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GI Flashcards

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1
Q

What leads infant growth

A

Nutrition

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2
Q

Is breast feeding or bottle feeding better

A

breast

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3
Q

What is the base of all formula feeds

A

Cow’s milk

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4
Q

Why is cow’s milk not suitable as the main drink until 1yr

A

Contains no iron

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5
Q

When should weaning commence

A

6 mnths

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6
Q

Reasons for weaning

A

Encourage tongue and jaw movements preparing for speech

Milk alone is inadequate

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7
Q

What is the most common food allergy in children

A

Cows Milk Protein Allergy

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8
Q

What type of reaction is CMPA

A

Delayed reaction

non- IgE mediated

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9
Q

Signs of CMPA

A

Diarrhoea
Abdo. Discomfort
Distension
Eczema

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10
Q

Ix for suspected CMPA

A

4wk trial avoidance
Special formula
Milk free diet for breast feeding mothers
Reintroduction at 4wks

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11
Q

1st line feed choice CMPA

A

Hyrolysed feed

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12
Q

2nd line feed choice CMPA

A

Amino acid based feeds

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13
Q

Which supplement may be required in CMPA

A

Calcium

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14
Q

Which milks are not advised for babies

A

Soya
Rice
Goats and Sheep
Oats and nut milks

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15
Q

Why is Rice milk not advised?

A

Contains arsenic

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16
Q

Why is goats and sheep milk not indicated

A

very allergenic

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17
Q

What is biliatry atresia

A

Type biliary obstruction

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18
Q

Pathology biliary atresia

A

Congenital fibro-inflammatory disease of bile ducts

Leading to destruction of extra-hepatic bile ducts

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19
Q

Signs biliary atresia

A

PALE STOOLS
Dark urine

Jaundice:
Prolonged
Conjugated

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20
Q

Why is timely Dx crucial for biliary atresia

A

Treatment time determines prognosis

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21
Q

Rx for Biliary atresia

A

Kasai Poroenterostomy:

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22
Q

Other causes biliary obstruction

A

Choledochoal cyst

Alagille Syndrome

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23
Q

Define chronic constipation

A

Infrequent passage stools

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24
Q

Causes of chronic constipation

A 
Poor diet:
Insufficient fluids 
Excessive milk 
Poor training 
School diet 
Intercurrent illness
Medications
FH 
Organic
Psychological Secondary Cause
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25
Which medications can cause constipation
Opiates | Gaviscon
26
Describe constipation cycle
Viscious cycle Child has a bad experience so shows faecal withholder behaviour Contracts external anal sphincter Can lead to megarectum
27
Which stool chart is used
Bristol
28
Advantages laxatives
Non invasive | Given by parents
29
Disadvantages laxatives
Non-compliance | side effects
30
Treatment of chronic constipation
Social: Explain Rx to parents Dietary: Increase fibre, fruits, veg Decrease milk Psychological: Soften stool Remove pain Reward good behaviour Soften stools and stimulate defeacation (Laxatives)
31
Which laxatives can be used
``` Osmotic laxatives (Lactulose) Simulant laxatives (Senna, Picolax) Isotonic Laxatives ```
32
Define chronic diarrhoea
4 or more stools/day | For >4 weeks
33
Describe osmotic diarrhoea
Movement H20 into bowel | Usually features of malabsorption (e.g CF, coeliac)
34
Describe Secretory diarrhoea
Classically associated with toxin production Need to rule out E.coli Also cholera Predominantly driven by active Cl- secretion via CFTR
35
Potential causes diarrhoea
Motility disturbance: Toddler Diarrhoea IBS Active Secretion: Acute infective diarrhoea IBD Malabsorption of Supplements: Food allergy Coeliac disease CF (particularly fat)
36
2 types IBS
Crohn's D | UC
37
Pathological features UC
Bloody mucous diarrhoea Limited to colon Tends to start distally and spread proximally No skip lesions Superficial inflammation (does not affect all the layers)
38
Pathological features CD
Can affect anywhere in the GI tract Depending on where is affected will determine the symptoms present Inflammation affect all layers Skip lesions can occur
39
CD manifestations skin
Erythema Nodusum
40
Differences between adults and child IBD
Children CD>UC Children M>F Isolated ileal disease less common children UC is typically pan colitis (less commonly proctitis)
41
Ix for IBD
``` History and Examination Exclude infection (stool culture) ``` Laboratory: FBC ESR Biochemistry: Stool Calprotectin CRP Radiological: MRI Barium meal ``` Endoscopy: Colonoscopy Upper GI endoscopy Mucosal biopsy Capsule endoscopy Enteroscopy ```
42
Management for IBD
Polymeric diet or oral prednisolone Steroid sparing agents (Azathioprine, Methotrexate) Biologics (Infliximab/ Adalibumab) Surgery
43
Which layer of the GIT is affected in CD
All layers
44
Which layer of the GI is affected in UC
Top layer
45
Where does UC affect in GIT
Limited to colon
46
Where does CD affect in GIT
Can affect anywhere
47
What should bilious vomiting always ring
ALARM BELLS
48
Potential causes bilious vomiting
Intestinal atresia Malrotation Ileus
49
What is bilious vomiting underlying cause
Due to intestinal obstruction until proven otherwise
50
Ix for bilious vomiting
Abdo. x-ray Contrast meals Surgical opinion: Exploratory laparotomy
51
What colour is bilious vomiting
Bile is green | NOT yellow
52
Rx for bilious vomiting
``` Urgent surgical opinion IV access IV fluids Nil by mouth NG tube ``` Treat underlying cause
53
Is GORD common
Yes very common
54
Features of GORD
``` Vomiting Hematemesis (rarely) Feeding problems Failure to thrive Apnoea Cough Wheeze Chest infections ```
55
Rx for GORD
Self-limiting Feeding advice: Thickeners for liquids Nutritional support: Calories supplemnet Exclusion diet NG tube Medial Rx: Feed thickener Pro-kinetic drugs Acid suppressing drugs Surgery: Last ressort Nissen Fundoplication
56
Medical Rx for GORD
Feed thickener (e.g Gaviscon) Pro-kinetic drugs Acid suppressing drugs (PPI, H2 receptor antag)
57
Feeding advice Rx for GORD
Thickeners for liquids Feeding position (450 Behavioural programme
58
Surgery Rx for GORD
Nissen Fundoplication
59
Genetic susceptibility in Coeliac
HLA-DQ2 | HLA-DQ8
60
Associations with coeliac disease
Other auto-immune diseases
61
Histological features of coeliac disease
Partial/total villous atrophy Lymphocyte infiltration Crypt hyperplasia
62
Clinical features of coeliac
``` Abdo. pain Bloating Diarrhoea Failure to thrive Short stature Constipation Fatigue Dermatitis Herpatiformis ```
63
Skin manifestation of coeliac
Dermatitis Herpatiformis
64
Ix for coeliac disease
Anti-tissue transglutaminase (screening test) Anti-endomysial Anti-gliadin Serum IgA Gold Standard: Duodenal biopsy Genetic testing: HLA DQ2 HLA DQ8
65
Rx for coeliac
Diet free life
66
Complications of coeliac disease
Risk rare small bowl lymphoma Infertility Osteoporosis

Paediatrics (13 decks)

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