Gastro and Urinary Flashcards
What is enuresis defined as
Involuntary discharge of urine by day or night in a child over 5 in the absense of congenital or acquired defects of the NS or urinary tract
How is nocturnal enuresis categorised
Primary- never achieved continence
Secondary- child had been dry for at least 6 months
Management of enuresis
Rule out other causes
General adive- fluid intake, empty bladder before bed and during day
Reward system- eg star chart for going toilet before bed and not for a dry night
Then- Enuresis alarm
Then- desmopressin
When would use desmopressin for enuresis
Short term control needed- sleepoves
Enuresis alarm not effective or acceptable
Examination findings of testicular torsion
Swollen testicle
Absent cremasteric reflex
Elevation of testicle worsens pain
What causes threadworms
Enterobius vermicularis
Infestation occurs after swallowing eggs in the environment
How can threadworms be investigated
Could put piece of tape over anus and then do MCS
Management of threadworms
Under 6 months- hygiene measures for 6 weeks (same if pregnant or breastfeeding)
6 months- 2 years- piperazine single dose
Over 2 years- Single does of mebendazole with hygiene measures for 2 weeks if over 2 years
Consider treating whole family too
If infection persists over 2 weeks/6 weeks treat again
What is hirschprungs disease
Presence of aganglionic segement of bowel from developmental failure of parasympathetic Auerbach (myenteric) and meissner (submucosal) plexuses
Presentation of hirschprungs disease
Failure to pass meconium in first 24 hours
Bilious vomiting
Abdo distension
Constipation mixed with overflow diarrhoea
Complications of hirschprungs disease
Enterocolitis
Perofration
Meconium plug syndrome
Initial investigation for hirschprungs and diagnostic
AXR if obstruction
Full thickness rectal biopsy
Treatment for hirschprungs
Bowel irrigation initially- can be barium enema
Transanal endorectal pull through
Risk factors for hirshcprung disease
Trisomy 21
Male
MEN2A
Risk factors for GORD
Preterm delivery
Neuro disorders
Presentation of GORD
Vomiting of feeds
Develops before 8 weeks typically
Alongside
- arching of back
- irrittable
- crying
When should arrange same day referral for GORD
Haematemesis
Melaena
Dysphagia
When should arrange a specialist assessment by paediatrician GORD
Uncertain diagnosis
Growth issues
Unexplained distress in those with communication difficulty
Not responding to treatment
Avoiding food
Unexplained IDA
No improvement in GORD after a year
Sandifers syndrome suspected
Recurrent aspiration pneumonia
Upper airway erosion
Dental erosion in child with neurodisability
Recurrent otitis media (more than 3 episodes in 6 months)
Management of GORD in child breastfeeding
- Breastfeeding assessment and advice
- 1-2 week trial of alginate therapy- if symptoms improve after 2 weeks continue the therapy. Stop at regular intervals to see if symptoms have improved
If have not then medical treatment
Mangement of GORD in formula fed
- Reduce volume of milk if excessive (150ml a day per kg)
- Offer 1-2 weeks of smaller more frequent unless they already are small and frequent
- 1-2 weeks of feed thickeners
- Alginate therapy
- Medical management
Medical management of GORD
4 week suspension of omeprazole
If doesnt work refer for possible endoscopy and potential metoclopramide treatment
Complications of GORD
Distress
FTT
Aspiration
Frequent otitis media
Dental erosion in older children
When does pyloric stenosis typically present
2nd-4th week of life
What causes pyloric stenosis
Hypertrophy of smooth circular muscles of pylorus