GI Flashcards
(126 cards)
1
Q
In which age group in children is GOR most common?
A
Children under 1 years old
Resolves usually afterwards
2
Q
What does projectile vomiting suggest?
A
Pyloric stenosis or intestinal obstruction
3
Q
What does a baby not keeping down any feed suggest?
A
Pyloric stenosis or intestinal obstruction
4
Q
What does a baby with bile stained vomit suggest?
A
Intestinal obstruction. Malrotation +/- volvulus, duodenal or bowel atresia. Hisprungs. Etc.
5
Q
What does haematemesis or malena suggest?
A
Peptic ulcer
Oesophagitis
Varices
6
Q
What does abdomen distension suggest?
A
Intestinal obstruction leading to food being stuck.
7
Q
What is the brief pathophysiology behind GOR?
A
Babies have immature lower oesophageal sphincter which allows stomach contents to reflux easily into oesophagus.
8
Q
Risk factors for GOR
A
Premature baby
Horizontal laying, not upright most of the time.
Sedentary activity.
9
Q
Imaging of choice for GOR
A
Barium meal + endoscopy
10
Q
What advice would you give for GOR children’s parents?
A
Small meals
No overfeeding
Burp regularly
Thickened milk or formula
11
Q
What medications exist for GOR in children?
A
Gaviscon (mixed with feeds)
Ranitidine +/- omeprazole
12
Q
What surgery can be used to correct severe cases of GOR?
A
Fundoplication
13
Q
What is Sandifer syndrome?
A
Rare, brief episodes of abnormal movements associated with GOR (in infants). Resolves on treating the GOR.
14
Q
What are clinical features of Sandifer syndrome?
A
Torticollis and dystonia
15
Q
Pyloric stenosis is most common in ______ of life
A
First few weeks
16
Q
What is the “mass” that feels like a large olive in the abdomen?
A
Pyloric muscle hypertrophy causing the mass
17
Q
How would a baby look with pyloric stenosis?
A
Thin, pale and failing to thrive
18
Q
What is the risk of feeding with pyloric stenosis children?
A
Projectile vomiting
19
Q
Food is prevented from travelling to the ______ in pyloric stenosis
A
Duodenum
20
Q
Gold standard investigation for pyloric stenosis? And what would it show?
A
Abdo USS
Shows thickened pylorus
21
Q
Why would you get low chloride and metabolic alkalosis with pyloric stenosis?
A
Loss of HCl from stomach due to vomiting
22
Q
What is the treatment for pyloric stenosis?
A
Laparoscopic pyloromyotomy
Widens pyloric canal with an incision
23
Q
What does NESTS stand for with Crohn’s (Crow’s) disease?
A
No blood or mucus Entire GI tract Skip lesions Terminal ileum/transmural inflammation Smoking = risk factor
24
Q
What does CLOSEUP stand for with UC (U C CLOSEUP)?
A
Continuous inflammation Limited to colon and rectum Only superficial mucosa affected Smoking is protective Excrete blood and mucus Use aminosalycylates Primary sclerosing cholangitis
25
What are common clinical features of IBD?
```
Diarrhoea
Abdominal pain
Bleeding
Weight loss
Anaemia
Fevers malaise dehydration
```
26
Give some extra-GI signs of IBD
```
Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis and iritis
Inflammatory arthritis
PSC (In UC)
```
27
What blood tests can be done for IBD?
```
CRP (inflammation)
Faecal calprotectin
Anaemia (B12/folate/iron)
TFT
Kidney function tests
LFT
```
28
What is the gold standard test for IBD?
Endoscopy and biopsy
29
Why are USS/CT/MRI used in IBD?
Find fistulas, abscess and strictures
30
Which medications are used to a) induce remission in Crohn's, b) maintain remission in Crohn's?
a) Steroids
| b) Immunosuppresants - azathioprine, infliximab
31
What is the 2 most common medication types used in UC?
1. Mesasalazine (aminosalicylate)
| 2. Steroids
32
What surgical options are there for UC patients?
Surgical resection of colon and rectum and then put in ileostomy or J pouch
33
List 3 GI causes of constipation
Hirschsprung's
Intestinal obstruction
Anal stenosis/malformation
34
What conditions usually result in meconium ileus?
Cystic fibrosis
| Hirschsprung's
35
What feeding allergy can usually result in constipation?
Cow's Milk Protein allergy
36
Which lifestyle factors can result in long-standing constipation issues in children?
```
Low fibre diet
Habitual holding of stool in bowel
Poor fluid intake/dehydration
Sedentary
Psychosocial issues at home/school
```
37
Define encopresis
Faecal incontinence in children who are past the age of toilet training
38
How can chronic constipation affect the rectum?
Rectum stretched and loses sensation.
Only hard, large stools remain in rectum.
Only loose stools leak out and cause soiling.
39
List causes of encopresis
```
Spina bifida
Hirschsprung's
Cerebral palsy
LD
Psychosocial stress
Abuse
```
40
What is meconium comprised of?
Sticky, thick, dark green poop.
| Intestinal epithelial cells, Ianugo, amniotic fluid, bile and water.
41
Meconium aspiration syndrome: list some clinical features
Amniotic fluid is meconium-stained (green.
Baby has meconium stains.
Baby has breathing problems or slow HR.
Limp baby.
42
How can meconium aspiration syndrome be confirmed?
Chest X-ray in babies with breathing problems and born in meconium stained amniotic fluid.
43
How can children with constipation present?
```
Straining
Rabbit dropping stools
Retentive posture
Rectal bleeding
Encopresis
Loose, smelly stools
Hard stools palpable in abdomen
Loss of PR tone
```
44
What does ribbon stool suggest?
Anal stenosis
45
What can failure to thrive with constipation suggest?
Coeliac disease
HypOthyroidism
Safeguarding concerns
46
A baby has constipation with acute severe abdo pain and bloating. What are 2 main differentials?
Intestinal obstruction
| Intussusception
47
What advice can you give to parents if their child is constipated?
Praise and encourage proper toileting
High fibre diet and good hydration
Encourage activity
48
What is the first line drug used in constipation in children?
Movicol (laxative)
49
List some complications of long-term constipation
```
Anal fissures
Haemorrhoids
Loss of anal sensation
Encopresis
Psychosocial issues
Chronic pain
```
50
What are main causes of intussusception?
Concurrent viral infection (Viral URTI)
```
Others:
HSP
Cystic fibrosis
Intestinal polyps
Meckel's diverticulum
```
51
What are the 2 main clinical characteristics of intussusception?
Redcurrant jelly stool
| Sausage shaped mass on RUQ palpation
52
Gold standard investigation of intussception is ______
USS abdomen
Also contrast enema
53
Give a non-surgical way to treat intussusception
Therapeutic enema
54
When is surgical resection indicated in intussuception?
Gangrenous or perforated bowel
55
What can cause abdominal pain in girls exclusively?
```
Dysmenorhoea (period pain)
Mittelscherz (ovulation pain)
Ectopic pregnancy/Pregnancy
PID
Ovarian torsion
```
56
What can cause abdominal pain in boys exclusively?
Testicular torsion
57
Give some red flags for abdominal pain
```
Persistent or bile vomiting
Severe chronic diarrhgoea
Fever
Rectal bleeding
Weight loss or faltering growth
Dysphagia
Night time pain
Abdominal tenderness
```
58
What bloods can be done for abdominal pain?
Anaemia (IBD/Coeliac)
ESR/CRP (IBD)
Anti-TTG/Anti-EMA (Coeliac)
Faecal calprotectin (IBD)
59
Can UTI cause abdominal pain in children? And how would you find out?
Yes. Use urine dipstick test to check for leukocytes, nitrites and blood. Send for MC&S to culture urine growth
60
List differentials of appendicitis
```
Ectopic pregnancy
Ovarian cysts
Meckel's diverticulum
Mesenteric adenitis
Appendix mass
```
61
What is the most common position of the appendix?
Retrocaecal
62
What is mesenteric adenitis?
Inflamed abdominal lymph nodes.
Associated with tonsillitis or URTI. Causes abdo pain especially in younger children
63
How does the pain present with appendicitis
Generalised abdo pain that moves to the RIF over time
64
_______'s point is palpated in the abdomen to reveal tenderness in appendicitis
McBurney
65
What is Rovsing's sign?
Palpating LIF causes pain in RIF. (in appendicitis)
66
Which acute condition is guarding, rebound tenderness and percussion tenderness found in?
Appendicitis
67
Why can appendicitis lead to peritonitis?
Appendix inflames and becomes gangrenous. Ruptures and releases faecal content into abdomen, irritating the peritoneum.
68
How can gynae and ovarian causes be excluded in appendicitis in females?
USS abdomen
69
What are complications of appendicitis surgery?
Bleeding, infection, pain, scars
Damage to bowel and other structures around
Anaesthetic risks
VTE (DVT/PE)
70
What are the genes associated with Coeliac disease?
HLA-DQ2 (90%)
| HLA-DQ8
71
Give some clinical features of coeliac disease
```
Diarrhoea
Failure to thrive/weight loss
Fatigue
Mouth ulcers
Anaemia symptoms
Dermatitis herpetiformis
```
72
What is Dermatitis herpetiformis?
Itchy, blistering skin rash on abdomen. Occurs with Coeliac disease
73
Give 2 gold standard blood tests for Coeliac disease
Anti-TTG and Anti-EMA antibodies
74
Which immunoglobulin deficiency can cause a false negative for Coeliac disease?
IgA
75
What would an endoscopy with biopsy show for a Coeliac patient?
Crypt hypertrophy
| Villi atrophy
76
What is the only treatment for Coeliac disease?
Life-long gluten free diet
77
List some complications of Coeliac disease
```
Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
Non-Hodgkin's Lymphoma
```
78
How is the bowel affected in Hirschsprung's?
Section is devoid of parasympathetic ganglion cells.
Unable to peristalsis due to lack of innervation.
Bowel becomes +++ distended due to faecal collection
79
Give 2 gold standard investigations for Hirshsprung's
Rectal biopsy
| AXR
80
How does HAEC present?
2-4 week old neonate with Hirschsprung's. Fever, abdo distension, diarrhoea with blood and sepsis features.
81
How is HAEC treated?
Antibiotics
Fluid resuscitation
Decompression of obstructed bowel
82
How is Hirschsprung's affected bowel definitively treated?
Surgical removal of aganglionic bowel section and pull-through.
83
When the bile duct is narrowed or absent, this is called biliary ______
Atresia
84
What pigment builds up in the body due to biliary atresia?
Conjugated bilirubin
85
What is Kasai portoenterostomy?
Surgical treatment for biliary atresia.
Small intestine attached to liver opening to bypass all bile ducts.
Allows jaundice to be cleared as liver empties into small intestine directly.
86
How can breast milk cause jaundice?
Substances in breast milk inhibit gluconryl-transferase, reducing bilirubin conjugation and resulting in jaundice.
87
List the causes of vomiting in children
```
Bulimia
Intestinal obstruction
Infections
Appendicitis
overfeeding
GOR
Pyloric stenosis (projectile)
Gastroenteritis
```
88
What kind of infections can cause vomiting in children?
UTI
Tonsilitis
Meningitis
89
What the 2 most common viral causes of gastroenteritis?
Norovirus
| Rotavirus
90
What 3 factors are present in Haemolytic Uraemic Syndrome?
Low platelets
Low RBCs
Kidney failure
91
Haemolytic Uraemic Syndrome is caused by which bacteria and which toxin?
E. coli O157
Shigella
Shiga toxin
92
Which pathogen is responsible for Traveller's diarrhoea?
Campylobacter
93
Which pathogen grows best on left over fried rice (food not refrigerated after cooking)?
Bacillus cereus
94
How does gastroenteritis commonly present?
Abdo cramps/pain
Diarrhoea +/- blood
Fever
Vomiting
95
What investigations are done for gastroenteritis?
Stool - microscopy, culture and abx sensitivities
96
Why is dioralyte used in gastroenteritis treatment?
Rehydrate child after diarrhoea episodes
97
Can complications arise from gastroenteritis?
Yes:
IBS
GBS
Reactive arthritis
98
What is the gold standard investigation for Meckel's diverticulum?
Technetium scan
| shows uptake by ectopic gastric mucosa
99
How does a child with infant colic present?
Inconsolable crying/screaming
Drawing up of knees
Farting many times daily
100
What is a potential secondary cause if infant colic does not resolve?
GORD
| Cow's milk protein allergy
101
By which age does Cow's milk protein allergy usually resolve?
5 years old
102
Give some symptoms of Cow's milk protein allergy
Skin: rashes, eczema
GI: N+V, abdo pain
Resp: runny nose, wheeze
103
_____-feeding exclusively can protect against Cow's milk protein allergy
Breast
104
How do lactose intolerance and CMPA differ?
```
Lactose = sugar in milk
CMPA = protein in milk, presents earlier in childhood
```
105
What are the 5 main causes of faltering weight?
```
Inadequate intake
Inadequate retention
Malabsorption
Failure to utilise nutrients
Increased requirements
```
106
Give some examples of inadequate intake in FTT
Feeding problems
Psychosocial deprivation
Impaired suck/swallow
107
Give 2 examples of inadequate retention in FTT
Vomiting
| Severe GORD
108
Give examples of malabsorption in FTT
Coeliac
CF
CMPA
Cholestatic liver disease
109
Give examples of failure to utilise nutrients
```
Metabolic disorders
Chromosomal disorders (DS)
Extreme prematurity
Metabolic disorders
Congenital hypothyroidism
```
110
Give examples of increased requirements
```
Thyrotoxicosis
CF
Malignancy
HIV/Immunodeficient
Congenital heart disease
CKD
```
111
What blood tests can be done to identify iron-deficiency anaemia?
FBC
| Serum ferrittin
112
What professionals can aid with feeding issues?
SALT
Dietician
Health visitor
GP
113
What are the 2 main features of neonatal hepatic syndrome?
1. Neonatal jaundice
| 2. Hepatic inflammation
114
How many babies present with neonatal hepatic syndrome?
Low birthwieght
Faltering growth
Jaundice
115
What does liver biopsy show with neonatal hepatic syndrome?
Giant cell hepatitis
116
What are choledocal cysts?
Cystic dilations of extrahepatic biliary tree.
117
How are choledocal cysts investigated?
USS
| MR cholangiopancreatography
118
What would be found on blood tests to investigate liver failure?
```
Bilirubin elevated
AST/ALT elevated
ALP elevated
Coagulation abnormal
Plasma ammonia elevated
```
119
What can an EEG and CT show with liver failure?
EEG: Acute hepatic encephalopathy
CT: Cerebral oedema
120
What is kernicterus?
Encephalopathy resulting from excess unconjugated bilirubin.
(Not enough albumin to bind the excess bilirubin)
121
Why is kernicterus rarer nowadays?
Prophylactic anti-D immunoglobulins for rhesus-negative mothers.
Less cross reactivity between baby's and mother's blood --> less haemolysis and RBC breakdown.
122
Give 2 causes of jaundice <24 hours of age
1. Rhesus haemolytic disease
2. ABO incompatibility
3. G6PD deficiency
4. Spherocytosis
5. Pyruvate Kinase deficiency
123
Which test can show antibodies in ABO compatiblity on the surface of foetal red cells?
Coomb's test
124
Give 2 causes of jaundice between 24h to 2 weeks of age
```
Physiological jaundice
Breast milk jaundice
Infection - UTI
Haemolysis: G6PD deficiency, ABO incompatibility
Bruising
Polycythaemia
Crigler-Najjar syndrome
```
125
Give 2 causes of UNconjugated jaundice in children >2 weeks of age
```
Physiological jaundice
Breast milk jaundice
Infection
Hypothyroidism
Haemolysis: G6PD deficiency
High GI obstruction - e.g. pyloric stenosis
```
126
Give 2 causes of conjugated jaundice in children >2 weeks of age
Bile duct obstruction
| Neonatal hepatitis
