Paediatric GI Flashcards

Question

features of pyloric stenosis

Answer 1

projectile vomiting - 30 mins after feed constipation and dehydration palpable mass - upper abdomen - poss (hypertrophic muscle of pylorus) - hypochloraemic, hypokalaemic alkalosis due to persistent vomiting.

Answer 2

uss - thickened pylorus ramstedt pyloromyotomy. - laparoscopic pyloromyotomy : - incision into smooth muscle of pylorus - widen canal allowing food to pass from stomach to duodenum as normal. blood gas: hypochloric (low chloride) met alkalosis. - baby vomits the hcl from stomach.

Answer 3

1st few weeks of life hungry baby thin pale failing to thrive. projectile vomiting.

Answer 4

ring of smooth muscle forms canal between stomach and duodenum. hypertrophy and narrowing of pylorus causes the stenosis. food cant travel. then you get powerful peristalsis in stomach as it tries to push food into duodenum but it cant so goes other way: oeseophagus - projective vomit.

Answer 5

rare condition. duodenal or pancreatic tumour secretes excessive quantities of gastrin. gastrin: hormone stimulates acid secretion in stomach. = severe dyspepsia diarrhoea peptic ulces gastrin-secreting tumours - gastrinomas associated with MEN1 - autosomal dominant. - can cause parathyroid and pituitary tumours

Answer 6

CONGENITAL caused by aganglionic segment of bowel due to developmental failure or parasympathetic (MYENTERIC) auerback and meissner plexuses. RARE. important for childhood constipation!!

Answer 7

3 times mc in males downs syndrome neurofibromatosis MEN type II Waardenburg syndrome: pale blue eyes, hearing loss and patches of white skin and hair)

Answer 8

parasympathetic neuroblasts fail to migrate from neural crest to the distal colon and rectum. - section at end of colon left without parasympathetic ganglion cells. therefore : developmental failure of parasympathetic auerback and miessner plexuses therefore uncoordinated peristalsis therefore functional obstruction aganglionic section doesnt relax - constriction. - loss of movement of faeces and obstruction in bowel.

Answer 9

neonatal period: failure or delay to pass meconium more than 24 hrs. chronic constipation since birth vomiting poor weight gain/failure to thrive older children: constipation abdo distention

Answer 10

abdo x ray rectal biopsy - gold : bowel histology: abscence of ganglionic cells.

Answer 11

initially: rectal washouts/bowel irrigation fluid resus definitive: surgery to affected segment of colon

Answer 12

the myenteric plexus or the auerbachs forms the enteric nervous system - brain of gut. its not there for hirschsprungs. this nerve plexus run along bowel in bowel wall. - stimulates peristalsis of large bowel. - without it the bowel loses mobility and cant pass food along length.

Answer 13

inflammation and obstruction of intestine. 2-4 weeks of birth with : - fever -abdo distention -diarrhoea(often with blood) - features of sepsis life threatening. lead to : - toxic megacolon an perforation of the bowel. tx: - abx -fluid resus -decompression of obstructed bowel

Answer 14

CONGENITAL obliteration or discontinuity within extrahepatic biliary system : obstruction in bile flow.

Answer 15

1: proximal ducts patent, common duct obliterated 2: atresia of cystic duct and cystic structures found in porta hepatis 3: atresia of left and right ducts to level of porta hepatis.

Answer 16

1st few weeks of life jaundice - extending beyond phsyiological 2 weeks. darkin urine and pale stools. appetite and growth disturbance. - could be normal in some

Answer 17

jaundice hepatomegaly with splenomegaly abnormal growth cardiac murmurs if associated cardiac abnormalities present.

Answer 18

Serum Billirubin : conjugated and total. conjugated high total normal LFT: serum bile acids, aminotransferases raised. serum alpha 1 antitrypsin: deficiency sweat chloride test: CF involves biliary tract uss of biliary tree and liver: poss distention and tract abnormalities percutaneous liver biopsy with intraoperative cholangioscopy

Answer 19

surgery only definitive: dissection of abnormalities into distinct ducts and anastomosis creation. medical: abx and bile acid enhancers after surgery KASAI PROTOENTEROSTOMY: attack section of SI to liver opening where bile ducts normally attaches.

Answer 20

unsuccessful anastomosis formation progressive liver disease cirrhosis with eventual HCC

Answer 21

good if surgery successful if fails: liver transplant needed in 1st 2 yrs of life

Answer 22

Severe malnutrition caused by an overall deficiency in caloric intake (protein and energy). Usually kids under 5, in developing countries. Results in extreme fat and muscle loss, causing stunted growth, severe weight loss and immunodeficiency. Common in areas of famine or severe malnutrition

Answer 23

Severe weight loss Emaciation Prominent bones, sunken eyes, thin, dry skin Irritability Growth failure Weakness

Answer 24

Rehydration Gradual intro of calories Micronutrient supplementation Long term nutritional rehabilitation and infection management

Answer 25

Immunodeficiency leading to severe infection Electrolyte imbalance (hypokalaemia) Hypoglycaemia Growth retardation

Answer 26

Severe protein malnutrition that occurs despite sufficient caloric intake. Often areas where diet is primarily starchy or carbohydrate heavy with little protein. Children often appear puffy due to generalised oedema (hypoalbuminaemia), especially in legs and face.

Answer 27

Oedema (legs, face) Moon face Depigmented hair Enlarged, fatty liver

Answer 28

Sudden breastfeeding cessation Poverty Insufficient protein, high carbohydrate Food insecurity/scarcity

Answer 29

High mortality if untreated Heart failure (due to severe oedema) Sepsis Severe diarrhoea Refeeding syndrome if not treated properly

Answer 30

Electrolyte and fluid imbalance correction (slow, prevent osmotic demyelination syndrome) Gradual nutritional rehabilitation, protein rich etc

Answer 31

Inflammation of liver of newborns usually in first months of life. Can be due to viral infection, genetic disorders, or may be idiopathic. Inflammation leads to impaired bile flow, damaging liver

Answer 32

Viral (cytomegalovirus, hepatitis B) Metabolic disease (galactosemia, tyrosinaemia) Genetic disorders (alpha 1 antitrypsin deficiency) Family history and prematurity are RF

Answer 33

Jaundice >first 2 weeks, prolonged Hepatomegaly Dark urine and pale stools Poor feeding, failure to thrive

Answer 34

Treatment of underlying cause Fat soluble vitamin supplementation (ADEK) Ursodeoxycholic acid to aid bile flow Liver transplant if severe

Answer 35

Congenital diverticulum of the small intestine. Remnant of omphalomesenteric duct and contains ectopic ileal, gastric or pancreatic mucosa Usually asymptomatic but can present with abdominal (RLQ) pain, rectal bleeding or intestinal obstruction. It is the biggest cause of painless massive GI bleeding between 1 and 2y.

Answer 36

Meckels scan - 99m Technetium pertechnetate scan, which has an affinity for gastric mucosa Managed - Laparoscopic surgery or diverticulectomy. - Small bowel resection and anastomosis.

Answer 37

Meckel’s diverticulum - 2% of population - 2 inches long - 2 feet from ileocaecal valve - 2x as likely in boys - 2yo when it causes GI bleed - 2 types of ectopic tissue (pancreatic and gastric (susceptible to ulcer))

Answer 38

Meconium ileus Hirschprung’s disease Oesophageal/duodenal atresia Intussusception Intestinal malrotation

Answer 39

Persistent vomiting Abdominal pain/distention Failure to pass stool/wind Bowel sounds (tinkling early and absent later)

Answer 40

Abdominal X ray - Dilated loops of bowel proximal to obstruction and collapsed distal. - Absence of air in rectum

Answer 41

NBM NG Tube and draingage IV fluids Surgical definitive

Answer 42

Chronic, non specific diarrhoea, between 1 and 4 years of age. Is a diagnosis of exclusion

Answer 43

Frequent, poorly formed, offensive stools Food material easily recognisable Child is normally well, active and has unimpaired growth. Normal appetite and normal/increased fluid intake. No positive findings on examination or lab investigations

Answer 44

Paternal reassurance, avoidance of full strength fruit juice. Faeces normally becomes firm when child is toilet trained or by 3 years

Answer 45

Poor physical growth and development Faltering growth if they fall in centile spaces (e.g. distance between 75th and 50th centile) 1 if birthweight <9th centile 2 if birthweight 9-91st centile 3 if birthweight above 91st centile

Answer 46

Inadequate intake - Maternal absorption - Neglect - Poverty Difficulty feeding - Poor suck (cerebral palsy) - Cleft lip/palate - Pyloric stenosis Malabsorption Increased energy requirements - Hyperthyroid - Cystic fibrosis, heart disease - Chronic infection Inability to process nutrition

Answer 47

Height more than 2 centiles below mid parental height centile BMI below 2nd centile

Answer 48

Usually seen in the first 3 months of formula fed children, can rarely be seen in exclusively breastfed infants. CMPA for immediate (<2 hours, IgE mediated) CMPI if mild/moderate and delayed (several days, non IgE mediated)

Answer 49

Occurs in first 3 months of life: - Regurgitation and vomiting - Diarrhoea - Urticaria - Colic symptoms (crying, irritability) - Wheeze, chronic cough - Rarely anaphylaxis Cows milk protein intolerance has the bloating, wind, diarrhoea and vomiting, but no rash, angio-oedema, sneezing or coughing.

Answer 50

skin prick/patch testing total IgE and specific IgE (RAST) for Cows milk protein Avoiding cows milk should fully resolve issues

Answer 51

Avoid cow’s milk If formula fed - Extensive hydrolysed formula first line replacement - If intolerance, can be started on milk ladder Breast feeding - Breast feeding mother should avoid dairy products - May need maternal calcium supplements - Hydrolysed formula milk when breastfeeding stops until 12 months, for at least 6 months

Answer 52

A sensitivity to the gluten protein. Repeated exposure leads to villous atrophy causing malabsorption. Children normally present before 3yo. Normally affects small bowel, particularly the jejunum

Answer 53

Often asymptomatic, low threshold for testing - Failure to thrive - Diarrhoea - Abdominal distention - Anaemia - Mouth ulcers Dermatitis herpetiformis - itchy, blistering skin rash that typically appears on the abdomen

Answer 54

HLA-DQ2 (90%) HLA-DQ8

Answer 55

Antibodies - Anti-TTG and Endomysial antibodies (IgA - undetectable if IgA deficiency) - Anti-DGPs (Deaminated Gliadin Peptides) Endoscopy and intestinal - Crypt hyperplasia - Villous atrophy - Increased intraepithelial lymphocytes - Lamina propia infiltration Gluten free diet trial

Answer 56

gluten free diet

Answer 57

Autoimmune - T1DM - Thyroid disease - Autoimmune hepatitis - PBC/PSC - Down’s

Answer 58

Malnutrition/vitamin deficiency Anaemia Osteoporosis Non hodgkins lymphoma Small bowel adenocarcinoma

Answer 59

Abdominal pain or Bloating or Change in bowel habit and stool constitution (watery, loose, hard, mucus) Pain relieved with defecation. > 6 months. Diagnosed through exclusion and if - Altered stool passage - Abdominal bloating - Symptoms made worse by eating - Passage of mucus

Answer 60

Rectal bleeding Unexplained weight loss FH of bowel or ovarian cancer > 60y onset

Answer 61

FBC (check anaemia) Inflammatory markers Coeliac serology Faecal calprotectin CA125 (ovarian cancer) CA19/9 (pancreatic) *Ovarian presents similar, just much older. E.g. 50yo woman with bloating, abdo pain. Non specific

Answer 62

Lifestyle advice - Fluids - Regular small meals - Low FODMAP diet - Limit caffeine, alcohol, fatty foods - Reduce stress - Change fibre depending if constipation or diarrhoea CBT may be used

Answer 63

Loperamide for diarrhoea (slows down bowel) Linaclotide for constipation (laxative)

Answer 64

When a portion of the bowel invaginates into the lumen on the adjacent bowel, most commonly around the ileo-caecal region. This increases bowel size and narrows lumen, causing ostruction. Usually affects infants 6-24 months. Boys 2x as often

Answer 65

Intermittent severe crampy progressive abdo pain Inconsolable crying During attack the infant will raise knees up and turn pale Vomiting Bloodstained stools “red-currant jelly” late sign Sausage shaped mass in upper right quadrant May present with viral URTI preceding illness

Answer 66

Ultrasound is investigation of choice - target like mass Managed with reduction by air insufflation. OR Barium enema

Answer 67

obstruction gangrene perforation death

Answer 68

Appendix sits at end of caecum. Trapped stool or other obstruction causes infection and inflammation, which quickly causes gangrene and rupture. Rupture releases contents into abdomen, causing peritonitis and possibly sepsis.

Answer 69

Severe central abdominal pain that moves to RIF over time. Tenderness in McBurney’s point (2/3 of the distance from belly button to ASIS (Anterior Superior Iliac Spine)) Rovsing’s sign (palpation of left iliac fossa causes pain in RIF) Guarding Rebound tenderness and percussion tenderness if progression to peritonitis

Answer 70

Usually made clinically: - Pain moving centrally to RIF - low grade pyrexia - minimal vomiting CT GOLD Standard Ultrasound in women (rule out ovarian cancer and gynae pathology) Diagnostic laparoscopy if negative, with appendectomy in same procedure

Answer 71

Ectopic pregnancy - bHCG will be raised (test to rule out) Ovarian cysts - Pelvic and IF pain, not always right, can rupture or torsion Meckels diverticulum - Malformation of distal ileum, usually asymptomatic but can inflame, rupture, bleed, volvulus, intussusception. Mesenteric adenitis - Inflamed lymph nodes. Often associated with tonsilitis or URTI Appendix mass - Omentum surrounds and sticks to inflamed appendix. Treated with abx and supportively. Appendectomy once acute infection resolves

Answer 72

Bleeding, infection, pain scars Bowel adhesions, causing obstruction Damage to nearby organs Veneous thromboembolism

Answer 73

Chronic inflammation of the entire GI tract (mouth to anus). Terminal ileum and colon most commonly affected. Affects white people more

Answer 74

Family history Smoking White people OCP Diet low in fibre NSAID

Answer 75

NOD2/CARD15 gene mutation

Answer 76

Transmural inflammation with areas of healthy bowel in between known as skip lesions, giving a cobblestone appearance.

Answer 77

Aphthous mouth ulcers Abdominal tenderness and diarrhoea Perianal lesions- skin tages, fissures, abscesses, ulcers, etc Weight loss and failure to thrive

Answer 78

Skin - Perianal/mouth ulcers - Erythema nodosum - Pyoderma gangrenosum MSK - Arthritis - Seronegative spondyloarthropathy - Clubbing Eyes: - Conjunctivitis - Iritis

Answer 79

Faecal calprotectin raised Serology - pANCA Negative (more in UC) - ASCA positive (more in Crohns) Endoscopy + Biopsy - Endoscopy: Skip lesions, cobblestoning, strictures - Biopsy: Transmural inflammation, non caseating granulomas, goblet cells present Small bowel enema - High sensitivity/specificity for examination of terminal ileum - Stricturs (Kantor’s string sign) - Proximal bowel dilation - Rose thorn ulcers - Fistulae

Answer 80

Stop smoking, NSAID Induce remission - Glucocorticoids: Budesonide (mild), prednisolone (moderate), IV hydrocortisone (very severe) - Immunosuppressant: Azathioprine or methotrexate - AntiTNF (infliximab) Maintain remission: - Azathioprine

Answer 81

80% of patients - Sticturing terminal ileus disease (ileocaecal resection) - Perianal fistulae (Diagnosed with MRI, treated surgically and draining seton left in to prevent abscess formation) - Perianal abscess (Surgical incision and drainage)

Answer 82

Small bowel cancer Colorectal cancer Osteoporosis Perianal fissure/fistula/abscess Anaemia/malnutrition

Answer 83

Relapsing and remitting bowel disease that usually involves rectum and can extend up large bowel, up to ileocaecal valve (does not affect anus). 3X more common in non smokers (smoking protective)

Answer 84

Family History HLAB27 NSAIDs Infections Not smoking Chronic stress/depression

Answer 85

Continuous inflammation affecting only the mucosal layers. Usually starts at rectum, working its way proximally, never past the ileocaecal valve. Relapsing remitting course (flares with new damage, followed by healing) Regenerating mucosa forms a scar that looks like polyps (pseudopolyps)

Answer 86

LLQ and tenesmus Bloody, mucusy diarrhoea Abdominal pain, urgency, weight loss and malnutrition Extraintestinal manifestations - Uveitis - Colorectal cancer - Erythema nodosum - Pyoderma gangrenosum - Arthritis - PSC!

Answer 87

Colonoscopy - Avoid colonoscopy if severe (perforation risk) - Red, raw mucosa - Continuous inflammation - Loss of haustrations Biopsy - Pseudopolyps, crypt abscesses, goblet cell depletion, inflammation limited to mucosal layers

Answer 88

Arthritis PSC and uveitis more common in UC

Answer 89

Mild <4 stools/day, small amount of blood Moderate 4-6 stools/day, varying amounts of blood Severe 6+ bloody stools/day

Answer 90

Induce remission Rectal (topical) aminosalicylate - mesalazine/sulfasalazine. Add high dose oral aminosalicylate, and then oral corticosteroid, if extensive or if remission not achieved in 4 weeks. Maintain remission Aminosalicylate + azathioprine. If severe/non responsive, Colectomy is curative

Answer 91

PSC Bowel perforation Toxic megacolon Colonic adenocarcinoma Strictures and bowel obstruction

Answer 92

Sudden, acute, severe UC flareup > 10 bowel movements Continuous bleeding Abdominal tenderness Toxicity Colonic dilation Managed in hospital - IV corticosteroid - IV ciclosporin or infliximab Consider colectomy

Answer 93

Obesity Increased abdo pressure - ascites or multiparty

Answer 94

Barium swallow Endoscopy 1st line for the sx then you find incidentally

Answer 95

Dysphagia Heart burn Regurgitation Chest pain

Answer 96

Weight loss Ppi - omeprazole Surgery only if para oesophageal hernia

Paediatric GI Flashcards

(121 cards)