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Paediatrics > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Which conditions are associated with intussusception?

A
  • Concurrent viral illness
  • Henoch-Schonlein purpura
  • Cystic fibrosis
  • Intestinal polyps
  • Meckel diverticulum
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2
Q

At what site of the intestine is intussusception most common?

A

Ileocaecal

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3
Q

What is the typical presentation of intussusception?

A
  • 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)
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4
Q

What is the 1st-line investigation for intussusception?

A

Abdo USS

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5
Q

How does intussusception appear on abdo USS?

A

Target sign

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6
Q

What is the management of intussusception?

A
  • Air insufflation
  • Hydrostatic reduction
  • Surgical reduction
  • Surgical resection (bowel perforation/gangrene)
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7
Q

What are the complications of intussusception?

A
  • Bowel obstruction
  • Gangrenous bowel
  • Perforation and peritonitis
  • Death
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8
Q

Define biliary atresia.

A

Obliteration or discontinuity of the extrahepatic biliary system, most commonly of the common bile duct

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9
Q

Describe the pathophysiology of biliary atresia.

A
  • Discontinuity of the biliary system due to obliteration or fibrosis –> obstruction of bile flow (cholestasis) –> secondary biliary cirrhosis and portal hypertension
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10
Q

What are the clinical features of biliary atresia?

A
  1. Jaundice
    - prolonged (lasting >2 weeks)
    - occurring after 2 weeks
  2. Pale stools, dark urine
  3. Hepatomegaly and splenomegaly
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11
Q

What are the typical LFT results for biliary atresia?

A
  • Conjugated hyperbilirubinaemia
  • Raised aminotransferase and alkaline phosphatase
  • Raised GGT
  • Normal total bilirubin
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12
Q

What is 1st line imaging for biliary atresia?

A

USS

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13
Q

What is 1st line treatment for biliary atresia?

A

Kasai procedure (hepatoportoenterostomy) - a connection is created between the liver and small intestine to allow for bile drainage

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14
Q

What are the complications of biliary atresia?

A
  • Unsuccessful anastomosis formation
  • Progressive liver disease
  • Cirrhosis with eventual hepatocellular carcinoma
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15
Q

What are potential causes of bilious vomiting in neonates?

A
  • Duodenal atresia
  • Malrotation with volvulus
  • Jejunal/ileal atresia
  • Meconium ileus
  • NEC
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16
Q

Define duodenal atresia.

A

Complete occlusion or absence of the duodenal lumen

17
Q

Define duodenal stenosis.

A

Incomplete obstruction caused by narrowing of the lumen

18
Q

Describe the pathophysiology of duodenal atresia.

A

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

19
Q

What are the clinical features of duodenal atresia?

A
  1. Intrauterine: polyhydramnios
  2. Postpartum
    - Bilious vomiting (if the stenosis is distal to the major duodenal papilla)
    - Distended upper abdomen and scaphoid lower abdomen
    - Delayed meconium passage
20
Q

What is the 1st line imaging/investigation for duodenal atresia?

A

Abdominal x-ray

21
Q

What features on abdominal x-ray are typical of duodenal atresia?

A
  • Double bubble sign

- Gasless distal bowel

22
Q

What is the treatment for duodenal atresia?

A

Bypass of the atresia or stenosis

  • Duodenoduodenostomy
  • Duodenojejunostomy
23
Q

Define jejunal/ileal atresia.

A

Absence of the jejunal or ileal lumen

24
Q

What condition is commonly associated with jejunal/ileal atresia?

A

Cystic fibrosis

25
Q

Describe the pathophysiology of jejunal/ileal atresia?

A

Vascular accidental in utero (usually a disruption of superior mesenteric artery) –> ischaemic necrosis and reabsorption of the jejunum or ileum –> discontinuous bowel –> obstruction

26
Q

What are the clinical features of jejunal/ileal atresia?

A
  • Bilious vomiting

- Upper abdominal distension

27
Q

What is the 1st line imaging for jejunal/ileal atresia?

A

Abdominal x-ray –> triple bubble sign

28
Q

Define meconium ileus.

A

Failure to pass the first stool in neonates, usually in the first 48h after birth

29
Q

What is the most common cause of meconium ileus?

A

Cystic fibrosis is the cause in >90% of cases

30
Q

What are the clinical features of meconium ileus?

A
  • Bilious vomiting
  • Abdominal distension
  • No passing of meconium or stool
31
Q

What is 1st line imaging for meconium ileus?

A

Abdo x-ray –> dilated small bowel loops

32
Q

What is 1st line management for meconium ileus?

A

Enema with a contrast enema

33
Q

Define necrotising enterocolitis.

A

Haemorrhagic necrotising inflammation of the intestinal wall

34
Q

What areas of the colon are most commonly affected by necrotising enterocolitis?

A
  • Distal ileum

- Proximal colon

35
Q

What are the clinical features of necrotising enterocolitis?

A
  • Lethargy
  • Abdominal distension
  • Vomiting
  • Diarrhoea, rectal bleeding
  • Visible intestinal loops
  • Systemically unwell, features of sepsis
  • DIC and shock
36
Q

What is 1st line imaging for NEC?

A

Abdominal radiography/x-ray

  • Bubbles of gas within wall of intestine
  • ‘String of pearls’ sign
37
Q

What is the management of NEC?

A

Non-perforated:
- Conservative and supportive management

Perforated:
- Laparotomy and resection

Paediatrics (14 decks)

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