Conditions Part 2

Question 1

What is malrotation/volvulus?

Answer 1

Intestinal malrotation, also known as intestinal nonrotation or incomplete rotation, refers to any variation in this rotation and fixation of the GI tract during development

Paediatric - midgut volvulus requiring emergent operative intervention

Question 2

Signs and symptoms of malrotation?

Answer 2

Asymptomatic at any age with volvulus OR

First few days of life:

Obstruction

§ Obstruction + compromised blood supply

o Symptoms = abdominal pain, bilious vomiting, peritonism, etc.

o Scaphoid abdomen (i.e. concave abdomen)

Question 3

Management of malrotation?

Answer 3

Urgent laparotomy (Ladd’s procedure if signs of vascular compromise)

o Untwist volvulus, mobilize duodenum, place bowel in non-rotated position and remove necrotic bowel

Question 4

What is Irritable Bowel Syndrome?

Answer 4

Altered GI mobility and abnormal sensation ± psychosocial stress and anxiety effect

· Often a FHx component; Coeliac’s must be excluded; symptoms may be precipitated by GI infection

Question 5

What are some signs and symptoms of IBS?

Answer 5

Abdominal pain – often worse before or relieved by defecation

o Explosive loose or mucus stools

o Boating

o Feeling of incomplete defecation – tenesmus

o Constipation

Question 6

What is gastroenteritis?

Answer 6

Gastroenteritis is a nonspecific term for various pathologic states of the gastrointestinal tract.
The primary manifestation is diarrhea, but it may be accompanied by nausea, vomiting, and abdominal pain

Question 7

Causative agents of gastroenteritis?

Answer 7

Rotavirus infection MOST COMMON CAUSE (60%)

o Campylobacter jejuni - Severe abdominal pain, bloody stool

o Shigella / Salmonella - Blood/pus in stool, pain, tenesmus, fever

o Cholera / E. coli - Dehydrating diarrhoea

o Protozoan (Giardia, Cryptosporidium)

Question 8

Signs and symptoms of gastroenteritis?

Answer 8

Loose stools
vomiting
travel history

Complications can lead to dehydration and shock in:
<6mnths
> 2 vomits in 24 hrs
> 5 poo in 24 hrs
Cant tolerate extra fluids

Question 9

Investigations for gastroenteritis?

Answer 9

AXR

Stool sample analysis

Question 10

Management for gastroenteritis?

Answer 10

Rehydration advice:

Notify health protection unit if caused by:
campylobacter
listeria
e coli
shigella
salmonella

safety net - diarrhoea stops within 2 weeks , vomiting within 3 days

Question 11

What are the indications of dehydration?

Answer 11

Weight loss
Shock
clinical dehydration = 5-10% body weight

Hypernatraemic causes:
Flushing 
Oedema 
Fever 
Seizures 
Agitation / jittery movements Low urine output 
Thirst

Hyponatreamia causes:
Stupor Anorexia (+ N&V) 
Limp tone 
Tendon reflexes reduced Lethargy 
Orthostatic hypotension Seizures 
Stomach cramps

Question 12

Investigations of dehydration?

Answer 12

Clincial exam

U+Es + FBC
Stool M+C

Question 13

Management of dehydration?

Answer 13

Oral rehydration solution -> clinical dehydration. Oral rehydration solution contains glucose -> absorption in gut -> water follows glucose absorption

IV fluids -> shock / deterioration / persistent vomiting / sick child

dehydration correction - over 24 hrs

normal maintenance - “4:2:1 Approach

Question 14

What is the management for hypernatraemic dehydration?

Answer 14

Oral rehydration solution

o If IV fluids required, take care with cerebral oedema

Question 15

What don’t you use for gastroenteritis?

Answer 15

antidiarrhoeal drugs
antiemetics
antibiotics

Question 16

What is post-gastroenteritis syndrome?

Answer 16

ntroduction of a normal diet results in a return of the watery diarrhoea

o Treatment: oral rehydration therapy