Gastrointestinal Disease Flashcards
What is simple telescoping?
Telescoping with non-pathological lead point
Intussusceptum and intussuscipiens - which is which?
Intussusceptum = middle bit Intussuscipiens = receiving outer bit
What is the pathophysiology behind intussusception?
Causes mesenteric compression, distension of bowel wall and luminal obstruction
Disrupted peristalsis
Lymphatic and venous obstruction
Where does intussusception most commonly occur in the bowel in kids?
Ileocoecal
When does intussusception occur most commonly and by what age?
5-10 months, usually under a year
What is the background behind a non-pathological lead point?
Over 90% of all
Typically viral, related to Peyers Patch hypertrophy
Background behind pathological lead point including 5 causes?
Less than 10% CF HSP Meckels diverticulum Polyps Peutz-jeghers syndrome
Symptoms of intussusception?
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
Late symptoms of intussusception?
Pyrexia
Mucoid/bloody red currant stools
What is Dance’s sign?
Absence of bowel in RLQ with intussusception
Signs on ultrasound of intussusception? (3)
Target/donut sign
Pseudokidney sign
Crescent sign
Management of intussusception
Supportive
Radiological: reduction (3x3 mins) or air/barium enema
Laparotomy
When does pyloric stenosis present?
Between 2-7 weeks
Who is pyloric stenosis more common in?
Boys with positive family history
Presentation of pyloric stenosis?
Vomiting which becomes more frequent and forceful over time, eventually projectile
Hunger after vomiting (unless dehydrated)
Weight loss/faltering growth
Can present as dehydration
Clinical blood/gas picture of pyloric stenosis due to repeated vomiting?
Hypochloraemic alkalosis
Hyponatraemia
Hypokalaemia
How to investigate pyloric stenosis?
Test feed - observe for visible peristalsis, olive shaped mass in RUQ, stomach can be overdistended with air
US
Management of pyloric stenosis?
Correct any fluid/electrolyte imbalance (IVT - 0.45% saline, 5% dextrose)
Pyloromyotomy
What is the pathogenesis of a Meckel Diverticulum?
Ileal remnant of vitello-intestinal duct
What can Meckel Diverticulum contain (2 things)
Ectopic gastric mucosa
Ectopic pancreatic tissue
How can Meckel Diverticulum present?
Severe rectal bleeding
Intussusception (focal lead point)
Volvulus
Diverticulitis
Investigation of Meckel Diverticulum by observation of ectopic gastric mucosa?
Technetium scan
Pathogenesis and most common presentation of malrotation?
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)
What is typically presentation of malrotation?
Bilious vomiting within first few days (obstruction below duodenal level - as opposed to pyloric stenosis)
