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Paediatrics > GI > Flashcards

GI Flashcards

1
Q

define intussusception

A

invagination (telescoping) of proximal bowel into a distal segment (commonly ileum) that passes into the caecum through the ileocaecal valve

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2
Q

clinical features of intussusception

A

paroxysmal severe colicky abdominal pain
brings up legs to chest
pale + lethargic
vomiting
passage of “red currant jelly stool”
abdominal distension
palpable mass in RUQ - often ‘sausage’ shaped

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3
Q

investigations of intussusception

A

air enema
US scan of abdomen - shows ‘target’ sign’

complications include:
free abdominal air
presence of gangrene

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4
Q

management of intussusception

A 
rectal air insufflation 
contrast enema (only if stable)
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5
Q

indications of surgery in intussusception

A

failure or non-operative management
peritonitis or perforation present
haemodynamically unstable

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6
Q

complications of intussusception

A

bowel perforation
peritonitis
obstruction
gut necrosis

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7
Q

common examination presentation of child with intussusception

A 
red currant jelly stool 
drawing up of legs 
sausage shape in abdomen 
recent viral URTI 
intestinal obstruction (vomiting, absolute constipation and distension)
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8
Q

define pyloric stenosis

A

a condition of hypertrophy (thickening and narrowing) of the outlet of pyloric sphincter of the stomach

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9
Q

clinical features of pyloric stenosis

A 
projectile vomiting after feeds 
failure to thrive 
pale and poor growth 
visible perastalsis of stomach
firm round mass in upper abdomen (large olive)
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10
Q

common blood gas finding in children with pyloric stenosis

A

hypokalaemic hypocholoric (low chloride) metabolic alkalosis

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11
Q

investigations of pyloric stenosis

A

abdominal US to visualise the thickened pylorus

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12
Q

management of pyloric stenosis

A

pyloromyotomy (Ramstedt’s)

fluids resus

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13
Q

define appendicits

A

inflammation of the appendix

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14
Q

causes of appendicitis

A

obstruction of appendix allowing multiplying of bacteria and invasion of wall

causes pressure necrosis and eventual perforation

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15
Q

clinical features of appendicitis

A 
peri-umbilical pain progressing to right iliac fossa
nausea and vomiting 
fever 
tachycardia 
anorexia 
constipation
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16
Q

signs of appendicitis

A

pain over right iliac fossa
+ve Rovsing’s sign
rebound and percussion tenderness

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17
Q

what can rebound and percussion tenderness indicate?

A

peritonitis due to a rupturing of the appendix

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18
Q

investigations in appendicitis

A 
VBG 
urine HCG and dip 
bloods (FBC, CRP, U+Es, LFTs, clotting, amylase and cross match) 
CXR
CT AP 
US of RIF
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19
Q

management of appendicitis

A

appendectomy or laparotomy

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20
Q

complications of appendicitis

A

local abscess
perforation
gangrene

21
Q

define paediatric constipation

A

a child defecating less than 3x per week or has significant difficulty passing stool

22
Q

what is considered chronic constipation?

A

association of passing stools that are pellet like and difficult to pass

23
Q

causes of paediatric constipation

A

low fibre diet
dislike of using the toilet
pain on passing stool
anal fissures

24
Q

diagnosis of paediatric constipation

A

history
palpation of impacted faeces on abdo examination
abdominal US

25
Q

management of paediatric constipation

A

movicol disimpaction regime followed by maintenance movicol
high fibre diet
advise parents to encourage good toilet habits

26
Q

define Hirschsprungs Disease

A

incorrect innervation of the distal colon causing lack of aganglionic colon distension - leads to stool being trapped in proximal colon

27
Q

clinical features of Hirschsprung’s Disease

A 
delay in passing meconium (>48hrs)
chronic constipation 
abdominal pain and distension
vomiting 
poor weight gain 
failure to thrive
28
Q

investigations of Hirschsprung’s Disease

A

history
DRE
rectal suction biopsy

29
Q

management of Hirschsprungs

A

surgical removal of aganglionic colon

30
Q

complication of Hirschsprungs

A

Hirschsprungs-associated enterocolitis (HAEC)

31
Q

define HAEC

A

inflammation and obstruction of intestines due to Hirschsprungs Disease

32
Q

clinical features of HAEC

A

fever
abdominal distension
diarrhoea (blood)
septic features

33
Q

complications of HAEC

A

toxic megacolon

bowel perforation

34
Q

management of HAEC

A

antibiotics
fluid resus
decompression of obstruction

35
Q

define biliary atresia

A

a rare condition where the bile ducts of the infant become progressively fibrosed and destroyed

36
Q

clinical features of biliary atresia

A

prolonged jaundice
dark urine
chalky white stool

37
Q

investigations in biliary atresia

A

bloods (FBC, CRP, LFTs +TFTs)
cholangiography
hepatic scintigraphy
abdominal US

38
Q

findings on cholangiography in biliary ateresia

A

failure to show normal architecture of the biliary tree

39
Q

management of biliary atresia

A

Kasai procedure (hepatoportoenterostomy)

40
Q

what type of bilirubin caused biliary atresia?

A

conjugated

41
Q

define meconium ileus

A

a condition in which the meconium becomes thickened and sticky, thus causing intestinal obstruction

42
Q

what condition is meconium ileus associated with?

A

cystic fibrosis - chloride channel mutations cause the mucous to become excessively thick

43
Q

clinical features of meconium ileus

A

delay in passing meconium (>48hrs for 1st poo)
bilious green vomiting
abdominal distension

44
Q

investigations in meconium ileus

A

abdominal XR

45
Q

findings on XR in meconium ileus

A

bubbly apperance of intestines

lack of air-fluid levels

46
Q

management of meconium ileus

A

‘drip and suck’ stomach drainage with NG tube and IV fluids

enemas to remove sticky meconium

47
Q

clinical features of mesenteric adenitis

A

diffuse abdominal pain
recent PMH of URTI
low grade fever
abdominal tenderness

48
Q

investigations in mesenteric adenitis

A

enlarged mesenteric lymph nodes and NORMAL appendix

49
Q

management of mesenteric adenitis

A

hospital admission for overnight monitoring

safety net parents

Paediatrics (9 decks)

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