Gastric Conditions Flashcards
What are the features of PYLORIC STENOSIS?
Presents in 2nd or 4th weeks of life with vomiting, latest 4 months
Caused by hypertrophy of the circular muscles of the pylorus
Features:
- ‘Projectile vomiting’, typically ~30min after a feed
- Associated constipation/dehydration
- Palpable mass present in the upper abdomen
- Hypochloraemic, hypokalaemic alkalosis (due to persistent vomiting)
What are the features of FOETAL ALCOHOL SYNDROME?
- Short palpebral fissure
- Thin vermillion border/hypoplastic upper lip
- Smooth/absent philtrum
- Learning difficulties
- Microcephaly
- Growth retardation
- Epicanthic folds
- Cardiac malformations
- Alcohol withdrawal symptoms - irritable, hypotonic, tremors
What are the features of a CONGENITAL DIAPHRAGMATIC HERNIA?
Incomplete formation of the diaphragm = herniation of abdominal viscera into the chest cavity (tinkling bowel sounds heard in the chest cavity)
Can cause pulmonary hypoplasia and hypertension = Respiratory distress shortly after birth
Most common: Bochdalek hernia (left-sided posterolateral)
Only ~50% of newborns survive
What is EPSTEIN’S PEARL?
A congenital cyst found in the mouth - common on the hard palate and gums. It can be mistaen for erupting teeth.
No treatment required - often resolves within weeks
What is MESENTERIC ADENITIS?
- Inflamed lymph nodes within the mesentery
- Similar symptoms to appendicitis
- Follows a recent viral infection and needs to further treatment
What is HIRSCHSPRUNG’S DISEASE?
Parasympathetic neuroblasts fail to migrate to distal colon -> leads to an aganglionic segment of bowel -> uncoordinated peristalsis -> functional obstruction.
Associated with Down’s Syndrome - a RARE but important condition
PRESENTATION: Failure/delay in passing meconium (48h). In older children, presents in constipation/abdominal distension
INVESTIGATION: Abdominal X-Ray, rectal biopsy (gold standard)
MANAGEMENT: Initially - rectal washouts/bowel irrigation. Surgery to affected segment of colon
What are ACUTE SCROTAL DISORDERS?
Testicular Torsion!
- Irreducible inguinal hernia : Most common in < 2y
- Epididymitis: Rare in prepubescent children
Most exclude testicular torsion as immediate surgery is required
What are the features of COELIAC’S DISEASE?
Sensitivity to gluten - repeated exposure causes villous atrophy = Malabsorption. Normally presents before 3, after the introduction of cereals into diet.
Features:
- Failure to thrive
- Diarrhoea
- Abdominal distension
- Anaemia in older children
Tested with Anti-gliadin antibodies or IgA TTG antibodies
What are the features of INTUSSUSCEPTION?
One portion of bowel has slide into the lumen of the adjacent bowel, most commonly around the ileo-caecal region
Typically affects infects between 6-18months, twice as common in M
- Paroxysmal abdominal colic pain - infant will draw their knees up and turn pale
- Vomiting
- Bloodstained stool - ‘redcurrant jelly’ is a late sign
- Sausage-shaped mass in the right upper quadrant
What is the management of INTUSSUSCEPTION?
Investigated via USS, showing a target-like mass
Treated via:
- reduction by air insufflation under radiological control
- If fails/signs of peritonitis, surgery is required
What is EXOMPHALOS (OMPHALOCOELE)?
The abdominal contents of the foetus protrude through the anterior abdominal wall but are covered in an amniotic sac, formed by amniotic membrane and peritoneum.
Associated with: Down’s syndrome, cardiac/kidney malformations, Beckwith-Wiedemann Syndrome
Management:
- C-section to reduce risk of sac rupture
- A staged repare
What are the features of GASTROSCHISIS?
A congenital defect in the anterior abdominal wall, lateral to the umbilical cord. This causes the baby’s intestines extend outside of the abdomen. Other organs including the stomach and liver may also occur outside the baby’s body
Management: Wrap in cling film and immediate send for surgery for staged repair
What are the features of EXOMPHALOS (OMPHALOCOELE)?
Abdominal contents protrude through the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum. Associated with: - Beckwith-Wiedemann Syndrome - Down's Syndrome - Cardiac and kidney malformations
Management:
- C-section to reduce risk of sac rupture
- Staged repair
What are the features of BILIARY ATRESIA?
Obliteration/Discontinuity within the extrahepatic biliary system, resulting in an obstruction in the flow of bile.
More common to females than males, and unique to neonatal children: presents in the first 2 weeks of life
Feature:
- Jaundice extending beyond the physiological 2 weeks
- Dark urine and pale stools
- Appetite and growth disturbance
- High conjugated bilirubin
What is the management for BILIARY ATRESIA?
- Surgical intervention
- Antibiotic coverage and bile acid enhances following surgery
Complications:
- Unsuccessful anastomosis formation
- Progressive liver disease
- Cirrhosis with eventual hepatocellular carcinoma
Good prognosis if surgery is successful - in cases where surgery fails, liver transplantation may be required in the first 2 years of life
