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Paediatrics > Gastrointestinal #2 > Flashcards

Gastrointestinal #2 Flashcards

1
Q

How is appendicitis treated?

A

Low threshold to admit
Surgery
Abx: Metronidazole &Cefuroxime
Surgery: Appendicectomy

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2
Q

What are the signs of appendicitis in a child?

A 
Rare <3yr
Most common- Primary school age &amp; teens
Abdo pain-McBurney's point
Low grade fever/pyrexia
Anorexia
Lying still/Flexed knees into tummy
N&amp;V
Constipation
Rovsing's sign: Palpate LIF causes pain in the RIF
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3
Q

What are the timings for the continuation of appendicitis?

A

6-12hr: Full thickness inflammation

24-36hr: Gangrenous & ?perforation- peritonitis

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4
Q

What is Coeliac disease associated with?

A

DM type 1
Down’s Syndrome
Juvenile chronic arthritis

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5
Q

What is the pathophysiology of Coeliac disease?

A

Autoimmune (T-cell mediated)
Enteropathy due to lifelong intolerance to gluten proteins
Bowel destruction in response to gluten

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6
Q

What are the signs & symptoms of Coeliac disease?

A 
Diarrhoea
Pale, floating stools
Anorexia
Irritable 
Fatigue
Failure to thrive
Late: Apathy, Gross motor delay, Ascites, Anaemia, Peripheral oedema, Delayed puberty
Coeliac Crisis: Dehydration following malabsorption &amp; diarrhoea
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7
Q

How is Coeliac disease investigated?

A

Serum Antigliadin Abx (IgA), tissue transglutaminase Abx
Faecal fat studies
S. bowel biopsy: Endoscopy shows diffuse subtotal villus atrophy, lymphocyte infiltration, crypt hyperplasia

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8
Q

How is Coeliac disease managed?

A

Gluten free diet (Villi return to normal)

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9
Q

What are the types of inguinal hernia?

A

Direct: Protrudes directly through a weakness in the posterior inguinal canal
Indirect: MOST COMMON, failure of inguinal canal to close after passage of testis in utero/neonatal. Sac passes through internal inguinal ring, along inguinal canal through patent processus vaginalis.

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10
Q

What is the treatment of inguinal hernias?

A

Repair via surgery

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11
Q

What is intussusception?

A

Part of the (small) bowel inserts into another part of the bowel causing obstruction

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12
Q

What is the pathophysiology of intussusception?

A

Infection (GE) leads to enlarged Peyer’s patches
Lymphatic tissue is leading edge pulling s.bowel into caecum
Results in obstruction

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13
Q

Where is intussusception most commonly seen?

A

Ileocaecal junction

Almost all happen when ileum folds into caecum

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14
Q

Who does intussusception usually affect?

A

Kids: 6m-2yr

Rarely adults

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15
Q

What are the causes of intussusception?

A

Idiopathic

Adults: Tumour, Meckle’s diverticulum

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16
Q

What are the RFs for intussusception?

A

Recent illness (viral GE- mesenteric nodes form point of traction)
Previous (10% recurrence)
Sibling w/intussusception
Intestinal malrotation

17
Q

How is intussusception investigated?

A

Blood on PR
AXR: S.bowel obstruction
USS: Target sign/donut sign
Palpation: Sausage shaped mass in RUQ

18
Q

What are the signs & symptoms of intussusception?

A 
Intermittent colicky abdo pain
Pallor
Episodic screaming
Drawing up legs
Sleeps between episodes of pain
Bile stained vomit
Recurrent jelly stool (sloughed off intestinal mucosa, mucus &amp;blood-LATE SIGN)
Peritonitis
19
Q

How does intussusception lead to infarction of the bowel?

A 
Pressure on walls of trapped bowel
Squeeze shut blood vessels
Lack of blood= ischaemia &amp; hypoxia
Results in death of tissue- infarction
Intestinal tearing &amp; perforation
Bacteria leaked into peritoneum- peritonitis
SEPSIS
20
Q

What are the complications of intussusception?

A

Perforation
Peritonitis/ Sepsis
Bowel necrosis
Volvulus

21
Q

How is intussusception treated?

A 
IV fluids
Analgesia
Abx:
Air enema reduction
Laparotomy
Vomiting: NG tube
Can resolve spontaneously
22
Q

What are the signs of an incarcerated inguinal hernia?

A

Unwell child
Irreducible swelling (firm mass) in the groin
Bilious vomiting
Complication: Testicular infarction (due to pressure

23
Q

What is mesenteric adenitis?

A

Inflammation of the mesenteric lymph nodes following an URTI

24
Q

What causes mesenteric adenitis?

A

Viral

Bacterial

25
Q

What are the signs & symptoms of mesenteric adenitis?

A 
Fever
Malaise
Central abdo pain
Cervical lymphadenopathy
Pain w/tachycardia &amp; flushed appearance= extra-abdominal cause (e.g otitis media)
26
Q

How is mesenteric adenitis treated?

A

Observation: Symptoms remai static/improve rather than progress (appendicitis)
Self-limiting condition

27
Q

What is the pathophysiology of pyloric stenosis?

A

Diffuse hypertrophy & hyperplasia of the pyloric smooth muscle

28
Q

How is an incarcerated hernia treated?

A

Rehydrate

Surgery: Reduced hernia, resect any necrotic bowel

29
Q

What are the signs & sypmtoms of duodenal atresia?

A

Occurs within days after birth
Bile-stained vomiting
+/- Abdo distension
May still pass stools (meconium till day 4)
Double bubble sign: Air in stomach & proximal duodenum on x-ray
Associated: Trisomy 21

30
Q

How is duodenal atresia treated?

A

duodeno-duodenostomy

31
Q

How is NEC diagnosed?

A

Abdo Xray: Thickened wall, dilated bowel loops

Paediatrics (26 decks)

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