Child health- GI Flashcards
main causes of diarrhoea in children
poor sanitation
malnutrition
treatment of diarrhoea in children
oral rehydration- uses Na/glucose co transporter
zinc supplements
most common cause of vomiting in infancy
GORD
risk factors for GORD in children
preterm birth
neurological disorders
when does GORD typically present in infants
before 8 weeks
NICE defines malnutrition as-
BMI less than 18.5 OR
unintentional weight loss >10% in last 3-6 months
or
BMI less than 20 and unintentional weight loss >5% in last 3-6 months
most common hernia in children
indirect inguinal hernia
inguinal hernias more common in right/left side?
right side
are inguinal hernias more common in boys/girls?
boys
clinical features of inguinal hernias
groin swelling which usually disappears when lying down
palpable cough impulse
investigation used for inguinal hernias
dynamic USS
what is gastroenteritis
broad term, but usually used to refer an infective illness which causes diarrhoea, vomiting, and abdominal pain
commonest viral cause of vomiting and diarrhoea in children under 3 years old
gastroenteritis- norovirus
how does gastroenteritis present in children
vomiting
diarrhoea
abdominal pain
fever
what is gastroenteritis in children commonly associated with
cruise ships
main symptom of appendicitis
abdominal pain- central pain that migrates to right iliac fossa
what is mcburneys point
point on lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis
in atypical/non-urgent cases of appendicitis what investigation is used
USS
constipation in children= < how many stools per week
< 3 stools per week
red flags for constipation in children
onset reported from birth or first few weeks of life
passage of meconium >48 hours
‘ribbon’ stools
faltering growth (amber flag)
abnormal appearance of anus
factors which suggest faecal impaction
severe constipation
overflow soiling
faecal mass palpable in abdomen
first line treatment for constipation in children
movicol paediatric plain- polyethylene glycol 3350 + electrolytes
if no response to movicol paediatric plain for constipation in children, what is added
stimulant laxative
treatment for constipation in children if movicol paediatric plain not tolerated
substitute stimulant laxative singly or in combo with osmotic laxative
what is intestinal obstruction
physical obstruction prevents the flow of faeces through the intestine; causes absolute constipation and leads to back pressure through the GI system which causes vomiting
what is a volvulus
loop of intestine twists around itself and the mesentery that supports it, resulting in bowel obstruction
what is malrotation
congenital anatomical anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis
when do babies with malrotation show signs-
40% first week of life
50-60% diagnosed by 1 month and 75% by 1 year
causes of intestinal obstruction in children
malrotation of intestines with midget volvulus
meconium ileus
hirschsprungs disease
oesophageal atresia
duodenal atresia
Intussusception
imperforate anus
strangulated hernia
clinical features of intestinal obstruction
persistent vomiting- bile (bright green)
abdominal pain and distention
failure to pass stool or wind
abnormal bowel sounds- can be high pitched and tinkling early in obstruction and absent later
investigation for intestinal obstruction
abdominal XRAY
intestinal obstruction on XRAY-
may show dilated loops of bowel proximal to the obstruction and collapsed loops of bowel distal to obstruction
absence of air in rectum
what is intussusception
the bowel ‘invaginates’ or ‘telescopes’ into itself, narrowing the lumen, which results in a palpable mass in the abdomen and an obstruction of the passage of faeces into the bowel
conditions associated with intussusception
concurrent viral illness
henoch-schonlein purpura
cystic fibrosis
intestinal polyps
meckel diverticulum
symptoms of intussusception
severe, colicky abdominal pain
pale, lethargic, unwell
vomiting
signs of intussusception
signs of dehydration
‘redcurrant jelly stool’
right upper quadrant mass on palpation
intussusception on USS
target sign
management of intussusception
air reduction- relieves obstruction in >85% of cases
surgical reduction if non-invasive measure fails
‘target sign’ on USS-
intussusception
what is congenital pyloric stenosis
narrowing of the opening from the stomach to the first part of the small intestine (the pylorus)
signs and symptoms of pyloric stenosis
projectile vomiting without the presence of bile (vomiting milk), most occurs after baby is fed
keen to feed
dehydration
peristalsis across abdomen
may feel abdomen mass
typical age symptoms of pyloric stenosis becomes obvious in a baby
2-12 weeks
typically 6 weeks
what investigation is used to diagnose pyloric stenosis
US upper abdomen
management of pyloric stenosis
surgery- pyloromyotomy (open or lap)
which acid-base abnormality is likely to be seen in a patient with pyloric stenosis
hyochloraemic hypokalaemic metabolic alkalosis
what is jejunal atresia
congenital anomaly characterised by obliteration of the lumen of the jejunum
how does jejunal atresia present
abdominal distention and bilious vomiting within first 24 hours of birth
investigation for jejunal atresia
abdominal XRAY
management of jejuna atresia
surgical correction
what is necrotising enterocolitis
disorder affecting premature neonates, where part of the bowel becomes necrotic
clinical features of necrotising enterocolitis
intolerance to feeds
vomiting, particularly green bile
generally unwell
distended, tender abdomen
absent bowel sounds
blood in stool
bloods in babies with necrotising enterocolitis
thrombocytopenia
neutropenia
crp- inflammation
capillary blood gas in babies with necrotising enterocolitis
metabolic acidosis
abdominal XRAY findings in necrotising enterocolitis
dilated loops of bowel
bowel wall oedema
gas in bowel wall
gas in peritoneal cavity
management of necrotising enterocolitis
nil by mouth with IV fluids and TPN
antibiotics- clindamycin and cefotaxime
immediate referral to neonatal surgical team
