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Year 4 Child Health > GI > Flashcards

GI Flashcards

1
Q

GI symptoms affecting the mouth/face

A 
angular cheilitis 
ulcers 
swollen lips 
facial rash 
thrush 
dental caries 
recurrent cold sores 
pigmented lips
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2
Q

what condition is pigmented lips associate with

A

Peutz-Jeghers syndrome

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3
Q

features of Peutz-Jeghers syndrome

A 
Autosomal dominant 
benign hamartomatous polyps in GI tract 
risk of bleeding and intussusception 
pigmented macules on lips 
may develop cancer 
breast, testes, ovarian, pancreas in adulthood
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4
Q

causes of angular cheilitis

A 
infection 
drooling 
eczema 
candida 
immunodeficiency 
IBD
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5
Q

causes of mouth ulcers

A

IBD

Coeliac disease

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6
Q

features of OFG

orofacialgranulomatosis

A

ulcers
swollen lips
facial rash

Granulomas
associated with Crohns disease

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7
Q

cause of recurrent thrush and ulcers

A

immunodeficiency

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8
Q

causes of dental caries

A

reflux
regurgitations
high sugar diet
poor dental hygiene

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9
Q

all endoscopies are carried out under GA in paediatric, true or false

A

true

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10
Q

imaging for small bowel

A

MRI (preferable - thickness of bowel wall and nodes)

barium follow through study

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11
Q

symptoms affecting the oesophgus

A 
retrosternal pain 
vomiting 
back arching 
cough / aspiration pneumonia 
malaena 
dysphagia 
odynophagia 
food bolus obstruction
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12
Q 
causes of:
retrosternal pain 
vomiting 
back arching 
cough / aspiration
A

GORD

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13
Q

If GORD leads to oesophageal erosion, what can develop

A

malaena

anaemia

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14
Q

Causes of:
dysphagia
odynophagia
food bolus obstruction

A

eosinophilic oesophagitis

achalasia (much rarer)

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15
Q

symptoms affecting stomach

A

epigastric pain
vomiting
malaena

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16
Q

symptoms of gastritis

A

epigastric pain
vomiting
malaena

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17
Q

causes of gastritis and ulcers

A

H.Pylori

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18
Q

H.pylori infection can present before 2 years old, true or false

A

false, rarely does

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19
Q

symptoms affecting small bowel

A 
(colicky) pain 
diarrhoea 
malaena 
vomiting 
failure to thrive
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20
Q

causes of diarrhoea

A

IBD
coeliac
food allergy

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21
Q

causes of blood in stool

A

Meckels diverticulum =

ectopic gastric tissue in the small bowel

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22
Q

bilious vomit?

A

bowel obstruction

needs urgent surgical review

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23
Q

the younger a child is the more likely they are to have bowel perforation from bowel obstruction, true or false

A

true

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24
Q

consequences of small bowel disease

A

failure to thrive, stunted growth

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25
symptoms affecting the large bowel
diarrhoea constipation bleeding pain
26
causes of diarrhoea
infection IBD coeliac disease
27
common cause for PR bleeding
constipation passage of bulky stools IBD infection
28
symptoms affecting perianal area
``` fissures ulcers abscess fistula skin tags ```
29
perianal crohns disease has a better/worse outcome than other types of crohns disease
worse prognosis | usually requires biological therapy
30
causes of fissures
crohns disease constipation child sexual abuse
31
symptoms of perianal crohns disease
``` fissures ulcers abscess fistula skin tags ```
32
kids commonly can develop haemorrhoids, true or false
false, very rare | skin tags are mistaken for haemorrhoids
33
skin manifestations of GI conditions
``` anaemia - pallor erythema nodosum pyoderma gangrenosum dermatitis herpetiformis eczema finger clubbing jaundice ```
34
what GI condition is erythema nodosum associated with
crohns disease
35
what GI condition is pyoderma gangrenosum associated and finger clubbing with
crohns and UC
36
what GI condition is associated with dermatitis herpetiformis
coeliac disease
37
eczema below the age of 6 months can be associated with with GI condition
cows milk protein allergy
38
what other conditions are associated with erythema nodosum
TB | sarcoidosis
39
features of erythema nodosum
painful ulcerate confined to legs and buttocks
40
features of pyoderma gangrenosum
confined to arms and legs | not responsive to antibiotics
41
management of erythema nodosum and pyoderma gangrenosum
steroids
42
features of dermatitis herpetiformis
can appear anywhere on the body | usually around elbows, knees, sacral/buttocks or perioral
43
structure for GI history taking
``` age of patient height / weight are they normally well weight loss infectious: contacts, travel, food, fever, drinking water N+V - how often stools: diarrhoea, constipation, PR bleeding, night rising acute vs chronic >6wk mouth ulcers appetite + feeding: quantify e.g. milk sleep Hx: allergies, eczema, autoimmunity FH - atopy, IBD, autoimmune medications - NSAIDs ```
44
``` what are possible pathologies associated with pain in the following regions: retrosternal epigastric RIF RUQ ```
retrosternal - GORD epigastric - gastritis RIF - appendicitis RUQ - gallstones
45
causes of gastroenteritis
viral (most common) bacterial parasitic
46
viral causes of gastroenteritis
noravirus adenovirus rotavirus (has vaccine)
47
bacterial causes of gastroenteritis
E.coli 0157 --> HUS C. difficile salmonella cryptosporidium
48
parasitic causes of gastroenteritis
giardia
49
treatment of all gastroenteritis involves antibiotics, true or false
FALSE! | most cases are viral anyway but if it happened to be E.coli 0157, then this would worsen HUS
50
what is HUS
haemolytic uraemic syndrome - haemolytic anaemia - thrombocytopaenia - AKI
51
management of gastroenteritis
trial oral rehydration and oral rehydration solution e.g. diarolyte, rehydrat consider ondansetron for vomiting if not tolerated: NG tube, IV fluids
52
define diarrhoea, generally
>3 stools / day
53
causes of diarrhoea
infection IBD malabsorption / enteropathies
54
non-infectious causes of malabsorption
``` Coeliac disease IBD CF food allergies lactose intolerance other rare disease ```
55
what is 'toddler's diarrhoea'
benign condition due to colonic immaturity self limiting - improves y 5-6 years child is thriving up to 10 stools a day still investigate to rule out pathologies management: reduces excessive fruit juice, increase fat, normal fibre, rarely use loperamide
56
gastroesophageal reflux is very common in infancy, true or false
true | generally benign and self limiting
57
cause of gastroesophageal reflux in infancy
overfeeding | ? CMPA especially if rash
58
management of gastroesophageal reflux
assess for overfeeding reassurance that it is self limiting consider CMPA and try hydrolysed formula gaviscon as thickener consider PPI further investigate if there are any red flags
59
what is coeliac disease
autoimmune enteropathy to gluten
60
symptoms of coeliac disease
``` diarrhoea abdominal pain failure to thrive dermatitis herpetiformis pale stools bloating anaemia excessive tiredness constipation - atypical ```
61
investigations for coeliac disease
anti TTG anti endomesial antibodies FBC, LFT, U+E, CRP, iron studies, stool cultures, feacal calprotectin these are dependent on normal IgA
62
what is the gold standard diagnosis for coeliac disease
endoscopy with duodenal (D2) biopsy
63
only in children you can diagnose coeliac disease with blood tests, what are the requirements for this
classical symptoms AND TTG >10x upper limit of normal then second sample required (either TTG or EMA)
64
histology of coeliac disease biopsy
crypt hyperplasia flattening of villi lymphocytic infiltration
65
associations of coeliac disease
``` T1DM autoimmune thyroid disease juvenile chronic arthritis other autoimmune conditions Downs syndrome Turner syndrome Williams syndrome ```
66
complications of Coeliac disease
``` anaemia malabsorption failure to thrive osteoporosis short stature delayed puberty female infertility intestinal malignancies (T-cell lymphomas, MALT) ```
67
management of coeliac disease
gluten free diet for life | annual review by dietician for: height, weight, FBC, ferritin, TTG
68
you can only accurately diagnose coeliac disease if you have gluten in your diet, true or false
true
69
what foods include gluten
``` pasta bread noodles pastries crackers cereal ```
70
features of crohns disease
autoimmune disease entire GI tract can be affected diarrhoea, PR bleeding, weight loss, anaemia, abdominal pain, perianal/oral disease extra-GI symptoms: liver, eyes, skin
71
investigations for crohns disease
FBC, LFT, U+E, CRP, ferritin, coeliac screen faecal calprotectin stool cultures x3 upper and lower GI endoscopy MRI small bowel / barium study if younger
72
histological features of crohns disease biopsy
``` skip lesions oedema inflammation crypt abscesses non caseating granulomas ```
73
management of crohns disease
induce remission: elemental diet, prednisolone maintenance: azathioprine, +- infliximab/adalimumab surgery is last line high calorie, low bulk nutrition
74
complications of crohns disease
``` perforation fistulae colon Ca sclerosing cholangitis autoimmune hepatitis ```
75
we try to avoid steroids in children, true or false
true, can magnify osteoporosis and can affect growth
76
what can be used to score crohns disease
wPCDAI
77
D.Dx for daily soiling
constipation with faecal impaction
78
general definitions/features of constipation
at least 2 of the following for at least 1 month: <3 defecations / week at least 1 episode / week of feacal incontinence history of excessive stool retention or retentive posturing history of painful/hard bowel movements presence of large faecal ass in rectum history of stools with large diameter that may obstruct the toilet
79
features of organic disease in constipation
delayed passage >24hr meconium after birth - Hirschsprungs disease recurrent rectal prolapse - CF abnormal position of anus explosive passage of stool following PR exam - Hirschsprungs disease skin tags / healed fissures - crohns, sexual abuse
80
how many stool types are there on the bristol stool chart
6
81
RF for constipation
``` low fibre intake low fluid intake excessive dairy products lack of exercise obesity problems with toilet training ```
82
management of constipation
stool softeners e.g. laxido, magrocol aim for BSC type 5 for 2 weeks then type 4 for 6 months may need stimulant e.g. senna or docusate
83
laxatives make the bowel lazy, true or false
false | longstanding constipation is worse
84
why do you get soiling associated with constipation
faecal impaction causes overflow diarrhoea
85
what is infant dyschezia
problem in learning to defecate with poor coordination of straining and opening external anal sphincter babies appear in pain then settle when stool passes self limiting - 2-4 weeks no treatment required
86
is infant dyschezia the same as constipation
no
87
what is IBDU
IBD unspecified | no clear cut between crohns and UC
88
what scoring system is used for UC
PUCAI
89
what is UC
multifactorial autoimmune condition confined to large bowel only continuous lesions
90
severities of UC
mild: distal colon, <3stools/day, little blood moderate: 3-5 stools/day, abdo pain, weight loss severe: >5 stools/day, frank blood, anaemia, hypoalbuminaemia, leukocytosis, pain, risk of toxic megacolon and perforation
91
what is toxic megacolon
transverse colon diameter >5cm in adults on plain AXR film rare in children so no other paeds parameters managament: drip and suck, IV antbx, early surgical review
92
complications of UC
``` CRC growth failure arthropathy episcleritis erythema nodosum/pyoderma gangrenosum autoimmune liver disease ```
93
investigations for UC
``` stool cultures x3 FBC, LFT< U+E, ferritin faecal calprotectin upper and lower GI endoscopy MRI small bowel ```
94
histology of UC biopsy
PMN cells crypt abscesses NO granulomas
95
UC management
``` steroids to induce remission maintenance therapy: mild - mesalazine only mod-severe - mesalazine + azathioprine non-responders - mesalazine + azathioprine + biologic cure = colectomy ```
96
D.Dx of food bolus obstruction
eosinophilic oesophagitis oesophageal stricture (from GORD) didnt chew well enough
97
what is eosinophilic oesophagitis EO
immune condition characterised by eosinophilic infiltration of the oesophageal mucosa 2nd most common cause of oesophagitis following GORD
98
symptoms of EO
dysphagia odynophagia food bolus obstruction
99
management of EO
1st line: dietary management top 6 food elimination - seafood, nuts, dairy, eggs, wheat, soya 2nd line: topical budesonide
100
complication of EO
oesophageal stricture
101
main investigations in paediatric gastroenterology
``` FBC U+E LFT CRP ferritin Coeliac screen stool cultures faecal calprotectin MRI / barium study - small bowel upper and lower GI endoscopy ```
102
causes of vomiting due to obstruction
pyloric stenosis intussusception intestinal volvulus adhesions post surgery
103
``` which of the following present with bile stained vomit: pyloric stenosis intussusception intestinal volvulus adhesions post surgery ```
intussusception intestinal volvulus adhesions post surgery
104
GI conditions causing abdominal pain
``` colic intussusception appendicitis mesenteric adenitis constipation IBD coeliac disease ```
105
Non-GI causes of abdominal pain
migraine DKA infection elsewhere stress
106
rare but severe causes of abdominal pain
malignancy - neuroblastoma, Wilms tumour testicular torsion bowel obstruction
107
what can be associated with intussuscpetion
preceding infection e.g. tonsillitis | can lead to lymphadenopathy of Peyer's patches which acts as a lead on point for this

Year 4 Child Health (22 decks)

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