7. GI minor Flashcards
What are red flag symptoms associated with abdominal pain?
-Peritonitis
-Rigid abdomen
-Guarding
-Signs of shock
-Bilious vomiting
What can cause acute abdominal pain in children?
GI:
-Gastroenteritis
-Peptic ulcer
-Acute appendicitis
-Mesenteric adenitis
-IBD
-Constipation
-Diabetes
-Necrotising enterocolitis
-Malrotation with volvulus
-Intussusception
-Intestinal obstruction
Non-GI:
-UTI
-Diabetes
-Lower lobe pneumonia
-Renal calculi
-Henoch-Schonlein purpura
What is mesenteric adenitis?
-Swollen lymph glands in the stomach
-Occurs after recent viral infection
-Can mimic appendicitis
What is Henoch-Schonlein purpura?
-Disease causing inflammation of small blood vessels - skin, intestines, kidneys, joints
-Purpuric rash seen on legs + joint pain
What is malrotation with volvulus?
-Torsion of intestine causing compromised blood flow and closed loop obstruction
-A surgical emergency occurring in the first month of life
-Causes bilious vomiting, peritonitis, haemodynamic instability, difficulty feeding
What is intussusception?
-Part of the intestine folds into the section next to it
-Causes colic, shock, jelly stool
What are some red flags associated with recurrent abdominal pain?
-Weight loss
-Diarrhoea
-Blood PR
-Joint symptoms
-Rashes
-FHx of coeliac / IBD
What are some gynae causes of recurrent abdo pain?
-Dysmenorrhoea
-PID
-Ovarian cyst
-Haematocolpos (= vagina fills with menstrual blood due to imperforate hymen)
What causes appendicitis?
-Appendix becomes blocked by stool, foreign body, tumour, infection
–Appendix can swell in response to any infection in the body
-Uncommon in children <4
What are the components of McBurney’s triad?
-Pain in RIF
-Low grade fever
-N+V (usually only once or twice)
What signs would you expect to find with appendicitis?
-Pain on movement
-Tenderness in RIF
-Decreased bowel sounds
-Tachycardia
-Rovsing’s sign (= pain in RIF on palpation of LIF)
What is the pathophysiology of coeliac disease?
-Repeated exposure to gluten causes villous atrophy in the intestine
-Causing malabsorption
What investigations can be done to diagnose coeliac disease?
-TTG (=tissue transglutaminase) antibodies
-FBC, folate (iron deficiency anaemia)
-Jejunal biopsy (crypt hyperplasia, subtotal villous atrophy)
-TFTs)
What complications can arise from coeliac disease?
-Iron-deficiency anaemia
-Hyposplenism
-Osteoporosis
-Lactose intolerance
-Subfertility
-Enteropathy-associated T-cell lymphoma of small intestine, rarely other malignancies
What is the mainstay of treatment for coeliac disease?
-Gluten free diet + re-challenge after 2 years
-Also give pneuomoccocal vaccine due to functional hyposplenism
What can cause feeding problems in children?
-Cleft palate
-CNS disorders
-Prematurity / LBW
-Airway problems
-Head + neck problems including muscle weakness
-Autism
-Parent-child issues
What issues with food can cause feeding techniques?
-Quantity of food
-Kind of food eg early mixed feeding
-Feeding technique
What does WHO recommend for weaning children from 6 months?
-Combine food with milk to ensure getting nutrients until 8 months before cutting down
-One taste at a time
-Blend at first, gradually do so less to get child used to new textures
-Once weaned, move from being fed with a spoon –> finger feeding –> feeding themselves
-Avoid low fat, high sugar + salt foods, soya + soft cheeses
-No honey or cow’s milk until 12 months
What is an inguinal hernia?
-Protrusion of abdominal cavity contents through the inguinal canal
-Indirect >common than direct
-More common in boys, prom babies and on the right side due to later descent of the right testis
-Due to patent processus vaginalis
-Usually asymptomatic, increases in size on crying
How is an indirect inguinal hernia confirmed on examination?
-Does not transluminate (whereas a hydrocele would)
-Testis should be palpable and distinct from swelling
-Reduction of swelling should be possible
How should an inguinal hernia be managed?
-Surgery - within a few weeks of diagnosis due to risk of incarceration
-Urgent if irreducible, hard, tender, vomiting
What causes a hydrocele?
-Forms instead of a hernia when connection with processus vaginalis is small
-Swelling is painless, transluminates and cannot be reduced
-Spontaneous resolution by 12 months
What is the pathophysiology of intussusception?
-Telescoping of proximal bowel into distal bowel
-Usually ileum –> caecum
-In infants 6-18m, usually caused by Peyer’s patch (= lymph tissue in bowel wall) becoming slightly inflamed after a viral gastroenteritis and gets stuck
-In older children, caused by polyps, Meckel’s diverticulum
How should you investigate intussusception?
-USS = gold standard - target-like mass seen in RLQ
-Sausage shaped mass may be palpable on abdo exam
-Red-currant jelly stool
