Gastroenterology Flashcards
What are the red flags for constipation in paeds?
Not passing meconium with 48hr of birth.
Neurological symptoms.
Vomiting.
Ribbon stool (anal stenosis),
Abnormal anus,
Abnormal lower back or buttock.
Failure to thrive,
Acute severe abdominal pain and bloating.
Presentation of coeliac’s disease in paeds?
Failure to thrive,
Diarrhoea,
Weight loss,
Fatigue,
Weight loss,
Anaemia,
Dermatitis herpetiformis.
Rarely - peripheral neuropathy, cerebellar ataxia or epilepsy.
Investigations and complications of coeliacs disease?
Investigations - Raised anti-TTG antibodies and total immunoglobulin A levels and anti-endomysial antibodies. Endoscopy and intestinal biopsy shows crypt hypertrophy and villous atrophy.
Complications - Vitamin deficiency, anaemia, osteoporosis, ulcerative jejunitis, enteropathy-associated T-cell lymphoma. Non-Hodgkins lymphoma. Small bowel adenocarcinoma.
Associations of coeliac’s disease?
Type 1 diabetes,
Thyroid disease,
Autoimmune hepatitis,
Primary biliary cirrhosis,
Primary sclerosing cholangitis,
Down’s syndrome
Features of pyloric stenosis?
Stenosis of pyloric sphincter.
Presents with projectile vomiting, mass in upper abdomen which feels like a large olive (hypertrophy of pylorus). Blood gas shows hypochloric metabolic alkalosis.
Management - Diagnosis via abdominal US and treat with laparoscopic pyloromyotomy.
Management of Crohn’s in Paeds?
Induce remission with steroids. If steroids alone don’t work then add immunosuppressant medication (azathioprine, mercaptopurine, methotrexate, infliximab).
Maintain remission with azathioprine or mercaptopurine
Management of ulcerative colitis in Paeds?
Induce remission in mild-mod disease - first line is aminosalicylate. Second line is corticosteroids.
Induce remission in severe disease - first line is IV corticosteroids, second line is IV ciclosporin.
Maintain remission with aminosalicylate or can use azathioprine/mercaptopurine.
explain features of biliary atresia?
Condition where bile duct is either narrow or absent.
High conjugated bilirubin levels which presents with persistent jaundice > 14 days (>21 days in premature babies).
Management - Kasai portoenterostomy however often needs full liver transplant
Causes of intestinal obstruction in paeds?
Meconium ileus
Hirschsprung’s disease,
Oesophageal atresia,
Duodenal atresia,
Intussusception,
Imperforated anus,
Malrotation of intestines with volvulus,
Strangulated hernia
What is Hirschsprung’s disease?
Congenital condition where parasympathetic ganglion cells of myenteric plexus are absent in distal bowel and rectum.
It is responsible for stimulating peristalsis.
There may be only one section of the bowel without the plexus or you may have total colonic aganglionosis.
Presentation and management of Hirschsprung disease?
Presentation - Delay in passing meconium (> 24 hours),
Chronic constipation since birth,
Abdominal pain and distention,
Vomiting,
Poor weight gain and failure to thrive.
Management - abdominal xray, rectal biopsy to confirm diagnosis and then surgery to remove aganglionic section of bowel.
Explain features of Hirschsprung associated entercolitis
Inflammation and obstruction of intestine.
Presents 2-4 weeks after birth with fever, abdominal distention, diarrhoea and sepsis.
Life threatening and can lead to toxic megacolon and perforation.
Rx - antibiotics, fluid resus and decompression.
Presentation, investigations, management and complications of Intussusception
Presentation - Severe, colicky abdominal pain, pale and lethargic, redcurrent jelly stool, sausage shaped RUQ mass, vomiting and intestinal obstruction.
Ix - Ultrasound and contrast enema.
Rx - Theraputic enema, surgical reduction if enema unsuccessful.
Complications - Obstruction, gangrenous bowel, perforation and death
What conditions is intussusception associated with?
Concurrent viral illness,
HSP,
Cystic fibrosis,
Intestinal polyps,
Meckel diverticulum
Location of liver on palpation in infants?
3cm below costal maegin in nipple line in infancy.
2cm at 1 year.
1cm at 5 years
