Abdo Flashcards
Pyloric stenosis
Hypertrophy of sphincter to duodenum (that’s why it’s milky vomit, not billious)
Presentation:
- Usually age 2-8 weeks
- Projectile vomiting after every feed
- Weight loss, dehydration, hunger
- Pulsatile abdo mass
Investigation:
- Blood gas - hypochloraemic metabolic alkalosis
- Abdo US
Management:
- Fluid resus - inc electrolyte correction
- NG tube to aspirate stomach
- Surgery - Ramstedt pyloromyotomy
Intussuception
Telescoping of one part of the bowel into another (usually ileum into the caecum)
Presentation:
- Usually age 3 months to 2 years
- Episodic crying
- ‘Sausage shaped’ abdo mass
- Blood stained mucus in stools - ‘red currant jelly’ - late sign
Investigations:
- Blood gas
- Abdo XR - shows gas filled lumen of distal bowel - bowel obstruction
- Abdo US [intUSsception] - confirms through ‘target’ sign
- Fluoroscopy is gold standard but rarely done as it’s an emergency
Management:
- Fluid resus
- Urgent surgery - reduction by air enema; laparotomy if peritonitis
Umbilical hernias
Presentation:
- Usually resolves by 2-3 years
- Common
- Bulge worsens when crying
- Well baby
Management:
- If painful and swollen - ?incarcerated - surgery
- Usually, no investigation necessary
- Reassure as usually resolves
- If non-resolving - operate if large at age 2/3; if smaller, wait until 4/5 yrs
GORD
Presentation:
- Milky vomits after feeds
- Worse on lying down
- May arch back and draw up knees
- More common in preterms
Investigations:
- Usually a clinical diagnosis
- Barium swallow and monitoring of oesophageal pH only if it’s significant
- Endoscopy to confirm oesophagitis
Management:
- Keep upright after feeds
- Thicken feeds
- Wind baby after feeds
- Gaviscon
- Omeprazole
- Usually resolves once on more solid diet
Malrotation with volvulus
Congenital - small intestine is rotated and then becomes twisted (volvulus)
Presentation:
- Young baby e.g. 48hrs
- Bilious vomiting
- Severe abdo pain
- Blood in nappy
Investigations:
- Abdo XR
- Urgent contrast scan - need to transfer to GOSH
Management:
- Urgent Surgery (Ladd’s procedure) - to untwist volvulus and correct underlying malrotation
Biliary atresia
Congenital - bile duct doesn’t go anywhere
Presentation:
- Neonate - 2 - 8 weeks
- Prolonged jaundice
- Hepatomegaly
- Splenomegaly
- Reduced appetite
- Reduced growth
Investigations:
- LFTs - obstructive cholestatic picture
- Raised conjugated bilirubin
- Liver and biliary tree US
- Percutaneous liver biopsy
Management:
- Surgery
Necrotising enterocolitis
Leading cause of death in preterm infants. Breast feeding reduces risk.
Presentation:
- Young neonate up to 3 weeks
- Abdo distension
- Reduced feeding
- Bloody stools
- Bilious vomiting
- Sepsis - fever, lethargy, shock
Investigations:
- Septic screen inc blood culture
- Abdo XR - shows dilated bowel loops, bowel wall oedema, intramural gas, pneumoperitoneum
Management:
- NBM
- Broad spectrum antibiotics
- Surgery if perforated
Congenital diaphragmatic hernia
Herniation of abdominal viscera into chest due to incomplete formation of the diaphragm. Usually L sided.
Presentation:
- Would normally see prenatally - on US screening
- Respiratory distress shortly after birth - due to pulmonary hypoplasia and pulmonary hypertension
- Reduced air entry on affected side
- Displaced apex beat
Investigation:
- Chest and abdo XR
Management:
- Intubate and ventilate
- NG tube to keep air out of gut
- TPN
- Repair surgically once stable
Mesenteric adenitis
Inflammation of intra abdo lymph nodes after an URTI or gastroenteritis.
Presentation:
- Abdo pain - mimics appendicitis but no peritonism or guarding
- Recent URTI
Investigation:
- Diagnosis of exclusion
Management:
- Self-limiting
- Simple analgesia
Hirschprung’s disease
No parasympathetic ganglion in the distal end of the bowel - means it can’t relax, always constricted. Associated with Down’s syndrome.
Presentation:
- Failure to pass meconium
- Constipation
Investigations:
- Abdo XR
- Rectal biopsy to confirm diagnosis
Management:
- Fluid resus
- Rectal washouts/bowel irrigation
- Surgery to remove aganglionic section
Risk of hirchsprung associated enterocolitis
Acute appendicitis
Presentation:
- Any age
- Periumbilical pain moves to right iliac fossa
- Constipation/diarrhoea/vomiting
- Low grade fever
Investigations:
- Urine dip to exclude infection
- Pregnancy test to exclude ectopic
- Abdo US
Management:
- Appendicectomy - laparoscopic
Cow’s milk protein allergy
Allergy rather than intolerance is rare.
Presentation:
- Irritability
- Reflux/vomiting
- Diarrhoea
- Itching
- Rashes
- Severe - anaphylaxis
Investigations:
- Clinical diagnosis based on elimination (inc from mother’s diet if breast feeding)
Management:
- Elimination trial of 4 weeks
- Reintroduce for 1 week - if symptoms return - confirmed
- Cow’s milk free diet until 9-12 months and for at least 6 months, then plan reintroduction
