Abdominal Histories

Question 1

Colic

Answer 1

Paroxysmal crying with pulling up of the legs > 3h on >3 d/wk
DDx: - CMPA - if faltering growth, eczema req tx, alternating bowel habit, fam hx
- transitory lactose intolerance, parental discord
Assoc feeding difficulties
If BF: finish the 1st breast - hindmilk easier to digest
Soy not recommended - oestrogens
Resolves by 6mo
Cry-sis

Question 2

GORD

Answer 2

Begins before 8 weeks old
Resolves between 6-12mo
CMPA - if faltering growth, eczema req tx, alternating bowel habit, fam hx
Underlying neurological - poor weight gain, refusal to feed, pain, apnoea and cough/aspiration
Upright after feeds but NOT on incline when sleeping

Gavison trial 1-2/52
Smaller, more frequent feeds, review feed volumes
Consider thickening agents
If regurgitation with 1+ of:
- refusing feeds, gagging or choking; distressed behaviour; faltering growth
Consider 4/52 of PPI - can reduce B12

Question 3

Biliary Atresia

Answer 3

Jaundice, dark urine and pale stools
Palpable spleen and liver
Excessively hungry

Kasai: hepatoportoenterostomy - intestinal limb drains bile from porta hepatitis
Assoc: polysplenia and situs inversus

ES: Liver transplant

Question 3

HDN

Answer 3

Vit K def. Well baby with bruising or bleeding.
PT and PTT raised. Vit K

Question 4

Necrotising Enterocolitis

Answer 4

Inflam bowel necrosis
Prem is key RF. Enteral feeds.
Sign: abdo distensions, blood/mucus PR, tenderness, shock, DIC.

CXR: pneumatosis intestinalis
Tx: stop feeds, crossmatch, sugical rv and antibiotics.

Question 5

Sandifer Syndrome

Answer 5

GI symotoms and neurological features
In <1% with reflux. Peaks at 18-36 months

Spasmodic torticollis and dystonia
Nodding and rotation of the head, neck extension, gurgling and writing, hypotonia.
Lasts 1-3 minutes up to 10 times a day
Ingestion of food is associated with sspasms -> reluctance to feed.

Tx: Underlying cause: GORD or hiatus hernia