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Paediatrics > GI > Flashcards

GI Flashcards

1
Q

How common is constipation in children?

A

Is common

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2
Q

What is constipation?

A

There is a wide range and a wide range what is normal
-As long as it is soft, easy to pass and not painful

Has there been a change?

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3
Q

S+S for constipation?

A 
Poor appetite
Irritable
Lack of energy
Abdominal pain or distension
Withholding or straining

Even children with diarrhoea may be constipated

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4
Q

Why do children become constipated?

A

Social = poor diet, potty training / school toilet

Physical = intercurrent illness / medication

FH, psychological or organic

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5
Q

What condition can make you constipated?

A

Hypothyroidism

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6
Q

What main class of drugs can make you constipated?

A

Opioids

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7
Q

What is the treatment for constipation?

A 
Explanation 
Make sure the stool never gets hard again
-Osmotic laxatives (movicol)
-Stimulant laxatives (senna)
Re-train the bowel
Remove the impaction
Dietary changes
Reduce aversive factors of going to the toilet
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8
Q

What is the treatment for impaction?

A

Empty impacted rectum

Empty colon

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9
Q

What is the difference between adult and child UC?

A

Worse in children

Common to have pancolitis

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10
Q

What is the difference between adult and child Crohn’s?

A

Panenteric disease in children
More extensive
Gets worse with time

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11
Q

How does UC present?

A

Diarrhoea, rectal bleeding and abdominal pain
Does not affect their growth
Bloods can be normal
Not many systemic features

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12
Q

How does Crohn’s disease present?

A

Depends where it is
Weight loss and abdominal pain
May not be diarrhoea and therefore difficult to diagnose

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13
Q

History and examination for inflammatory bowel disease?

A 
Intestinal symps
Extra-intestinal manifestations
Exclude infection - arthritis
FH
Growth and sexual development
Nutritional status
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14
Q

Investigations for inflammatory bowel disease?

A

FBC
Faecal calprotectin
Endoscopy and colonoscopy + mucosal biopsy

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15
Q

What are the 3 phases of vomiting?

A

Pre-ejection
Ejection
Post-ejection

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16
Q

What stimulates vomiting?

A 
Pathogens / infection
Inflammation
Metabolic derangement
Head injury
Visual or middle ear stimuli
17
Q

What is pyloric stenosis?

A

Projectile non-bilious vomiting
Weight loss
Dehydration
-Metabolic alkalsosis

18
Q

What is bilious vomiting?

A

Red flag

Due to intestinal obstruction until proven otherwise

19
Q

What can cause bilious vomiting?

A 
Intestinal atresia
Malrotation
Intussusception
Ileus
Crohn's disease
20
Q

What are the investigations for bilious vomiting?

A

Abdominal x-ray
Contrast meal
Surgical exploratory laparotomy

21
Q

What can cause effortless vomiting?

A

Gastro-oesophageal refulx

22
Q

What are the symptoms of GO reflux?

A

Vomiting and haematemesis
Feeding problems and FTT
Apnoea, cough, wheeze and chest infections
Sandifer’s syndrome

23
Q

How to assess GO reflux?

A 
H+E
Radiological investigations
pH study
Oesophageal impedance monitoring
Endoscopy
24
Q

What is the treatment for reflux?

A

Feeding advice
Nutritional support
Medical treatment
Surgery

25
Q

What is Nissen fundoplication?

A

Fundus is wrapped around the oesophagus

26
Q

What is chronic diarrhoea?

A

4 or more stools per day for more than 4 weeks

27
Q

What can cause diarrhoea?

A

Motility disorders
-Toddler diarrhoea and IBS

Active secretion

  • Acute infective diarrhoea
  • Inflammatory bowel disease

Malabsorption of nutrients

  • Food allergy
  • Coeliac diseas
  • CF
28
Q

What is secretory diarrhoea?

A

Associated with toxin produced from pathogens

29
Q

What is motility diarrhoea?

A

Classically toddlers diarrhoea

-Irritable bowel, hyperthyroidism or chronic intestinal pseudo-obstruction

30
Q

What is inflammatory diarrhoea?

A

Malabsorption due to intestinal damage
Secretory effects of cytokines
Accelerated transit time

31
Q

Clinical approach to diarrhoea?

A

History
Consider growth and weight gain of child

faeces analysis

  • Appearance
  • Culture
  • Secretory vs. osmotic
32
Q

What can cause fat malabsorption?

A

Pancreatic disease

  • Lack of lipase
  • Classically CF

Hepatobiliary disease

  • Chronic liver disease
  • Cholestasis
33
Q

How does coeliac disease present?

A 
Bloated
Diarrhoea
FTT
Short
Constipation
Tiredness
Dermatitis herpatiformis
34
Q

What are the screening test for coeliac?

A

Seological screens
-Anti-tissue transgluraminase

Gold standard is a duodenal biposy

Genetic testing of HLA DQ2/8

35
Q

What is the treatment for coeliac disease?

A

Gluten-free for life

Paediatrics (15 decks)

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