Gastro Flashcards
Dx pyloric stenosis
Abdo US– hypertrophy of sphincter
Barium- string sign, pyloric beak
Tx pyloric stenosis
- Fluid and electrolytes
2. Pyloromyotomy- Ramstedt (old), lapro
PC meckels
Incidental
Acute intermittent rectal bleeding
OB V I
Dx Meckels
Tc 99– ectopic gastric mucosa
Tx Meckels
Surgical excision– if it’s bleeding from surrounding ulceration
Associated with pyloric stenosis
M-E-T
Maternal history
Erythromycin
TEF
Associated with hirschsprungs
DOWNS
MEN 2
WAARDENBERG syndrome
PC hirschsprungs
Failure to pass meconium
FTT
billious vomiting
Abdo distension
Empty vault on DRE
Explosive stool discharge
Abnormal sphincter tone
Chronic constipation if older kid
Dx Hirschsprungs
- Barium enema
- PFA
- Anorectal manometry
- failure of internal sphincter to relax - Rectal suction bx
- absence Meissner and Auerbach
- hypertrophied nerve endings with AChE stain
Tx hirschsprungs
TWO STEPS:
- Diverting colostomy
- Definitive pull through
MCC bowel obstruction in first two years of life
Intussusception
Risk factors intussusception
Polyp
Lymphoma
Rotavirus
Adenovirus
Parasites
HSP
CF
Celiac
Meckels
PC intussusception
SUDDEN COLICKY abdo pain
Sausage mass in RUQ
Vomiting
Currant jelly stools (later)
Absence bowel RLQ
MC site intussusception
Ileocecal
Proximal into distal
Dx intussusception
- PFA- obstruction, perforation, mass
2. US- target sign
Tx intussusception
- Volume and electrolytes and CBC
- NG tube decompression
- Air contrast barium enema- insuffulation
- diagnostic> therapeutic - Surgery- reduction and resection of gangrenous bowel
Sites of malrotation
DJ
IC
PC malrotation and volvulus
FIRST MONTH of life
- bilious vomiting
Cramps abdo pain
Distension
Bloody / mucus diarrhea
Dx malrotation and volvulus
- AXR- bird beak and air fluid levels
- Abnormal lig of treitz
- US
Tx malrotation and volvulus
- NG tube decompression
- IV fluids
- Sx repair ER– gastric volvulus
- Sx repair or endoscopy – intestinal volvulus
PC NEC
Preme
First few days of life
Feeding intolerance
Bloody stools
Delayed gastric emptying
Abdo distension
Dx NEC
- LABS
- PFA
Dilation/ portal venous has/ free air/ pneumatosis intestinalis - US
Tx NEC
Supportive
Surgery – ileostomy with mucus fistula
PC pyloric stenosis
Little boy
3 weeks old, becomes projectile vomiting non bilious
Palpable olive like mass = visible peristalsis
HINGRY – malnourished and dehydrated
HypoK hypoCl met alkalosis
CB jaundice
- Extra hepatic- Bili atresia, choledochal cysts
- Intra hepatic
- IEM: tyrosinemia, AAT, galactosemia
- neonatal hepatitis
- TPN cholestasis - Dubin Johnson
- Rotor
- TORCH
UCB jaundice
Physiologic
- increase Hct, enterohepatic circulation
- decrease rbc life span, gluc transferase
- patent ductus venous
UCB pathological
- BREAST milk
- Criggler
- Gilbert’s
- increase enterohepatic
- sepsis
- haemolysis
BREAST milk jaundice
Steroids and Esterfied Fatty acids
- inhibit conjugation
- activate enterohepatic circulation
Definition jaundice levels
> 5mg/dL
NB Hx points jaundice
- diet
- drug exposure intrauterine
- familial Hb / rbc problems
Exam jaundice
- Hb
- pallor
- EHA- HM
- bruising- Petechiae, cephalohematoma - Hepatic/ GI
- abdo distension
- delayed MEC passage
- light stools dark urine - Infection signs
Dx jaundice
1. BLOOD smears DCT Bili levels Blood typing
- LIVER
US, HIDA - Levels and IEM
Tx jaundice
- Underlying
- UCB
- photo tx
- exchange transfusion - Phenobarbital
- Gilbert’s
- type 2 gluc transferase def
SE’s photo tx
Decrease intestinal motility
Dehydration, hyperthermia
Decrease maternal time
Retinal damage
SE’s exchange transfusion
Death Thrombocytopenia NEC PCT GvHd Infection Electro
Jaundice
Haemolysis - UCB
Congenital infection- CB
Jaundice 24hrs- 2 weeks
Physiologic BREAST milk Jaundice Haemolysis Infection Criggler Bruising Pgcythemia
Jaundice > 2 weeks
CB
- bile duct obs
- neonatal hepatitis
ICB
- physio or breast
- infection
- hypothyroidism
- HA
- high GIT obstruction
Kasai procedure
hepato-porto-enterostomy
MCC OLT in paeds
biliary atresia
Choledochal cysts definition
= extrahepatic biliary tree cysts
PC choledochal cysts
25%= IFNANTS= CHOLESTASIS Older kids: - jaundice - abdo pain - abdo mass - cholangitis
Dx biliary atresia
- fasting US
- HIDA/ TIBIDA
- liver bx
- liver lapro
Dx choledochal cysts
- US
2. Radionucleide scan
Dx of AAT deficiency
ANTENATAL
- levels of AAT
- phenotype
Prognosis of AAT
50%= good 50%= OLT
Dx of galactosemia
- reducing sugar in urine
2. enzyme in RBC
Tx of galactosemia
galactose free diet= protective to liver
STILL…
- developmental delay and
- OVARIAN FAILURE
In born errors of bile acid synthesis
increase in cholenoic acid bile acids
NORMAL GGT
PC inborn errors of bile acid synthesis
CHOLESTASIS
PC progressive familial intrahepatic cholestasis
- jaundice
- itching
- diarrhoea with FTT
- rickets / CLD
Progressive familial intrahepatic cholestasis
RECESSIVE– bile acid transporter problem
DECREASE GGT
Dx of inborn errors of bile acid synthesis
Mass spectrometry
Tx of inborn errors of bile acid synthesis
Ursofalk= ursodeoxycholic acid
Biopsy of neonatal hepatitis syndromes
NON-specific,
GIANT CELL hepatitis
4 complications of acute liver failure
Cerebral edema
Haemorrhage
Pancreatitis
Sepsis
2 things a/w reyes
Aspirin
Medium Chain Acyl dehydrogenase deficiency
Liver work up
- bilirubin
- transaminases
- ALP
- coagulation screen
- plasma ammonia
- acid base balance
- blood glucose
- EEG
- CT
Tx acute liver failure
- IV dextrose
- antibiotics and antifungals
- coag: FFP, vit K, H2 ant, PPI’s
- OLT
- cerebral edema: mannitol and fluid restriction
poor prognosis acute liver failure
shrinking liver
increase bilirubin with decrease transaminases
worsening coagulopathy
coma
fibropolycystic kidney disease
= liver disease a/w ADPCKD and ARPCKD
causes of chronic liver disease in kids
- chronic infection
- autoimmune hepatitis
- wilsons disease
- CF
- fibropolycystic liver disease
- alpha 1 AT
- neonatal liver disease
- bile duct lesions
- NAFLD
diagnosis of cirrhosis
transaminases
ALP
bilirubin
PT
Tx cirrhosis
- nutrition
- pruritus
- encephalopathy
- OLT
nutrition cirrhosis
ADEK
high protein/ carbs/ long chain FA’s
NG
TPN
pruritus cirrhosis
loose clothes emollients cholestyramine phenobarbitol ursodeoxycholic acid
encephalopathy cirrhosis tx
protein restriction
lactulose
rifaxamin
OLT cirrhosis indications
FTT
severe complications despite tx
poor QoL
severe malnutrition
6 RED FLAG SIGNS OF SHOCK/DEHYDRATION
- eyes shrunken and tearless
- decreased skin turgor
- tachypnea
- tachycardia
- irritable/lethargic
- deteriorating
risk factors for dehydration
- low BW or 6 stools past 24hrs
- vomit 3x/1 day
- unable to tolerate XS fluids
- malnutrition
prevention of dehydration
breast/formula
increase fluids
ORS
clinical dehydration
ORS**** breast/formula normal fluids ------> IV: 0.9% saline if vomiting \+ IV vit K \+ breast
SHOCK
IV 0.9% NaCl and PICU
after rehydration mgmt
reintroduce solids
hygiene
NO carbonated drinks
NO fruit juices
NO school until 48hours after last episode
Clinitest
presence of non-absorptive sugar in stools
—> return to ORS 24hrs……then reintroduce normal diet
for post-gastroenteritis syndrome
— give TPN until mucosa recovered
Toddler diarrhear= Chronic Nonspecific Diarrhea treatment
4F's Fibre Fluids Fat (35-40%) Fruit juice XS AVOID
Gluten free diet— avoid….
BROW Barley Rye Oats Wheat
Rome 3 criteria for constipation
> 1 fecal incont toilet/week
risk factors for hemorrhagic disease of the newborn
perinatal asphyxia
maternal anticonvulsants
breast fed
preme
risk factors for haemolytic disease of newborn
miscarriage
abortion
amnionitis
bleeding during pregnancy previous
when do babies present with hemorrhagic disease of newborn
day 2-4
weeks 1-8
Kleihauer test
checking for fetal Hb in maternal blood
[anaemia]
4 ways to protect from jaundice in newborn
- RhoGAM
- feeding
- breast
- metaloporphyrins: inhibit haemoxygenase
drugs causing acute liver failure
paracetamol
halothane
INH
amantia phalloides
phenobarbitol in treatment of jaundice
type 2 glucuronysl transferase def
gilberts syndrome