Gastroenterology Flashcards
Causes of acute abdominal pain
Non-specific abdominal pain and mesenteric adenitis
Why should you take a urine sample?
identify DM and conditions affecting the urinary tract
Symptoms and signs of acute appendicitis
Symptoms:
- anorexia
- vomiting
- abdominal pain (initial central and colicky then localising to RIF)
Signs:
- fever
- abdominal pain aggravated on movement
- persistent tenderness with guarding in RIF (McBurney’s point)
NB: with retrocaecal appendix, localised guarding may be absent. With pelvic appendix there may be few abdominal signs
In what age can you see appendicitis in childten
differences in adults vs preschool children
any age but uncommon in under 3 y/o
diagnosis is more difficult in preschool children, particularly early on in the disease
perforation may be rapid as omentum is less well developed and fails to surround the appendix, and signs easy to underestimate at this age
how do we diagnose appendicits?
repeated observation and clinical review every few hours
raised neutrophil (not always present in FBC)
WBCs/organisms in urine can be seen as appendix adjacent to bladder and ureter
USS supports diagnosis = thickened, non-compressible appendix with increased blood flow. also shows complications liek abscess, perforation or an appendix mass
how do we treat acute appendicitis?
appendicectomy in uncomplicated
fluid resus and IV abx in complicated (mass, abscess, perforation)
IV abx, then appendicectomy after several weeks if palpable mass with no signs of generalised peritonitis
mx should be guided by the surgical team
Non-specific acute abdominal pain and mesenteric adenitis definition and characteristics
NSAP = abdominal pain which resolved in 24-48 hours
- less severe pain than appendcitis
- tenderness in RIF is variable
- often accompanites URTI with cervical lymphadenopathy
- constipation is a common cause
Mesenteric adenitis
- large mesenteric nodes observed
- appendix normal
Non-specific acute abdominal pain and mesenteric adenitis management
resolving/self-limiting
if not = laparascopy and appendicectomy
Diagnosing acute abdominal pain in older children and adolescents
exclude medical causes = LL pneumonia, DKA, hepatitis, pyelonephritis
check for strangulated inguinal hernia or torsion of the testis in boys
guarding and rebound tenderness absent or unimpressive
pain from peritonela inflammation may be demonstrated on coughing, walking or jumping
distinguish between acute appendicitis and NSAP = close monitoring, joint management between paediatricians and paediatric surgeons, and repeated evaluation in hospital
Intusssusception
age
complications
invagination of proximal bowel into distal segement (ileum passing into caecum through ileocaecal valve)
MOST COMMON cause of intestinal obstruction in infants after neonatal period
3 months to 2 years of age
complications:
- stretching and constriction of mesentery -> venous obstruction, engorgement and bleeding from bowel mucosa -> fluid loss, bowel perforation, peritonitis -> gut necrosis
Intussusception presentation
paroxysmal colicky pain with pallor around mouth
- draws up legs
- recovery between painful episodes but child may become increasingly lethargic
may refuse feeds, may vomit (may be bile-stained depending on site of intusussception)
sausage-shaped mass (often palpable on abdomen)
redcurrant jelly stool (blood-stained mucus) = occurs later in illness and may be first seen in a rectal examination
abdominal distension and shock
intussusception diagnosis and mx
recurrence
AXR = distended small bowel and absence of gas in distal colon or rectum , sometimes outline of intussusception can be outlined and visaulised
USS to confirm diagnosis = target/doughnut sign
IV fluid resus IMMEDIATELY (as pooling of fluid in gut -> hypovolaemic shock) SHOCK IS AN IMPORTANT COMPLICATION AND REQUIRES URGENT TX
rectal air insufflation/air contrast enema (US guided) by radiologist and under supervision of paed surgeon in case procedure is unsuccessful or bowel perforation occurs = when no peritonitis
IF FAIL/PERITONITIS = operative reduction
recurrence occurs in less than 5% but more frequent after hydrostatic reduction
Meckel diverticulum definition
symptoms
ix and findings
what can it mimic
mx
ileal remnant of vitello-intestinal duct (2% of people)
contains ectopic gastric muscosa/pancreatic tissue
most asymptomatic but may present with severe rectal bleeding which may be LIFE THREATENING (not bright nor true melaena)
techentium scan = increased uptake by ectopic gastric mucosa
- negative scan does not exclude possibility and a laparoscopic exam can be used to make the diagnosis
acute reduction in Hb
can mimic appendicitis when inflamed
mx = surgical resection
Malrotation definition and how it turns to volvulus
congenital abnormality of the midgut
- small intestine mostly right-hand side of abdomen
- caecum URQ
- Ladd bands (fibrous) tether caecum to URQ -> intestinal obstruction by compressing duodenum -> poorly tethered gut swings and twists more readily -> volvulus -> ischaemia of small and proximal large intestine
malrotation and volvulus presentation
and ix for a specific presentation
and mx for a specific presentation
1) obstruction
2) obstruction with compromised blood supply
First few days of life (also seen later in age) = obstruction with bilious vomiting
- URGENT UGI CONTRAST STUDY to assess intestinal rotation
- if signs of vascular compromise present = URGENT LAPARATOMY
Defintion of recurrent abdominal pain
Causes and assessment of the child with recurrent abdominal pain
episodes of abdominal pain at least 4 times per month sufficient to interrupt normal activities and lasts for at least 2 months
classically periembulical pain and child otherwise entirely well
IBS pathogenesis
disorder of visceral hypersensitivity and neurological hypervigilance in combination with psychosocial stressors
- early life events = bowel surgery
- environmental = cow’s milk protein allergic, post enteritis
- GI = infections, abx
