgmt
check/ask re impaction - severe constp symps, overflow, mass palpable movicol (+ stimulant lax if no response) - maintenance for several weeks then taper when bowels regular increase fibre + fluids increase activity level
29
red flags constipation
neonatal: from birth/first weeks of life meconium >48h the poo itself: ribbon abdo distension w vomiting - obstruction/hirschprungs systemic: faltering growth leg weakness, locomotor delay
30
faecal impaction due to constipation - management + counselling
movicol on escalating dose regimen inform this can initially increase soiling + abdo pain add stimulant laxative if not disimpacted in 2wk
31
appendicitis - symptoms
``` central abdo pain that radiates to RIF low grade pyrexia minimal vomiting but can be anything >4y ```
32
congenital diaphragmatic hernia - what is it? outcomes?
herniation of abdo into chest from incomplete diaphragm formation can → pulmonary hypoplasia + HTN → resp distress after birth 50% mortality can be screen detected *think of the hernia squishing the lungs, increasing the pressure inside and preventing their growth*
33
cows milk protein intolerance/allergy - features? outcome?
``` skin - urticaria + atopic eczema GI - regurg, vomiting, diarrhoea resp - wheeze + chronic cough mood - irritability + crying growth - failure to thrive ``` immediate (minutes) - allergy delayed (hours-days) - intolerance usually resolves by 1-2y
34
cows milk protein allergy - diagnosis
often clinical - cut out and see if need to test: skin prick / patch testing CMP-specific + total IgE (RAST)
35
cows milk protein allergy - management
if formula fed: 1° - extensively hydrolysed milk 2° - amino acid based formula if breastfed: eliminate CMP from mum's diet + continue breastfeeding when breastfeeding stops - use eHF milk until 12mo safety net anaphylaxis refer paeds if severe
36
how long should D+V last in kids? max duration?
D - 5-7d, max 2wk | V - 1-2d, max 3d
37
hirschprung's - what is it? presentation? diagnosis? associations? management?
aganglionic segment of bowel assoc with down's neonate - meconium absent or >24h older - constipation + distension diagnosis: 1) abdo xray 2) confirmation - full thickness rectal biopsy rectal washouts then anorectal pull through procedure - dodgy bowel pulled out + healthy bits joined together
38
pyloric stenosis - age group affected, presentation, diagnosis + management
``` at 2-6wk projectile, non-bilious vomiting usually 30min after feed diagnosis - USS or test feed treatment - surgery ``` hypertrophy of circular muscles of pylorus
39
meconium ileus - presentation, association + management
delayed meconium distension + bilious vomiting most have CF management: 1° - contrast enema - may dislodge mucus plugs 2° - nasogastric n-aycetylcysteine 3° - surgery
40
umbilical hernia - when found? assoc? outlook?
may be found on newborn exam should resolve by 3y assoc - afrocaribbean, down's
41
chronic diarrhoea in kids - differentials
cows milk intolerance coeliac post-GE lactose intolerance IBD
42
D+V in kids - management if no signs of dehydration
continue usual feeds + encourage fluids | discourage juice + fizzy
43
causes of jaundice in first 24h of life
ABO haemolytic disease Rhesus haemolytic disease G6PD Hereditary spherocytosis ARGH! just been born and i've already got fuckin jaundice
44
causes of jaundice in 2-14d of life
usually physiological eg breastfeeding
45
jaundice after 14d - investigations
prolonged jaundice screen, incl: c + uc bilirubin - biliary atresia coombs - autoimmune haemolytic anaemia TFTs
46
jaundice after 14d - causes
Biliary atresia Infection (congenital) eg CMV, toxoplasmosis Galactosaemia Hypothyroidism UTI Breastmilk big hub of bilirubin in me skin
47
intussusception - age? RF?
age 3mo-2y | HSP

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