Gastrointestinal/Liver Flashcards
What is the stepwise management of constipation in children?
Dietary and lifestyle modification. Stool softener (e.g. Movicol) for 2 weeks. If no responsead stimulant laxative (e.g. senna) and consider adding osmotic laxative (e.g. lactulose). If still no response, consider enema (under sedation) or manual evacuation (under GA). Once faeces have been passed at whatever stage, maintenance laxatives in the form of Movicol should be offered.
What is the most common causative organism of gastroenteritis in children?
Rotavirus
What feature of diarrhoea in gastroenteritis suggests a bacterial infection?
Bloody diarrhoea
Particularly campylobacter, shigella, salmonela, E.coli O157
What investigations should be considered in a child with gastroenteritis?
Stool MC+S, FBC, U+Es, blood culture if worried about sepsis
How should gastroenteritis be managed?
Encourage good hand hygiene. Oral rehydration solution (50 mls/kg over 4 hours) or, if severe dehydration, iv fluids. Antibiotics if septic/salmonella/C.diff. Avoid anti-diarrhoeals
What imaging modality is most appropriate in children presenting with possible appendicitis?
Ultrasound abdomen
What is the conservative approach to managing simple gastro-oesophageal reflux in babies?
Reassure, monitor growth. Thicken feeds to help milk stay down. Avoid overfeeding, smaller but more frequent feeds are better. Position upright for 30 mins after feeds.
What features help to differentiate mesenteric adenitis from appendicitis?
Mesenteric adenitis is usually the result of an intercurrent viral infection. Usually no guarding or peritonism.
What does bile stained vomit indicate?
Intestinal obstruction
What is the most likely cause of non-bilious, projectile vomiting in the first few weeks of life?
Pyloric stenosis
How may Hirschprung’s disease present?
Failure to pass meconium in first 24 hours of life. Abdominal distension and later bile-stained vomit develop. Some may present with life-threatening Hirschprung’s enterocolitis during first few weeks of life due to C. diff infection. FTT.
In later childhood, chronic constipation with profound abdo distension.
How is Hirschprung’s disease definitively diagnosed?
Suction rectal biopsy showing absence of ganglion cells and presence of thickened non-myelinated nerves; increased activity of acetylcholinesterase
What genes are linked to Coeliac disease?
HLA-DQ2 and HLA-DQ8
Which patient groups have an increased risk of coeliac disease?
T1DM, autoimmune thyroid disease, Down’s syndrome. Positive family history.
Which highly sensitive and specific serological tests are used to aid diagnosis of coeliac disease
IgA tissue transaminase antibodies and endomysial antibodies
How is coeliac disease definitively diagnosed?
Endoscopic small intestinal biopsy showing mucosal changes (raised intraepithelial lymphocytes, villous atrophy, crypt hypertrophy) followed by resolution of symptoms upon withdrawal of gluten
How can you differentiate between an inguinal hernia and a hydrocele?
Can get above a hydrocele, can’t get above an inguinal hernia. Also a hydrocele, transilluminates.
Where does intussusception most frequently occur?
The ileum passing through into the caecum through the ileocaecal valve.
How may intussusception present?
Sausage-shaped mass, red-currant jelly stool, spasmodic abdominal pain. Child usually well between the painful periods.
What often forms the pathological and non-pathological lead points in intussusception?
Non-pathological (younger kids): Enlarged Peyer’s patch - often following viral infection
Pathological (older kids): Meckel’s diverticulum or polyp
What is sign is classically seen on US in intussusception?
Target sign - showing invagination of proximal bowel into distal bowel
How is intussusception managed?
Urgent surgical referral. NBM. Drip and suck (NG tube to decompress the bowel and fluids).
If < 24 hours since onset: air enema to correct
If > 24 hours since onset or very sick child: surgery as enema may cause perforation
What is seen on ABG/VBG in pyloric stenosis?
Hypochloraemic, hypokalaemic, hyponatraemic metabolic alkalosis
In what relatively common neonatal condition may you see visible gastric peristalsis?
Pyloric stenosis
