Gastroenterology Flashcards
What is a posset?
A non forceful return of milk
What is the term for a non-forceful return of milk after feeding?
Posset
At what age does pyloric stenosis present? In whom?
Roughly 6 weeks
Boys with FH
How does pyloric stenosis present?
Recurrent projectile vomiting immediately after feeding - non bilious +/- blood
May see visible peristalsis and olive shaped upper stomach mass
What metabolic disturbance is present in pyloric stenosis?
Hypochloraemic hypokalaemic metabolic alkalosis
At what age does intussusception tend to present?
6m-18m
Following what does intussusception often present and why?
Post viral e.g. Gastroenteritis
Due to inflamed peyers patches acting as foci for telescoping
What may be more likely the case if intussusception presents in an older child or adult?
Pathological focus e.g. Polyp or Meckel diverticulum
Where is the most common site for intussusception?
Ileum telescoping into caecum through ileocoecal valve
How does intussusception present?
Intermittent colicky abdominal pain presenting as episodic drawing up of knees, pallor between
Bile stained vomiting, may refuse feeds, abdominal distension
Red currant jelly stool a late and ominous sign
Sausage shaped abdominal mass
Management of intussusception?
Radiological reduction with air enema (pneumatic reduction)
Or surgical laparotomy
2 contraindications to radiological reduction of intussusception?
Pancreatitis
Gangrene
When is intussusception most likely to recur?
Within first year post illness
What is the point of localised tenderness/guarding in appendicitis?
McBurney’s point
What is Rovsing’s sign?
Pressing on LLQ elicits pain in RLQ
What complication may occur earlier in preschool children with appendicitis and why?
Peroration
As omentum is less well developed and doesn’t surround appendix as effectively
Post viral differential for appendicitis?
Mesenteric adenitis
2 major differentials for testicular torsion?
Epididymoorchitis
Torted cyst of Morgani
How long do you have from onset of pain before testicular damage is caused in testicular torsion?
4 hours
What is the most common hernia presenting in children?
Indirect Inguinal hernia
What is the most common side for inguinoscrotal hernia? Why?
Right side as R testis descends later
What needs to be done for childhood Inguinal hernia and why?
Surgical repair within a few weeks
As can incarcerate and strangulate, leading to vomiting and unwell child
What causes meconium ileus particularly in CF?
Reduced pancreatic enzymes and thick, viscous meconium that tends to obstruct terminal ileum
Management of meconium ileus?
Gastrograffin enema
Or laparotomy if contraindicated, unsuccesful or perforated
Why is malrotation such an important diagnosis to make?
Volvulus of midgut may occur and is catastrophic and life threatening
How does midgut malrotation without volvulus present and why?
Subacute duodenal level obstruction around 1-3 days of life
Due to obstruction by Ladds bands from malrotated midgut
Leading to non-specific bilious vomiting, abdo pain but no distension
How does volvulus present?
Acute collapse, bile stained vomit
Scaphoid abdomen
What does the double bubble sign on AXR suggest?
Duodenal atresia
Later onset ddx for double bubble gas sign?
Annular pancreas
What is the football sign?
Air either side of falciform ligament which splits liver in half
Seen in perforation (nec)
