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Paediatrics > 2: GI - Duodenal Atresia, Coeliac Disease, Hernias, Functional Abdominal Pain, Hirschsprung's, IBD > Flashcards

2: GI - Duodenal Atresia, Coeliac Disease, Hernias, Functional Abdominal Pain, Hirschsprung's, IBD Flashcards

1
Q

What is duodenal atresia

A

Complete occlusion of the duodenum

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2
Q

What is duodenal stenosis

A

Narrowing of duodenum

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3
Q

What condition is duodenal atresia associated with

A

Down’s Syndrome (30%)

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4
Q

How will an infant with duodenal atresia present in-utero

A

Polyhydramnios

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5
Q

Why does a foetus with duodenal atresia have polyhydramnios

A

Unable to swallow and process amniotic fluid

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6
Q

What are neonatal features of duodenal atresia

A
  • Billous post-partum vomiting
  • Meconium ileum
  • Distended upper abdomen
  • Scaphoid lower abdomen
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7
Q

Why is vomiting bilious in duodenal atresia

A

Obstruction after major duodenal papilla

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8
Q

Why is scaphoid lower abdomen in duodenal atresia

A

No gas in abdomen beyond the obstruction

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9
Q

What is used to investigate duodenal atresia

A

AXR

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10
Q

What is seen on AXR

A

Double-bubble sign

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11
Q

What is the double-bubble sign

A

Accumulation of gas before the stenosis and after the stenosis - giving appearance of two bubbles

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12
Q

How is duodenal atresia managed

A
  • Gastric decompression
  • Parental nutrition
  • Duodenostomy
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13
Q

What is coeliac disease

A

Enteropathy caused by sensitivity to gluten

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14
Q

When does coeliac disease typically present in children

A

4-6 months

- Introduction of solid foods

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15
Q

What gene is most associated with coeliac disease

A

HLADQ2 (95%)

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16
Q

Aside from HLA DQ2, what other gene is associated with coeliac disease

A

HLADQ8 (10%)

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17
Q

What happens in coeliac disease

A

Gliadin triggers an auto-immune reaction

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18
Q

How does coeliac disease present clinically

A
  • Diarrhoea
  • FTT
  • Distended abdomen
  • Everted umbilicus
  • Irritability
  • ANAEMIA
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19
Q

What is a late presentation of coeliac disease

A

Wasting of the buttocks

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20
Q

What are very late signs of coeliac disease

A
  • Hypotonia
  • Apathy
  • Delayed puberty
  • Gross motor developmental delay
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21
Q

How is coeliac disease stereotypically identified on growth chart

A

4-6m (gluten introduced) will be crossing-down of centiles

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22
Q

What is first-line investigation for coeliac disease

A

anti-TTG (IgA)

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23
Q

What is second-line investigation for coeliac disease

A

anti-EMA

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24
Q

What is third-line for coeliac disease

A

Total IgA

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25
Q

When is serology for coeliac disease less reliable

A

Under 18 months

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26
Q

What imaging should be ordered in coeliac disease

A

Endoscopy (OGD)

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27
Q

Explain management of coeliac disease

A

Gluten-free diet

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28
Q

What is a complication of coeliac disease

A

Increases risk of small bowel lymphoma, even if asymptomatic

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29
Q

What are the three types of hernias that may occur in children

A

Umbilical
CDH
Inguinal

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30
Q

What is an umbilical hernia

A

Protrusion abdominal contents through umbilicus

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31
Q

What can cause umbilical hernia

A

Increase intra-abdominal pressure

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32
Q

Describe clinical features of umbilical hernia

A
  • Mass protruding through umbilicus
  • Increased on increasing intra-abdominal pressure
  • Can be easily reduced
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33
Q

What are two differential diagnoses of umbilical hernia

A
  • Omphalocele

- Gastrochisis

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34
Q

What is an omphalocele

A

Organs herniate through midline abdominal wall

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35
Q

When do majority of umbilical hernias resolve by

A

2-3 years

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36
Q

What are the TWO indications for repair of umbilical hernia

A
  1. > 4-years

2. > 1.5cm

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37
Q

What is gastrochisis

A

Paraumbilical herniation intestine

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38
Q

Will inguinal hernias in paediatrics be direct or indirect and why

A

Indirect - due to patent processes vaginalis

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39
Q

Will indirect inguinal hernias be medial or lateral to the inferior epigastric vessels

A

Lateral to inferior epigastric vessels

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40
Q

Describe position of inguinal hernias relative to pubic tubercle

A

Superior-medial

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41
Q

When are inguinal hernias most common in paediatrics

A

Before 1-year

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42
Q

What causes inguinal hernias

A

Patent processes vaginalis

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43
Q

What are 4 risk factors for inguinal hernias

A
  • FH
  • Male
  • Pre-Mature
  • Raised intra-abdominal pressure
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44
Q

What can cause raised intra-abdominal pressure

A

Prolonged ventilation

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45
Q

What is the main presentation of inguinal hernia in children

A

Intermittent swelling inguinal-scrotal region

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46
Q

What is the main risk with inguinal hernias

A

Strangulation

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47
Q

What is strangulation

A

Occlusion blood supply resulting in necrosis

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48
Q

How will strangulation of an inguinal hernia

A
  • Irritability

- Absolute bowel obstruction (no defectation or flatulence)

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49
Q

What are two factors that increase risk strangulation inguinal hernia

A
  • Smaller hernia

- Younger child

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50
Q

What is the main differential diagnosis of inguinalscrotal swelling, aside from inguinal hernia

A

Hydrocele

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51
Q

What is the main differentiating feature of hydrocele and inguinal hernia

A

Can get above a hydrocele, not a inguinal hernia

52
Q

What two conditions does a patent process vaginalis predispose to

A

Inguinal hernia

Hydrocele

53
Q

If asymptomatic, how are inguinal hernias managed

A

Elective repair within 1-month

54
Q

If incarcerated, how are inguinal hernias managed

A

Repair in 24-hours

55
Q

If strangulated, how are inguinal hernias managed

A

Urgent herniotomy

56
Q

If a boy under 2-years or girl more than 5-years with inguinal hernias and what is required and why

A

Laparoscopy - to investigate for contralateral hernia

57
Q

what is a congenital diaphragmatic hernia

A

when portion bowel protrudes through diaphragm

58
Q

what is the most common type of CDH

A

bochdalek

59
Q

what is a bochdalek CDH

A

posterior-lateral hernia

60
Q

what is a morgagni hernia

A

anterior hernia

61
Q

in which gender is CDH more common

A

males

62
Q

what are two causes of CDH

A

Idiopathic

Failure diaphragm to form

63
Q

how does congenital diaphragmatic hernia present clinically

A
  • Respiratory distress
  • Barrel chest
  • Scaphoid abdomen
64
Q

what are symptoms of respiratory distress

A
  • Breathlessness
  • Cyanosis
  • Grunting
  • IC recessions
65
Q

why does respiratory distress happen in CDH

A

as abdominal contents in the mediastinum - prevent growth of the lungs

66
Q

what are two signs of CDH on auscultation

A
  • absent breath sounds unilaterally

- bowel sounds in the chest

67
Q

which side is CDH more common

A

left

68
Q

why is CDH of the left more common

A

as liver protects the right hemidiaphragm

69
Q

explain CDH

A

failure of pneumoparietal membrane to fuse

70
Q

what is bochdalek hernia

A

postero-lateral defect in diaphragm

71
Q

what is morgagni hernia

A

anterior defect

72
Q

when is CDH usually detected

A

antenatally on 20W anomaly scan

73
Q

what investigation is ordered if postnatally suspect CDH

A

CXR - bowels present

74
Q

what is antenatal management of CDH

A

corticosteroids: 2-doses 24h apart

75
Q

explain management of CDH

A

Resp distress: resuscitation

Bowel decompression: NG tube decompression

Surgical repair: thoracotomy or laparotomy 24-48h after repair

76
Q

what is functional abdominal pain

A

abdominal pain with no identifiable organic cause

77
Q

what is the most common cause of chronic abdominal pain in children and adolescents

A

functional abdominal pain

78
Q

what are risk factors for functional abdominal pain

A

Family history of: migraines, IBS

79
Q

explain features of functional abdominal pain

A
  • Central abdominal pain
  • Erratic: pain for several days and then no pain for a prolonged period. May be related to anxiety (eg. school)
  • Often school-age
  • No change in growth
80
Q

what is a key feature of functional abdominal pain

A

no change in growth

81
Q

explain management of functional abdominal pain

A
  • Explain to child there is no serious underlying disorder explaining their pain. Try to reassure and distract

Exclude following from diet:

  • Sorbitol
  • Fizzy drinks
  • Caffeine

Keep a food diary to identify triggers

82
Q

Define Hirschsprung’s disease

A

Inherited disorder with aganglionic section colon due to failure Auerbach and meissner plexus

83
Q

What does hirchspung’s disease cause

A

impaired failure bowel to relax causing intestinal obstruction

84
Q

In which gender is Hirschsprung’s disease more common

A

Males

85
Q

What two genetic conditions is Hirschsprung’s associated with

A

Down syndrome

MEN2

86
Q

Explain 4 early-features of Hirschsprung’s disease

A
  1. Meconium Ileus (>48h)
  2. Abdominal distention
  3. FTT
  4. Tight anal sphincter. Results in explosive release of stools on removing finger
87
Q

Explain late-features of Hirschsprung’s disease

A
  • Chronic constipation

- Inability to pass flatus

88
Q

in 80% of cases, where does hirchsprung’s disease affect

A

Rectosigmoid colon

89
Q

what causes hirchsprungs

A

Failure caudal migration parasympathetic neuroblasts from neural crest to distal colon

90
Q

explain histology of hirchsprungs

A

Absence myenteric and Auerbach’s plexus. This causes un-co-ordinated peristalsis and slowed motility

91
Q

what happens proximal to aganglionic segment

A

Dilation bowel segment proximal - this can lead to toxic megacolon

92
Q

What is work-up of Hirschsprung’s

A

AXR
Barium enema
Rectal biopsy

93
Q

What is first-line for Hirschsprung’s

A

AXR

94
Q

What will be seen on AXR in Hirschsprungs

A
  • No air in the rectum

- Dilated segment proximal to aganglionic segment

95
Q

Why is a barium enema performed

A

Determine length aganglionic segment prior to surgery

96
Q

When is anal manometry used

A

Atypical presentations

97
Q

What is the confirmatory test for Hirschsprung’s

A

Rectal biopsy

98
Q

What two findings will be seen on rectal biopsy

A
  • Aganglionic

- Increase acetylcholinesterase activity

99
Q

What is surgical management of Hirschsprung’s

A
  1. Diverting colostomy - relieve dilated bowel

2. Resection aganglionic segment

100
Q

What is a complication of Hirchsprung’s

A

Toxic megacolon

101
Q

What is the prevalence of IBD in children

A

Rare - only 1/4 presents in childhood

102
Q

What age does IBD usually present in children

A

Adolescence

103
Q

How does Crohn’s disease present in children

A
  • Abdominal pain
  • Diarrhoea
  • Weight loss
  • FTT
104
Q

What else may present in crohn’s disease

A

Apthous ulcers

Perianal disease: skin tags, fissures, abscesses

105
Q

what is the most-specific symptom of crohns disease in children

A

Abdominal pain

106
Q

what are symptoms of UC in children

A
  • Blood in stool
  • Diarrhoea
  • Abdominal pain
  • Arthropathy
107
Q

what blood tests are ordered in IBD

A
  • FBC

- CRP and ESR

108
Q

what stool test are ordered in IBD

A

Faecal calprotectin

109
Q

what imaging is ordered in IBD

A

OGD and colonoscopy

110
Q

why is a colonoscopy required, opposed to sigmoidoscopy

A

90% children with IBD will have pancolitis and hence require colonoscopy

111
Q

list 5 findings crohn’s on endoscopy

A
  • Entire GI tract
  • Skip lesions
  • Transmural inflammation
  • Fissures and fistulas
  • Non-caesating granuloma
112
Q

what investigation should all children with Crohn’s disease have

A

barium enema with small-bowl follow through (SBFT)

113
Q

why is barium enema with small bowl follow through (SBFT) ordered

A

to determine extent small bowel is involved in crohn’s

114
Q

how will barium enema with small bowel follow through present in Crohn’s disease

A

string sign

115
Q

what antibodies may be present in Crohn’s disease

A

ASCA

116
Q

what antibodies may be present in ulcerative colitis

A

p-ANCA

117
Q

For Crohn’s disease, what is first-line

A

oral corticosteroids and enteral nutrition (EEN)

118
Q

What is used for maintenance in Crohn’s disease

A

azathioprine

119
Q

What are two indications for azathioprine

A
  • More than two remissions per year

- Remission in less than 6-months

120
Q

What needs to be tested before giving azathioprine

A

TPMT levels

121
Q

What is third-line for crohn’s disease

A

Infliximab (Biologics)

122
Q

What is used for mild-UC

A
  • Left side colitis = topical mesalazine

- Oral mesalazine

123
Q

What is used for moderate-UC

A

Oral corticosteroids

124
Q

What is used for acute-severe UC

A

IV hydrocortisone, IV Fluid, Colectomy and ileostomy

125
Q

What are complications of UC

A

Toxic megacolon

126
Q

What are complications of Crohn’s

A

Strictures (Bowel Obstruction)

Abscesses

Paediatrics (61 decks)

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