Gastroenterology Flashcards
What are the features of pyloric stenosis?
Hypertrophy of the pyloric muscle
* Projectile vomiting * Hunger * Dehydration * Hypochloremic metabolic alkalosis (low K+/Na+) * Pyloric mass in RUQ
What is the management of pyloric stenosis?
Investigation:
Abdominal ultrasound showing hypertrophy of the circular pyloric muscles
Treatment:
• IV fluid resuscitation
• Ramstedt pyloromyotomy
What are the features of infant colic?
Collection of symptoms seen in first few months of life • Inconsolable crying • Drawing up of knees • Excessive flatus • Several times a day
If severe and persistent it may be cows’ milk protein allergy
Management is reassurance. Normally disappears after 6 months
What are the features of intussusception?
Most common cause of intestinal obstruction
Occurs in ileocaecal region
Peak age 3 months - 2 years
* Episodes of severe colicky pain with pallor * Refusing feeds * Vomiting (sometimes bile-stained) * Sausage shaped mass in abdomen * Redcurrent jelly stool (response to gut ischaemia) * May occur following viral infection (peyer's patch enlargement)
Investigation:
• X-ray showing abdominal distension
• Abdominal ultrasound showing target sign
What is the management of intussusception?
Rectal air insufflation
If unsuccessful (25%), surgery with broad spectrum antibiotics are necessary
What are the features of Meckel’s Diverticulum?
A diverticulum originating from the omphalomesenteric duct. Contains either gastric mucosa or pancreatic tissue
* Massive rectal bleeding (Painless) * If infected, can lead to meckel's diverticulitis, mimicking pain of appendicitis * Complications: Intussusception, volvulus
What is the management of Meckel’s Diverticulum?
Investigation:
• Technetium scan (Demonstrates increased uptake due to ectopic gastric mucosa)
Treatment:
• If causes bleeding, surgical removal with blood transfusion
• If causes obstruction, surgical removal with lysis of adhesion
What is malrotation?
Failure of duodenal rotation during foetal development, presenting as obstruction with bilious vomiting
In some cases there may be compromised blood supply
Typically presents within the first week of life
Investigated with urgent upper GI contrast
What is the management of malrotation?
Investigation:
• Urgent upper GI contrast for rotation
Treatment:
• Ladd procedure (Laparoscopically)
• If signs of vascular compromise, urgent laparotomy
• Antibiotics
What are the features of irritable bowel syndrome?
- Non-specific abdominal pain
- Explosive loose stool
- Bloating
- Constipation
Must always check coeliac antibodies (Anti-TTG) as coeliac may occur with IBS
What are the features of peptic ulceration?
Epigastric pain that:
• Is worse at night
• Radiates to the back
• History of peptic ulcers in family
Uncommon in children
Typically caused by H. pylori
What is the management of peptic ulceration?
Investigations:
CLO test (Gastric biopsy, placed in urea, produces ammonia)
C-13 urease test
Stool antigen
Treatment:
Triple therapy
• Amoxicillin
• Clarithromycin
• Omeprazole
If they don’t respond, conduct Upper GI endoscopy
• If normal - Functional dyspepsia (Symptoms of peptic ulcer + bloating, early satiety, postprandial vomiting)
What are the features of eosinophilic oesophagitis?
- Discomfort when swallowing
- Vomiting
- Dysphagia
More common in children with atopy
What is the management of eosinophilic oesophagitis?
Investigation:
• Endoscopy
• You will see trachealised oesophagitis (oesophagus has rings resembling trachea)
• On microscopy, increased eosinophils
Management:
• Oral corticosteroids
What are the different causes of gastroenteritis and what are their distinguishing features?
Rotavirus:
• Most common cause of gastroenteritis in developed world
Bacterial causes are associated with blood in stool
Campylobacter jejuni:
• Most common bacterial cause
• Severe abdominal pain
Shigella/Salmonella:
• Blood/Pus in stool
• High fever
• Tenesmus
Cholera/E.coli:
• Profuse, dehydrating diarrhoea
How is level of dehydration assessed?
Most accurate = Change in weight Other clinical signs: • Reduced skin turgor • Tachycardia • Tachypnoea • Sunken eyes • Irritable/Lethargic
What are the clinical features of coeliac disease?
Malabsorption syndrome following initiation of wheat in diet:
• Bulky, hard to flush stool or diarrhoea
• Weight loss
• Foul smelling stool
• Rash - Dermatitis herpetiformis
Other:
• Faltering growth
• Abdominal distension
• Buttock wasting
What is the management of coeliac disease?
Investigations:
Anti-TTG antibodies
Endomysial antibodies
Duodenal biopsy for confirmation
Treatment:
Removal of wheat from diet
Annual review - Assess body weight, height, BMI
If non-adherent to gluten-free diet, can lead to:
• Micronutrient deficiency (osteopaenia)
• Risk of bowel cancer
What are the clinical features of Hirschsprung disease?
Caused by an absence of of ganglionic cells, most commonly at the rectosigmoid colon
Commonly seen in Down’s syndrome
* Failure to pass meconium in first 24 hours * Abdominal distention * Bilious vomiting
If it develops later in life, it may cause:
• Chronic constipation
• Associated with abdominal distention
• Signs of growth failure
Can suffer from Hirschsprung enterocolitis, due to C. difficile infection. This is life-threatening
What is the management of Hirschsprung disease?
Investigation:
• Full thickness rectal suction biopsy
• This typically shows an absence of ganglionic nerve cells and excess, large acetylcholinesterase-positive nerve trunks
Treatment:
• Resection of aganglionic rectal tissue and anastomosis of health colon
• Procedure is known as an anorectal pull-through
What are the features of duodenal atresia?
Polyhydramnios during pregnancy Bilious vomiting presenting immediately after birth (compared to volvulus which takes up to a week) Higher likelihood in Down's patients AXR shows double bubble sign Upper GI contrast study may confirm
What are the clinical features of biliary atresia?
Progressive fibrosis and obliteration of extra/intrahepatic biliary tree
* Mild jaundice more than 2 weeks after birth * Pale stools * Faltering growth * Hepatomegaly * Splenomegaly from portal hypertension
What is the management of biliary atresia?
Investigations: • Raised conjugated bilirubin • Abnormal LFT (Raised ALP) • Ultrasound ○ Absent or contracted gallbladder • Confirmed by cholangiogram ○ Fails to outline normal biliary tree • TIBIDA ○ Uptake scan to see bile flow ○ Blocked in biliary atresia
Treatment:
• Kasai hepatoportoenterostomy
○ Join the liver initial biliary tract to duodenum
• Performed asap
What are the clinical features of choledochal cyst?
Cystic dilatation of extrahepatic biliary tree May present with neonatal jaundice In older children: • Abdominal pain • Palpable abdominal mass • Jaundice • Sometimes cholangitis
What is the management of choledochal cyst?
Investigation:
• Ultrasound - Dilated biliary tree
• MRCP
Treatment:
• Surgical excision of cyst
• Formation of Roux-en-Y anastomosis to biliary duct
What are the clinical features of alpha-1 antitrypsin deficiency?
Autosomal recessive
Abnormal folding of alpha-1 antitrypsin protein, this accumulates in the hepatocytes, resulting in liver disease
Deficiency in lungs lead to emphysema
* Prolonged neonatal jaundice * Bleeding due to vitamin K deficiency * Hepatomegaly * Splenomegaly due to portal hypertension/cirrhosis
What is the management of alpha-1 antitrypsin?
Investigations:
• Measure alpha-1 antitrypsin in plasma
Treatment:
• Avoid alcohol and smoking
• Management of manifestations similar to COPD and liver disease
What are the clinical features of galactosaemia?
Features seen when drinking milk
• Poor feeding
• Jaundice
• Vomiting
Can develop: • Hepatomegaly • Cataracts • Liver failure • Developmental delay
What is the management of galactosaemia?
Investigations:
• Galactose in the urine
• Measuring galactose-1-phosphate-uridyl transferase in red cells (Decreased)
Management:
• Galactose-free diet
What are the clinical features of spontaneous bacterial peritonitis?
Diagnosed when there is undiagnosed fever, abdominal pain, tenderness or unexplained deterioration in hepatic or renal function
What is the management of spontaneous bacterial peritonitis?
Diagnostic paracentesis
• Sent for WCC and culture
• More than 250 neutrophils/mm3 is diagnostic
Management:
• Broad-spectrum antibiotics
