Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

My Phase 3a Revision > PAEDS - GI/LIVER > Flashcards

PAEDS - GI/LIVER Flashcards

(212 cards)

Start Studying
1
Q

MALABSORPTION
What is malabsorption?

A
  • Disorders affecting digestion or absorption of nutrients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MALABSORPTION
How does it present?

A

It manifests as:
– Abnormal stools (difficult to flush, offensive odour)
– Failure to thrive or poor growth
– Nutrient deficiencies (Fe anaemia, B12 deficiency)

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

MALABSORPTION
What are some causes of malabsorption?

A
  • Small intestine disease = coeliac
  • Exocrine pancreas dysfunction = CF
  • Cholestatic liver disease, biliary atresia
  • Short bowel syndrome (NEC, bowel removal)
  • Loss of terminal ileum function (resection, Crohn’s, absent bile acid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

IBD
What is inflammatory bowel disease (IBD)?

A
  • Umbrella term for Crohn’s disease + ulcerative colitis
  • Relapsing-remitting conditions involving inflammation of walls in the GI tract
  • Result of environmental triggers in a genetically predisposed individual
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

IBD
Where does Crohn’s disease tend to affect?

A
  • Mouth>anus,
  • spares rectum,
  • favours terminal ileum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

IBD
Which layer of the GI tract is affected by Crohn’s disease?

A

It is transmural - it affects all the layers

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

IBD
Is the inflammation in Crohn’s disease continuous?

A

No - there are skip lesions

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

IBD
Are granulomas found in Crohn’s disease?

A

Yes - it is granulomatous

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

IBD
What is the effect of smoking on Crohn’s disease?

A

It is a risk factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

IBD
Are goblet cells present in Crohn’s disease?

A

Yes

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

IBD
What is the histology of Crohn’s disease?

A

Non-caseating epithelioid cell granulomata

Transmural inflammation
Goblet cells
Granulomas

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

IBD
Where is affected by ulcerative colitis?

A

Colon only (never further than ileocaecal valve), starts at rectum

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

IBD
Which layer of the GI tract is affected by ulcerative colitis?

A

Only the mucosa

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

IBD
Is the inflammation in ulcerative colitis continuous?

A

Yes - the whole colon is affected

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

IBD
Is granulomatous inflammation found in ulcerative colitis?

A

No

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

IBD
What is the effect of smoking on ulcerative colitis?

A

It is protective

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

IBD
Are goblet cells present in ulcerative colitis?

A

There is depletion of goblet cells

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

IBD
what is the histology of ulcerative colitis?

A
  • Increased crypt abscesses,
  • pseudopolyps,
  • ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

IBD
What is the clinical presentation of Crohn’s disease?

A
  • Abdominal pain (RLQ), diarrhoea (often non-bloody) + weight loss
  • Failure to thrive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

IBD
What is the clinical presentation of Ulcerative colitis?

A
  • PR bleeding (+ mucus), diarrhoea + colicky pain (LLQ)
  • Tenesmus and urgency too
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

IBD
What extra-intestinal features are seen in…

i) Crohn’s disease?
ii) Ulcerative colitis?
iii) Both?

A

i) Perianal disease = skin tags, anal fissures, abscesses + fistulas, strictures, obstruction
ii) primary sclerosing cholangitis
iii) Arthritis, erythema nodosum, pyoderma gangrenosum, uveitis + episcleritis, finger clubbing

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

IBD
What are some initial investigations for IBD?

A
  • FBC (microcytic anaemia, raised WCC + platelets)
  • U+Es
  • Low albumin (malabsorb)
  • Raised ESR/CRP
  • Stool MC&S
  • Faecal calprotectin released by intestines when inflamed (useful screening)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

IBD
What test is diagnostic for IBD?
What would it show?
What other investigation might you do?

A
  • Colonoscopy with biopsy (histology)
  • Crohn’s = small bowel narrowing, fissuring or thickened bowel wall, cobblestone appearance
  • UC = visible ulcers
  • Further imaging (USS, CT or MRI) to look at complications of Crohn’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

IBD
How do you treat flares of crohns disease?

A

PO prednisolone or IV hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
IBD How do you induce remission in crohns disease?
1st line = steroids (e.g. oral prednisolone or IV hydrocortisone). If steroids alone don’t work, consider adding immunosuppressant medication under specialist guidance: Azathioprine Mercaptopurine Methotrexate Infliximab Adalimumab
26
IBD How do you maintain remission in crohns disease?
1st line = Azathioprine or Mercaptopurine Alternatives: Methotrexate Infliximab Adalimumab
27
IBD What is the surgical management of Crohn's disease?
- Surgical resection of distal ileum if only affected area - Treat strictures + fistulas secondary to Crohn's
28
IBD How do you induce remission in Ulcerative colitis?
Mild to moderate disease - 1st line = aminosalicylate (e.g. mesalazine oral or rectal) - 2nd line = corticosteroids (e.g. prednisolone) Severe disease - 1st line = IV corticosteroids (e.g. hydrocortisone) - 2nd line = IV ciclosporin
29
IBD How do you maintain remission in Ulcerative colitis? What should be cautioned?
- PO/PR mesalazine, azathioprine or mercaptopurine - Mesalazine can cause acute pancreatitis
30
IBD What is the surgical management of Ulcerative colitis?
- Panproctocolectomy = curative as removes disease - Pt left with permanent ileostomy or ileo-anal anastomosis (J-pouch) where ileum folded back on itself + fashioned into large pouch that functions as a rectum as it attaches to anus
31
COELIAC DISEASE What is coeliac disease?
- Gluten-sensitive enteropathy
32
COELIAC DISEASE What is the pathophysiology?
Autoimmune response to alpha-gliadin portion of protein gluten causes inflammation in small intestine (particularly jejunum)
33
COELIAC DISEASE What is the consequence of the autoimmune response in coeliac disease?
- Autoantibodies in response to gluten exposure target epithelial cells of intestine > inflammation + atrophy of the intestinal villi > malabsorption of nutrients
34
COELIAC DISEASE What is the aetiology of coeliac disease?
- Genetics = HLA-DQ2 + HLA-DQ8
35
COELIAC DISEASE What conditions is coeliac disease associated with?
- T1DM, - thyroid, - Down's syndrome, - FHx = test for it
36
COELIAC DISEASE What is the clinical presentation of coeliac disease?
- Abnormal stools (smelly, diarrhoea, floating) - Abdo pain, distension + buttock wasting - Failure to thrive, weight loss, fatigue - Dermatitis herpetiformis = itchy blistering skin rash, often on abdo - Nutrient deficiencies (B12, folate, Fe)
37
COELIAC DISEASE What are the investigations for coeliac disease?
- Pt must be on gluten-containing diet to be accurate - Raised antibodies (IgA), useful to monitor disease too – anti-tissue transglutaminase (TTG = first choice), anti-endomysial - Endoscopic small intestinal biopsy = gold standard
38
COELIAC DISEASE What are the characteristic features seen on small intestinal biopsy?
- Villous atrophy - Crypt hyperplasia - Increased intraepithelial lymphocytes
39
COELIAC DISEASE What are some complications of coeliac disease?
- Anaemias - Osteoporosis - Lymphoma (EATL) - Hyposplenism - Lactose intolerance
40
COELIAC DISEASE What is the management of coeliac disease?
- Lifelong gluten free diet = curative, supervised by dietician - May have gluten challenge later in life if Dx at <2y to ensure still intolerant - PCV vaccine with booster every 5y due to hyposplenism
41
HIRSCHSPRUNG'S DISEASE What is Hirschsprung's disease?
- Absence of ganglionic cells from myenteric (Auerbach's) plexus of large bowel resulting in narrow, contracted section of bowel > large bowel obstruction
42
HIRSCHSPRUNG'S DISEASE Where is most affected by Hirschsprung's disease? What is it associated with
- 75% confined to rectosigmoid - Commonly ileum moves into the caecum via the ileocaecal valve - M>>F, Down's syndrome
43
HIRSCHSPRUNG'S DISEASE What is the clinical presentation of Hirschsprung's disease?
- Failure or delay to pass meconium within 24h - Abdo pain, distension + later bile (green) stained vomit = obstruction - Chronic constipation + failure to thrive
44
HIRSCHSPRUNG'S DISEASE What are some investigations for Hirschsprung's disease?
- PR exam = narrow segment + withdrawal causes flow of liquid stool + flatus - AXR with barium contrast = dilated loops of bowel with fluid level - Suction rectal biopsy = DIAGNOSTIC showing absence of ganglionic cells
45
HIRSCHSPRUNG'S DISEASE What is a complication of Hirschsprung's disease?
- Hirschsprung-associated enterocolitis (HAEC) = inflammation + obstruction of intestine, sometimes due to C. difficile
46
HIRSCHSPRUNG'S DISEASE How does hirschsprung associated enterocolitis (HAEC) present?
- 2-4w after birth = fever, abdo distension, diarrhoea (bloody) + signs of sepsis
47
HIRSCHSPRUNG'S DISEASE What is a complication of Hirschsprung associated enterocolitis (HAEC)?
Toxic megacolon + perforation = life-threatening
48
HIRSCHSPRUNG'S DISEASE How is Hirschsprung associated enterocolitis (HAEC) managed?
Urgent Abx, fluid resus + decompression of obstructed bowel
49
HIRSCHSPRUNG'S DISEASE What is the management of Hirschsprung's disease?
- Bowel irrigation as initial management so meconium can pass - Surgical resection of aganglionic section of bowel = anorectal pullthrough (anastomosing innervated bowel>anus)
50
PYLORIC STENOSIS What is pyloric stenosis? What is the epidemiology?
- Hypertrophy of the pyloric (circular) muscle causing gastric outlet obstruction - Presents 2–7w, M>F 4:1, particularly first-borns
51
PYLORIC STENOSIS What is the clinical presentation of pyloric stenosis?
- Projectile vomiting (no bile) due to powerful peristalsis AFTER feeds - Hunger after vomiting until dehydration > loss of interest - Failure to thrive - Palpable abdominal 'olive' mass in RUQ (hypertrophic muscle of pylorus)
52
PYLORIC STENOSIS What are some investigations for pyloric stenosis?
- Test feed = visible gastric peristalsis - Hyponatraemic, hypokalaemic + hypochloraemic metabolic acidosis - USS = Dx, visualises thickened pylorus
53
PYLORIC STENOSIS What is the management of pyloric stenosis?
- Correct fluid + electrolyte disturbances (0.45% saline, 5% dextrose + K+ supplements) before any surgery - Laparoscopic Ramstedt's pyloromyotomy
54
PYLORIC STENOSIS What is Ramstedt's pyloromyotomy? What is the after care?
- Incision into smooth muscle of pylorus to widen canal - Can feed 6h after
55
ABDOMINAL PAIN What are some causes of acute abdominal pain?
- Surgical = appendicitis, intussusception, Meckel's, malrotation, mesenteric adenitis - Boys = exclude testicular torsion + strangulated inguinal hernia - Medical = UTI, DKA, HSP, lower lobe pneumonia
56
ABDOMINAL PAIN What is recurrent abdominal pain?
- Recurrent pain sufficient to interrupt normal activities + lasting ≥3m - Often functional abnormalities of gut motility or enteral neurones = IBS, abdominal migraine or functional dyspepsia
57
ABDOMINAL PAIN What are some causes of recurrent abdominal pain?
- No structural cause in >90% - GI = IBS, abdominal migraine, coeliac - Gynae = ovarian cysts, PID, Mittelschmerz (ovulation pain) - Hepatobiliary = hepatitis, gallstones, UTI - Psychosocial = bullying, abuse, stress
58
ABDOMINAL PAIN What are some red flags in recurrent abdominal pain for organic disease?
- Epigastric pain at night, haematemesis = duodenal ulcer - Vomiting = pancreatitis - Jaundice = liver disease - Dysuria, secondary enuresis = UTI - Bilious vomiting + abdo distension = malrotation
59
ABDOMINAL PAIN What are some investigations for abdominal pain?
- Guided by clinical features, urine MC&S essential - Endoscopy if dyspeptic - Colonoscopy if any PR bleeding
60
ABDOMINAL PAIN How can abdominal pain be managed?
- Encourage parents to not ask about or focus on pain - Distract child with other interests + activities - Advice about sleep, regular balanced meals, exercise etc
61
APPENDICITIS What is appendicitis?
- Commonest cause of surgical abdominal pain, very uncommon in <3y
62
APPENDICITIS What is the pathophysiology of appendicitis?
- Obstruction of the appendix lumen (faecolith) causing inflammation + infection of the appendix wall - This makes it liable to perforation which can be rapid as omentum less developed so fails to surround the appendix + then peritonitis
63
APPENDICITIS What are the symptoms of appendicitis?
- Classic central, colicky abdominal pain which localises to RIF from localised peritoneal inflammation - Anorexia - Minimal vomiting
64
APPENDICITIS What are the signs of appendicitis?
- Low grade fever - Abdominal pain aggravated by movement - RIF tenderness + guarding (McBurney's point) - Rebound + percussion tenderness (precipitated by cough, jump) - Rovsing's sign = LIF pressure causes RIF pain
65
APPENDICITIS What are some investigations for appendicitis?
- FBC (raised WCC), CRP raised - Faecoliths can be see in AXR - USS to exclude gynae pathology - Gold standard = CT abdomen esp if uncertain - -ve tests but clinical suspicion = diagnostic laparoscopy
66
APPENDICITIS What is the management of appendicitis?
- ?Perforation = fluid resus + prophylactic IV Abx before surgery - Appendicectomy (often diagnostic laparoscopy, may be delayed if stable)
67
INTUSSUSCEPTION What is intussusception and where does it most commonly affect?
- Bowel telescopes (invaginates) into itself (proximal bowel into distal segment) - Commonly ileocaecal valve (ileum>caecum)
68
INTUSSUSCEPTION What is the epidemiology?
- Most common cause of intestinal obstruction in infants 2m–2y, M>F
69
INTUSSUSCEPTION What are some symptoms of intussusception?
- Severe paroxysmal abdominal colic pain + food refusal - Child becomes pale + draws up legs during episodes of pain (colic), screaming - Vomiting (bilious), abdominal distension + shock
70
INTUSSUSCEPTION What are some signs of intussusception?
- RUQ 'sausaged-shaped' mass - Redcurrant jelly stool as blood + mucus in stool
71
INTUSSUSCEPTION What are the investigations for intussusception?
- USS #1 choice, shows 'target sign' - AXR shows distended small bowel + no gas distally in large bowel
72
INTUSSUSCEPTION What is the management of intussusception?
- Aggressive IV fluid resus - Reduction via air enema (air insufflation) by radiologist (risk of perf) - Caution as risk of gangrenous bowel + perf so laparotomy if air enema fails
73
MECKEL'S DIVERTICULUM What is Meckel's diverticulum?
- Ileal remnant of the vitello-intestinal duct which contains ectopic gastric mucosa or pancreatic tissue
74
MECKEL'S DIVERTICULUM What are some features of Meckel's diverticulum?
Rule of 2s – - 2% population - 2 feet from ileocaecal valve - 2 inches - 2 types of tissue - 2y/o
75
MECKEL'S DIVERTICULUM What is the clinical presentation of Meckel's diverticulum?
- Severe, painless, dark red PR bleeding - May present with intussusception, volvulus or diverticulitis (mimics appendicitis)
76
MECKEL'S DIVERTICULUM What are the investigations for Meckel's diverticulum?
- Technetium scan will demonstrate increased uptake by ectopic gastric mucosa
77
MECKEL'S DIVERTICULUM What is the management of Meckel's diverticulum?
Surgical resection, may need transfusion if severe haemorrhage
78
IBS What is irritable bowel syndrome (IBS)?
- Associated with altered gastrointestinal motility + an abnormal sensation of intra-abdominal events - Can be exacerbated by psychosocial factors like stress + anxiety
79
IBS How does IBS present?
- Abdo pain often worse before or relieved by defecation - Intermittent explosive, loose or mucous stools + constipations - Bloating - Feeling of incomplete defecation
80
IBS How is IBS diagnosed?
- By exclusion (FBC, CRP/ESR, coeliac screen, faecal calprotectin + MC&S) - Dietician involvement with possibility of excluding foods if they aggravate Sx
81
IBS What is the management of IBS?
- Constipation = good water + fibre intake, physical activity, PRN laxatives - Diarrhoea = avoid alcohol + caffeine, try bulking agent ± anti-motility such as loperamide after each loose stool - Anti-spasmodic for pain like mebeverine or hyoscine butylbromide (Buscopan)
82
CONSTIPATION What is constipation?
- Infrequent passage of dry, hardened faeces often accompanied by straining or pain, by definition <3 complete stools per week
83
CONSTIPATION What is encopresis?
Involuntary soiling
84
CONSTIPATION What are some features of constipation?
- Hard or like rabbit droppings (type 1) - May have PR bleed if hard - Waxing + waning of pain with stool passage - Retentive posturing
85
CONSTIPATION What are some causes of constipation?
- Usually idiopathic - Meds (opiates) - LDs - Hypothyroidism - Hypercalcaemia - Poor diet (dehydration, low fibre) - Occasionally forceful potty training
86
CONSTIPATION What are some red flags in constipation?
- Delayed passage of meconium = Hirschsprung's, CF - Failure to thrive = hypothyroid, coeliac - Abnormal lower limb neurology = lumbosacral pathology - Perianal bruising or multiple fissures = ?abuse
87
CONSTIPATION What investigations might you do in constipation?
- Abdo exam may reveal palpable faecal mass - PR examination only by an expert
88
CONSTIPATION What are some complications of constipation?
- Acquired megacolon - Anal fissures - Soiling + behavioural problems - Child may avoid defecating due to pain > constipation + overflow diarrhoea
89
CONSTIPATION What is the process of constipation and overflow diarrhoea?
- Prolonged faecal status = resorption of fluids = increase in size + consistency - This leads to rectal stretching + reduced sensation > overflow + soiling (very smelly)
90
CONSTIPATION What conservative management is given for constipation?
- Balanced diet with adequate fibre + sufficient fluids - Toilet train to sit on toilet after mealtimes - Star charts reward - Use these in combination with medical management
91
CONSTIPATION What is the medical management of constipation?
- 1st = macrogol (osmotic) laxative like polyethylene glycol + electrolytes (Movicol) - 2nd = stimulant laxative if no effect like Senna, bisocodyl ± osmotic laxative (lactulose) or stool softener (docusate) if hard stools - 3rd = consider enema ± sedation or specialist manual evacuation - Continue for several weeks after regular bowel habit then gradual dose reduction
92
GOR What is gastro-oesophageal reflux (GOR)? What are some risk factors?
- Involuntary passage of gastric contents into the oesophagus due to inappropriate relaxation of the lower oesophageal sphincter, often due to functional immaturity - Preterm delivery, neuro disorders (cerebral palsy)
93
GORD What is the clinical presentation of GORD?
- Recurrent regurgitation or vomiting but normal weight gain
94
GORD When can it become problematic?
Problematic = chronic cough, hoarse cry, distress after feeding + reluctance to feed, failure to thrive
95
GORD What are the investigations for GORD?
- Usually clinical but if atypical Hx, complications or failed Tx... – 24h oesophageal pH monitoring – Endoscopy + biopsy to identify oesophagitis – Contrast studies like barium meal
96
GORD What are some complications of GORD?
- Failure to thrive from severe vomiting - Oesophagitis = haematemesis, discomfort on feeding or heartburn, Fe anaemia - Aspiration > recurrent pneumonia, cough/wheeze - Sandifer syndrome = dystonic neck posturing (torticollis)
97
GORD What is the management of uncomplicated GORD?
- Small + frequent meals, do not over feed - Regular burping to help milk settle - Keep baby upright after feeds - Trial thickening agents like Nestargel or add Gaviscon to feeds (not at same time)
98
GORD What is the management of more significant GORD?
- Acid suppression = H2 receptor antagonists (ranitidine) or PPI (omeprazole) - Surgical Mx (fundoplication) if complications, unresponsive to intensive medical treatment or oesophageal strictures
99
GASTROENTERITIS What is gastroenteritis?
- Inflammation of the stomach and intestines with diarrhoea, nausea + vomiting
100
GASTROENTERITIS What is the most common cause?
- Viral rotavirus in paeds, - norovirus in adults
101
GASTROENTERITIS What are some risk factors?
- Poor hygiene, - immunocompromised, - poorly cooked foods
102
GASTROENTERITIS What is the difference in gastroenteritis in developing and developed countries?
- Developing = causes thousands of deaths, mostly bacteria from contaminated food - Developed = mostly viral, infants susceptible to dehydration
103
GASTROENTERITIS What is the clinical presentation of gastroenteritis?
- Diarrhoea = change in consistency of stools to loose/liquid ± increase in frequency of passing stools (acute if <2w, often lasts 5–7d) - Vomiting (1–3d), abdominal cramps - Bloody diarrhoea associated with bacterial infection
104
GASTROENTERITIS What are 5 bacteria that can cause gastroenteritis?
- Campylobacter jejuni - E. coli - Shigella - Salmonella - Bacillus cereus
105
GASTROENTERITIS What is campylobacter jejuni? How is it spread? How does it present?
- #1 bacterial cause worldwide, gram negative curved/spiral bacteria - Raw/poorly cooked poultry, untreated water, unpasteurised milk - Abdominal cramps, bloody diarrhoea, vomiting + fever
106
GASTROENTERITIS What is the management of campylobacter jejuni?
- Abx considered after isolating organism where pts have severe symptoms or other risk factors - Azithromycin or ciprofloxacin
107
GASTROENTERITIS What E. coli strain is important to be aware of in terms of gastroenteritis? How is it spread? How does it present?
- E. coli 0157 as produces the Shiga toxin - Contact with infected faeces, unwashed salads or contaminated water - Abdominal cramps, bloody diarrhoea + vomiting
108
GASTROENTERITIS What is a complication of E. coli 0157?
- Destroys blood cells + can lead to haemolytic uraemic syndrome - Abx increase this risk so avoid
109
GASTROENTERITIS How is Shigella spread? How does it present? Complication?
- Faeces contaminating drinking water, swimming pools + food - Bloody diarrhoea, abdominal cramps + fever - Shiga toxin > HUS
110
GASTROENTERITIS what is the management for shigella infection?
severe = azithromycin or ciprofloxacin
111
GASTROENTERITIS How is Salmonella spread? How does it present?
- Raw eggs, poultry - Watery diarrhoea ± mucus or blood
112
GASTROENTERITIS What is Bacillus Cereus? How does it present?
- Gram +ve rod spread through inadequately cooked food, grows well on food, classically undercooked or reheated rice - Produces toxin (cereulide) > abdominal cramping + vomiting soon after ingestion, reaches intestines + different toxin causes watery diarrhoea, resolves within 24h
113
GASTROENTERITIS What are the main investigations for gastroenteritis?
- Assess for dehydration as main concern - FBC, CRP/ESR, U+Es - ?Stool MC&S (electron microscopy if viral) if blood in stool, immunocompromised, travel Hx, not improved in a week
114
GASTROENTERITIS What are signs of clinical dehydration?
- Sunken eyes - Reduced skin turgor - Lethargic - Tachycardia, tachypnoea - Dry mucous membranes - Appears unwell - Oliguria
115
GASTROENTERITIS What are signs of clinical shock?
- Pale/mottled - Hypotension - Prolonged CRT - Cold - Decreased GCS - Sunken fontanelle - Weak pulses - Anuria
116
GASTROENTERITIS what is the management for shigella infection?
severe = azithromycin or ciprofloxacin
117
GASTROENTERITIS What are some complications of gastroenteritis?
- Isonatraemic + hyponatraemic dehydration - Hypernatraemic dehydration - Post-infective lactose intolerance (remove lactose + slowly reintroduce) - Guillain-Barré - Dehydration #1 cause of death
118
GASTROENTERITIS What is isonatraemic dehydration?
- Water loss + Na+ loss are proportional
119
GASTROENTERITIS What is hyponatraemic dehydration?
- Child with diarrhoea drinks large quantities of water, Na+ loss greater than water so fall in plasma Na+ – Fluid shifts from ECF>ICF + can result in convulsions
120
GASTROENTERITIS What is hypernatraemic dehydration?
- Water loss exceeds Na+ loss + fluid shifts from ICF>ECF (rare)
121
GASTROENTERITIS How does hypernatraemic dehydration present?
Jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness/coma
122
GASTROENTERITIS How is hypernatraemic dehydration managed?
Slow rehydration over 48h
123
GASTROENTERITIS What are the general measures of managing gastroenteritis?
- Isolation if in hospital with barrier nursing as spreads easily - School isolation until Sx settled for 48h - Continue feeds (not solids) - Encourage PO fluids - Discourage fruit juices + carbonated drinks - Mx at home if can keep fluid down
124
GASTROENTERITIS What is the management of gastroenteritis with clinical dehydration?
- 50ml/kg low osmolarity oral rehydration solution (Dioralyte) in addition to maintenance fluid, - may need NG tube if unable to drink or vomiting
125
GASTROENTERITIS How is shock managed in gastroenteritis?
Rapid IVI (0.9% NaCl 20ml/kg), repeat if necessary, Abx if septicaemia
126
TODDLER'S DIARRHOEA What is Toddler's diarrhoea? How common is it?
- Chronic non-specific diarrhoea - Commonest cause of persistent loose stools in pre-school children
127
TODDLER'S DIARRHOEA What causes it?
Likely maturational delay in intestinal motility
128
TODDLER'S DIARRHOEA What is the clinical presentation of Toddler's diarrhoea?
- Stools vary in consistency (well-formed>explosive + loose) - Presence of undigested vegetables common = 'peas + carrots diarrhoea'
129
TODDLER'S DIARRHOEA What is the management of Toddler's diarrhoea?
- Most outgrow by age 5 but may be delay in reaching faecal continence - Ensure adequate fat to slow gut transit + fibre, avoid fresh fruit juice
130
BILIARY ATRESIA What is biliary atresia?
- Congenital condition where section of bile duct either narrowed or absent - Results in cholestasis as bile cannot be transported from liver>bowel so increase in conjugated bilirubin
131
BILIARY ATRESIA What is the clinical presentation of biliary atresia?
- Prolonged jaundice >2w - Pale stools + dark urine (obstructive pattern) - Failure to thrive - Hepatosplenomegaly
132
BILIARY ATRESIA What are the investigations for biliary atresia?
- Serum split bilirubin = conjugated elevated - USS abdo gold standard for Dx, laparotomy confirms
133
BILIARY ATRESIA What genetic mutation is biliary atresia associated with?
Associated with CFC1 gene mutations
134
BILIARY ATRESIA What is the management of biliary atresia?
- Kasai portoenterostomy (attach section of small intestine to opening of liver where bile duct attaches) - Some will need full liver transplant - Success decreases with age so early Dx crucial
135
CHOLEDOCHAL CYST What is a choledochal cyst?
Cystic dilatations of extrahepatic or intrahepatic biliary system It is a congenital anomaly
136
CHOLEDOCHAL CYST what are the different types?
Type 1 - cyst of extrahepatic bile duct (most common) Type 2 - abnormal pouch/sac opening from duct Type 3 - cyst inside the wall of the duodenum Type 4 - cysts on both intrahepatic and extrahepatic bile ducts
137
CHOLEDOCHAL CYST How may it present?
- Cholestatic jaundice - abdominal mass - pain in RUQ - nausea and vomiting - fever
138
CHOLEDOCHAL CYST what are the investigations?
can be detected on ultrasound before the child is born after the baby is born, the parent's may notice lump in RUQ, the following tests are then done: - CT scan - cholangiography
139
CHOLEDOCHAL CYST What are the complications?
- Cholangitis - small risk of malignancy
140
CHOLEDOCHAL CYST What is the management?
Surgical cyst excision
141
NEONATAL HEPATITIS What is neonatal hepatitis syndrome?
- Prolonged neonatal jaundice + hepatic inflammation
142
NEONATAL HEPATITIS How does it present?
- Intruterine growth restriction (IUGR), - hepatosplenomegaly at birth, - failure to thrive - dark urine
143
NEONATAL HEPATITIS What are some investigations for neonatal hepatitis syndrome?
- Deranged LFTs with raised unconjugated + conjugated bilirubin - Liver biopsy = multinucleated giant cells + Rosette formation
144
NEONATAL HEPATITIS What are 4 main causes of neonatal hepatitis?
- Congenital infection - Alpha-1-antitrypsin (A1AT) deficiency - Galactosaemia - Wilson's disease
145
NEONATAL HEPATITIS What is A1AT deficiency?
- Deficiency of protease A1AT which inhibits neutrophil elastase + protects tissues
146
NEONATAL HEPATITIS What is the cause of A1AT deficiency?
AR on chromosome 14
147
NEONATAL HEPATITIS What is the presentation of A1AT deficiency?
- Prolonged neonatal jaundice (cholestasis), worse on breast feeding, - can have (prolonged) bleeding due to vitamin K deficiency, - COPD
148
NEONATAL HEPATITIS How do you diagnose A1AT deficiency?
- Serum A1AT concentration
149
NEONATAL HEPATITIS What is the management for A1AT deficiency?
- ?Transplantation - Never smoke
150
NEONATAL HEPATITIS What is galactosaemia?
- Deficiency of galactose-1-phosphate uridyltransferase (GALT) involved in galactose metabolism (lactose breaks down into galactose)
151
NEONATAL HEPATITIS How does galactosaemia present?
- Poor feeding, - vomiting, - jaundice + hepatomegaly when fed milk
152
NEONATAL HEPATITIS What are the complications of galactosaemia?
- Rapidly fatal course with shock, DIC + haemorrhage due to gram -ve sepsis - Liver failure, cataracts + Developmental delay if untreated
153
NEONATAL HEPATITIS What is the management of galactosaemia?
- Stop cow's milk, breastfeeding C/I - Dairy-free diet - IV fluids
154
NEONATAL HEPATITIS What is Wilson's disease?
- Reduced synthesis of caeruloplasmin (normally binds to copper + allows it to be excreted with bile)
155
NEONATAL HEPATITIS What are the genetics for Wilson's disease?
AR on chromosome 13
156
NEONATAL HEPATITIS How does Wilson's disease present?
Sx of copper accumulation - Eyes (Kayser-Fleischer rings) - Brain (Parkinsonism + psychosis) - Kidneys (vit D resistant rickets) - Liver (jaundice)
157
NEONATAL HEPATITIS What are the investigations for Wilson's disease?
- 24h urine copper assay (high), - serum caeruloplasmin (low)
158
NEONATAL HEPATITIS What is the management of Wilson's disease?
Penicillamine for copper chelation
159
FAILURE TO THRIVE What is failure to thrive?
- Failure to gain adequate weight or achieve adequate growth at a normal rate during infancy or childhood - Descriptive term (aka faltering growth)
160
FAILURE TO THRIVE What are the different categories of causes for failure to thrive?
- Inadequate calorie intake (most common) - Malabsorption - Inadequate retention - Increased calorie requirements
161
FAILURE TO THRIVE What are some causes of inadequate calorie intake?
- Impaired suck/swallow (cleft palate, neuro-motor dysfunction, CP) - Inadequate availability of food (socioeconomic deprivation) - Neglect - Maternal depression
162
FAILURE TO THRIVE What are some causes of malabsorption?
- Cystic fibrosis - Cow's milk protein intolerance - Coeliac disease - IBD - Short gut syndrome
163
FAILURE TO THRIVE What are some causes of inadequate retention?
- Vomiting (GORD, pyloric stenosis), - gastroenteritis
164
FAILURE TO THRIVE What are some causes of increased calorie requirements?
- Chronic illness (CHD, CKD, CF, HIV), - hyperthyroidism, - cancer
165
FAILURE TO THRIVE What are some causes of inability to process nutrients properly?
- T1DM, - inborn errors of metabolism
166
FAILURE TO THRIVE What is marasmus?
- Severe protein malnutrition - Weight for height >3 standard deviations below the median - Wasted, wrinkly appearance due to severe protein-energy malnutrition
167
FAILURE TO THRIVE What is kwashiorkor?
- Severe protein malnutrition - Generalised oedema - Sparse + depigmented hair - Skin rash - Angular stomatitis - Distended abdomen - Hepatomegaly + diarrhoea
168
FAILURE TO THRIVE How is failure to thrive defined by height?
- Mild = fall across 2 centile lines on growth chart - Severe = fall across 3 centile lines on growth chart
169
FAILURE TO THRIVE How does NICE define faltering growth in children by weight?
- ≥1 centile spaces if birth weight was <9th centile - ≥2 centile spaces if birth weight was 9th–91st centile - ≥3 centile spaces if birth weight was >91st centile - Current weight is below 2nd centile for age, regardless of birth weight
170
FAILURE TO THRIVE What are some investigations for failure to thrive?
- Serial measurements on growth charts for Dx - Full Hx + examination - Measure height + weight > BMI (if >2y) - Calculate mid-parental height - Food diary - Urine dipstick for UTI + coeliac screen (anti-TTG) for 1st line investigations
171
FAILURE TO THRIVE What would you ask about in a failure to thrive history + examination?
- Pregnancy, birth, developmental + social Hx - Feeding or eating Hx (breast/bottle, times, volume, frequency) - Observe feeding - Mum's physical + mental health - Parent-child interactions
172
FAILURE TO THRIVE What might BMI tell you? Any other investigations to perform?
- <2nd centile = ?undernutrition or small build, <0.4th centile = likely undernutrition > assessment + intervention - Specific underlying cause if suspected (CRP/ESR, U+Es, LFTs, TFTs)
173
FAILURE TO THRIVE What is the MDT management approach for failure to thrive?
- Health visitor (parental support if inorganic) - Dietician may suggest nutritional supplement drinks or add energy dense foods, encourage regular structured mealtimes + Snacks - Community paediatrician - SALT if impaired suck or swallow
174
FAILURE TO THRIVE When would hospital admission be required?
- Severe failure to thrive + require active refeeding - Can use this time to observe + improve method of feeding if needed
175
FAILURE TO THRIVE What is the last line consideration in failure to thrive?
- Enteral tube feeding - Must have clear goals + defined end point - Only used if serious concerns about weight gain + other interventions tried
176
CMPA What is cow's milk protein allergy (CMPA)?
- Affects children <3y where there's hypersensitivity to protein in cow's milk, - most outgrow by age 3, - IgE and non-IgE types
177
CMPA What is cow's milk protein allergy (CMPA) associated with?
- More common in formula fed babies - those with personal or FHx of atopy
178
CMPA How does cows milk protein allergy (CMPA) differ from lactose intolerance?
- Lactose is a sugar - Explosive watery stools, abdo distension, flatulence + audible bowel sounds
179
CMPA What is the clinical presentation of cows milk protein allergy (CMPA)?
- Apparent when weaned from breast > formula milk or food with milk - GI = bloating + wind, abdo pain, D+V, failure to thrive - Allergic = urticaria, cough, wheeze, sneezing, itching - Anaphylaxis + angioedema is rare
180
CMPA How does cows milk protein allergy (CMPA) differ to cow's milk intolerance?
- cows milk intolerance is not an allergic reaction (mild-mod delayed reactions) so does not involve immune system - Same GI Sx but not allergic features - Infants may be able to tolerate some cow's milk just with Sx, same Mx
181
CMPA What are the investigations for cows milk protein allergy (CMPA)?
- IgE mediated = skin prick tests + RAST for cow's milk protein - Gold standard if doubt = elimination diet under dietician supervision
182
CMPA What is the management for cows milk protein allergy (CMPA)?
- Breastfeeding mothers should avoid dairy - Replace formula with extensive hydrolysed formula - Amino acid-based formula if severe or no response to eHF - Food challenge may be performed in hospital setting
183
CMPA How do hydrolysed and amino acid-based formulas work?
- Proteins broken down so they no longer trigger an immune response
184
CMPA How should allergic attacks be managed in cows milk protein allergy (CMPA)?
- Antihistamines or IM adrenaline (EpiPen) if severe reactions
185
FOOD ALLERGIES What food allergies present in children?
- Infants = milk, egg, peanut - Older children = peanut, fish + shellfish
186
FOOD ALLERGIES What are the different types of food allergy?
- IgE mediated = urticaria, angioedema, wheeze - Non-IgE = D+V, failure to thrive, abdo pain
187
FOOD ALLERGIES What is a food intolerance?
Non-immunological hypersensitivity reaction to food
188
KWASHIOKOR what is it?
it is a type of protein-energy malnutrition caused by a severe deficinecy pf protein/amino acids
189
KWASHIOKOR what are the clinical features?
- growth retardation - diarrhoea - anorexia - oedema - defining characteristic - skin/hair depigmentation - abdominal distension with fatty liver
190
KWASHIOKOR what are the investigations?
bloods - FBC, U+E, serum protein, urine dipstick - hypoalbuminaemia - normo/microcytic anaemia - low calcium, magnesium, phosphate and glucose
191
MARASMUS what is it?
a type of protein-energy malnutrition caused by a severe energy (calories) deficiency
192
MARASMUS what are the clinical features?
- height is relatively preserved compared to weight - wasted appearance - muscle atrophy - listless - diarrhoea - constipation
193
MARASMUS what are the investigations?
- bloods - FBC, U+Es - stool MC+S for intestinal ova, cysts and parasites
194
KWASHIOKOR what is the management?
ready-to-use therapeutic food (RUTF) antibiotics milk-based liquid food followed by RUTF if severe (complicated)
195
MARASMUS what is the management?
correct dehydration and electrolyte imbalance treat underlying infection/parasitic infections treat causative disease orally refeed slowly - watch for refeeding syndrome
196
HERNIA what are the most common types of hernia that affect children?
indirect inguinal hernia - caused by an opening in the abdominal wall that is present at birth umbilical hernia
197
HERNIA what are the risk factors for developing a hernia?
- premature, underweight babies - male gender - family history - medical conditions - undescended testes, CF - African descent
198
HERNIA what is the clinical presentation?
- lump or swelling near the groin/belly button - pain or tenderness around the groin/lower belly - unexplained crying or fussiness - visible bulge that gets bigger during straining, crying or coughing
199
HERNIA what is the treatment for umbilical hernias?
small = 85% will close without surgery large/stays open past 2yrs = surgery
200
HERNIA what is the treatment for indirect inguinal hernias?
require surgery to reduce the hernia
201
HERNIA what are the complications of hernias?
strangulation/incarceration - there is 30% chance of testicular infarction due to pressure on gonadal vessels
202
LIVER FAILURE what are the causes?
- chronic hepatitis - biliary tree disease - toxin induced - A1AT deficiency - autoimmune hepatitis - wilson's disease - CF - budd-chiari syndrome - primary sclerosing cholangitis
203
LIVER FAILURE what is the clinical presentation?
- jaundice (not always present) - GI haemorrhage - pruritis - FTT - anaemia - enlarged hard liver - non-tender splenomegaly - hepatic stigmata e.g. spider naevi - peripheral oedema and/or ascites - nutritional disorders - developmental delay - chronic encephalopathy
204
LIVER FAILURE what are the investigations?
- BLOODS - FBC = low WCC, low Hb (if GI bleed), low platelets - LFT = normal/low bilirubin, raised AST/ALT - coagulation = increased prothrombin time (PTT) - glucose = normal/low - U+Es, viral serology, IgG, complement, autoimmune antibodies - METABOLIC STUDIES - sweat test = CF - serum/urinary copper = Wilson's disease - ABDOMINAL ULTRASOUND - LIVER BIOPSY - UPPER GI ENDOSCOPY
205
LIVER FAILURE what is the management?
- treat the underlying cause + give nutritional support - lower protein, increased energy, higher carb diet - vitamin supplementation (ADEK) - fluid restriction for ascites (alternatively use spironolactone) - liver transplantation
206
LIVER FAILURE what is the prognosis?
there is up to 50% mortality without liver transplant
207
INFANT COLIC what is it?
The term is used to describe a symptom complex that occurs in the first few months of life
208
INFANT COLIC What is the epidemiology?
It occurs in up to 40% of babies It typically occurs in few few weeks of life and resolves by 4 months
209
INFANT COLIC What is the clinical presentation?
Paroxysmal inconsolable crying or screaming Often accompanied by drawing up of the knees Passage of excessive wind several times per day, particularly in the evening
210
INFANT COLIC what is the risk of this condition?
It is very frustrating for parents It may precipitate non-accidental injury in infants already at risk
211
INFANT COLIC what is the cause?
Unknown but thought to be gastrointestinal If severe and persistent it may be due to cow's milk protein allergy or GORD
212
INFANT COLIC What is the management?
Support and reassurance If severe an empirical 2-week trial of a whey hydrolysate formula followed by a trial of anti-reflux treatment may be considered.

My Phase 3a Revision (27 decks)

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