Gastroenterology Flashcards
Which conditions are associated with intussusception?
- Concurrent viral illness
- Henoch-Schonlein purpura
- Cystic fibrosis
- Intestinal polyps
- Meckel diverticulum
At what site of the intestine is intussusception most common?
Ileocaecal
What is the typical presentation of intussusception?
- Paroxysmal abdominal colicky pain - often with legs drawn up
- Pale, lethargic, unwell
- Vomiting
- Sausage-shaped massed in RUQ
- High-pitched bowel sounds
- Red currant jelly stools (late sign)
What is the 1st-line investigation for intussusception?
Abdo USS
How does intussusception appear on abdo USS?
Target sign
What is the management of intussusception?
- Air insufflation
- Hydrostatic reduction
- Surgical reduction
- Surgical resection (bowel perforation/gangrene)
What are the complications of intussusception?
- Bowel obstruction
- Gangrenous bowel
- Perforation and peritonitis
- Death
Define biliary atresia.
Obliteration or discontinuity of the extrahepatic biliary system, most commonly of the common bile duct
Describe the pathophysiology of biliary atresia.
- Discontinuity of the biliary system due to obliteration or fibrosis –> obstruction of bile flow (cholestasis) –> secondary biliary cirrhosis and portal hypertension
What are the clinical features of biliary atresia?
- Jaundice
- prolonged (lasting >2 weeks)
- occurring after 2 weeks - Pale stools, dark urine
- Hepatomegaly and splenomegaly
What are the typical LFT results for biliary atresia?
- Conjugated hyperbilirubinaemia
- Raised aminotransferase and alkaline phosphatase
- Raised GGT
- Normal total bilirubin
What is 1st line imaging for biliary atresia?
USS
What is 1st line treatment for biliary atresia?
Kasai procedure (hepatoportoenterostomy) - a connection is created between the liver and small intestine to allow for bile drainage
What are the complications of biliary atresia?
- Unsuccessful anastomosis formation
- Progressive liver disease
- Cirrhosis with eventual hepatocellular carcinoma
What are potential causes of bilious vomiting in neonates?
- Duodenal atresia
- Malrotation with volvulus
- Jejunal/ileal atresia
- Meconium ileus
- NEC
Define duodenal atresia.
Complete occlusion or absence of the duodenal lumen
Define duodenal stenosis.
Incomplete obstruction caused by narrowing of the lumen
Describe the pathophysiology of duodenal atresia.
Occurs when recanalisation of the close duodenum during the embryonic period fails or is only partial
Since the development of the duodenum is connected to the growth of the pancreas and the hepatobiliary system, duodenal atresia is also commonly associated with anomalies of these organs
What are the clinical features of duodenal atresia?
- Intrauterine: polyhydramnios
- Postpartum
- Bilious vomiting (if the stenosis is distal to the major duodenal papilla)
- Distended upper abdomen and scaphoid lower abdomen
- Delayed meconium passage
What is the 1st line imaging/investigation for duodenal atresia?
Abdominal x-ray
What features on abdominal x-ray are typical of duodenal atresia?
- Double bubble sign
- Gasless distal bowel
What is the treatment for duodenal atresia?
Bypass of the atresia or stenosis
- Duodenoduodenostomy
- Duodenojejunostomy
Define jejunal/ileal atresia.
Absence of the jejunal or ileal lumen
What condition is commonly associated with jejunal/ileal atresia?
Cystic fibrosis
