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
How are infantile inguinal hernias referred and managed?
<1 year: manage as high risk of strangulation
>1 year: refer for elective repair
What would a baby experiencing colic look like?
Red faced Crying Knees drawn up to chest Flatus Inconsolable crying NORMAL WEIGHT
How is colic managed?
- reassurance for the parents
- increased parenting support
- can try maternal hypoallergenic diet
What are some causes of dehydration in children?
Reduced intake: mouth ulcers, teething, tonsillitis
Increased output: diabetes, gastroenteritis
Other losses: fever, burns
A dehydrated child needs fluid replacement therapy. How is the volume given calculated?
pre-dehydration weight (kg) x % weight loss x 10 ADD maintenance needs ADD ongoing losses
What are the symptoms of lactose intolerance?
Watery, foamy diarrhoea
Burning on defecation
Bloating
What is the pathophysiology of coeliac disease?
Autoimmune condition caused by sensitivity to gluten
What are the signs and symptoms of coeliac disease? At what age does it most commonly present?
Presents at weaning (6 months - 1 year)
- diarrhoea (grey, oily, smelly), bloating, pain, mouth ulcers
- FTT
- Tired all the time
- Iron deficiency anaemia
- Dermatitis herpetiformis
What is the pathway for diagnosing coeliac disease?
IgA tTGA measured
Negative = test for IgA deficiency and if deficient measure IgG tTGA
?? = IgA endomysial antibody
Positive = biopsy
What biopsy results indicate coeliac disease?
Flat mucosa
Crypt hyperplasia
Lymphocyte infiltration
What are the complications of coeliac disease?
Anaemia (iron, folate, B12) Hyposplenism Osteoporosis Infertility Lymphoma
Compare Gastroschisis and Exomphalos and their management
G = defect in anterior abdominal wall leading to free loops of bowel being visible outside. They need immediate surgery
E = amniotic membrane and peritoneum covers the protruding bowel. Cover the sac with non-adherent gauze
