GI Flashcards
define intussusception
invagination (telescoping) of proximal bowel into a distal segment (commonly ileum) that passes into the caecum through the ileocaecal valve
clinical features of intussusception
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
investigations of intussusception
air enema
US scan of abdomen - shows ‘target’ sign’
complications include:
free abdominal air
presence of gangrene
management of intussusception
rectal air insufflation contrast enema (only if stable)
indications of surgery in intussusception
failure or non-operative management
peritonitis or perforation present
haemodynamically unstable
complications of intussusception
bowel perforation
peritonitis
obstruction
gut necrosis
common examination presentation of child with intussusception
red currant jelly stool drawing up of legs sausage shape in abdomen recent viral URTI intestinal obstruction (vomiting, absolute constipation and distension)
define pyloric stenosis
a condition of hypertrophy (thickening and narrowing) of the outlet of pyloric sphincter of the stomach
clinical features of pyloric stenosis
projectile vomiting after feeds failure to thrive pale and poor growth visible perastalsis of stomach firm round mass in upper abdomen (large olive)
common blood gas finding in children with pyloric stenosis
hypokalaemic hypocholoric (low chloride) metabolic alkalosis
investigations of pyloric stenosis
abdominal US to visualise the thickened pylorus
management of pyloric stenosis
pyloromyotomy (Ramstedt’s)
fluids resus
define appendicits
inflammation of the appendix
causes of appendicitis
obstruction of appendix allowing multiplying of bacteria and invasion of wall
causes pressure necrosis and eventual perforation
clinical features of appendicitis
peri-umbilical pain progressing to right iliac fossa nausea and vomiting fever tachycardia anorexia constipation
signs of appendicitis
pain over right iliac fossa
+ve Rovsing’s sign
rebound and percussion tenderness
what can rebound and percussion tenderness indicate?
peritonitis due to a rupturing of the appendix
investigations in appendicitis
VBG urine HCG and dip bloods (FBC, CRP, U+Es, LFTs, clotting, amylase and cross match) CXR CT AP US of RIF
management of appendicitis
appendectomy or laparotomy
complications of appendicitis
local abscess
perforation
gangrene
define paediatric constipation
a child defecating less than 3x per week or has significant difficulty passing stool
what is considered chronic constipation?
association of passing stools that are pellet like and difficult to pass
causes of paediatric constipation
low fibre diet
dislike of using the toilet
pain on passing stool
anal fissures
diagnosis of paediatric constipation
history
palpation of impacted faeces on abdo examination
abdominal US
management of paediatric constipation
movicol disimpaction regime followed by maintenance movicol
high fibre diet
advise parents to encourage good toilet habits
define Hirschsprungs Disease
incorrect innervation of the distal colon causing lack of aganglionic colon distension - leads to stool being trapped in proximal colon
clinical features of Hirschsprung’s Disease
delay in passing meconium (>48hrs) chronic constipation abdominal pain and distension vomiting poor weight gain failure to thrive
investigations of Hirschsprung’s Disease
history
DRE
rectal suction biopsy
management of Hirschsprungs
surgical removal of aganglionic colon
complication of Hirschsprungs
Hirschsprungs-associated enterocolitis (HAEC)
define HAEC
inflammation and obstruction of intestines due to Hirschsprungs Disease
clinical features of HAEC
fever
abdominal distension
diarrhoea (blood)
septic features
complications of HAEC
toxic megacolon
bowel perforation
management of HAEC
antibiotics
fluid resus
decompression of obstruction
define biliary atresia
a rare condition where the bile ducts of the infant become progressively fibrosed and destroyed
clinical features of biliary atresia
prolonged jaundice
dark urine
chalky white stool
investigations in biliary atresia
bloods (FBC, CRP, LFTs +TFTs)
cholangiography
hepatic scintigraphy
abdominal US
findings on cholangiography in biliary ateresia
failure to show normal architecture of the biliary tree
management of biliary atresia
Kasai procedure (hepatoportoenterostomy)
what type of bilirubin caused biliary atresia?
conjugated
define meconium ileus
a condition in which the meconium becomes thickened and sticky, thus causing intestinal obstruction
what condition is meconium ileus associated with?
cystic fibrosis - chloride channel mutations cause the mucous to become excessively thick
clinical features of meconium ileus
delay in passing meconium (>48hrs for 1st poo)
bilious green vomiting
abdominal distension
investigations in meconium ileus
abdominal XR
findings on XR in meconium ileus
bubbly apperance of intestines
lack of air-fluid levels
management of meconium ileus
‘drip and suck’ stomach drainage with NG tube and IV fluids
enemas to remove sticky meconium
clinical features of mesenteric adenitis
diffuse abdominal pain
recent PMH of URTI
low grade fever
abdominal tenderness
investigations in mesenteric adenitis
enlarged mesenteric lymph nodes and NORMAL appendix
management of mesenteric adenitis
hospital admission for overnight monitoring
safety net parents
