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Paediatrics > Paediatric Gastroenterology > Flashcards

Paediatric Gastroenterology Flashcards

1
Q

What are some symptoms that can present in coeliac disease in kids?

A

Diarrhoea, fatigue, weight loss, failure to thrive, abdominal pain, steatorrhoea.
Often asymptomatic

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2
Q

What are some signs of coeliac disease?

A

Mouth ulcers, anaemia, dermatitis herpetiformis

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3
Q

What does dermatitis herpetiformis look like?

A

An itchy blistering rash usually seen on the abdomen

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4
Q

Patients first diagnosed with which conditions will also then be tested for coeliac disease?

A

T1DM and autoimmune thyroid disease

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5
Q

What is the pathophysiology of coeliac disease?

A

Autoimmune reaction to gliadin protein
T-cell mediated with consequent production of anti-gluten antibodies, anti-tissue transglutaminase and anti-endomysial antibodies, and activation of epithelial lymphocytes. This all results in epithelial cell destruction and Villous atrophy

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6
Q

What is seen on histology in coeliac?

A

Villous atrophy and crypt hyperplasia

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7
Q

What are some extra-intestinal features of coeliac disease?

A

Dermatitis herpetiformis, dental enamel hypoplasia, osteoporosis, delayed puberty, iron deficiency anaemia, arthritis, neuro symptoms (epilepsy, peripheral neuropathy, ataxia)

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8
Q

What are some conditions commonly associated with coeliac disease?

A

Thyroid disease, type 1 diabetes, Down’s syndrome, autoimmune hepatitis

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9
Q

What are some differential diagnoses for coeliac disease in kids?

A

IBD, cystic fibrosis, post-gastroenteritis, autoimmune enteropathy, eosinophilic enteritis,

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10
Q

What investigations can be done to check for coeliac disease?

A

Serology: total IgA and anti-TTG levels
Endoscopy with duodenal biopsy

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11
Q

If total IgA levels are seen to be low which other antibody can be measured for coeliac disease?

A

IgG DGP (deaminated gliadin peptide), IgG EMA, IgG tTG

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12
Q

What is the management of coeliac disease?

A

Gluten free diet

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13
Q

What are some complications of coeliac disease?

A

Anaemia, osteoporosis, vitamin deficiency, malignancy, ulcerative jejunitis

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14
Q

What are causes of vomiting in an infant?

A

GORD, overfeeding, infection, food allergy/intolerance, form of intestinal obstruction, congenital adrenal hyperplasia, renal failure

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15
Q

What is bile stained vomit a reg flag for?

A

Intestinal obstruction

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16
Q

What is haematemesis a red flag for in a vomiting child?

A

Oesphagitis, peptic ulceration, oral/nasal bleeding, oesophageal variceal bleeding

17
Q

What is projectile vomiting a red flag for in a vomiting child?

A

Pyloric stenosis

18
Q

What is coughing at the end of paroxysmal coughing a red flag for in a vomiting child?

A

Whooping cough

19
Q

What is abdominal distention a red flag for in a vomiting child?

A

Intestinal obstruction e.g strangulated inguinal hernia, ascites

20
Q

What is Hepatosplenomegaly a red flag for in a vomiting child?

A

Chronic liver disease, inborn error of metabolism

21
Q

What is blood in the stool a red flag for in a vomiting child?

A

Intussusception, bacterial gastroenteritis, IBD

22
Q

What is severe dehydration a red flag for in a vomiting child?

A

Severe gastroenteritis, systemic infection or DKA

23
Q

What is a bulging fontanelle a red flag for in a vomiting child?

A

Raised intracranial pressure, Meningitis

24
Q

who is typically affected by cows milk protein allergy?

A

formula-fed infants in the first3 months of life

25
Q

what are some features of CMPA?

A

regurgitation and vomiting, diarrhoea, non blanching rash (urticaria) and eczema, colic symptoms, chronic cough

26
Q

what is the first line management of mild to moderate CMPA?

A

eHF (extensive hydrolysed formula) milk

27
Q

what is the management in formula fed babies with severe CMPA or no response to eHF milk?

A

amino-acid based formula (AAF)

28
Q

what percentage of infants with CMPA are also intolerant to soya milk?

A

10%

29
Q

how would CMPA be managed in a child who is exclusively breast fed?

A
  • continue breast feeding and cut out cows milk protein from mums diet
  • calcium supplements for mother so baby not deficient
30
Q

does cow milk protein intolerance usually resolves?

A

-if IgE mediated 55% will resolve by 5y
-non IgE mediated most resolve by 3y

31
Q

What is the first line investigation when suspecting mesenteric adenitis?

A

abdominal ultrasound

32
Q

what are features suggestive of hypernatraemic dehydration?

A

jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness and coma

33
Q
A
34
Q

What is the number one cause of painless massive GI bleeding requiring transfusion in children between ages of 1 and 2?

A

Meckels diverticulum

Paediatrics (15 decks)

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