Gastrointestinal Flashcards
GORD
Presence of the symptoms of reflux. Regurgitation - Reflux of stomach contents beyond the oesophagus. Contents from the stomach reflux through the lower oesophageal sphincter.
Immaturity of the lower esophageal sphincter = content reflux easily.
GORD impacts ___% of infants
40
When does GORD usually appear?
first 2 weeks of life
Who is GORD more common in?
premature babies
Symptoms of GORD
-Symptoms should have started in the first 2 months of life -Distressed behaviour
-Feeding difficulty
-Chronic crying
-Faltering Growth
-If onset is >6 months or symptoms continue over 1 year, it is unlikely to be reflux - Often after large feeds. - Chronic cough, hoarse cry, reluctance to feed and poor weight gain.
Ix for GORD
-Urinalysis to rule out UTI (RARELY = barium meal and endoscopy.)
Management of GORD
-Usually resolves by 1 year of life -Can mix alginate with feeds (Gaviscon) for breastfed babies
-For formula fed, encourage smaller, more regular feeds otherwise use thickened formula
-Consider trial to PPI for 4 weeks
Referral if symptoms still persisting. Treatment = gaviscon, thickened milk and PPIs
Red Flags for GORD
-Projectile vomiting.-Bile stained vomiting -Reduced consciousness and bulging fontanelle Signs of infection
Advice for parents with children who have GORD?
small meals, burping regularly and not-over feeding.
Sandifer’s syndrome is a rare complication of GORD. What is it?
Brief episodes of abnormal movement associated with GORD. Torticollis and dystonia. Tx = resolvement of GORD.
What is torticolis?
-Torticollis = forceful contraction of the neck = twisting of the neck.
What is Dystonia?
-Dystonia = abnormal muscle contraction = arching of the back.
Why is it important to differentiate GORD ?
Important to differentiate this as normally babies do regurgitate as the lower oeseopahgeal sphincter is still immature therefore it is easily for stomach contents to regurg however the key thing with this is that babies will be well and growing normally
What is poor feeding in paediatrics?
Poor feeding refers to an infant or child not feeding as expected, either due to reduced intake, difficulties during feeding, or an underlying medical condition.
Poor feeding in infants is characterized by ________ intake or difficulties during ________.
Reduced; feeding
What are some common causes of poor feeding in infants?
Infection (e.g., sepsis, UTI, respiratory infections).
Gastroesophageal reflux disease (GERD).
Congenital heart disease.
Neurological conditions (e.g., cerebral palsy).
Structural abnormalities (e.g., cleft palate).
Feeding aversion or maternal factors (e.g., poor latch, inadequate milk supply).
Congenital ________ disease and ________ reflux are common causes of poor feeding in infants.
Heart; gastroesophageal
What are some red flags associated with poor feeding in infants?
Lethargy or drowsiness.
Persistent vomiting.
Poor weight gain or weight loss.
Signs of dehydration (e.g., sunken fontanelle, reduced wet nappies).
Difficulty breathing.
Cyanosis or pallor.
Red flags in poor feeding include lethargy, ________ gain, and signs of ________.
Poor weight; dehydration
What key points should be included in the history of a child with poor feeding?
Feeding history (frequency, duration, difficulties).
Associated symptoms (e.g., vomiting, cough, fever).
Growth and development milestones.
Antenatal and birth history.
Family history of conditions affecting feeding.
A detailed history for poor feeding should include ________ history and associated ________.
Feeding; symptoms
What are some physical examination findings to look for in poor feeding?
Signs of dehydration (e.g., dry mucous membranes, sunken eyes).
Growth parameters (e.g., weight, length, head circumference).
Respiratory distress (e.g., tachypnoea, intercostal recession).
Cardiac murmurs or cyanosis.
Neurological signs (e.g., abnormal tone, reflexes).
Structural abnormalities (e.g., cleft palate).
A physical examination for poor feeding should assess for signs of ________, respiratory distress, and ________ abnormalities.
Dehydration; structural
What investigations might be indicated for an infant with poor feeding?
Blood tests: FBC, CRP, blood glucose, electrolytes.
Urine analysis: To rule out UTI.
Echocardiogram: If congenital heart disease is suspected.
Swallow study: For structural abnormalities or aspiration.
Imaging: Chest X-ray or brain imaging if neurological causes are suspected.
Blood ________, urine analysis, and ________ are key investigations in poor feeding.
Tests; echocardiogram
What is the role of growth charts in evaluating poor feeding?
Growth charts are used to monitor weight, length, and head circumference over time to assess for faltering growth or failure to thrive.
________ charts help assess faltering growth or failure to ________ in poor feeding.
Growth; thrive
How is gastroesophageal reflux disease (GERD) managed in infants with poor feeding?
Positioning (upright after feeds).
Thickened feeds.
Medications if severe (e.g., proton pump inhibitors like omeprazole).
GERD in infants is managed with upright positioning, ________ feeds, and ________ if severe.
Thickened; proton pump inhibitors
What are the principles of management for poor feeding?
Treat the underlying cause (e.g., infection, structural abnormality).
Nutritional support (e.g., NG feeding if needed).
Parent education on feeding techniques.
Monitoring growth and hydration status.
Multidisciplinary involvement if complex (e.g., dietitian, speech therapist).
Management of poor feeding includes treating the underlying ________ and providing ________ support.
Cause; nutritional
What is faltering growth, and how does it relate to poor feeding?
Faltering growth refers to insufficient weight gain or inappropriate weight loss in infants, often secondary to poor feeding or inadequate nutrient intake.
Faltering growth in infants is often secondary to ________ or inadequate ________ intake.
Poor feeding; nutrient
Pyloric Stenosis
Progressive hypertrophy of the pyloric sphincter causing gastric outlet obstruction
Pyloric Stenosis is more common in ____
Boys
Epidemiology of Pyloric Stenosis
Affects 1 in 500 - Family history - First borns
Symptoms of Pyloric Stenosis
Presents 4-6 weeks of age - Non bilious, forceful, projectile vomiting after every feed approx 30 mins - Will continue to feed despite vomiting - Weight loss - Dehydration - Constipation - Visible peristalsis
Signs of Pyloric Stenosis
Palpable olive sized pyloric mass felt
Ix for Pyloric Stenosis
Test feed with NG tube and empty stomach to feel for visible peristalsis and olive shaped mass + USS + Blood gas
Gold Standard Ix for Pyloric Stenosis
USS
What will USS show for Pyloric Stenosis
Hypertrophic pylorus (target sign)
What will a blood gas show for Pyloric Stenosis
Hypochloremic, Hypokalemic Metabolic Alkalosis (loss of hydrogen and chloride ions due to vomiting gastric contents)
Management for Pyloric Stenosis
Correct metabolic imbalances - NaCl - Fluid bolus for hypovolemia - NG tube and aspiration of the stomach - Ramstedt’s Pyloromyotomy
How long after Ramstedt’s Pyloromyotomy can feeding commence?
feeding can commence 6 hours after procedure
What is Irritable Bowel Syndrome (IBS)?
IBS is a functional gastrointestinal disorder characterized by recurrent abdominal pain or discomfort associated with altered bowel habits in the absence of identifiable organic disease.
Irritable Bowel Syndrome (IBS) is a ________ gastrointestinal disorder with no identifiable ________ cause.
Functional; organic
What are the common clinical features of IBS in children?
Recurrent abdominal pain (often in the lower abdomen).
Altered bowel habits: diarrhoea, constipation, or alternating patterns.
Relief of symptoms after defecation.
Bloating or abdominal distension.
Mucus in stools (sometimes).
IBS symptoms often include recurrent abdominal ________ and altered ________ habits.
Pain; bowel
What are the criteria for diagnosing IBS in children?
Abdominal pain or discomfort at least once a week for the last three months.
Symptoms associated with two or more of the following:
Related to defecation (improved or worsened).
Change in stool frequency.
Change in stool form (appearance).
Diagnosis of IBS includes abdominal ________ occurring at least ________ a week for three months.
Pain; once
What investigations are used to exclude organic causes in children with suspected IBS?
Stool tests: for infections or inflammatory markers (e.g., calprotectin).
Blood tests: FBC, CRP, ESR, coeliac serology.
Imaging: Abdominal ultrasound (if red flags present).
Lactose tolerance or hydrogen breath test (if lactose intolerance is suspected).
Stool tests for IBS rule out infections or ________, while blood tests check for coeliac disease or ________.
Inflammation; anaemia
What are the red flag symptoms in children with suspected IBS that require further investigation?
Unintentional weight loss.
Persistent diarrhoea.
Nocturnal symptoms.
Rectal bleeding.
Family history of inflammatory bowel disease or coeliac disease.
Red flags for IBS include ________ bleeding and unintentional ________ loss.
Rectal; weight
What is the initial management of IBS in children?
Reassurance and education about the functional nature of IBS.
Dietary advice:
Avoid triggers like caffeine, fizzy drinks, or fatty foods.
Trial of a low FODMAP diet (if appropriate).
Regular meals with a balanced diet.
Encouraging adequate hydration and physical activity.
Dietary advice for IBS includes avoiding ________ foods and considering a ________ diet.
Trigger; low FODMAP
What pharmacological treatments may be used in paediatric IBS?
Antispasmodics (e.g., hyoscine, peppermint oil) for abdominal pain.
Laxatives for constipation (e.g., polyethylene glycol).
Anti-diarrhoeal agents (e.g., loperamide) for diarrhoea.
Probiotics may be trialled to improve gut flora.
Antispasmodics like ________ are used for abdominal pain in IBS, while ________ agents treat diarrhoea.
Peppermint oil; anti-diarrhoeal
How can psychological support help children with IBS?
Psychological therapies like cognitive behavioural therapy (CBT) or counselling can reduce stress and improve coping mechanisms, as stress often exacerbates IBS symptoms.
Psychological therapies like ________ help reduce stress, which often worsens ________ symptoms.
CBT; IBS
What complications can arise from IBS in children?
Reduced quality of life due to chronic symptoms.
Social or school avoidance.
Anxiety and depression.
Nutritional deficiencies (in severe cases).
IBS complications include reduced ________ of life and potential nutritional ________.
Quality; deficiencies
What lifestyle modifications are recommended for children with IBS?
Regular sleep routines.
Adequate physical activity.
Stress reduction techniques (e.g., mindfulness, relaxation exercises).
Structured daily routines for meals and activities.
Lifestyle changes for IBS include ________ reduction and maintaining regular ________ routines.
Stress; sleep
Gastroenteritis
Infection and inflammation in stomach and intestines
Most common causes for Gastroenteritis
Rotavirus and Norovirus
Other causes of Gastroenteritis
-Bacterial: campylobacter jejuni, shigella, salmonella, e.coli (0157)
Symptoms of Gastroenteritis
-Nausea -Diarrhoea
-Vomiting
-Fever
-Dehydration
Ix for Gastroenteritis
-Clinical diagnosis -Stool sample may help identify cause
Management of Gastroenteritis
-Oral rehydration solution IV fluid only required for shock or clinical deterioration
Constipation
An extremely common condition affecting children characterised by decreased frequency, increased harness of the stool and painful defecation. - Most cases of constipation are idiopathic
Secondary Causes of Constipation
Hirschprung’s disease - Cystic fibrosis - Hypothyroidism - Spinal cord lesions - Sexual abuse - Intestinal obstruction - Cows milk intolerance
Symptoms of Constipation
Less than 3 stools a week - Hard stools that are difficult to pass - Rabbit dropping stools - Straining and painful passages of stools - Abdominal pain - Overflow soiling caused by faecal impaction - Palpable hard stools in the abdomen
Management of Constipation
Idiopathic constipation can be diagnosed clinically, once red flags have been considered. - Correction of any reversible contributors e.g. high fibre diet, good hydration - Laxatives: Movicol is first line - Disimpaction regimen may be needed with high dose of laxatives at first followed by half the disimpaction dose as maintenance - Encouragement of visiting the toilet to reduce withholding.
What is the first line laxative for Constipation tx ?
Movicol
What is appendicitis?
Appendicitis is the inflammation of the appendix, a small, blind-ended tube attached to the cecum, typically caused by obstruction of the appendiceal lumen.
Appendicitis is the inflammation of the ________, often caused by obstruction of the ________ lumen.
Appendix; appendiceal
What are the common causes of appendiceal lumen obstruction?
Fecaliths (hardened stool).
Lymphoid hyperplasia (e.g., after viral infections).
Foreign bodies.
Parasites (e.g., worms).
Common causes of appendiceal obstruction include fecaliths, ________ hyperplasia, foreign bodies, and ________.
Lymphoid; parasites
What are the classic clinical features of appendicitis in children?
Abdominal pain, initially periumbilical and later localized to the right iliac fossa (RIF).
Nausea and vomiting.
Fever.
Reduced appetite (anorexia).
Guarding and rebound tenderness in RIF.
In appendicitis, abdominal pain typically starts in the ________ region and later localizes to the ________.
Periumbilical; right iliac fossa
What atypical symptoms of appendicitis may be seen in younger children?
Diffuse or poorly localized abdominal pain.
Vomiting as the primary symptom.
Irritability or lethargy.
Diarrhoea or urinary symptoms (e.g., dysuria).
Atypical symptoms of appendicitis in younger children may include ________ pain and ________ as the primary symptom.
Diffuse; vomiting
What is McBurney’s point?
McBurney’s point is located one-third of the way along a line from the anterior superior iliac spine (ASIS) to the umbilicus, where tenderness is often observed in appendicitis.
McBurney’s point is located between the ________ and the ________.
Anterior superior iliac spine (ASIS); umbilicus
What investigations are commonly used to diagnose appendicitis in children?
Blood tests: raised white cell count (WCC) and CRP.
Ultrasound: to visualize an inflamed or swollen appendix.
CT scan (if ultrasound is inconclusive).
Urinalysis: to rule out urinary tract infection (UTI).
In suspected appendicitis, ________ is the preferred imaging modality, while a ________ scan is used if the diagnosis is unclear.
Ultrasound; CT
What is the Alvarado score?
The Alvarado score is a clinical scoring system used to assess the likelihood of appendicitis. It includes parameters such as migratory pain, anorexia, nausea/vomiting, tenderness in RIF, rebound pain, fever, WCC, and neutrophil count.
The ________ score is used to assess the likelihood of appendicitis and includes symptoms like ________ pain and fever.
Alvarado; migratory
What is the definitive management for appendicitis?
Appendectomy, which can be performed laparoscopically or via open surgery.
The definitive treatment for appendicitis is ________, which can be performed laparoscopically or via ________ surgery.
Appendectomy; open
When might conservative management of appendicitis be considered?
Conservative management, involving antibiotics alone, may be considered in specific cases, such as mild appendicitis or in patients unfit for surgery.
In mild cases of appendicitis or patients unfit for surgery, ________ management with ________ may be considered.
Conservative; antibiotics
What are the potential complications of untreated appendicitis?
Appendiceal rupture.
Peritonitis.
Abscess formation.
Sepsis.
Complications of untreated appendicitis include ________ rupture, ________, and abscess formation.
Appendiceal; peritonitis
How can appendicitis present differently in cases of pelvic appendicitis?
Pelvic appendicitis may cause lower abdominal pain, diarrhoea, urinary symptoms, and tenderness during a rectal or vaginal examination.
Pelvic appendicitis may cause ________ abdominal pain, diarrhoea, and ________ symptoms.
Lower; urinary
Why might a child with appendicitis have a normal appetite?
A normal appetite is rare in appendicitis and should prompt reconsideration of the diagnosis, as anorexia is a typical feature.
A child with appendicitis typically presents with ________, and a normal ________ is uncommon.
Anorexia; appetite
What is a hernia?
A hernia is the protrusion of an organ or tissue through an abnormal opening or weakened area in the surrounding muscle or connective tissue.
A hernia is the ________ of an organ or tissue through an ________ or weakened area in muscle or connective tissue.
Protrusion; abnormal opening
What are the two main types of hernia in paediatrics?
Inguinal hernia.
Umbilical hernia.
The two main types of hernia in children are ________ hernia and ________ hernia.
Inguinal; umbilical
What is the difference between a direct and indirect inguinal hernia?
Indirect inguinal hernia: Protrusion occurs through the deep inguinal ring, following the inguinal canal, often congenital due to a patent processus vaginalis.
Direct inguinal hernia: Protrusion occurs directly through the posterior wall of the inguinal canal, usually acquired and rare in children.
An ________ inguinal hernia occurs through the deep inguinal ring, while a ________ inguinal hernia occurs directly through the posterior wall of the inguinal canal.
Indirect; direct
What are the risk factors for an inguinal hernia in children?
Prematurity.
Male sex.
Family history of inguinal hernia.
Conditions causing increased intra-abdominal pressure (e.g., cystic fibrosis, ascites).
Risk factors for inguinal hernia in children include prematurity, ________ sex, and conditions that increase ________ pressure.
Male; intra-abdominal
What are the clinical features of an inguinal hernia in children?
Swelling in the groin, more noticeable when crying or straining.
Reducible lump.
Non-tender unless complicated.
The clinical features of an inguinal hernia include a ________ lump in the groin that becomes more noticeable when ________ or straining.
Reducible; crying
What is the management of an inguinal hernia in children?
Surgical repair (inguinal herniotomy), often performed urgently in infants to prevent complications like incarceration.
The management of inguinal hernia involves ________, typically performed urgently in ________.
Surgical repair; infants
What are the complications of an untreated inguinal hernia?
Incarceration: Trapping of hernia contents, leading to obstruction.
Strangulation: Compromised blood supply, leading to ischaemia.
Complications of an untreated inguinal hernia include ________, where the contents are trapped, and ________, where the blood supply is compromised.
Incarceration; strangulation
What is an umbilical hernia?
An umbilical hernia is a protrusion of abdominal contents through the umbilical ring, often due to incomplete closure of the abdominal wall.
An ________ hernia is the protrusion of abdominal contents through the ________ ring.
Umbilical; umbilical
What are the typical features of an umbilical hernia in children?
Swelling at the umbilicus, more prominent when crying.
Reducible and non-tender lump.
Most resolve spontaneously by 3-5 years of age.
Most umbilical hernias in children resolve spontaneously by ________ years of age.
36955
What is the management of an umbilical hernia in children?
Observation for spontaneous resolution.
Surgical repair if it persists beyond 5 years or is symptomatic.
Umbilical hernias are usually managed with ________, but ________ repair is performed if they persist beyond 5 years or are symptomatic.
Observation; surgical
What is an epigastric hernia, and how does it differ from umbilical and inguinal hernias?
An epigastric hernia is a defect in the linea alba above the umbilicus, involving preperitoneal fat. Unlike umbilical and inguinal hernias, it often causes pain and is not reducible.
An epigastric hernia occurs in the ________ above the umbilicus and typically involves ________ fat.
Linea alba; preperitoneal
What is the risk of hernia recurrence after repair in children?
Recurrence is rare but may occur if there is incomplete closure or underlying risk factors like prematurity or connective tissue disorders.
Hernia recurrence after repair is ________, but risks increase with incomplete closure or ________ disorders.
Rare; connective tissue
What is Inflammatory Bowel Disease (IBD)?
IBD is a group of chronic inflammatory conditions of the gastrointestinal tract, primarily including Crohn’s disease and ulcerative colitis.
IBD consists of chronic inflammatory conditions of the GI tract, primarily ________ disease and ________ colitis.
Crohn’s; ulcerative
What is the difference between Crohn’s disease and ulcerative colitis?
Crohn’s disease: Can affect any part of the GI tract, from mouth to anus, with skip lesions and transmural inflammation.
Ulcerative colitis: Limited to the colon and rectum, with continuous inflammation confined to the mucosa and submucosa.
________ disease affects the entire GI tract with skip lesions, while ________ colitis is confined to the colon and rectum with continuous inflammation.
Crohn’s; ulcerative
What are the common clinical features of IBD in children?
Abdominal pain.
Chronic diarrhea (may be bloody in ulcerative colitis).
Weight loss and growth failure.
Fatigue.
Perianal disease (specific to Crohn’s).
Common symptoms of IBD in children include abdominal ________, chronic ________, and weight ________.
Pain; diarrhea; loss
What are the extraintestinal manifestations of IBD in children?
Arthritis.
Erythema nodosum.
Uveitis or episcleritis.
Primary sclerosing cholangitis.
Aphthous ulcers.
Extraintestinal manifestations of IBD include arthritis, ________ nodosum, and ________ cholangitis.
Erythema; primary sclerosing
What investigations are used to diagnose IBD in children?
Blood tests: FBC, CRP, ESR, LFTs, and iron studies.
Stool tests: Calprotectin, culture, and Clostridium difficile testing.
Imaging: Endoscopy with biopsy, MRI for small bowel disease.
Key stool test for IBD diagnosis is ________, while endoscopy with ________ is essential for confirmation.
Calprotectin; biopsy
How does fecal calprotectin help in diagnosing IBD?
Fecal calprotectin is a marker of intestinal inflammation, useful for distinguishing IBD from irritable bowel syndrome (IBS).
________ calprotectin is a marker of intestinal inflammation used to distinguish IBD from ________.
Fecal; IBS
What is the first-line management for mild-to-moderate ulcerative colitis in children?
Aminosalicylates, such as mesalazine.
First-line treatment for mild-to-moderate ulcerative colitis is _______
Mesalazine
What are the treatment options for Crohn’s disease in children?
Exclusive enteral nutrition (EEN).
Corticosteroids for acute flares.
Immunomodulators (e.g., azathioprine).
Biologics (e.g., infliximab).
In Crohn’s disease, ________ nutrition is a key dietary intervention, while ________ are used for acute flares.
Exclusive enteral; corticosteroids
What is exclusive enteral nutrition (EEN), and how is it used in Crohn’s disease?
EEN involves using a liquid formula diet for 6-8 weeks as a first-line treatment to induce remission, particularly in pediatric Crohn’s disease.
Exclusive enteral nutrition involves a liquid formula diet for ________ weeks to induce ________ in Crohn’s disease.
6-8; remission
What surgical options are available for IBD in children?
Colectomy for ulcerative colitis refractory to medical treatment.
Resection of strictures or fistulas in Crohn’s disease.
Surgery for refractory ulcerative colitis involves ________, while ________ is performed for strictures in Crohn’s disease.
Colectomy; resection
What are the complications of IBD in children?
Growth failure and delayed puberty.
Intestinal obstruction or strictures.
Fistulas (Crohn’s disease).
Increased risk of colorectal cancer.
Complications of IBD include growth ________, intestinal ________, and fistulas in ________ disease.
Failure; obstruction; Crohn’s
How is nutritional support managed in children with IBD?
Adequate caloric intake for growth.
Vitamin and mineral supplementation (e.g., vitamin D, calcium, iron).
Nutritional support in IBD includes ensuring adequate ________ intake and supplementing ________ and calcium.
Caloric; Vitamin D
What role do biologics like infliximab play in IBD management?
Biologics are used to manage moderate-to-severe IBD, especially in cases resistant to standard therapies, and help reduce inflammation by targeting TNF-α.
Biologics like ________ target ________ to reduce inflammation in severe IBD.
Infliximab; TNF-α
What is coeliac disease?
Coeliac disease is an autoimmune condition triggered by the ingestion of gluten, leading to damage to the small intestine’s mucosa and malabsorption of nutrients.
Coeliac disease is an ________ condition triggered by ________, leading to damage to the small intestine’s mucosa.
Autoimmune; gluten
Which protein in gluten triggers coeliac disease?
Gliadin.
The protein in gluten that triggers coeliac disease is ________.
Gliadin.
What is the pathophysiology of coeliac disease?
Gluten ingestion causes an autoimmune response in genetically susceptible individuals, leading to inflammation and villous atrophy in the small intestine, reducing nutrient absorption.
In coeliac disease, ________ ingestion causes villous ________, leading to reduced nutrient absorption.
Gluten; atrophy
What are the genetic markers associated with coeliac disease?
HLA-DQ2 and HLA-DQ8.
The genetic markers associated with coeliac disease are ________ and _______
HLA-DQ2; HLA-DQ8
What are the common clinical features of coeliac disease in children?
Chronic diarrhea or steatorrhea.
Abdominal pain and bloating.
Failure to thrive or weight loss.
Fatigue and irritability.
Dermatitis herpetiformis (rare).
Clinical features of coeliac disease include chronic ________, abdominal ________, and failure to ________.
Diarrhea; pain; thrive
What is dermatitis herpetiformis, and how is it related to coeliac disease?
Dermatitis herpetiformis is an itchy, blistering skin rash associated with coeliac disease due to gluten sensitivity.
The itchy, blistering rash associated with coeliac disease is called ________ ________.
Dermatitis herpetiformis
What investigations are used to diagnose coeliac disease?
Blood tests: Tissue transglutaminase (tTG) IgA antibodies, total IgA, endomysial antibodies (EMA).
Duodenal biopsy: Villous atrophy, crypt hyperplasia.
The primary antibody test for coeliac disease is ________, and the definitive test is a ________ biopsy.
tTG IgA; duodenal
Why is it important to measure total IgA in suspected coeliac disease?
Total IgA is measured to rule out IgA deficiency, which can cause false-negative tTG IgA results.
Total ________ is measured in coeliac disease to rule out deficiency, which can lead to false-negative ________ results.
IgA; tTG
What histological findings are characteristic of coeliac disease on biopsy?
Villous atrophy.
Crypt hyperplasia.
Increased intraepithelial lymphocytes.
Histological findings in coeliac disease include villous ________, crypt ________, and increased intraepithelial ________.
Atrophy; hyperplasia; lymphocytes
What is the primary management strategy for coeliac disease?
A lifelong gluten-free diet.
The primary management for coeliac disease is a lifelong ________-free diet.
Gluten
What are common gluten-containing foods to avoid in coeliac disease?
Wheat.
Barley.
Rye.
Products like bread, pasta, and certain sauces.
Gluten-containing foods to avoid in coeliac disease include ________, ________, and ________.
Wheat; barley; rye
What nutritional deficiencies are common in untreated coeliac disease?
Iron deficiency anemia.
Folate and vitamin B12 deficiency.
Calcium and vitamin D deficiency.
Untreated coeliac disease can lead to deficiencies in ________, folate, and ________.
Iron; Calcium
What complications are associated with untreated coeliac disease?
Osteoporosis.
Growth failure in children.
Increased risk of small bowel lymphoma.
Infertility.
Complications of untreated coeliac disease include ________, growth failure, and increased risk of ________ lymphoma.
Osteoporosis; small bowel
What is the recommended follow-up for children with coeliac disease?
Regular monitoring of growth, nutritional deficiencies, and adherence to a gluten-free diet.
Follow-up for coeliac disease includes monitoring growth, checking for nutritional ________, and ensuring ________ to the gluten-free diet.
Deficiencies; adherence
What is failure to thrive (FTT)?
Failure to thrive refers to inadequate growth or the inability to maintain expected growth, typically identified as weight below the 2nd centile or crossing two major centile lines on growth charts.
Failure to thrive is defined as weight below the ________ centile or crossing ________ major centile lines on growth charts.
2nd; two
What are the classifications of failure to thrive (FTT)?
Organic FTT: Due to underlying medical conditions.
Non-organic FTT: Due to environmental, psychosocial, or behavioral factors.
Mixed FTT: Combination of organic and non-organic causes.
The three classifications of failure to thrive are ________, ________, and ________.
Organic; non-organic; mixed
What are the common causes of organic failure to thrive?
Chronic illnesses (e.g., congenital heart disease, cystic fibrosis).
Malabsorption (e.g., coeliac disease).
Endocrine disorders (e.g., hypothyroidism, growth hormone deficiency).
Infections (e.g., HIV, TB).
Genetic or metabolic disorders (e.g., Down syndrome, inborn errors of metabolism).
Examples of chronic illnesses causing organic failure to thrive include ________ heart disease and ________ fibrosis.
Congenital; cystic
What are some common causes of non-organic failure to thrive?
Neglect or abuse.
Inadequate caloric intake (e.g., incorrect formula preparation).
Parental mental health issues (e.g., postnatal depression).
Poverty or food insecurity.
Non-organic failure to thrive may result from neglect, abuse, or ________ mental health issues.
Parental
What are the clinical features of failure to thrive?
Poor weight gain.
Delayed milestones.
Wasting or reduced subcutaneous fat.
Signs of malnutrition (e.g., hair thinning, pallor).
Behavioral changes (e.g., irritability, lethargy).
Clinical features of failure to thrive include poor ________ gain, delayed ________, and signs of ________.
Weight; milestones; malnutrition
What investigations are conducted for failure to thrive?
Growth chart analysis: Plot weight, height, and head circumference.
Dietary history: Assess caloric intake.
Blood tests: FBC, U&E, LFT, TFT, coeliac screen.
Urine tests: Dipstick and microscopy for infection.
Imaging: Consider chest X-ray or abdominal ultrasound for specific concerns.
Growth ________, dietary history, and ________ tests are key investigations for failure to thrive.
Chart; blood
What is the role of a dietary history in assessing failure to thrive?
To evaluate caloric intake and identify possible feeding issues or malnutrition.
A detailed ________ history helps assess caloric intake in cases of failure to thrive.
Dietary
What are the general principles of managing failure to thrive?
Address the underlying cause (organic or non-organic).
Optimize nutrition with dietary counseling.
Provide psychosocial support.
Monitor growth and development closely.
Management of failure to thrive includes addressing the ________ cause, optimizing ________, and providing psychosocial ________.
Underlying; nutrition; support
What nutritional interventions are used in failure to thrive?
Increased caloric intake with nutrient-dense foods.
Fortified formulas or supplements.
Feeding support (e.g., occupational therapy for feeding difficulties).
Nutritional interventions in failure to thrive include increased caloric intake, ________ formulas, and feeding ________.
Fortified; support
What are the potential complications of untreated failure to thrive?
Stunted growth and short stature.
Developmental delay.
Increased susceptibility to infections.
Long-term cognitive and behavioral issues.
Complications of untreated failure to thrive include ________ growth, developmental ________, and increased susceptibility to ________.
Stunted; delay; infections
How can multidisciplinary teams support children with failure to thrive?
Pediatricians for medical management.
Dietitians for nutritional planning.
Social workers for family support.
Psychologists for addressing parental or child mental health issues.
Multidisciplinary support for failure to thrive includes pediatricians, ________, and ________.
Dietitians; social workers
Hirschsprungs Disease
Nerve cells of the myenteric plexus are absent in the distal bowel and rectum, specifically the parasympathetic ganglionic cells resulting in lack of peristalsis.
Epidemology of Hirschsprungs Disease in Neonatal Period
90% present in the neonatal period
Average age of presentation of Hirschsprungs Disease
Average age of presentation: 2 days
Which gender is Hirschsprungs Disease more common in?
Males (3x more common)
What condition is associated with Hirschsprungs Disease
Down’s syndrome
Explain the pathophysiology of Hirschsprungs Disease
Short segment is the most common type where the disease is confined to the rectosigmoid part of the colon - Ganglion cells of the submucosal plexus aren’t present - Failure of peristalsis and bowel movements causing obstruction - Can lead to bacterial build up and enterocolitis (inflammation) and sepsis
Symptoms of Hirschsprungs Disease
Failure to pass meconium (within 48 hours of birth) 2. Abdominal distention 3. Bilious vomiting - Palpable faecal mass in the left lower abdomen - Empty rectal vault
Ix for Hirschsprungs Disease
Rectal suction biopsy + Contrast Enema
First line Ix for Hisrchprungs disease
Abdomniaml X -ray
Gold Standard Ix for Hirschsprung’s disease
rectal biopsy
When is a rectal suction biopsy used for and who for?
to test for ganglionic cells in anyone who has: - Delayed passage of meconium - Constipation in the first few weeks - Chronic abdominal distention - Positive family history - Faltering growth
What does a contrast enema show for Hirschsprungs Disease
- Shows short transition zone between proximal and distal colon and a small rectal diameter
Management of Hirschsprungs Disease
IV Abx Bowel decompression NG tube Surgery
Initial Tx for Hirschsprungs disease
Bowel irrigation/ rectal washouts
What is the definitive treatment for Hirschsprungs Disease
Surgery is definitive treatment: Swenson, Soave, Dunhamel pull through surgery
Intussusception
One piece of the bowel telescopes inside another leading to ischaemia and bowel obstruction. Thickens the bowel and narrows the lumen. Obstructiion.
Where is Intussusception most common?
Most common in the distal ileum at the ileocecal junction
Which age group is affected by Intussusception ?
3 months to 3 years
In which age group is Intussusception most common ?
Most commonly < 1
What is the most common cause of obstruction in neonates?
Intussusception
Risk factors for Intussusception
CF - Meckel’s diverticulum - HSP - Rotavirus vaccine > 23 weeks
Symptoms of Intussusception
Colic abdominal pain - Pallor - Abdominal distention
- Shock
- Peritonitis: Guarding, rigidity,pyrexia
Signs of Intussusception
Sausage shaped mass palpable in the RUQ - Redcurrant jelly stools, often late in presentation
Ix for Intussusception
USS: target shaped mass & Abdominal X Ray . US or Contrast Enema
What might you see on Abdominal X-ray in Intussusception
Distended small bowel, absence of gas in the large bowel
First line Tx for Intussusception
Therapeutic enema e.g. water or air
Tx for Intussusception
Medical emergency IV fluids Air Enema using USS to stretch the walls of the bowel and reduce the intussusception -> if this is unsuccessful then surgery to repair manually
If there is perforation and peritonitis, what is the tx for Intussusception?
broad spec Abx e.g Gentamicin
Meckel’s Diverticulum
Congenital diverticulum of the small intestine containing ileal, gastric and pancreatic mucosa
Meckel’s Diverticulum occurs in __% of the population
2
Meckel’s Diverticulum occurs __cm from the ileocecal valve
2
Meckel’s Diverticulum is supplied by which artery?
Supplied by the omphalomesenteric artery
What is the risk with Meckel’s Diverticulum?
Risk of peptic ulceration
Symptoms of Meckel’s Diverticulum
Abdominal pain - Rectal bleeding in children age 1-2 years - Obstruction due to intussusception and volvulus
Management of Meckel’s Diverticulum
Removal if symptomatic (resection)
Acute causes of diarrhoea in children
Gastroenteritis & Food Poisoning
Chronic causes of diarrhoea in children
CMPA, Toddler’s diarrhoea, Coeliac disease
What is colic?
Colic is defined as excessive crying in an otherwise healthy infant, lasting more than 3 hours per day, occurring more than 3 days per week, and persisting for at least 3 weeks.
Colic is excessive crying lasting more than ________ hours per day, occurring more than ________ days per week, and persisting for at least ________ weeks
3; 3; 3
At what age is colic most commonly observed?
Colic typically affects infants between 2 weeks and 4 months of age.
Colic usually occurs in infants aged ________ weeks to ________ months.
2; 4
What are the suspected causes of colic?
Immature digestive system.
Gas or bloating.
Overstimulation or sensory overload.
Food allergies or intolerances (e.g., cow’s milk protein intolerance).
Parental stress or feeding difficulties.
Suspected causes of colic include an immature ________ system, ________, and food ________.
Digestive; overstimulation; allergies
What are the key clinical features of colic?
Intense, inconsolable crying episodes, often in the late afternoon or evening.
Pulling legs up to the abdomen or clenching fists.
Red or flushed face during crying episodes.
Passing gas or appearing bloated.
Normal feeding, growth, and development between episodes.
Clinical features of colic include inconsolable crying, pulling legs to the ________, and a ________ face during episodes.
Abdomen; red
How is colic diagnosed?
Colic is a clinical diagnosis based on history and exclusion of other causes of excessive crying, such as infection, reflux, or cow’s milk protein allergy.
The diagnosis of colic is made clinically after excluding other causes like ________, reflux, or cow’s milk protein ________.
Infection; allergy
What conditions should be ruled out when diagnosing colic?
Gastro-oesophageal reflux disease (GORD).
Cow’s milk protein allergy.
Lactose intolerance.
Infection (e.g., otitis media, urinary tract infection).
Intussusception or other bowel obstruction.
Conditions to rule out in colic include ________, cow’s milk protein ________, and ________ obstruction.
GORD; allergy; bowel
What are the non-pharmacological management options for colic?
Parental reassurance and support.
Establishing a calm feeding routine.
Soothing techniques (e.g., swaddling, white noise, rocking).
Avoiding overstimulation.
Trial of feeding changes, such as hypoallergenic formula, if cow’s milk protein allergy is suspected.
Management of colic includes parental ________, calming feeding ________, and soothing techniques like ________.
Reassurance; routines; swaddling
When should pharmacological options be considered for colic?
Pharmacological options, such as simethicone or probiotics, may be considered in cases unresponsive to non-pharmacological interventions, but evidence of their efficacy is limited.
Pharmacological options for colic, like ________ or probiotics, are considered if non-pharmacological measures fail.
Simethicone
What advice can be given to parents about the prognosis of colic?
Colic is self-limiting and resolves by 3-4 months of age in most infants.
It does not affect long-term health, growth, or development.
Reassure parents that colic does not indicate poor parenting or feeding practices.
Colic is self-limiting and usually resolves by ________ months of age without affecting long-term ________ or development.
: 3-4; health
What are the potential complications of colic for parents?
Parental stress, anxiety, or depression.
Fatigue due to disrupted sleep.
Strain on parent-infant bonding.
Increased risk of non-accidental injury if frustration escalates.
Complications of colic for parents include ________, fatigue, and strain on parent-infant ________.
Stress; bonding
What is cow’s milk protein allergy (CMPA)?
CMPA is an immune-mediated allergic reaction to proteins found in cow’s milk, occurring in infants and young children.
Cow’s milk protein allergy (CMPA) is an ________-mediated reaction to proteins in ________ milk.
Immune; cow’s
What are the two main types of CMPA?
IgE-mediated CMPA (immediate hypersensitivity).
Non-IgE-mediated CMPA (delayed hypersensitivity).
The two main types of CMPA are ________-mediated (immediate) and ________-mediated (delayed) hypersensitivity.
IgE; non-IgE
What are the key clinical features of IgE-mediated CMPA?
Rapid onset symptoms (within minutes to 2 hours).
Urticaria (hives), angioedema, or pruritus.
Vomiting or diarrhea.
Respiratory symptoms (wheezing or stridor).
Anaphylaxis in severe cases.
IgE-mediated CMPA presents with rapid symptoms such as ________, ________ symptoms, and, in severe cases, ________.
Urticaria; respiratory; anaphylaxis
What are the key clinical features of non-IgE-mediated CMPA?
Delayed symptoms (hours to days).
Gastrointestinal issues (diarrhea, vomiting, constipation, blood/mucus in stool).
Skin manifestations (eczema or rash).
Poor feeding or irritability.
Failure to thrive in severe cases.
Non-IgE-mediated CMPA is characterized by ________ onset symptoms such as gastrointestinal issues, ________, and poor feeding.
Delayed; eczema
How is CMPA diagnosed?
Diagnosis is based on clinical history, symptom resolution with cow’s milk elimination, and recurrence on reintroduction. Allergy testing (skin prick or serum-specific IgE) can confirm IgE-mediated CMPA.
CMPA is diagnosed through clinical history, symptom resolution after ________ elimination, and recurrence on ________.
Cow’s milk; reintroduction
What tests are used to diagnose IgE-mediated CMPA?
Skin prick testing.
Serum-specific IgE levels.
Diagnostic tests for IgE-mediated CMPA include ________ testing and serum-specific ________ levels.
Skin prick; IgE
What is the first-line management for CMPA?
Elimination of cow’s milk protein from the infant’s diet and use of hydrolyzed formula (extensively hydrolyzed or amino acid-based formula).
The first-line treatment for CMPA is ________ of cow’s milk protein and using ________ formula.
Elimination; hydrolyzed
What formulas are recommended for CMPA?
Extensively hydrolyzed formula (eHF) for most cases.
Amino acid-based formula (AAF) for severe or resistant cases.
________ formula is used for severe cases of CMPA, while ________ formula is first-line for most cases.
Amino acid-based; extensively hydrolyzed
What dietary advice is given to breastfeeding mothers of infants with CMPA?
Mothers should eliminate all cow’s milk protein from their diet and consider calcium and vitamin D supplementation.
Breastfeeding mothers of CMPA infants should avoid ________ and take ________ and ________ supplements.
Cow’s milk; calcium; vitamin D
How is tolerance to cow’s milk tested in infants with CMPA?
A supervised milk challenge is performed after 6-12 months of elimination to assess for tolerance.
Tolerance to cow’s milk in CMPA is assessed through a supervised ________ after ________ months of elimination.
Milk challenge; 6-12
What is the long-term prognosis for CMPA?
Most children outgrow CMPA by the age of 3-5 years, especially IgE-mediated types.
CMPA typically resolves by the age of ________ to ________ years.
3; 5
What complications can arise from untreated CMPA?
Nutritional deficiencies.
Growth failure.
Persistent symptoms like eczema or gastrointestinal distress.
Untreated CMPA can lead to nutritional ________, growth ________, and persistent symptoms like ________.
Deficiencies; failure; eczema
Biliary Atresia
Obstruction of the biliary tree due to sclerosis of the bile duct, reducing bile flow
Epidemiology of Biliary Atresia
Females - Neonatal cholestasis 2-8 weeks -Congenital malformations
Which condition is associated with Biliary Atresia ?
Associated with CMV
Type 1 Biliary Atresia
Common duct is obliterated
Type 2 Biliary Atresia
Atresia of the cystic duct in the porta hepatis
Type 3 Biliary Atresia
atresia of the right and left ducts at the level of the porta hepatis
Which type of Biliary Atresia is most common?
Type 3
Symptoms of Biliary Atresia
Jaundice post 2 weeks - Dark urine - Pale stools - Appetite disturbance
Signs of Biliary Atresia
Hepatosplenomegaly - Abnormal growth - Duodenal atresia - presents in the first 24 hours of life and more common in trisomy 21
Ix for Biliary Atresia
Serum Bilirubin + LFT + USS to look for structural abnormalities
What would serum bilirubin show in Biliary Atresia ?
conjugated bilirubin high
How would LFTs change in Biliary Atresia ?
Raised
Name 2 rule out tests for Biliary Atresia
Alpha 1 antitrypsin to rule out deficiency - Sweat test to rule out CF
Managment of Biliary Atresia
Surgical dissection of the abnormalities: Kasai procedure - Abx
Name 2 complications of Biliary Atresia
Cirrhosis and HCC + Progressive liver disease
What is neonatal hepatitis syndrome (NHS)?
NHS refers to inflammation of the liver in neonates, typically presenting within the first few weeks of life, leading to jaundice and other liver-related symptoms.
Neonatal hepatitis syndrome (NHS) is ________ of the ________ in neonates, often presenting with ________.
Inflammation; liver; jaundice
What are the main causes of neonatal hepatitis syndrome?
Infectious causes: Viral infections (e.g., CMV, herpes simplex, rubella, hepatitis B/C).
Metabolic causes: Galactosemia, hereditary fructose intolerance, alpha-1 antitrypsin deficiency.
Genetic causes: Alagille syndrome, bile acid synthesis defects.
Idiopathic: No identifiable cause in a significant number of cases.
The causes of neonatal hepatitis syndrome include ________, ________, ________, and idiopathic origins.
Infectious; metabolic; genetic
What are the common infectious causes of neonatal hepatitis syndrome?
Cytomegalovirus (CMV).
Herpes simplex virus (HSV).
Rubella virus.
Hepatitis B and C viruses.
Bacterial infections (e.g., syphilis, sepsis).
Common infectious causes of neonatal hepatitis syndrome include ________, ________, and ________.
CMV; HSV; rubella
What are the key clinical features of neonatal hepatitis syndrome?
Jaundice.
Pale or clay-colored stools.
Dark urine.
Hepatomegaly.
Failure to thrive.
Splenomegaly in severe cases.
Clinical features of neonatal hepatitis syndrome include ________, ________ stools, ________ urine, and hepatomegaly.
Jaundice; pale; dark
How is neonatal hepatitis syndrome differentiated from biliary atresia?
Biochemical tests: Elevated conjugated bilirubin in both conditions.
Imaging: Ultrasound and hepatobiliary scintigraphy can help differentiate.
Liver biopsy: Can confirm diagnosis in challenging cases.
________ and ________ imaging are used to differentiate neonatal hepatitis syndrome from biliary atresia.
Ultrasound; hepatobiliary scintigraphy
What investigations are used in neonatal hepatitis syndrome?
Blood tests: LFTs, conjugated bilirubin, viral serology, metabolic screening.
Imaging: Ultrasound, hepatobiliary scintigraphy.
Liver biopsy: If diagnosis remains unclear.
Genetic testing: If genetic causes are suspected.
Key investigations in neonatal hepatitis syndrome include ________ tests, ________, and liver biopsy.
Blood; imaging
What is the management of neonatal hepatitis syndrome?
Treat underlying cause (e.g., antiviral therapy for viral infections, dietary modifications for metabolic disorders).
Supportive care (e.g., hydration, nutrition).
Vitamin supplementation (e.g., fat-soluble vitamins A, D, E, K).
Consider liver transplant in severe or irreversible cases.
Management of neonatal hepatitis syndrome includes treating the ________ cause, providing ________ care, and supplementing ________ vitamins.
Underlying; supportive; fat-soluble
What are the potential complications of neonatal hepatitis syndrome?Complications of neonatal hepatitis syndrome include ________, cirrhosis, and ________ delays.
Liver failure.
Cirrhosis.
Growth and developmental delays.
Fat-soluble vitamin deficiencies.
Complications of neonatal hepatitis syndrome include ________, cirrhosis, and ________ delays.
Liver failure; developmental
What is the prognosis for neonatal hepatitis syndrome?
The prognosis depends on the underlying cause. Many idiopathic cases resolve spontaneously, while genetic or metabolic causes may have a worse prognosis if untreated.
The prognosis for neonatal hepatitis syndrome varies, with ________ cases often resolving, but ________ causes having a worse prognosis if untreated.
Idiopathic; genetic/metabolic
What is liver failure?
Liver failure is the inability of the liver to perform its normal synthetic and metabolic functions due to severe liver damage.
Liver failure occurs when the liver cannot perform its normal ________ and ________ functions due to severe damage.
Synthetic; metabolic
What are the causes of liver failure in children?
Infections: Hepatitis A, B, C, E, cytomegalovirus, Epstein-Barr virus.
Metabolic disorders: Wilson’s disease, galactosemia, hereditary fructose intolerance.
Drugs/toxins: Paracetamol overdose, poisoning.
Autoimmune conditions: Autoimmune hepatitis.
Vascular causes: Budd-Chiari syndrome.
Neoplasms: Hepatoblastoma, hepatocellular carcinoma.
Key causes of liver failure in children include ________, ________ disorders, drugs/toxins, and autoimmune diseases.
Infections; metabolic
What are the clinical features of liver failure in children?
Jaundice.
Hepatomegaly.
Coagulopathy (e.g., easy bruising, bleeding).
Encephalopathy (e.g., confusion, lethargy).
Hypoglycemia.
Ascites.
Peripheral edema.
Clinical features of liver failure include ________, coagulopathy, ________, and encephalopathy.
Jaundice; hepatomegaly
How is encephalopathy graded in liver failure?
Grade 1: Mild confusion, altered sleep patterns.
Grade 2: Lethargy, personality changes.
Grade 3: Somnolence, minimal arousability.
Grade 4: Coma.
In Grade 3 encephalopathy, the patient exhibits ________ and minimal _______
Somnolence; arousability
What investigations are performed in a child with suspected liver failure?
Blood tests: LFTs, INR/PT, ammonia levels, viral serologies, metabolic screens.
Imaging: Abdominal ultrasound, Doppler studies for vascular causes.
Liver biopsy: If diagnosis remains unclear.
Key investigations for liver failure include ________, ________ imaging, and liver biopsy.
Blood tests; ultrasound
What is the role of ammonia levels in liver failure?
Elevated ammonia levels indicate impaired detoxification by the liver and correlate with the severity of hepatic encephalopathy.
Elevated ________ levels in liver failure suggest impaired ________ and hepatic encephalopathy.
Ammonia; detoxification
What is the management of liver failure in children?
Supportive care: Fluid management, glucose supplementation, correcting electrolyte imbalances.
Specific treatment: Treat underlying cause (e.g., antivirals for hepatitis, chelation for Wilson’s disease).
Nutritional support: Enteral feeding, vitamins (e.g., fat-soluble vitamins).
Monitoring: Regular LFTs, INR, and glucose levels.
Liver transplant: In cases of acute or chronic irreversible liver failure.
Management of liver failure includes supportive care, treating the ________ cause, and considering ________ transplant in severe cases.
Underlying; liver
What are the complications of liver failure in children?
Cerebral edema.
Coagulopathy and bleeding.
Multiorgan failure.
Hypoglycemia.
Sepsis.
Hepatorenal syndrome.
Complications of liver failure include cerebral edema, ________, and ________ failure.
Coagulopathy; multiorgan
What is hepatorenal syndrome, and how is it related to liver failure?
Hepatorenal syndrome is kidney failure that occurs secondary to severe liver disease, often due to altered blood flow and reduced renal perfusion.
Hepatorenal syndrome is ________ failure caused by severe ________ disease.
Kidney; liver
What factors indicate a poor prognosis in paediatric liver failure?
Grade 3–4 encephalopathy.
INR >6.5 despite vitamin K.
Hypoglycemia.
Evidence of multiorgan failure.
Poor prognostic indicators in liver failure include severe ________, INR > ________, and hypoglycemia.
Encephalopathy; 6.5
What diagnostic concern is associated with failure to pass meconium within 24 hours of life?
Hirschsprung’s disease.
What diagnostic concerns should be considered for failure to thrive or growth failure?
Hypothyroidism, coeliac disease, and other causes.
Gross abdominal distension is a red flag symptom for which conditions?
Hirschsprung’s disease or other gastrointestinal dysmotility.
What does abnormal lower limb neurology or deformity (e.g., talipes or secondary urinary incontinence) suggest?
Lumbosacral pathology.
What diagnostic concern is linked to a sacral dimple above the natal cleft with features like a nevus, hairy patch, central pit, or discolored skin?
Spina bifida occulta.
Abnormal appearance, position, or patency of the anus is indicative of what?
Abnormal anorectal anatomy.
What are the potential diagnostic concerns for perianal bruising or multiple fissures?
Sexual abuse.
Perianal fistulae, abscesses, or fissures are red flag symptoms for which condition?
Perianal Crohn’s disease.
Vomit becomes billous when ___
there is bowel obstruction
Differentials for billous vomiting
Intussusception, Malrotation/Volvulus,
Differentials for acute abdominal pain in children?
Constipation, Gastroenteritis, UTI. Appendicitis, Mesenteric adenitis, Intussusception, Volvulus, Testicular Torsion, Ectopic Pregnancy, Ovarian Cyst rupture or torsion, IBD, DKA, Pelvic inflammatory disease, Pancreatitis
How to differentiate between billous or non-billous vomit?
•bile released into duodenum- issues before this will result in non bilious vomiting, issues after this will result in bilious vomiting
Which conditions present with non-billous vomit?
GORD, pyloric stenosis, milk protein insensitivity, overfeeding, gastroenteritis (all before small intestine)
Which conditions present with billous vomit?
Intussusception, Malrotation, Obstruction, NEC
Which condition is associated with projectile vomiting?
GORD
Give an example of a conditiion which is associated with non-projectile vomiting?
Pyloric stenosis
Malrotation & Volvulus
Twisting loop of bowel leading to intestinal obstruction
Malrotation
Twisting of the bowel in utero
Volvulus
Twisting that leads to obstruction
When does Malrotation & Volvulus present in life?
Generally presents in the first month of life
Causes of Malrotation & Volvulus
Congenital, Assoicated with other GI anomalities, 80% diagnoses aged 1 month
Symptoms of Malrotation & Volvulus
Abdominal pain - Bilious vomiting - Caecum at the midline - Reflux symptoms
Ix for Malrotation & Volvulus
Barium enema - Abdominal X-ray with contrast (to look for obstruction)
What might you see on X-ray for Malrotation & Volvulus
dilated stomach and proximal small bowel - double bubble sign
Tx for Malrotation & Volvulus
Emergency surgical repair : Laparotomy if malrotation or Ladd’s procedure if has progressed to volvulus
