Gastrointestinal #2 Flashcards
How is appendicitis treated?
Low threshold to admit
Surgery
Abx: Metronidazole &Cefuroxime
Surgery: Appendicectomy
What are the signs of appendicitis in a child?
Rare <3yr Most common- Primary school age & teens Abdo pain-McBurney's point Low grade fever/pyrexia Anorexia Lying still/Flexed knees into tummy N&V Constipation Rovsing's sign: Palpate LIF causes pain in the RIF
What are the timings for the continuation of appendicitis?
6-12hr: Full thickness inflammation
24-36hr: Gangrenous & ?perforation- peritonitis
What is Coeliac disease associated with?
DM type 1
Down’s Syndrome
Juvenile chronic arthritis
What is the pathophysiology of Coeliac disease?
Autoimmune (T-cell mediated)
Enteropathy due to lifelong intolerance to gluten proteins
Bowel destruction in response to gluten
What are the signs & symptoms of Coeliac disease?
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 & diarrhoea
How is Coeliac disease investigated?
Serum Antigliadin Abx (IgA), tissue transglutaminase Abx
Faecal fat studies
S. bowel biopsy: Endoscopy shows diffuse subtotal villus atrophy, lymphocyte infiltration, crypt hyperplasia
How is Coeliac disease managed?
Gluten free diet (Villi return to normal)
What are the types of inguinal hernia?
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.
What is the treatment of inguinal hernias?
Repair via surgery
What is intussusception?
Part of the (small) bowel inserts into another part of the bowel causing obstruction
What is the pathophysiology of intussusception?
Infection (GE) leads to enlarged Peyer’s patches
Lymphatic tissue is leading edge pulling s.bowel into caecum
Results in obstruction
Where is intussusception most commonly seen?
Ileocaecal junction
Almost all happen when ileum folds into caecum
Who does intussusception usually affect?
Kids: 6m-2yr
Rarely adults
What are the causes of intussusception?
Idiopathic
Adults: Tumour, Meckle’s diverticulum
What are the RFs for intussusception?
Recent illness (viral GE- mesenteric nodes form point of traction)
Previous (10% recurrence)
Sibling w/intussusception
Intestinal malrotation
How is intussusception investigated?
Blood on PR
AXR: S.bowel obstruction
USS: Target sign/donut sign
Palpation: Sausage shaped mass in RUQ
What are the signs & symptoms of intussusception?
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 &blood-LATE SIGN) Peritonitis
How does intussusception lead to infarction of the bowel?
Pressure on walls of trapped bowel Squeeze shut blood vessels Lack of blood= ischaemia & hypoxia Results in death of tissue- infarction Intestinal tearing & perforation Bacteria leaked into peritoneum- peritonitis SEPSIS
What are the complications of intussusception?
Perforation
Peritonitis/ Sepsis
Bowel necrosis
Volvulus
How is intussusception treated?
IV fluids Analgesia Abx: Air enema reduction Laparotomy Vomiting: NG tube Can resolve spontaneously
What are the signs of an incarcerated inguinal hernia?
Unwell child
Irreducible swelling (firm mass) in the groin
Bilious vomiting
Complication: Testicular infarction (due to pressure
What is mesenteric adenitis?
Inflammation of the mesenteric lymph nodes following an URTI
What causes mesenteric adenitis?
Viral
Bacterial
What are the signs & symptoms of mesenteric adenitis?
Fever Malaise Central abdo pain Cervical lymphadenopathy Pain w/tachycardia & flushed appearance= extra-abdominal cause (e.g otitis media)
How is mesenteric adenitis treated?
Observation: Symptoms remai static/improve rather than progress (appendicitis)
Self-limiting condition
What is the pathophysiology of pyloric stenosis?
Diffuse hypertrophy & hyperplasia of the pyloric smooth muscle
How is an incarcerated hernia treated?
Rehydrate
Surgery: Reduced hernia, resect any necrotic bowel
What are the signs & sypmtoms of duodenal atresia?
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
How is duodenal atresia treated?
duodeno-duodenostomy
How is NEC diagnosed?
Abdo Xray: Thickened wall, dilated bowel loops
