Gastroenterology Flashcards
Mesenteric (lymph)adenitis
- Definition
- Causes/ associations
- Presentation
Inflammation of the mesenteric lymph nodes, leading to their enlargement.
Association
- Post-URTI/ tonsilitis
- Appendicitis
Presentation
- Acute abdominal pain/ tenderness (periumbical, RIF, epigastrium)
- Anorexia
- Vomiting/ nausea
- Diarrhoea
Pyloric stenosis epidemiologyP
Typically presents age 2-8 weeks
- More common in boys
First born male
Presentation of pyloric stenosis
Vomiting after feeding
- Projectile vomiting
Failure to thrive/ poor weight gain
Dehydration
- Dry nappies and mucous membranes
- Depressed fontanelles
Signs
- Olive shaped mass in RUQ
- Visible peristaltic waves
Investigations for pyloric stenosis
Bloods
- U+Es: hypochloraemia, low Na, low K+
- VBG: metabolic alkalosis
Imaging
- Abdominal US
Management of pyloric stenosis
Manage acute electrolyte imbalance
- IV fluids
Immediate referral to surgery
- Pyloromyotomy
Most common cause of gastroenteritis
Viral
- Rotavirus
- Norovirus
- Adenovirus
Bacterial
- Campylobacter jejuni
- Shigella
- E.coli O571
- Clostridium perfringens
Parasitic
- Giardia
- Cryptosporidum
Complications of gastroenteritis
Dehydration + electrolyte imbalance
- Severe: shock, AKI
Reactive arthritis (shigella, campylobacter)
Haemolytic uraemic syndrome
Guillain-Barre
Presentation of gastroenteritis
GI
- Vomiting, diarrhoea
- Campylobacter, shigella= blood in stool
- Viral= vomiting
Dehydration
- Dry mucous membranes
- Sunken eyes
- Depressed fontanelle
- Loss of skin turgor
Features of campylobacter gastroenteritis
- presentation
- Incubation period
Abdominal pain/ cramps
Blood diarrhoea
Fever
Vomiting
2-5 days incubation
Causes of baccillus cereus GE
Ingestion of poorly cooked food or food refrigerated after cookin
Management of GE
- No clinical dehydration
Ensure hydration is mantained
- Breastfeeding/ milk
- Adequate oral intake
Management of GE
- Clinical dehydration
Oral rehydration
- Fluid challenge every 5-10 mins
- Rehydration solution
- Fluid balance
Shock
- IV fluid resus
- Maintenance fluids over 24 hours
Antibiotic indications in GE
Sepsis
Pathogens
- Salmonella in < 6 months
- Shigella
- Giardia
- Cholera
- C.difficile
Malnourised/ immunocompromised
Cryptosporidiosis presentation
Profuse watery diarrhoea
- Lasts 1-2 weeks
Abdominal pain/ nausea, vomiting
- Fever
- Anorexia
Hirschsprung’s disease
- Pathology
Congenital abscence of myenteric plexus in the distal bowel.
- Aganglionic portions of bowel become constricted, when can cause obstruction.
Complication of Hirschsprung’s disease
Hirschsprung’s associated enterocolitis (HAE)
- Inflammation and obstruction
Presents
- Bloody diarrhoea
- Abdominal distension
- Fever
- Severe: sepsis
Presentation of Hirschsrung’s disease
Failure to pass meconium
Weight loss/ failure to thrive
Chronic constipation/ bowel obstruction
- Distended abdomen
Vomiting
Gold standard investigation for Hirschsprung’s disease
Rectal biopsy and histology
Definite management of Hirschsprung’s disease
Resection of aganglionic bowel.
Sandifer’s syndrome
- description
Spasmodic torsion dystonia
- Causes back/neck arch
- Predisposes to GORD
Epidemiology of GORD in children
Typically started before 8 weeks
- 90% resolves by 1 year
Presentation of GORD
Chronic cough
- Hoarse voice/ crying
Vomiting
- After feeding
Poor weight gain/ failure to thrive
Distress after feeding
Pneumonia
Red flags in GORD (6)
Projectile vomiting
- Pyloric stenosis/ bowel obstruction
Neurological signs
- meningitis, raised ICP
Green/ bilous vomiting
- Bowel obstruction
Haematemesis/ malaena
- GI bleed
Blood in stools
- GE, cow milk protein allergy
Allergic features
- Cow milk protein allergy
Investigations for GORD in children
Largely clinical diagnosis
If needed:
- Abdominal ultrasound
- Barium meal
- Endoscopy
Management of GORD in children
- Conservative
- medical
Conservative
- Avoid overfeeding
- Feed small, frequent meals
- Burping after eating
- Avoid laying flat after eating
Medical
- OTC special reflux-preventing formula
- Gaviscon in feeds
- Ranitidine
Epidemiology of intussusception
Most common in 3 months- 2 years
Risk factors for intussusception
Viral illness
Cystic fibrosis
Henoch- Schonlein purpura
Intestinal polyps
Meckel diverticulum
Presentation of intussusception
Acute bowel obstruction
- Colicky abdominal pain
- Distended abdominal
- Vomiting
Red currant/ jelly stools
Pallor
Sausage-shaped abdominal mass
Shock
Investigation findings for intussusception
FBC
- may show anaemia
U+E
- low Na and K+ if vomiting
AXR
- Distended small bowel
- No gas in distal colon/rectum
After appropriate resuscitation, what is first line management of intussuception
If non-peritonic
- Rectal air insufflation
Second line/ in peritonitis
- Surgical resection
