Gastroenterology Flashcards
Give some differentials for constipation in children
Psychological Poor diet Anal fissure (pain) Hirschsprung Cow's milk allergy Hypercalcaemia
What is a disimpaction regime for constipation in children?
- Movicol Paediatric Plain
- Stimulant (Senna)
- No Movicol, Stimulant + Osmotic (lactulose)
What are some differentials for diarrhoea in children?
Overflow from constipation Gastroenteritis Systemic infection Surgical: appendicitis, volvulus Food intolerance CF
What are the signs and symptoms of intussusception?
Spasms of pain, distress and draw up the legs
Palpable mass in RUQ
Bilious vomiting
Red current jelly stool
How is intussusception investigated and what is seen?
USS shows target sign
How is intussusception managed?
NG tube and NBM
Rectal insufflation of air
Surgical if conservative doesn’t work
What is Hirschsprung disease?
Failure of the parasympathetic ganglions to innervate a section of bowel (often hindgut) leading to failure of coordinated peristalsis and a functional obstruction
What condition is Hirschsprung associated with?
Downs syndrome
What are the signs and symptoms of Hirschsprung disease?
How might it present later in life?
Failure to pass meconium in 24 hours
Absolute constipation
Bilious vomiting
Abdominal distention
Diarrhoea as a result of enterocolitis by C.Diff
How is Hirschsprung diagnosed?
Rectal biopsy shows an aganglionic portion of bowel
How is Hirschsprung managed?
- Rectal washout whilst awaiting surgery
2. Removal of the aganglionic portion
What are the signs and symptoms of GORD?
Regurgitation Irritability FTT Cough Sandifer's syndrome - extension of neck and dystonic posture
How is infantile GORD managed?
Feed at 30 degrees
Thicken feeds
Feed little and often
Omeprazole
What is Meckel’s diverticulum?
Diverticulum of the small intestine
How does Meckel’s diverticulum present?
Abdominal pain
Painless rectal bleeding
Obstruction
May present as peptic ulceration if the diverticulum contains ectopic gastric mucosa
What are the signs and symptoms of pyloric stenosis?
Projectile non-bilious vomiting
Hungry
FTT
Dehydration and constipation as a result
Olive shaped mass above and slightly to the right of the umbilicus
What investigations would you do if you suspect pyloric stenosis? What would the results be?
- Test feed: observe if truly “projectile” and see visible peristalsis
- ABG: hypochloraemic, hypokalaemic metabolic alkalosis (progresses to acidosis as dehydration worsens)
- USS
- Barium meal
Describe the location of abdominal contents in malrotation
Caecum in RUQ
Duodenal jejunal flexure in midline
Mesentery mobile
If an asymptomatic malrotation was picked up, how would you manage it?
Ladd’s procedure
What are the signs and symptoms of volvulus?
Bilious vomiting
Abdominal pain
Shock
What imaging is used in diagnosing volvulus? What would the results be?
AXR: double bubble sign (both stomach and duodenum dilated) with no other air fluid level
GI contrast study: bird beak obstruction of the duodenum
What are the features of congenital diaphragmatic hernias?
Herniation of intestines in to the thorax Lung hypoplasia Apparent dextrocardia Pulmonary hypotension Lack of surfactant
How are congenital diaphragmatic hernias managed?
Mechanical ventilation
How are infantile umbilical hernias referred and managed?
They are ok to be left
Generally refer at age 4/5 but if >2cm or symptomatic then at age 2/3
