Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 4 PAEDS > GI and Liver 3 > Flashcards

GI and Liver 3 Flashcards

(75 cards)

Start Studying
1
Q

Summarise bilirubin metabolism

A

Bilirubin is produced as a result of breakdown of haem from haemoglobin
= conjugated bilirubin

Unconjugated bilirubin metabolised by liver cells to a soluble conjugated form and is excreted via the hepatic and bile ducts into the duodenum

Bilirubin and bile salts in the bowel aid absorption of fats and fat-soluble vitamins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens to conjugated bilirubin?

A

Approx half of conjugated bilirubin is reabsorbed from the bowel as urobilinogen in the enterohepatic circulation

Urobilinogen may be excreted in urine or remetabolised through the liver

In jaundice - excessive conjugated bilirubin may be excreted in the urine, causing urine to be dark

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some of the commoner causes of jaundice in childhood?

A 
Mostly unconjugated:
- Haemolytic disease of the newborn
- Sickle cell disease
- Spherocytosis
Rarely:
- Hepatic (rare)

Mostly conjugated
- Hepatitis
- CF
- Cirrhosis
Obstructive:
- Hepatitis
- Biliary atresia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is important to ask in a history of jaundice?

A

Insidious vs sudden onset - first sign of insidious onset is yellowing of sclera
- haemolysis is usually rapid onset

Malaise
- Duration of malaise, abdo pain, anorexia

Symptoms of anaemia
- Occurs as a result of haemolysis

Pruritus
- Intense skin irritation as a result of bile salts in the skin

Urine colour
- Very dark indicated conjugated bilirubin is the cause

Steatorrhoea

  • Frothy, foul-smelling stool which floats in toilet
  • Commonly seen in children with long-standing cirrhotic liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What may be found on physical examination of a jaundiced child?

A

FTT or poor growth

Skin signs:

  • Scratch marks on skin
  • Signs of long-standing liver disease including spider naevi, clubbing and ascites

Hepatosplenomegaly

  • Hard liver suggests cirrhosis
  • Splengomegaly can suggest haemolysis or cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What may bloods reveal in a jaundiced child?

A

Hb:
- Low Hb with increased reticulocytes indicates haemolysis

Bilrubin:

  • Unconjugated = haemolysis
  • Conjugated = hepatic / post-hepatic

Liver enzymes:
- Raised in hepatitis

Alkaline phosphatase:
- Elevated in cirrhosis or in cases of long-standing jaundice

Serology
- Identification of hepatitis virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of jaundice in older children?

A

Hepatitis A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Reye’s syndrome?

A

Acute encephalopathy associated with fulminant liver failure

Can be induced by aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What metabolic syndromes can lead to progressive jaundice?

A

Wilsons disease

  • Defect in copper metabolism
  • Leads to neurodevelopmental delay and FTT
  • Brown ‘Kayser-Fleischer rings’ around cornear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What enzyme defects can lead to chronic hyperbilirubinaemia?

A

Criggler-Najar disease
- Glucuronyl transferase deficency

Gilbert’s syndrome
- Bilirubin uridine diphosphate glucuronosyltransferase enzyme

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is mesenteric adenitis?

A

Diagnosed where no other cause for acute abdo pain can be found

Caused by acute enlargement of intra-abdo LN as a result of infection in URTI, chest or gastroenteritis

These enlarged LN cause pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How may mesenteric adenitis present?

A

Recent hx of infection and signs may still be present in chest or throat

Fever, malaise, central abdo pain

NEVER peritonism or guarding = diagnosis of exclusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of mesenteric adenitis?

A

Exclude other conditions

Expectant management - usually resolves within 24-48hrs

Analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is pyloric stenosis?

A

Hypertrophy and hyperplasia of the pylorus muscle

Results in narrowing of the pyloric canal which can then easily become obstructed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When does pyrloric stenosis usually develop? In who?

A

First 4-6 weeks of life

M:F 7:1

Most common in firstborn male children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does pyloric stenosis present?

A

Projectile vomiting during or immediately after feeding
- But not necessarily at every feed

Infant hungry and ready to take another feed immediately

Vomit may be blood tinged but not bile-stain

Weight loss and dehydration often seen

Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What may be noted on examination of an infant with pyloric stenosis?

A

Visible peristalsis from the LUQ to RUQ immediately after a feed or just prior to vomiting

Hard mobile tumour ‘olive mass’ to R of epigastrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How should pyloric stenosis be investigated?

A

If olive ass found, no need for barium studies or USS

If diagnosis suspected but tumour not palpable, confirm with USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What may occur as a result of prolonged vomiting in pyloric stenosis?

A

Loss of acidity from stomach leads to hypochloraemic alkalosis and reduced sodium and potassium levels in serum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the management of pyloric stenosis?

A

Surgical treatment

  • Ramstedt procedure involves splitting pyloris muscle without penetrating the mucosa
  • If infant is dehydrated rehydration must take place prior to surgery with replacement of sodium, chloride and potassium
  • Oral feeds can be given within hours postoperatevely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the pathophysiology of hypochloraemic, hypokalaemic metabolic alkalosis?

A

Hydrogen chloride loss from vomiting leads to hypochloraemic metabolic alkalosis

Renal compensation by maximising bicarb reabsorption

Exchange of potassium and sodium for hydrogen ions in DCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is testicular torsion?

A

More accurately = torsion of the spermatic cord

Common urological emergency

Causes occlusion of testicular blood vessels

Unless rapidly treated leads to ischaemia, leading to loss of the testis

(Germ cells are the most susceptible cell line to ischaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the two types of testicular torsion?

A

Intravaginal

Extravaginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is intravaginal testicular torsion?

A

Secondary to the lack of normal fixation of the posterior lateral aspect of the testes to the tunica vaginalis

Results in testis being free to swing and rotate within the tunica vaginalis of the scrotum

= “bell-clapper deformity”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What % of testicular torsions are intravaginal and what % of these are bilateral?
Intravaginal testicular torsion = 12% males 40% bilateral
26
What is extravaginal testicular torsion?
Occurs more often in neonates and occurs in utero or around the time of birth, before the testis is fixed in the scrotum by the gubernaculum Thus both the spermatic cord and tunica vaginalis undergo torsion together, either in or just below the inguinal canal
27
How does testicular torsion present?
Sudden, severe pain in one testis - Often during sport / physical activity - May be associated lower abdo pain Often hx of a previous similar episode +/- n&v
28
Is easing pain a good sign in testicular torsion?
Not necessarily - pain also eases as necrosis sets in
29
What may be found upon examination of testicular torsion?
Reddening of scrotal skin Swollen, tender testis retracted upwards Lifting testis up over symphysis increases pain - Unlike epididymitis where this relieves pain
30
What test can be performed to check for testiclar torsion?
Looking for absence of cremasteric reflex - 100% sensitivity and 66% specificity for testicular torsion - L1/L2 spinal nerves elicited by gentle pinching or stroking of the inner thigh while observing the scrotal contents
31
Who does testicular torsion typically affect?
Neonates and post-pubertal boys Peak 12yrs But can affect all ages
32
Which side is more commonly affected by testicular torsion?
L more than R Bilateral rare
33
Ddx testicular torsion (4)
Epididymitis, orchitis or epididymo-orchitis - Usually from reflux of infected urineor from STI Hydrocele - Painless and transilluminatable Incarcerated hernia Testicular tumour - Rarely painful Mumps - Swelling of parotid glands - Mumps orchitis rare before puberty
34
What investigations are done for testicular torsion?
All cases of acute testicular pain are torsion unless proved otherwise = URGENT TREATMENT
35
What is the management of testicular torsion?
Prompt surgical exploration is required to untwist and fix testis to the scrotum
36
What is the prognosis of testicular torsion?
If corrected within 6 hours, good prognosis If >24hrs - may have become necrotic and require removal The contralateral testis must also be fixed as it is also prone to torsion
37
What is biliary atresia?
Important but rare condition Caused by atresia of intrahepatic or extrahepatic bile ducts
38
How do babies with biliary atresia present?
Persistent jaundice with rising conjugated bilirubin Pale, chalky stools From 4 weeks of life
39
What happens if biliary atresia goes undiagnosed?
Rapid progression to liver failure and death But if diagnosed within 3 months - surgery can resolve liver function to near normal
40
How is biliary atresia managed?
Urgent referral for assessment Diagnostic isotope scan and surgical correction - Kasai procedure
41
What is cryptorchidism?
Undescended or ectopic testes
42
How can undescended or ectopic testes be differentiated?
Only during operation
43
How does cryptorchidism occur?
Usually the testes descend from their fetal intra-abdo position through the processus vaginalis and into the scrotum during the 7th month of gestation The undescended testicle is found along the normal path of descent and the processus vaginalis is usually patent If bilateral - consider hypopituitarism Ectopic testicle is one that has completed its path of descent through the inguinal canal but ends up at the wrong destination, usually in the groin
44
How does cryptorchidism present?
Asymptomatic
45
What may be found on examination of a child with cryptorchidism?
Warm rooms and warm hands Testes impalpable or high in inguinal region or scrotum Empty hemi-scrotum +/- inguinal hernia Attempt to bring testis down into position by sweeping massage into inguinal region (differentiates from retractile testis)
46
What investigations are performed for cryptorchidism?
Clinical diagnosis USS can help to locate testis Hormonal testing if testes impalpable bilaterally
47
Who are more likely to be affected by cryptorchidism? How common is it?
Premature babies 5% undescended at term 1% by 12 months (Spontaneous descent may occur in first 6 months but unlikely after this)
48
What often accompanies cryptorchidism?
Inguinal hernia
49
What is the management of cryptorchidism?
Surgery - ochidoplexy if not spontaneously resolved by one year (most do by 6 months) - Important to be before age 2 yrs (by this age the number of germ cell s in the undescended is already reduced and the risk of infertility is increased, whether unilateral or bilateral)
50
Other than reduced fertility, what is a risk of delayed surgery in cryptorchidism?
Testicular tumour
51
What % of undescended testis are palpable and impalpable? Where are they and how should they be managed?
Palpable = 80% - Usually in inguinal canal - Tests can be bought down into scrotum, referred to paediatric surgeon at one year Impalpable = 20% - Either intra-abdo (risk of malignant degeneration), inside the canal or absent - Investigate with laparoscopy
52
What is the most common cause of hepatitis?
Viral infections: - Hep A (most common) - Hep B - Hep C (rare) - EBV - CMV
53
How is Hep A transmitted?
Faeco-oral route | Associated with poor hygiene and limited sanitation
54
What age group has the highest incidence of Hep A? What is the incubation period?
Age 5-15yr 2-6 weeks
55
How is hep B transmitted and prevented? What is the incubation period?
Blood products eg vertical transmission from mother to baby - however if mother has hepatitis B antibodies her baby is protected Immunisation of the newborn infant is possible if the infected mother is recognised antenatally 2-6 months
56
How does Hep A present?
Insidious onset Child is unwell with anorexia, nausea, and jaundice appears 5 days later Pale stools and dark urine
57
What may be found on examination of a child with hep A?
Tender but not enlarged liver
58
What may be found on investgiation of a child with hep A?
LFTS - high transaminases and raised conjugated hyperbilirubinaemia Identify virus serologically
59
How is hep B serologically investigated?
Presence of hep B surface and core antigens
60
How is viral hepatitis managed?
No specific treatment Hep A highly infectious during prodromal phase but by the time jaundice has presented the pt is no longer excreting the virus Hep B highly contagious
61
What is the prognosis of viral hepatitis?
Hep A - good prognosis and rare to develop chronic hepatitis Hep B - more common to develop chronic hepatitis, and increased risk of developing subsequent hepatocellular carcinoma in adult life for carriers
62
What is Crohn's disease?
Type of IBD that may affect any part of the GI tract from mouth to anus Discontinuous mucosal involvement Cobblestoning in severe vases
63
How does Crohn's disease present?
``` Recurrent abdo pain Anorexia Growth failure Fever Diarrhoea Anaemia Oral and perianal ulcers Arthritis ```
64
How is Crohn's disease diagnosed?
Endoscopic biopsy
65
How is Crohn's disease managed?
Remission induced by: - Elemental diet - Immunomodulator drugs - Anti-TNF drugs eg infliximab - Steroids For localised disease surgical resection may be indicated
66
What is ulcerative colitis?
Inflammation with ulcer formation in the lining of the colon Continuous
67
How does ulcerative colitis present?
Bloody diarrhoea Abdo pain Possibly: - Weight loss - Arthritis - Liver disturbances
68
What is the management of ulcerative colitis?
Mesalazine - PO or PR Steroid enemas Severe cases: - Immunosuppressive therapy - Infliximab - Colectomy
69
What is toddlers diarrhoea?
Toddlers often experience non-specific diarrhoea probably due to rapid gastrocolic reflex
70
How does toddlers diarrhoea present?
Diarrhoea Drinking excessive fluids esp fruit juices Food particles in stool
71
How is toddlers diarrhoea diagnosed?
Only is child is thriving
72
How is toddlers diarrhoea managed?
Reassurance
73
What is a volvulus?
Torsion of a mal-rotated intestine
74
How does volvulus present?
Severe abdo pain with bilious vomiting
75
How is volvulus treated?
Urgent surgery to untwist the volvulus and treat underlying malrotation If missed bowel may infarct

Year 4 PAEDS (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions