Gastrointestinal Flashcards
what is oesophageal atresia
birth defect where oesophagus ends in a pouch
- often occurs alongside a tracheo-oesophageal fistula
- associated with polyhydramnios in utero
presentation of oesophageal atresia
excessive oral secretions
aspiration / regurgitation when fed
episodes of cyanosis
persistent crying/discomfort in a healthy thriving infant, particularly at night/ after feeds is most likely to be ?
colic
advice for management of colic
small frequent meals – avoid overfeeding
burping regularly to help milk settle
keep baby upright post feed
what treatment options are available for infants with problematic colic? i.e. poor weight gain, refusing feeds
gaviscon mixed with feeds
ranitidine (H2 inhibitor)
what is pyloric stenosis
hypertrophy of the pyloric sphincter causing narrowing of the pylorus
- prevents food from passing from stomach to duodenum normally
presentation of pyloric stenosis
projectile milky vomit after every feed
blood gas result in pyloric stenosis
hypochloric metabolic alkalosis
- baby is vomiting hydochloric acid from the stomach
investigation + management of pyloric stenosis
abdo USS - visualise thickened pylorus
tx - laparoscopic pyloromyotomy (Ramstedt operation)
what is coeliacs disease
autoimmune reaction to gluten causing inflammation in the small intestine
- usually presents in early childhood but can present at any age
antibodies in coeliacs disease
IgA anti-tissue transglutamase (Anti-TTG)
anti-endomysial (Anti-EMA)
- important to test for total IgA levels, as patients with low IgA will be negative for these antibodies even if they have the disease
symptoms of coeliacs disease
failure to thrive
- diarrhoea
- fatigue
- weight loss
- mouth ulcers
- anaemia
dermatitis herpetiformis rash
gene linked to coeliacs disease
HLA- DQ2
what condition is strongly linked to coeliacs disease
type 1 diabetes
findings on endoscopy coeliac disease
villous atrophy
crypt hyperplasia
management of coeliac disease
life long gluten free diet
presentation of IBD in children
abdominal pain
diarrhoea (bloody in UC/allergic colitis)
failure to thrive – weight loss
screening test for IBD
faecal calprotectin - raised due to inflammation in intestines
- 90% specific to IBD
what should you suspect in baby with delayed passage of meconium, dilated bowel loops + absence of rectal air on XR
Hirshsprungs disease
what is Hirshsprungs disease
aganglionic segment of bowel (loss of parasympathetic)
- causes delayed passage of meconium in infants
- differential of constipation + abdo pain in young children
what is meconium ileus
delayed passage of meconium + abdo distention
what condition do the majority of babies with meconium ileus have?
cystic fibrosis
what should you suspect in a baby with persistent jaundice (past 14 days), pale stools + dark urine, splenomegaly ?
biliary atresia
what is biliary atresia
section of bile duct is either narrowed or absent
- results in cholestasis
- high conjugated bilirubin levels
red current jelly stools + sausage shaped abdo mass
intussusception
what is intussuception
telescoping of the bowel
investigation of intussusception
USS
bile stained vomit
malrotation
Ix + management of malrotation
upper GI contrast + USS
surgery
what is Meckels Diverticulum
congenital diverticulum of small intestine
- occurs in 2% of population
- 2 feet from ileocaecal valve
- 2 inches long
most common cause of painless massive GI bleeding in children 1-2
Meckels Diverticulum
laxative choice in children with constipation
movicol paediatric plan (osmotic)
+ Senna if ineffective
colicky abdominal pain where child draws knees up to chest
intussusception
double bubble sign
duodenal atresia
what is gastroschisis?
how is this managed?
abdominal contents on outside of body with NO peritoneal covering
surgery as soon as possible i.e. within 4 hours
what is exomphalos?
how is this managed?
abdo contents on outside of body WITH a peritoneal covering
staged closure by 6 - 12 months
what is the initial management of Hirshsprungs?
what is the definitive management?
initial – bowel irrigation / rectal washout
definitive – anorectal pull through
what is Toddlers diarrhoea
benign condition due to fast transit through digestive system
watery stools that often contain undigested food
child otherwise thriving
will resolve
what is a common complication of gastroenteritis in children
lactose intolerance
Target sign
intusseseption
management of intusseseption
reduction under fluoroscopic guidance
features of necrotising enterocolitis
common in premature infants
- abdo distention, bloody stools, dilated bowel loops, bowel wall oedema, intramural gas
imaging used in suspected necrotising enterocolitis
XRAY
management of necrotising enterocolitis
gut rest, TPN feeding, antibiotics
- required laparotomy if perforation
management of an umbilical hernia
majority spontaneously resolve
elective repair if persists past 4/5 years or causing significant symptoms
what is mesenteric adenitis
abdominal pain caused by inflamed lymph node in the mesentery
- will typically follow viral infection
- resolves spontaneously
how is the diagnosis of hirschsprungs made
rectal biopsy showing absence of ganglionic cells
