Gastrointestinal Flashcards
What laxatives are given in children with constipation?
Osmotic laxatives such as lactulose or movical to soften the stools.
Projectile milky vomit at age 4 weeks.
Pyloric stenosis
What is the treatment for pyloric stenosis?
Pyloromyotomy
A 7 year old child presents with abdominal pain after having had a cold for the last week. Observations are mostly normal/
Mesenteric adenitis
7 month old girl presents with vomiting and diarrhoea. She is crying and drawing her legs up. There is a a sausage shaped mass in the abdomen.
Intussusception
A 1 month old baby girl presents with bile stained vomiting. She has an exomphalos and a congenital diaphragmatic hernia.
Malrotation
What is the treatment of intussception?
Air enema
If you suspect malrotation of the bowel what investigations should you order?
Ultrasound
Upper GI contrast
What is hirschprungs disease?
An absence of ganglion cells from the myenteric and submucosal plexuses. This causes a delayed passage of menonium and abdominal distention.
What is the diagnostic test for hirschprungs disease?
Full thickness rectal biopsy
What disease is often the underlying cause of a meconium ileus?
Cystic fibrosis
What is the treatment for NEC?
Total gut rest and TPN.
What is toddlers diarrhoea?
A benign condition in which toddlers can have 12 stools per day but are otherwise well and thriving with no abdominal symptoms which is self limiting and improving by age 5 - 6.
What is the management of GORD?
Reassurance
Gaviscon
Ranitidine
What HLA subtypes are associated with coeliac disease?
HLA DQ2 or 8
What is the screening test for coeliac disease?
Tissue transglutaminase (TTG)
What is the diagnostic test for coeliac disease?
Endoscopy with duodenal biopsy
What is the histology of coeliac disease?
Crypt hyperplasia with flattening of villi
What is the criteria that must be met for a diagnosis of functional constipation to be made?
Must include at least 2 of the following:
Less than three defecations per week
At least one episode per week of faecal incontinence after the child has acquired toileting skills
A history of excessive stool retention or retentive posturing
A history of painful or hard bowel movements
Presence of a large faecal mass in the rectum
A history of stools with large diameter that may obstruct the toilet
In infants and children up to a developmental age of 4 years, these symptoms must be present for at least one month. In children older than 4 years, symptoms should be present for at least two months, with insufficient criteria for the diagnosis of irritable bowel syndrome.
What are the features of constipation that suggest an organic disease?
Delayed passage of meconium after birth (over 24 hours)
Recurrent rectal prolapse (CF)
Failure to thrive (could be a food allergy or hypothyroidism)
Abnormal position of anus
Explosive passing of stool following rectal exam (hirschprungs disease)
Skin tags (usually causes by healed fissures but can suggest anal sexual abuse)
A child who is constipated has leakage of stool after rectal examination
Hirschprungs disease
What non invasive investigations are done if you suspect crohns disease in a child?
FBC, U & E, CRP, ferritin, Plasma viscosity (children over 12)
Stool cultures (including C Diff)
Stool calpotectin
What invasive investigations are done if you suspect crohns disease in a child?
Upper and lower GI endoscopy with biopsies
MRI small bowel study
What is stool calpotectin and what is it looking for?
A test done if you suspect crohns disease.
Elevated faecal calprotectin indicates the migration of neutrophils to the intestinal mucosa, which occurs during intestinal inflammation, including inflammation caused by inflammatory bowel disease. Under a specific clinical scenario, the test may eliminate the need for invasive colonoscopy or radio-labelled white cell scanning.
What is the treatment of crohn’s disease in a child?
- Steroids to induce remission
2. Azathioprine, methotrexaxte, infliximab and adalimumad to maintain remission.
What is the most common type of UC seen in paediactric patients?
Moderate to severe pancolitis
What do you see on the histology of crohns disease?
Skip lesions, oedema, inflammation, criptitis, abscesses and granulomas
What do you see on the histology of UC?
Polymorphic nuclear leucocytes near the base of crypts, crypt abscesses. NO granulomas
What is the treatment of UC in a child?
- Steroids to induce remission
- Mesalazine
- Azathioprine, infliximab, adalimumab
- Colectomy
A child of 3 months presents with bilious vomiting.
Volvulus until proven otherwise
What is meant by malrotation and volvulus?
Malrotation: Congenital anomaly that causes the intestine to be in an abnormal position - the caecum is displaces, the small intestine is predominately on the right side of the abdomen and the small intestine has an unusually narrow base and therefore is prone to volvulus.
Volvulus: Complete twisting of a loop of intestine around its mesenteric attachment.
What is meant by a midgut volvulus?
The entire midgut from the proximal jejunum to the proximal colon may twist around the mesenteric base.
What would you see on an abdominal X ray of a midgut volvulus?
Partial suodenal obstruction (causes dilation of the stomach and the proximal duodenum - double bubble sign)
What do you do for abdominal malrotation in children?
Operative treatment (even if asymptomatic)
How do treat a volvulus in children?
Ladds procedure - the volvulus is corrected by rotating the small intestine in an anti clockwise direction
