Paediatrics - GI Flashcards
(149 cards)
1
Q
What are some common medical causes of abdominal pain in children (9)?
A
- Non-specific abdominal pain/ unknown/ functional
- Constipation
- UTI/ pyelonephritis
- Gastroenteritis
- IBD
- Diabetic ketoacidosis
- Gynaecological causes
- Henoch Schonlein purpura
- Abdominal migraine
2
Q
What are some common surgical causes of abdominal pain (5)?
A
- Appendicitis
- Intussusception
- Bowel obstruction
- Hernias
- Pancreatitis
3
Q
What are some extra-abdominal causes of abdominal pain (2)?
A
- Lower lobe pneumonia
- Testicular torsion
4
Q
What has been suggested to be a cause of non-specific abdominal pain in children?
A
Mesenteric adenitis
often occurs together with an URTI - causing enlarged lymph nodes
5
Q
What are some common causes of diarrhoea in children (6)?
A
- Gastroenteritis
- IBD/IBS
- Coeliacs
- Chronic non-specific diarrhoea/ toddlers diarrhoea
- Cow’s milk protein allergy/ lactose intolerance
- Liver (or pancreatic) disease
6
Q
What are the most common causes of constipation (7)?
A
- Idiopathic/ lifestyle = MC
- Hirschprungs
- CF
- Hypothyroidism
- Anal stenosis
- Intestinal obstruction
- Lactose intolerance
7
Q
What would be the presentation of a child with constipation (6)?
A
- Less than 3 stool per week
- Hard, difficult to pass stools
- Abdo pain
- Holding abnormal posture
- Overflow diarrhoea
- Rectal bleeding
8
Q
What is the term for faecal incontinence?
A
Encopresis
9
Q
What may cause encopresis in children (5)?
A
- Constipation
- Hirschprungs disease
- Learning difficulties
- Cerebral palsy
- Stress/ abuse
10
Q
When is encopresis considered abnormal?
A
Past the age of 4
11
Q
What viscous cycle can occur that makes constipation progressively worse?
A
Impacted stool in the rectum –> stretched rectum –> desensitisation of rectum –> urge to defecate less frequently –> further impacted stool
12
Q
How should constipation be managed in children (3)?
A
- Lifestyle advice/ factors
- Laxatives
- Schedule visits to toilet/ keep bowel diary
13
Q
What laxatives should be used to treat constipation in children (3)?
A
- Macrogol (e.g. movicol) disempaction regimen - 2 weeks
- senna if needed
- others (e.g. lactulose)
14
Q
What are the typical signs/ symptoms of appendicitis (8)?
A
- Central abdo pain, localising to McBurneys point
- Anorexia
- Nausea/ vomiting
- Fever
- Rosvings sign
- Guarding
- Rebound/ percussion tenderness (peritonitis)
- Psoas + obturator sign
15
Q
How is appendicitis diagnosed (3)?
A
- Raised CRP/ESR
- Ultrasound/ CT (sometimes used)
- Diagnostic laparoscopy
16
Q
A
n
17
Q
What is the most common cause of gastroenteritis in children?
A
Rotavirus
Norovirus most common in adults
18
Q
What are some other viral causes of gastroenteritis other than rotavirus in children (2)?
A
- Norovirus
- Adenovirus
19
Q
What are the most common causes of bacterial diarrhoea (4)?
A
- C. jejuni = MC
- E. coli (most strains don’t cause infection)
- Shigella
- Salmonella
20
Q
What symptom may point more towards bacterial gastroenteritis?
A
Bloody diarrhoea
21
Q
What are two parasitic causes of gastroenteritis?
A
- Gardia
- Cryptosporidium
mostly water born
22
Q
What is the main risk associated with gastroenteritis?
A
Dehydration - the very old, young or vulnerable may need to be admitted for IV fluids
23
Q
What are signs of dehydration in an infant (7)?
A
- Hypotension
- Cold extremities
- Reduced skin turgor
- Tachypnoea/ tachycardic
- Slow cap refill
- Sunken fontanelle
- Dry mucous membranes
24
Q
How long should a child stay off school with gastroenteritis?
A
48 hours post diarrhoea/ vomiting
25
What are some post gastroenteritis complications (5)?
* GBS
* IBS
* Lactose intolerance
* Reactive arthritis
* Mesenteric adenitis
26
What is coeliacs disease?
Autoimmune reaction where exposure to gluten causes an immune reaction creating inflammation in the intestines
27
What are the signs/ symptoms of coeliacs in children (6)?
* Failure to thrive
* Diarrhoea
* Abdo pain
* Fatigue
* Weight loss
* Dermatitis herpetiformis
28
What other parts of the body (other than intestines) may be affected in those with coeliacs disease (2)?
* Brain - ataxia, epilepsy
* Skin - dermatitis herpetiformis
29
What part of the bowel is particularly affected by coeliac's disease?
Jejunum
30
What genes are associated with coeliacs disease (2)?
* HLA-DQ2 (90%)
* HLA-DQ8
31
What is the first line investigation for coeliacs disease?
* anti TTG-IgA
* Total IgA
32
What antibody can also be tested for if anti TTG is inconclusive for coeliacs disease?
EMA-IgA
33
If there is IgA deficiency how can coeliacs be tested for?
* anti TTG-IgG
* anti EMA-IgG
34
How is a diagnosis of coeliacs disease confirmed?
Duodenal biopsy
35
What would a duodenal biopsy show in those with coeliacs (2)?
* Crypt hyperplasia
* Villous atrophy
36
What is important for those suspected of coeliac to carry on doing during investigation for coeliacs?
They must continue to eat a gluten diet
37
For which conditions is a serological screen for coeliacs disease indicated (3)?
* T1DM
* Autoimmune thyroid disease
* Downs syndrome
38
What are some complications of coeliacs disease (4)?
* Malabsorption
* Anaemia
* Osteoporosis
* Small intestine cancers (rarer)
39
How is coeliacs treated?
Gluten free diet
40
What is inflammatory bowel disease?
Inflammation of the walls of the GI tracts, with periods of remission and exacerbation
41
What age children are usually affected by IBD?
15+ year olds
42
What is the general presentation of a child/ teen with IBD (7)?
* Diarrhoea
* Abdo pain
* Bleeding
* Weight loss
* Anaemia
* Fever
* Dehydration
43
What are some extra-intestinal manifestations of IBD (5)?
* Arthritis/ enthesitis
* Aphthous mouth ulcers (mostly crohns)
* Primary sclerosing colangitis (UC only)
* Erythema nodosum
* Episcleritis + uveitis
44
What is the first line test for IBD?
Faecal calprotectin
45
What is the gold standard test for IBD?
OGD/ colonoscopy with biopsy
46
What other investigation can be done to investigate IBD?
Imaging (US/CT/MRI) to look for fistulas, abscesses and strictures
47
How is a flare of Crohns treated (3)?
1. Steroids (oral prednisolone or IV hydrocortisone)
2. Mesalazine
3. (+ azathioprine, mercaptopurine, infliximab)
48
How is crohns remission maintained (2)?
1. **Azathioprine** or mercaptopurine
2. Methotrexate, infliximab, adalimumab
49
How is a mild - moderate flare of UC treated (2)?
1. **Aminosalicylate** (mesalazine - oral or rectal)
2. Oral **steroids**
50
How is a sever flare of UC treated (2)?
1. IV hydrocortisone
2. IV ciclosporin
51
How is remission maintained in UC (2)?
1. **Aminosalicylate** (mesalazine)
2. Azathioprine/ mercaptopurine
52
What other treatment as well as medication can be offered to those with IBD?
Surgery
53
What is a common cause of diarrhoea in toddlers?
Toddlers diarrhoea/ chronic non-specific diarrhoea (maybe a form of IBS)
54
What is the prognosis for chronic non-specific diarrhoea?
Most children usually grow out of it
55
What are some causes of vomiting in children (8)?
* **Overfeeding**
* GORD
* Pyloric stenosis
* Gastroenteritis
* Other infections e.g. UTI + meningitis
* Intestinal obstruction
* Bulimia nervosa
* Cows milk protein allergy
56
What are some red flag symptoms associated with vomiting in babies (5)?
* Not keeping any food down
* Projectile vomiting
* Bile stained vomit
* Haematemesis
* Abdominal distension
57
What age are children commonly affected by GORD?
Under 1 year
58
Why are children under 1 year commonly affected by GORD?
They have an underdeveloped/ immaturity of the lower oesophageal sphincter
59
What is the presentation of GORD in those under 1 (6)?
* Chronic cough
* Hoarse voice
* Distress/crying/ unsettled after feed
* Reluctance to feed
* Pneumonia
* Poor weight gain
60
How can GORD typically be managed in babies (4)?
* Small frequent meals
* Burping regularly
* Not overfeeding
* Keeping baby upright after meals
61
What can be used to treat more problematic cases of GORD in babies (3)?
* Gaviscon mixed with feed = (first for breastfed)
* Thickened milk or formula (first for formular fed)
* PPIs
62
What is a worrying syndrome associated with GORD in babies?
Sandifers syndrome
63
What are the symptoms of Sandifers syndrome?
Episodes of abnormal movements and muscles spasms particularly in the back and neck
64
What is the prognosis for Sandifers syndrome?
The outcome is good, however other conditions need to be ruled out such as **infantile spasms** and **epilepsy**
65
What are the symptoms of cows milk protein allergy (4)?
* Regurg/ vomiting
* Diarrhoea
* Uticaria
* 'Colic' symptoms
66
How common is cows milk protein allergy?
3-6% of children
67
What is a severe complication of cows milk protein allergy?
Anaphylaxis - if IgE mediated allergy is suspected (rapid onset, angioedema, wheeze)
68
Which group of children and what age does cows milk protein allergy typically occur in?
Formula fed infants in first 3 months of life
*can occasionally occur in breast fed infants, when mother has cows milk in diet*
69
What are the symptoms of lactose intolerance (4)?
* Flatulence
* Diarrhoea
* Abdo pain
* Nausea
70
When does lactose intolerance usually present?
Past age 5 when our bodies stop making lactase
71
What is pyloric stenosis?
Hypertrophy of the pyloric sphincter
72
How does pyloric stenosis present (2)?
* Projectile vomiting after feeding
* Failure to thrive
73
What age does pyloric stenosis usually present?
4-6 weeks after birth
74
What is the pathophysiology of projectile vomiting in pyloric stenosis?
Increasingly strong peristaltic waves in the stomach eventually overcome the LOS and project food out of the mouth
75
What would a blood gas analysis show on a baby with pyloric stenosis?
Hypochloric hypokalaemic metabolic alkalosis
76
Why does pyloric stenosis cause hypochloric metabolic alkalosis?
Baby is vomiting HCl therefore this causes an alkalosis and low chlorine
77
What may be seen on examination of a baby with pyloric stenosis (2)?
* Round mass in upper abdomen
* Visible peristalsis
78
How is pyloric stenosis diagnosed?
Abdominal ultrasound
79
How is pyloric stenosis treated?
**Laparoscopic pyloromyotomy** (surgery to cut/ widen pyloric sphincter) - Ramstedt's
80
What is the most common hernia in children?
Inguinal hernia
81
What type of inguinal hernia occurs in children?
**Indirect** hernia
*direct more common in adults*
82
What is the pathophysiology of an indirect inguinal hernia compared to a direct?
* Indirect - passes through the inguinal canal
* Direct - bulge through abdominal wall in weak spot
83
What are the symptoms of an inguinal hernia in a child (2)?
* Bulge/ swelling in the groin/ scrotum
* Discomfort/ pain --> crying
*sometimes it appears the child is crying because of the hernia, but in reality the normal crying causes the hernia to bulge*
84
What are 2 features suggestive of hernias?
* Lump protrudes on coughing/ straining/ crying
* Lump reducible
85
How are inguinal hernias treated in children?
Open/ laparoscopic surgery shortly after diagnosis
86
Who do inguinal hernias occur more frequently in?
Boys
87
What is a differential diagnosis for an inguinal hernia in children?
Hydrocele
88
What is the cause of a hydrocele in a newborn?
Collection of fluid around the testicle that enters via a small opening in the inguinal canal, but not large enough opening for bowel to protrude through
89
What is the second most common hernia in children?
Umbilical hernia
90
Where do umbilical hernias occur?
A bulge/ lump around the belly button
91
How are umbilical hernias managed in children?
Small umbilical hernias usually close on their own. If large or no improvement by age 3-5, surgical repair can be performed.
92
What is a severe congenital type of hernia?
Diaphragmatic hernia
93
What is a diaphragmatic hernia?
Protrusion of the abdominal organs through an abnormal opening in the diaphragm into the chest
94
What causes a diaphragmatic hernia?
Malformation of the diaphragm during foetal development
95
What are the symptoms of a diaphragmatic hernia (3)?
* Respiratory distress immediately after birth
* Cyanosis
* Sunken abdomen (due to displacement of organs into chest)
96
How is a diaphragmatic hernia usually diagnosed?
Usually prenatally through ultrasound
97
How is a diaphragmatic hernia usually managed (2)?
* Stabilisation
* Surgical repair
98
What are some other hernias that can occur in children (other than inguinal, umbilical and diaphragmatic) (3)?
* **Epigastric** - midline between umbilicus and sternum
* **Incisional** - through surgical scar
* **Hiatal** - stomach protrudes into chest
99
What are some possible complications of hernias in children (3)?
* Strangulation
* Obstruction (bowel)
* Incarceration (irreducible)
100
What are some risk factors for hernias in children (3)?
* Low birth weight
* Genetics/ race
* Gender (inguinal more common in boys)
101
What is hirschprungs disease?
Ganglion cells of the **myenteric plexus** are absent in the distal bowel and rectum
102
What is the pathophysiology of hirschprungs disease?
Parasympathetic ganglion cells travel down the gut during development they do not reach the end of the gut in hirschprungs disease leaving a portion without innervation
103
What is a risk factor for hirschprungs disease?
A number of genetic conditions including downs syndrome, neurofibromatosis
104
What are the symptoms/ signs of hirschprungs disease (6)?
* Acute intestinal obstruction
* Delayed meconium
* Chronic constipation
* Abdo pain + distension
* Vomiting
* Poor weight gain/ failure to thrive
105
What is a severe complication of hirschprungs?
Hirschprungs associated enterocolitis
106
What are the symptoms of hirschprungs associated enterocolitis (3)?
* Fever
* Abdo distension
* Diarrhoea
*+sepsis symptoms*
107
How is hirschprungs disease diagnosed?
Rectal biopsy = absence of ganglionic cells
108
What other investigation is useful for hirschprungs disease?
**Xray** - look for signs of HAEC, obstruction
109
How is hirschprungs treated?
Surgical removal of the aganglionic section of the bowel
110
What is meckels diverticulum?
Outpouching of the embryological remnant of the midgut toward to umbilicus 1 meter from the end of the ileum
111
How common is meckels diverticulum?
2% of people have it
112
What is intussusception?
Telescoping of the bowel into itself
113
What age does intussusception usually occur?
6 months to 2 years
114
What are some associated conditions with intussusception (5)?
* Concurrent viral illness
* CF
* Meckels diverticulum
* Intestinal polyps
* Henoch Schonlein purpura
115
What are the signs/ symptoms of intussusception (5)?
* **Redcurrant jelly stool**
* Severe colicky abdo pain
* RUQ mass (sausage-shaped mass)
* Vomiting
* Pale lethargic child
116
How is intussusception investigated (2)?
* Ultrasound scan
* Contrast enemas
117
How is intussusception managed (2)?
* Therapeutic enema (air or water pumped in)
* Surgical reduction
118
What are some complications of intussusception (3)?
* Obstruction
* Gangrenous bowel
* Perforation
119
What should be suspected in an infant with green bilious vomiting?
Intestinal obstruction (particularly malrotation + volvulus)
*other causes include atresia, meconium ileus, necrotising enterocolitis)
120
What are the signs/ symptoms of intestinal malrotation with volvulus (6)?
* Green bilious vomiting
* Distended abdomen
* Painful abdomen
* Infrequent bowel movements
* Lethargy
* Poor appetite
121
What is a volvulus?
Twisted intestine that obstructs passage of faeces through it
122
How is intestinal malroatation investigated (2)?
* USS
* Upper GI contrast study
123
What age does malrotation usually present?
Within first year of life
124
How is malrotation treated?
Surgery (laparotomy)
125
What disease is caused by a deficiency in protein intake?
Kwashiorkor
126
What are the signs/ symptoms of Kwashiorkor (5)?
* Failure to thrive
* Fatigue
* Muscle waisting
* Oedema
* Immunodeficiency
127
What is a key blood finding for those with kwashiorkor?
Hypoalbuminaemia
128
What disease is caused by a deficiency in all macronutrients?
Marasmus
129
What are the key macronutrients deficient in those with marasmus (3)?
* Protein
* Carbohydrates
* Fats
130
What are the signs/ symptoms of marasmus (4)?
* Failure to thrive
* Low BMI/ weight loss
* Brittle hair
* Immunodeficiency
131
What is the key difference between marasmus and kwashiorkor in terms of presentation?
Marasmus does not cause oedema, kwashiorkor does
132
What is colic?
Frequent, prolonged episodes of crying in a healthy infant
133
What ages does colic usually occur between?
2 weeks to 4 months (first year of life)
134
What is important to do in babies with colic?
Rule out other causes of colic e.g. GORD, milk protein allergy
135
What disease may affect the bile ducts of children?
Choledochal cysts
136
What is a choledochal cyst?
A congenital cystic dilation of bile ducts (intra or extra hepatic)
137
What is the key triad of symptoms suggestive of a choledochal cyst?
* Jaundice
* Abdominal pain
* Abdominal (RUQ) mass
138
What are some other symptoms of choledochal cyst (other than the triad of symptoms) (3)?
* Nausea
* Vomiting
* Fever
139
What age do choledochal cysts usually present?
Usually in early childhood, < 5 years
*However they can go undiagnosed until adulthood*
140
How is a choledochal cyst investigated (3)?
* Ultrasound
* MRCP/ ERCP
* CT
141
How are choledochal cysts treated?
Surgical removal + reconstruction
142
What are some complications of choledochal cysts (3)?
* Stone formation
* Pancreatitis
* Increased risk of **cholagiocarcinoma**
143
What are the causes of acute liver failure in children (4)?
* Viral hepatitis (hep A-G/ other viruses)
* Paracetamol overdose
* Wilsons
* Autoimmune hepatitis
144
What are the causes of chronic liver disease in children (8)?
* Postviral hepatitis
* Autoimmune hepatitis + PSC
* Wilsons
* CF
* Drug induced (e.g. NSAIDs)
* NAFLD
* A1ATD
* Idiopathic (may be an unidentified viral infection)
145
What virus other than hep A-G commonly causes hepatitis?
EBV
146
What are the symptoms of liver disease in children (7)?
* Jaundice
* Vomiting
* Lethargy
* Abdo pain
* Confusion
* Increased bruising/ bleeding
* Failure to thrive
147
What are some GI causes of failure to thrive in children (10)?
* GORD
* Poor feeding
* Pyloric stenosis
* IBD
* Coeliacs
* Nutritional deficiencies (e.g. marasmus/ kwashiorkor)
* Food intolerance/ allergy
* Liver disease
* CF
* Chronic diarrhoea/ constipation
* Hirschprungs
148
What is a key differential for failure to thrive?
Normal growth variation in healthy children (due to parents being short for example)
149
What are some important causes of poor feeding in babies (9)?
* **GI disorders** e.g. GORD, coeliacs, constipation, food intolerance/ allergy
* **Neurological disorders** e.g. cerebral palsy
* **Congenital/ structural** e.g. cleft lip, tongue tied
* **Endocrine** e.g. hypothyroidism
* Congenital heart disease
* Chronic lung disease
* Infection
* Behavioural disorders e.g. ASD
* Neglect/ abuse/ poverty
