gastrointestinal disorders Flashcards
does pyloric stenosis affect more boys or girls?
boys (M>F)
a) key signs in pyloric stenosis?
b) at what age?
a) projectile vomiting, olive mass in RUQ
b) 4-6 weeks old
how is pyloric stenosis diagnosed? 2 ways
- test feed
- USS
management of pyloric stenosis?
Ramstedt pyloromyotomy
presentation of mesenteric adenitis?
- central abdo pain
- URTI
management of mesenteric adenitis?
conservative
where does intussusception occur?
at the level of the ileocaecal valve
age demographic for intussusception?
6-9 months
signs of intussusception?
- colicky pain
- diarrhoea
- vomiting
- sausage-shaped mass
- red currant jelly stool
management of intususception?
air insufflation
which other conditions is malrotation commonly associated with?
- exomphalos
- diaphragmatic hernia
- duodenal atresia
how can you tell that malrotation has been complicated by a volvulus?
the vomit will be bile-stained
how is malrotation diagnosed?
- UGI contrast study
- USS
management of malrotation?
- laparotomy
- Ladd’s procedure if volvulus is present
what causes Hirschsprung’s disease?
absence of ganglion cells from myenteric + submucosal plexuses
how is Hirschsprung’s disease diagnosed?
full-thickness rectal biopsy
signs of Hirschsprung’s disease in neonate?
- distended abdomen
- failure to pass meconium
management of Hirschsprung’s disease?
- rectal washouts
- anorectal pull through procedure
presentation of oesophageal atresia?
- choking
- cyanotic spells (following aspiration)
presentation of meconium ileus?
- delayed passage of meconium
- distended abdomen
what is meconium ileus strongly associated with?
cystic fibrosis
management of meconium ileus?
- PR contrast can dislodge the meconium plug
- NG N-acetyl cysteine
- surgery to remove plug
presentation of biliary atresia?
- jaundice > 14 days
- dark yellow / brown urine
- pale stools
- hepatosplenomegaly
- failure to thrive
management of biliary atresia?
Kasai procedure (urgent!)
main risk factor for necrotising enterocolitis?
prematurity
presentation of necrotising enterocolitis?
- abdo distension
- poor feeding
- passage of (fresh) bloody stools
X-ray findings in necrotising enterocolitis?
- dilated bowel loops
- pneumatosis intestinalis
- air on both sides of bowel wall
management of necrotising enterocolitis?
- broad spectrum ABx
- total gut rest
- TPN
- laparotomy if there is any perforation
complications of GOR?
- failure to thrive from severe vomiting
- oesophagitis
- iron deficiency anaemia
- recurrent pulmonary aspiration
- dystonic neck
- ALTE
how can GOR be investigated in an atypical history?
- 24h oesophageal pH test
- endoscopy with oesophageal biopsy
- contrast study of UGI tract
management of GOR?
- reassurance
- thickening agents in milk
- position 30 deg head-up prone after feed
- surgery where unresponsive to domperidone
at-risk group for severe GOR?
- cerebral palsy
- any other neurodevelopmental disorder
risk factors for hirschsprung’s disease?
- male (3x more)
- Down’s syndrome
presentation of hirschsprung’s disease in neonates?
failure / delay in passing meconium
presentation of hirschsprung’s disease in older children?
- constipation
- abdominal distension
