Gastrointestinal Disease

Question 0

What is simple telescoping?

Answer 0

Telescoping with non-pathological lead point

Question 1

Intussusceptum and intussuscipiens - which is which?

Answer 1

Intussusceptum = middle bit
Intussuscipiens = receiving outer bit

Question 2

What is the pathophysiology behind intussusception?

Answer 2

Causes mesenteric compression, distension of bowel wall and luminal obstruction
Disrupted peristalsis
Lymphatic and venous obstruction

Question 3

Where does intussusception most commonly occur in the bowel in kids?

Answer 3

Ileocoecal

Question 4

When does intussusception occur most commonly and by what age?

Answer 4

5-10 months, usually under a year

Question 5

What is the background behind a non-pathological lead point?

Answer 5

Over 90% of all

Typically viral, related to Peyers Patch hypertrophy

Question 6

Background behind pathological lead point including 5 causes?

Answer 6

Less than 10%
CF
HSP
Meckels diverticulum
Polyps
Peutz-jeghers syndrome

Question 7

Symptoms of intussusception?

Answer 7

Sudden onset colicky abdominal pain + crying
Vomiting (early and bile stained)
Lethargy, hypotonia, irritability, sweating
Palpable RUQ mass (sausage shaped)
Absence of bowel in RLQ
If severe, dehydration, pallor, shock

Question 8

Late symptoms of intussusception?

Answer 8

Pyrexia

Mucoid/bloody red currant stools

Question 9

What is Dance’s sign?

Answer 9

Absence of bowel in RLQ with intussusception

Question 10

Signs on ultrasound of intussusception? (3)

Answer 10

Target/donut sign
Pseudokidney sign
Crescent sign

Question 11

Management of intussusception

Answer 11

Supportive
Radiological: reduction (3x3 mins) or air/barium enema
Laparotomy

Question 12

When does pyloric stenosis present?

Answer 12

Between 2-7 weeks

Question 13

Who is pyloric stenosis more common in?

Answer 13

Boys with positive family history

Question 14

Presentation of pyloric stenosis?

Answer 14

Vomiting which becomes more frequent and forceful over time, eventually projectile
Hunger after vomiting (unless dehydrated)
Weight loss/faltering growth
Can present as dehydration

Question 15

Clinical blood/gas picture of pyloric stenosis due to repeated vomiting?

Answer 15

Hypochloraemic alkalosis
Hyponatraemia
Hypokalaemia

Question 16

How to investigate pyloric stenosis?

Answer 16

Test feed - observe for visible peristalsis, olive shaped mass in RUQ, stomach can be overdistended with air
US

Question 17

Management of pyloric stenosis?

Answer 17

Correct any fluid/electrolyte imbalance (IVT - 0.45% saline, 5% dextrose)
Pyloromyotomy

Question 18

What is the pathogenesis of a Meckel Diverticulum?

Answer 18

Ileal remnant of vitello-intestinal duct

Question 19

What can Meckel Diverticulum contain (2 things)

Answer 19

Ectopic gastric mucosa

Ectopic pancreatic tissue

Question 20

How can Meckel Diverticulum present?

Answer 20

Severe rectal bleeding
Intussusception (focal lead point)
Volvulus
Diverticulitis

Question 21

Investigation of Meckel Diverticulum by observation of ectopic gastric mucosa?

Answer 21

Technetium scan

Question 22

Pathogenesis and most common presentation of malrotation?

Answer 22

Mesentery of small bowel not fixed at either duodenojejunal flexure or Ileocoecal region
Mesentery therefore has shorter base than normal and predisposed to malrotation (Ladd bands obstruct duodenum)

Question 23

What is typically presentation of malrotation?

Answer 23

Bilious vomiting within first few days (obstruction below duodenal level - as opposed to pyloric stenosis)