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Paediatrics > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

GOR is v common in infants, it’s caused by __ as a result of functional ___. although common, by what age should symptomatic GORD resolve?

A

inappropriate relaxation of the LOS
immaturity
by 12 months old

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2
Q

Why is GOR v common in <1yr olds?

A
  • mostly liquid diet
  • horizontal posture
  • short-intra abdo length of oesophagus
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3
Q

What will an infant with GOR be like? Symptoms? Weight/general health? Effect on carers?

A
  • recurrent regurg w vomiting
  • put on weight normally, otherwise well
  • mess, smell, changing soiled clothes is frustrating for carers
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4
Q

GOR in infants is usually benign and self-limiting but complications leading to GORD need treatment, suggest some:
e.g. growth, oesophagus, lungs, neck

A
  • faltering growth (from vomiting)
  • oesophagitis (heamatemesis, feeding discomfort, IDA)
  • recurrent pulmonary aspiration
  • dystonic neck posturing
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5
Q

In what groups of infants is GOR more common?

A
  • children w CP/neurodevelopmental disorders
  • preterm infants esp with bronchopulmonary dysplasia
  • following surgery for oesophageal atresia/CDH
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6
Q

GOR in infancy is a clinical diagnosis but if atypical/complications/fails to respond to rx, what investigations could be done to investigate GORD?

A
  • 24h oesoph. pH monitoring (quantifys degree of reflux)
  • 24h impedance monitoring
  • endoscopy w biopsy (can identify oesophagitis and exclude other causes of vomiting)
  • contrast studies (check for underlying anatomical abnormalities)
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7
Q

GOR management in uncomplicated cases during infancy? (NB: it has a great prognosis)

A
  • parental reassurance
  • add inert thickening agents to feeds
  • smaller, more frequent meals
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8
Q

How is significant GORD in infancy managed?

to reduce vol of gastric contents and treat acid-related oesophagitis

A
  • H1 R antagonists e.g. ranitidine

- PPIs e.g. omeprazole

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9
Q

If a child fails to respond to GORD treatment with e.g. -H1 R antagonists e.g. ranitidine & PPIs e.g. omeprazole, what should be done?

A
  • investigate other diagnoses

- e.g. consider cow’s milk protein allergy

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10
Q

When is a Nissen Fundoplication done to treat an infant?

A

-children w complications of GORD unresponsive to intensive medical treatment

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11
Q

CDH in newborn may present with:

NB: now most are diagnosed at antenatal screening

A
  • failure to respond to resuscitation

- respiratory distress

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12
Q

Usually in CDH, there is a ___ sided herniation of abdo contents through the ____ foramen of the diaphragm. The apex beat and___ _____ will be displaced to the __ with poor air entry in the ___ __.

A
  • left-sided
  • posterolateral
  • heart sounds
  • right
  • left chest
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13
Q

Once diagnosis of CDH is made in a newborn, what is done to prevent distension of the intrathoracic bowel ?

A

-large NG tube inserted and suction applied

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14
Q

After stabilisation surgery is performed to treat a CDH, but what problem persists in many infants with this condition?

A

-Pulmonary hypoplasia (high mortality)

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15
Q

Inguinal hernias are common esp in prematures and boys. Usually caused by a persistently patent ___ ___ and emerges from the __ inguinal ring through the canal so is therefore usually ___.

A
  • processus vaginalis
  • deep
  • indirect hernia
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16
Q

How may an inguinal hernia present in a baby?

A
  • lump in groin (may extend to scrotum/labia)
  • asymptomatic, may be visible on straining
  • thickened cord structures on palpation
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17
Q

Hernia contents in an infant can become ___ causing pain and sometimes ___ ___ or damage to the ___ by ____. The lump in this case will be ___ and the infant may be irritable/may vomit.

A
  • irreducible/incarcerated
  • intestinal obstruction
  • testes by strangulation
  • tender
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18
Q

Most hernias can be successfully reduced by “taxis” then surgery planned for a time when oedema is settled. If reduction impossible, what do you do, why?

A
  • emergency surgery

- risk of bowel/testes compromise or ovary which can become incarcerated within a hernia

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19
Q

Surgery for ing. hernia involves: ligation and division of the __ ___ which has become the ___ __.

A
  • processus vaginalis

- hernial sac

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20
Q

Acute abdomen in children is important. the most common cause is ___ note that the __, __ ___ and ___ __ must always be checked.

A

Appendicitis

Testes, hernial orifices and hip joints

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21
Q

How can all of the following present? lower lobe pneumonia, ascites from nephrotic s., DKA, UTI, pancreatitis

A

ACUTE ABDOMINAL PAIN

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22
Q

Appendicitis may occur at any age but is very uncommon in children < __. The clinical features include:

A
  • <3yrs

- anorexia, vomiting, abdo pain worse w movement, fever, guarding of RIL

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23
Q

US may support a clinical diagnosis of appendicitis, what may the findings from this be?

A

-thickened, non-compressible appendix with increased blood flow

24
Q

If there generalised guarding consistent with perforation, what should be given prior to laporatomy?

A
  • IV abx

- fluid resuscitation

25
Q

Define intussusception:

A

the invagination of proximal bowel into a distal segment

26
Q

What segments are most commonly affected in intussusception?

A

-ileum passing into cecum through the ileocaecal valve.

27
Q

What is the most common cause of intestinal obstruction in young infants?

A

intussusception

28
Q

The most serious complication of intussusception is:

  • stretching and constriction of the … resulting in …. causing … &… from the bowel mucosa, fluid loss
  • and subsequent __ ____, peritonitis and gut ___
A
  • mesentery -> venous obstruction
  • engorgement and bleeding
  • bowel perforation, gut necrosis
29
Q

What is essential to avoid complications of intussusception? Prompt __, immediate __ __ and urgent ____ of intussusception.

A
  • diagnosis
  • fluid resuscitation
  • reduction
30
Q

Name ways in which intussusception may present:

e.g. -paroxysmal, severe, colicky pain and pallor

A
  • drawn up legs during episodes of pain and pallor
  • increasing lethargy
  • may refuse food/vomit (maybe bile stained)
  • sausage shaped abdo mass
  • abdo distention and shock
  • redcurrant jelly stool
31
Q

What is red-current jelly stool a late sign of? What is it, when is it seen?

A
  • intussusception
  • blood-stained mucus in stool
  • seen after a rectal exam
32
Q

Name 3 poss causes of intussusception:

A
  • post viral infection causing enlarged peyer’s patched
  • meckel diverticulum
  • polyp
33
Q

The diagnosis of intsussusception can be confirmed with US, what sign is seen?

A

Target/doughnut sign

34
Q

What will an x-ray in a child with intussusception show

A
  • distended small bowel

- absence of gas in distal colon/rectum

35
Q

How is reduction of intussusception done? by who?

(success rate ~75%) if not successful what is needed?

A

rectal air insufflation by a radiologist

-operative reduction

36
Q

usually intussusception is treated with rectal air insufflation, in what case must the child go straight to surgery?

A

Peritonitis

37
Q

What is a Meckel Diverticulum a remnant of?

~2% individuals have this

A

An ileal remnant of the vitello-intestinal duct

38
Q

What may a Meckel Diverticulum contatin?

A
  • ectopic gastric mucosa

- or pancreatic tissue

39
Q

In 70% meckel diverticuli, what scan will demonstrate increased uptake by ectopic gastric mucosa?

A

-technetium scan

40
Q

How are symptomatic Meckel Diverticuli treated?

A

surgical resection

41
Q

What process in fetal life can predispose to volvulus because of the mesentery base being shorter than normal.

A

-if the mesentery is not fixed at the duodenojejunal flexure or in the ileo-caecal region

42
Q

What are Ladd bands? What effect can they caues?

A
  • peritoneal bands that may cross the duodenum

- can obstruct the duodenum

43
Q

How may a case of malrotation present?

usually in first 3days of life

A
  • obstruction (+/-compromised blood supply)

- bilious vomiting

44
Q

Any child with dark green vomiting should have a _____ study to assess intestinal __, unless there are signs of ___ _____ present in which case an urgent ______ is needed

A
  • contrast study
  • intestinal rotation
  • vascular compromise
  • laparotomy
45
Q

Why is a volvulus from malrotation a surgical emergency?

A
  • the SMA blood supply to the small intestine and proximal large intestine is compromised
  • these areas can become infarcted
46
Q

At operation a volvulus is untwisted, the ______ mobilised, and the bowel placed in the ___-______ position. The malrotation is not corrected but the ____ is broadened. The _____ is generally removed.

A
  • duodenum
  • non-rotated position
  • mesentery
  • appendix
47
Q

Pyloric Stenosis is caused by?
Presents around ___-___ weeks, irrespective of gestational age
More common in _boys__ especially in _____-____ and there may a ____ history, esp on the _____’s side

A
  • hypertrophy of pyloric muscle –> gastric outlet obstruction
  • presents 2-8 weeks of age
  • esp. firstborns
  • may be family history esp. on maternal side
48
Q

Give 2 clinical features of pyloric stenosis

A

-vomiting of increasing frequency and forcefulness –> projectile
-hunger after vomiting until dehydration -> loss of interest in feeding
-weight loss if presentation is delayed
-

49
Q

what metabolic abnormality can arise secondary to pyloric stenosis as a result of vomiting stomach contents?
-and plasma Na+ and K+ levels?

A
  • hypochloraemic metabolic alkalosis

- low plasma Na+ and K+

50
Q

Diagnosis of pyloric stenosis (provided child doesn’t need immediate fluid resus):

  • test feed of milk (calms hungry infant -> allows examination)
  • then what do you look for? what do you palpate for? If stomach is overdistended what do you need to do first?
  • what imaging is used prior to surgery?
A

-gastric peristalsis may be seen as a wave moving across the abdo left -> right
-pyloric mass may be palpable in RUQ, feels like an olive
-if overdistended w air, empty via NG tube first
-US can confirm dx before surgery
-

51
Q

Management of Pyloric Stenosis

NB: -post op can feed child after 6hrs and discharge after 2 days

A
  • correct any fluid/electrolyte abnormalities w IV fluid

- Pyloromyotomy (division of the hypertrophied muscle down to mucosa)

52
Q

Coeliac disease is an enteropathy where the ____ fraction of ____ and other related prolamines in wheat, barely and rye provoke a damaging immunological response in the _____ small intestine _____.

A
  • gliadin fraction of gluten

- in the proximal small intestine mucosa

53
Q

There is increased cell loss from the villous tips in Coeliac disease, although the rate of migration of enterocytes up the villi from crypts increases to compensate, what is the outcome?

A
  • insufficient compensation
  • villi become progressively shorter then absent –> flat mucosa

NB: increased intraepithelial lymphocytes, crypt hypertrophy, villus atrophy on biopsy

54
Q

How does Coeliac disease usually present and at what age?

hint: what muscle group may be wasted?

A
  • presents with profound malabsorptive syndrome
  • faltering growth, abdo distension, buttock wasting, abnormal stools, irritability
  • at 8-24 months after wheat-containing weaning foods are introduced
55
Q

What tests are used along side biopsy to diagnose Coeliac disease:

A
  • anti-TTG antibodies

- EMA (endomysial antibodies)

56
Q

Coeliac disease management:

-if not adhered to what is the risk to the bone? and the bowel?

A
  • remove all wheat, rye, barely products from diet –> resolution of sx
  • must have supervision from dietician
  • adhere to gluten-free diet for life, otherwise risks include:
  • micronutrient deficiency -> osteopenia
  • bowel malignancy esp small bowel lymphoma

Paediatrics (12 decks)

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