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GI Flashcards

1
Q

What are the 9 quadrants of the abdomen?

A

Right hypochondriac, epigastric, Left hypochondriac, right flank, umbilical, left flank, right iliac fossa, hypogastric, left iliac fossa

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2
Q

What can the causes of abdominal pain in children be split up into?

A

Non-organic, medical and surgical causes

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3
Q

What is the most common cause of abdominal pain in children over 5?

A

Non-organic/ functional

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4
Q

What are the differential diagnoses of organic abdominal pain?

A 
Constipation
UTI
Coeliac
IBD
IBS
Mesenteric adenitis
Abdominal migraine
Pyelonephritis
HSP
Tonsilitis
DKA
Infantile colic
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5
Q

What additional causes of abdominal pain are there in girls?

A 
Dysmenorrhea
Mittelschmerz (ovulation pain) 
Ectopic pregnancy
PID
Ovarian torsion
Pregnancy
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6
Q

What are the surgical causes of abdominal pain?

A

Appendicitis
Intussusception
Bowel obstruction
Testicular torsion

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7
Q

What are the red flags for abdominal pain?

A 
Persistent/ bilious vomiting
Severe chronic diarrhoea
Fever
Rectal bleeding
Weight loss/ faltered growth
Dysphagia
Night pain
Abdominal tenderness
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8
Q

What investigations should be done to rule out what pathologies?

A 
FBC for anaemia (IBD or coealiac)
Inflammatory markers (IBD) 
Anti-TTG/ Anti-EMA (coeliac)
Faecal calprotectin (IBD)
Urine dipstick (UTI)
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9
Q

When is a diagnosis of recurrent abdominal pain made?

A

When a child presents with repeated episodes of abdominal pain without an identifiable cause. (Non-organic/ functional pain)

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10
Q

What does recurrent abdominal pain usually correspond to?

A

Stressful life events

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11
Q

What is the leading theory for the cause of recurrent abdominal pain?

A

Increased sensitivity and inappropriate pain signals from visceral nerves in response to normal stimuli

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12
Q

What measures can be used to manage recurrent abdominal pain?

A

Distraction
Encourage parents not to ask about it
Sleep/ eating/ hydration/ reducing stress advice
Probiotic supplements
Avoid NSAIDS
Address pshycosocial triggers/ exacerbating factors

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13
Q

What is an abdominal migraine?

A

Episode of central abdominal pain lasting more than 1 hour

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14
Q

What symptoms may also occur with an abdominal migraine?

A 
N&V
Anorexia
Pallor
Headache
Photophobia
Aura
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15
Q

How can you treat an acute attack of abdominal migraine?

A

Low stimulus environment
Paracetamol
Ibuprofen
Sumatriptan

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16
Q

What medications can be used to prevent abdominal migraines?

A

Pizotifen
Propanolol
Cyproheptadine
Flunarazine

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17
Q

What is the main medication used to prevent abdominal migraine and what information should patients be given about it?

A

Pizotifen
Needs to be withdrawn slowly when stopping as it is associated with withdrawal symptoms (depression, anxiety, poor sleep, tremor)

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18
Q

What is the most common cause of constipation in children?

A

Idiopathic/ functional

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19
Q

What are some secondary causes of constipation in children?

A 
Hirschsprung's disease
Cystic fibrosis
Hypothyroidism
Spinal cord lesion
Sexual abuse
Intestinal obstruction
Anal stenosis
Cows milk intolerance
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20
Q

What are the typical features of a constipation history/ examination?

A 
< 3 stools per week
Hard/ difficult to pass stools
Rabbit dropping stools
Straining/ painful passage
Abdominal pain
Retentive posturing
Rectal bleeding
Overflow soiling caused by faecal impaction
Palpable abdomen
Loss of sensation of neeed to open bowels
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21
Q

What is encopresis?

A

Term for faecal incontinence

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22
Q

At what age does encopresis become pathological?

A

Older than 4

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23
Q

What is the most common cause of encopresis?

A

Chronic constipation causing the rectum to become stretched and lose sensation. Large hard stools remain, and only loose stools are able to bypass the blockage and leak out

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24
Q

What are other causes of encopresis?

A 
Spina bifida
Hirshchprung's disease
Cerebral palsy
Learning disability
Psychosocial stress
Abuse
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25
Q

What lifestyle factors can contribute to the development/ continuation of constipation?

A 
Bad toilet habits
Low fibre diet
Poor fluid intake
Sedentary lifestyle
Psychosocial problems
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26
Q

What is faecal impaction?

A

Where a large, hard stool blocks the rectum

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27
Q

What is desensitisation of the rectum and when does it occur?

A

When patients develop the habit of not opening their bowels and ignore the sensation of a full rectum, leading to retained faeces and faecal impaction. THis causes the rectum to stretch and dill with more faeces, leading to further desensitisation.

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28
Q

What red flags should you look our for with a constipation presentation?

A 
No meconium within 48 hours of birth
Neurological signs
Vomiting
Ribbon stool 
Abnormal anus
Abnormal lower back/ buttocks
Failure to thrive
Acute severe abdominal pain/ bloating
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29
Q

What are the complications of constipation?

A 
Pain
Reduced sensation
Anal fissures
Haemorrhoids
Overflow/ soiling
Psychosocial morbidity
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30
Q

How is idiopathic constipation managed?

A

High fibre diet
Good hydration
Start laxatives ( may need disimpactation regimen)
Encourage good toilet habits

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31
Q

What laxative is usually used in children with constpation?

A

Movicol

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32
Q

What is GORD?

A

Where contents of the stomach reflux through the lower oesophageal sphincter into the oesophagus, throat and mouth

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33
Q

Why is GORD common in babies?

A

Due to immaturity of the lower oesophageal sphincter

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34
Q

By what age do 90% of infants stop having reflux?

A

1

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35
Q

What are signs of problematic reflux?

A 
Chronic cough
Hoarse cry
Distress/ crying
Reluctance to feed
Pnaeumonia
Poor weight gain
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36
Q

What symptoms of GORD may children over 1 have?

A 
Similar to adults: 
Heartburn
Acid regurgitation
Retrosternal/ epigastric pain
Bloating
Nocturnal cough
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37
Q

What are the causes of vomiting in infants?

A 
Overfeeding
GORD
Pyloric stenosis 
Gastritis/ gastroenteritis
Appendicitis
Infections
Intestinal obstruction
Bulimia
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38
Q

What are the red flags of vomiting?

A 
Not keeping food down
Projectile/ forceful vomiting
Bile stained vomiting
Haematemesis/ melaena
Abdominal distention
Reduced consciousness/ bulging fontanelle/ neurological signs
Resp symptoms
Blood in stools
Signs of infection
Rash, angiodema/ other signs of allergy
Apnoeas
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39
Q

What are the key differential diagnoses with projectile or forceful vomitin?

A

Pyloric stenosis or intestinal obstrution

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40
Q

What are the key differential diagnoses with not being able to keep any feed down?

A

Pyloric stenosis or intestinal obstruction

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41
Q

What is the key differential diagnosis with bile stained vomit?

A

Intestinal obstruction

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42
Q

What are the key differential diagnoses with haematemesis/ melaena?

A

Peptic ulcer
Oesophagitis
Varices

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43
Q

What is the management advice for mild cases of GORD?

A

Small frequent meals
Burping regularly
Don’t overfeed
Keep baby upright after feeding

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44
Q

What is the management advice for more problematic cases of GORD?

A

Gaviscon
Thickened milk or formula
Ranitidine
Omeprazole

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45
Q

What may need to be done in severe cases of GORD?

A

Further investigation with barium meal and endoscopy

Surgical fundoplication in very severe cases

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46
Q

What is Sandifer’s syndrome?

A

Rare condition causing brief episodes of abnormal movements associated with GORD in infants

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47
Q

What are the key features of Sandifer’s syndrome?

A

Torticollis (forceful contraction of neck muscles)

Dystonia (abnormal muscle contractions causing twisting movements, arching of the back or unusual postures

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48
Q

How does Sandifer’s syndrome resolve?

A

As the reflux is treated/ improves

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49
Q

What is the pyloric sphincter?

A

The ring of smooth muscle that forms the canal between the stomach and duodenum

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50
Q

What is pyloric stenosis?

A

Hypertrophy and therefore narrowing of the pylorus

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51
Q

What is the key feature that indicates pyloric stenosis?

A

Projectile vomiting

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52
Q

Why does pyloric stenosis cause projectile vomiting?

A

Pyloric stenosis causes increasingly powerful peristalsis in the stomach to try to push food into the duodenum. Eventually it becomes so powerful that it ejects food into the oesophagus, out of the mouth and accross the room

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53
Q

What age range is affected by pyloric stenosis?

A

Neonate (birth- 6 months)

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54
Q

When does pyloric stenosis usually present?

A

In the first few weeks of life

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55
Q

How does a baby with pyloric stenosis usually present?

A

Projectile vomiting
Thin
Failing to thrive
Hungry

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56
Q

What might examination of pyloric stenosis show?

A

Visible peristalsis

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57
Q

What may you feel on examination of pyloric stenosis?

A

Firm round mass in upper abdomen- feels like large olive

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58
Q

Why can you feel a large mass in the upper abdomen in pyloric stenosis?

A

Hypertrophy of the pylorus muscle

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59
Q

What will blood gas analysis show in pyloric stenosis?

A

Hypochloric metabolic alkalosis

low chloride

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60
Q

Why do you get hypochloric metabolic alkalosis in pyloric stenosis?

A

The baby is vomiting hydrochloric acid from the stomach

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61
Q

How is pyloric stenosis diagnosed?

A

History/ examination
Blood gas analysis
Abdominal USS

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62
Q

What does USS show in pyloric stenosis?

A

Thickened pylorus

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63
Q

How is pyloric stenosis managed?

A

Laparoscopic pyloromyotomy (Ramstedt’s operation)

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64
Q

What is a Laparoscopic pyloromyotomy?

A

Incision made into smooth muscle of pylorus to widen canal

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65
Q

What causes pyloric stenosis?

A

Unknown?

Sex, race, prematurity, family history ect risk factors

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66
Q

What is acute gastritis?

A

Inflammation of the stomach

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67
Q

How does acute gastritis present?

A

Nausea and vomiting

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68
Q

What is enteritis?

A

Inflammation of the intestines

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69
Q

How does enteritis present?

A

Diarrhoea

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70
Q

What is gastroenteritis?

A

Inflammation in the stomach and intestines

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71
Q

How does gastroenteritis present?

A

Nausea
Vomiting
Diarrhoea

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72
Q

What is the most common cause of gastroenteritis?

A

Viral

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73
Q

What is the main complication of gastroenteritis?

A

Dehydration

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74
Q

What are the key differential diagnoses of diarrhoea?

A 
Gastroenteritis
IBD
Lactose intolerance
Coeliac disease
Cystic fibrosis
Toddler's diarrhoea
IBS
Medications (Abx)
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75
Q

What are the most common causes of viral gastroenteritis?

A

Rotavirus

Norovirus

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76
Q

What are the most common causes of bacterial gastroenteritis?

A 
E.coli
Campylobacter jejuni
Shigella
Salmonella
Bacillus
Cereus
Yersinia Enterocolitica
Staph aureus
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77
Q

Where is E.coli found under normal circumstances?

A

Normal intestinal bacteria

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78
Q

What strains of E.coli cause gastroenteritis?

A

E.coli 0157

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79
Q

How is E.coli infection spread?

A

Contact with infected faeces, unwashed salads or contaminated water

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80
Q

How does E.coli cause symptoms of gastroenteritis?

A

Produces the shiga toxin which causes abdominal cramps, bloody diarrhoea and vomiting.

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81
Q

What is the additional complication of infection by the Shiga toxin produced by E.coli?

A

Destroys blood cells and leads to haemolytic uraemic syndrome (HUS)

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82
Q

Why should antibiotics be avoided in E.coli infection?

A

Increases risk of haemolytic uraemic syndrome

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83
Q

What is the most common cause of travellers diarrhoea?

A

Campylobacter jejuni

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84
Q

How is campylobacter spread?

A

Raw/ uncooked poultry
Untreated water
Unpasteurised milk

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85
Q

What are the symptoms of infection with campylobacter?

A

Abdo cramps
Diarrhoea (without blood)
Vomiting
Fever

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86
Q

How long does campylobacter take to resolve?

A

Incubation 2-5 days

Symptoms resolve after 3-6 days

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87
Q

When would antibiotics be considered with campylobacter infection?

A

After isolating the organism
If there are severe symptoms
If there are other risk factors (HIV, heart failure)

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88
Q

What antibiotics would be considered with campylobacter jejuni?

A

Azithromycin

Ciprofloxacin

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89
Q

How is Shigella spread?

A

By food, water or pools containing contaminated faeces

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90
Q

What is the incubation period for Shigella and how long does it take to resolve?

A

1-2 days

Resolves within 1 week

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91
Q

How is salmonella spread?

A

By eating raw eggs, poulty or food infected with animal faeces

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92
Q

What is the incubation period for salmonella and how long does it take to resolve?

A

incubation= 12 hours- 3 days

Resolves within 1 week

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93
Q

What are the symptoms of salmonella?

A

Watery diarrhoea associated with mucus or blood, abominal pain and vomiting

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94
Q

What type of bacteria is bacillus cereus?

A

Gram positive rod

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95
Q

How is bacillus cereus spread?

A

Through inadequately cooked food (e.g fried rice left out)

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96
Q

How does bacillus cereus cause symptoms?

A

It produces the cereulide toxin which causes abdominal cramping and vomiting within 5 hours of ingestion, then produces different toxins in the intestines that cause watery diarrhoea/

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97
Q

What is the usual time course for bacillus cereus infection?

A

Vomiting within 5 hours, diarrhoea after 8 hours, resolution within 24 hours

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98
Q

What kind of bacteria is Yersinia Enterocolitica?

A

Gram negative bacillus

99
Q

How is Yersinia spread?

A

Pigs= carriers so eating raw/ undercooked pork.

Contimation with urine or faeces of other mammals

100
Q

Who is most affected by Yersinia infection?

A

Children

101
Q

What are the symptoms of Yersinia?

A

Watery/ bloody diarrhoea
Abdominal pain
Fever
Lymphadenopathy

102
Q

What is the time course or Yersinia infection?

A

4-7 day incubation period

Symptoms can last >3 weeks

103
Q

How may older children with Yersinia infection present and what may this be confused with?

A

Mesenteric lymphadenitis, causing right sided abdominal pain and giving the impression of appendicitis

104
Q

What does staph aureus produce and how does this cause gastroenteritis?

A

Enterotoxins, which can cause small intestine inflammation

105
Q

What is Giardia lamblia?

A

Microscopic parasite

106
Q

Where does giardia live?

A

In small intestines of mammals

107
Q

How is giardiasis transmitted?

A

Faecal- oral transmission (mammals release cysts in stools which then contaminate food and water)

108
Q

How is giardiasis diagnosed and treated?

A

Diagnosed by stool microscopy

Treated with metronidazole

109
Q

What are the principles of gastroenteritis management?

A

Infection control (Isolation and barrier nursing)
Stay of school for 48 hours
Manage dehydration

110
Q

How is gastroenteritis investigated?

A

Can do stool sample for microscopy, culture and sensitivities

111
Q

How is dehydration managed in gastroenteritis?

A

Establish if they can keep fluids down or need admission for IV fluids (fluid challenge)

112
Q

What is a fluid challenge?

A

Recording a small volume of fluid given orally every 5-10 minutes to see if it is tolerated. If so, can be managed at home

113
Q

How is gastroenteritis managed?

A

Fluid challenge
Dioralyte
IV fluids if required
Slowly introduce food once tolerated

114
Q

Should you use antidiarrhoeal medication with gastroenteritis?

A

No- especially with e.coli or shigella infection

115
Q

What are the possible post-gastroenteritis complications?

A

Lactose intolerance
IBS
Reactive arthritis
Guillain-Barre syndrome

116
Q

What is Toddler’s diarrhoea?

A

Chronic nonspecific diarrhoea

117
Q

What kind of condition is coeliac?

A

Autoimmune

118
Q

What is the pathophysiology of coeliac?

A

Autoantibodies are created in response to gluten exposure, which target the epithelial cells of the intestine and lead to inflammation. Inflammation causes atrophy of the intestinal villi, which leads to decreased nutrient absorption

119
Q

What are the two antibodies created in coeliac disease?

A

Anti-tissue transglutaminase (anti-TTG)

Anti-Endomysial (enti-EMA)

120
Q

Which part of the GI tract is most affected by the inflammation caused by coeliac?

A

Jejunum

121
Q

How does coeliac disease present in children?

A 
Often asymptomatic
Failure to thrive
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia
Dermatitis herpetiformis 
Neurological symptoms
122
Q

What is dermatitis herpetiformis?

A

Itchy blistering skin rash on the abdomen

123
Q

What genes are associated with coeliac disease?

A

HLA-DQ2 (90%)

HLA-DQ8

124
Q

How is coeliac disease investigated?

A

Blood tests for IgA levels and antibodies

Endoscopy and intestinal biopsy

125
Q

Why must immunoglobulin A levels be checked when testing for coeliac disease?

A

Anti-TTG and anti-EMA are both IgA, so in IgA deficiency, these may be low despite the presence of coeliac disease

126
Q

How can you test for coeliac if the patient has IgA deficiency?

A

Test for the IgG version of the anti-TTG or anti-EMA antibody
Endoscopy

127
Q

What will endoscopy and biopsy show in coeliac?

A

Crypt hypertophy

Villous atrophy

128
Q

What key conditions if coeliac disease associated with?

A 
T1 diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Down's syndrome
129
Q

What are the complications of untreated coeliac disease?

A 
Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
EATL of the intestine
Non-Hodgkin lymphoma
Small bowel adenocarcinoma
130
Q

What is the treatment of coeliac disease?

A

Lifelong gluten free diet

131
Q

What are the two forms of inflammatory bowel disease?

A

Crohn’s disease

Ulcerative colitis

132
Q

What are the key features of Crohns that differentiate it from UC?

A 
(NESTS) 
No blood or mucus
Entire GI tract affected
Skip lesions on endoscopy
Terminal ileum most affected
Transmural inflammation
Smoking is risk factir
133
Q

What are the key features of UC that differentiate it from Crohn’s?

A 
(CLOSEUP) 
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa affected
Smoking= protective
Excrete blood and mucus
Use aminosalicylates
Primary sclerosing cholangitis associated
134
Q

How does IBD present?

A 
Perfuse diarrhoea
Abdominal pain
Bleeding
Weight loss
Anaemia
Systemically unwell during flares (fevers, malaise, dehydration)
135
Q

What are some extra-intestinal manifestations of IBD?

A 
Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis & Iritis
Inflammatory arthritis
Primary sclerosing cholangitis
136
Q

How is IBD diagnosed?

A

Blood tests
Faecal calprotectin
Endoscopy
Imaging

137
Q

What blood tests are done to investigate IBD?

A 
Anaemia
Infection
TFT's
LFT's
U&E's 
Inflammatory markers
138
Q

What is faecal calprotectin and when its raised what does it indicate?

A

Marker for inflammation in the GI tract

139
Q

What is the gold standard test for diagnosis of IBD?

A

Endoscopy

140
Q

When might imaging be done in IBD?

A

To look for complications such as fistulas, abscesses and strictures

141
Q

Who should managed the care of a child with an IBD?

A 
MDT: 
Paediatrician
Specialist nurses
Pharmacists
Dieticians
Surgeons if necessary
142
Q

What should be monitored in children with IBD?

A

Growth and pubertal development

143
Q

What are the IBD treatment aims?

A

Inducing remission during flares and maintaining remission

144
Q

How is Crohn’s treated to induce remission during a flare?

A

Steroids (oral prednisolone or IV hydrocortisone)

May need further immunosuppressant medication

145
Q

What are the first line medications used to maintain remission in Crohns?

A

Azathioprine

Mercaptopurine

146
Q

What are alternative options for maintaining remission in Crohns?

A

Methotrexate
Infliximab
Adalimumab

147
Q

How else may Crohn’s be managed?

A

If it only affects distal ileum, can surgical resect this area

148
Q

What medications are used to induce remission in mild/ moderate UC?

A

Aminosalicyclate

Corticosteroids

149
Q

What medications are used to induce remission in severe UC?

A

IV corticosteroids

IV ciclosporin

150
Q

What medications can be used to maintain remission in UC?

A

Aminosalicyclate
Azathioprine
Mercaptopurine

151
Q

How can UC be cured?

A

Removing the colon and rectum (panproctocolectomy)

152
Q

What is the pateint left with after surgery for UC?

A

Ileostomy (stoma bag) or J-pouch (ileo-anal anastomosis)

153
Q

What is a J-pouch?

A

Where the ileum is folded back on itself and fashioned into a larger pouch that functions like a rectum. Is then attached to the anus

154
Q

What is biliary atresia?

A

Congenital condition where a section of the bile duct is narrowed or absent

155
Q

What does biliary atresia cause?

A

Cholestasis (bile cannot be transported from liver to bowel)

156
Q

How and when does biliary atresia present?

A

With significant jaundice shortly after birth

157
Q

Why do you get jaundice in biliary atresia?

A

Conjugated bilirubin is excreted in the bile, so biliary atresia prevent the excretion of conjugated bilirubin

158
Q

When should biliary atresia be suspected?

A

In babies with persistent jaundice

159
Q

What time frame is classified as persistent jaundice?

A

> 14 days in term babies

>21 days in premature babies

160
Q

What is the initial investigation for biliary atresia?

A

Conjugated and unconjugated bilirubin levels

161
Q

What will investigations into biliary atresia show?

A

High proportion of conjugated bilirubin

162
Q

How is biliary atresia managed?

A

Surgery- attaching section of small intestine to opening of liver where bile duct attached
Often will need full liver transplant to resolve condition

163
Q

What is intestinal obstruction?

A

Where physical obstruction prevents the flow of faeces through the intestines

164
Q

What does the blockage cause?

A

Back pressure that causes vomiting

Absolute constipation

165
Q

What are the causes of intestinal obstruction?

A 
Meconium ileus
Hirschsprung's disease
Oesophageal/ duodenal atresia
Intussusception
Imperforate anus
Malrotation of intestines with volvulus
Strangulated hernia
166
Q

What is meconium ileus?

A

Where the meconium is thick and sticky, causing it to get stuck and obstruct the bowel (Common in CF)

167
Q

How does a bowel obstruction present?

A 
Persistent vomiting 
Abdominal pain 
Distention
Failure to pass stools or wing
Abnormal bowel sounds
168
Q

What are the classic bowel sounds in bowel obstruction?

A

High pitched ‘tinkling’, followed by absence of bowel sounds

169
Q

What is the investigation of choice for bowel obstruction?

A

Abdominal xray

170
Q

What will xray show with bowel obstruction?

A

Dilated loops of bowel proximal to the obstruction
Collapsed loops of bowel distal to the obstruction
Absence of air in the rectum

171
Q

How are bowel obstructions managed?

A

Emergency paediatric surgery referral
Initial= nil by mouth, insert NG tube to help drain stomach and stop vomiting
IV fluids to correct dehydration/ electrolyte imbalances
Treat underlying cause

172
Q

What is the myenteric plexus?

A

The brain of the gut- forms the enteric nervous system

173
Q

What is the myenteric plexus also known as?

A

Auerbach’s plexus

174
Q

Where does the myenteric plexus run?

A

All the way along the bowel in the bowel wall

175
Q

What is the myenteric plexus made up of?

A

Complex web of neurones, ganglion cells, receptors, synapses and neurotransmitters

176
Q

What is the myenteric plexus responsible for?

A

Stimulating peristalsis in the large bowel

177
Q

What is Hirschsprung’s disease?

A

Congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum

178
Q

What is absent in Hirschsprung’s disease?

A

Parasympathetic ganglion cells in the distal colon and rectum

179
Q

How do the parasympathetic ganglion of the cells usually form and develop?

A

Cells start higher in the GI tract and gradually migrate down to the distal colon and rectum

180
Q

How does Hirschsprung’s occur?

A

When the parasympathetic ganglion cells do not travel all the way down the colon, so a section is left without them

181
Q

What is it called when the whole colon is affected by Hirschsprung’s disease?

A

Total colonic aganglionosis

182
Q

What happens to the aganglionic section in Hirschsprung’s disease?

A

It does not relax, causing it to become constricted

183
Q

What does the constriction of the aganglionic colon lead to?

A

Loss of movement of faeces and obstruction in the bowel

184
Q

What happens to the bowel proximal to the obstruction?

A

It becomes distended and full

185
Q

What increases the risk of Hirschsprung’s disease?

A 
Genetics
Family history 
Downs syndrome
Neurofibromatosis
Waardenburg syndrome
Multiple endocrine neoplasia type II
186
Q

How does Hirschsprung’s vary in its presentation?

A

Depends on age at diagnosis and extent of bowel affected:

May be acute intestinal obstruction shortly after birth or more gradual

187
Q

What are symptoms of Hirschsprung’s disease?

A 
Delay in passing meconium (>24 hours) 
Chronic constipation since birth
Abdominal pain and distension
Vomiting
Poor weight gain
Failure to thrive
188
Q

What is Hirschsprung-Associated Enterocolitis (HAEC)?

A

Inflammation and infection of the intestine occurring in around 20% of neonates with Hirschsprung’s disease

189
Q

When does Hirschsprung-Associated Enterocolitis usually present?

A

Within 2-4 weeks of birth

190
Q

How does Hirschsprung-Associated Enterocolitis present?

A

Fever
Abdominal distention
Diarrhoea (often bloody)
Features of sepsis

191
Q

What can Hirschsprung-Associated Enterocolitis lead to?

A

Death

Toxic megacolon and perforation of bowel

192
Q

How is Hirschsprung-Associated Enterocolitis managed?

A

Urgent antibiotics
Fluid resuscitation
Decompression of obstructed bowel

193
Q

How is Hirschsprung’s disease managed?

A

Abdominal Xray

Rectal biopsy

194
Q

How does rectal biopsy confirm a diagnosis of Hirschsprung’s disease?

A

Demonstrates absence of ganglionic cells

195
Q

How is Hirschsprung’s disease managed acutely?

A

Fluid resuscitation

Management of intestinal obstruction

196
Q

What is the definitive management of Hirschsprung’s disease?

A

Surgical removal of aganglioinic section of bowel

197
Q

What is intussusception?

A

Where the bowel folds inwards (invaginates/ telescopes) into itself

198
Q

What does intussusception do to the overall size of the bowel and the lumen?

A

Thickens overall size of bowel and narrows lumen at folded area

199
Q

What age range and population us most affected by intussusception?

A

6 months- 2 years

More common in boyrs

200
Q

What conditions are associated with intussusception?

A 
Concurrent viral illness
HSP
Cystic fibrosis
Intestinal polyps
Meckel diverticulum
201
Q

How does intussusception present?

A 
Signs of bowel obstruction
Severe colicky abdominal pain
Pale, lethargic unwell child
Bloody stool 
Right upper quadrant mass
Vomiting 
Intestinal obstruction
202
Q

What is the typical description of the stool in intussusception?

A

Redcurrant jelly stool

203
Q

What is the typical description of the mass felt on palpation of intussusception?

A

Sausage shaped

204
Q

Why do you get ‘redcurrant jelly stool’ in intussusception?

A

Trapped section of bowel goes ischaemic, and the mucosa responds by causing sloughing off into the gut

205
Q

What is the investigation of choice for intussusception?

A

USS (or contrast enema)

206
Q

What is the initial treatment of intussusception?

A

Therapeutic enemas- pumping contrast, water or air into the colon to force the folded bowel out into its normal position

207
Q

What can be done to treat intussusception if enema doesnt work?

A

Surgical reduction

208
Q

What must be done is the bowel becomes gangrenous or perforated?

A

Surgical resection

209
Q

What are the complications of intussusception?

A

Obstruction
Gangrenous bowel (due to disruption of blood supply)
Perforation
Death

210
Q

What is the appendix attached to?

A

The caecum

211
Q

When does the appendix become inflamed?

A

Due to infection trapped in the appendix by obstruction at the point where it meets the bowel

212
Q

What can inflammation of the appendix be quickly be proceeded by?

A

Gangrene and rupture

213
Q

What does rupture of the appendix lead to?

A

Release of faecal content and infective material into the abdomen, leading to peritonitis

214
Q

When is the peak incidence of appendicitis?

A

Patients afed 10-20 years

215
Q

What is the key presenting feature of appendicitis?

A

Abdominal pain

216
Q

What is the characteristic progression of the pain in appendicitis?

A

Central abdominal pain that moves down to right iliac fossa, and then becomes loalised at McBurney’s point

217
Q

What is McBurney’s point?

A

Localised area one third the distance from the anterior superior iliac spine (ASIS) to the umbilicus.

218
Q

What are the classic features of appendicitis?

A 
Tenderness/ pain at McBurney's point
Anorexia
N&V
Rovsing's sign
Guarding
Rebound tenderness
Percussion tenderness
219
Q

What is Rovsing’s sign?

A

Palpation of the lLIF causing pain in the RIF

220
Q

What signs indicate peritonitis?

A

Rebound tenderness

Percussion tenderness

221
Q

How is appendicitis diagnosed?

A

Based on clinical presentation and raised inflammatory markers

222
Q

What scans may be done to investigate appendicitis?

A

CT to confirm

USS to exclude ovarian/ gynae pathology

223
Q

What is the next step when a patient has a clinical presentation suggestive of appendicitis but investigations are negative?

A

Perform a diagnostic laparoscopy to visualise the appendix directly

224
Q

What are the key differential diagnoses of appendicitis?

A 
Ectopic pregnancy
Ovarian cysts/ torsion
Meckel's diverticulum
Mesenteric adenitis
Appendix mass
225
Q

What is Meckel’s diverticulum?

A

Congenital malformation of the distal ileum that causes bulge in lower part of small intestine

226
Q

What are the complications of Meckel’s diverticulum?

A

Can bleed, become inflamed, rupture or cause a volvulus or intussusception

227
Q

What is mesenteric adenitis?

A

Inflamation of the abdominal lymph nodes, presenting with abdominal pain

228
Q

What is an appendix mass and when does it occur?

A

When the omentum surrounds and sticks to the inflamed appendix, forming a mass in the right iliac fossa/

229
Q

How is appendicitis managed?

A

Appendicectomy

230
Q

What are the complications of appendicectomy?

A 
Bleeding, infection, scars, pain
Damage to bowel and bladder
Removal of normal appendix
Anaesthetic risks
VTE risks
231
Q

What are the causes of vomiting in infants?

A 
GORD
Feeding problems
Infection
Dietary protein intolerances
Intestinal obstruction
Inborn errors of metabolism
Congenital adrenal hyperplasia
Renal failure
232
Q

What are the causes of vomiting in preschool children?

A 
Gastroenteritis
Infection
Appendicitis
Intestinal obstruction
Raised intracranial pressure
Coeliac disease
Renal failure
Inborn errors of metabolism
Torsion of the testis
233
Q

What are the causes of comiting in shool age/ adolescent children?

A 
Gastroenteritis
Infection
Peptic ulceration
H.pylori
Appendicitis
Migraine
Raised ICP
Coeliac
Renal failure
DKA
Alchol/ drug ingestion
Cyclical vomiting syndrome
Bulimia
Pregnancy
Testicular torsion
234
Q

What causes bile stained vomit?

A

Bowel obstruction

235
Q

What is infant colic?

A

When in the first few months of life, there is paroxysmal inconsolable crying or screaming often accompanied by drawing up the knees and passing excessive flatus, for unknown reasons

236
Q

What is volvulus?

A

Condition where the bowel twists around itself and the mesentery

237
Q

Where does the blood supply to the bowel come from?

A

The mesentery (through mesenteric arteries)

238
Q

What does twisting in the bowel lead to?

A

Closed-loop bowel obstruction (where section of bowel is isolated by obstruction on either side), leading to ischaemia and necrosis

239
Q

What is malrotation?

A

When the bowel does not rotate into the normal position during fetal development

240
Q

What are the two presentations of malrotation?

A

Obstruction

Obstruction with compromised blood supply

241
Q

How does malrotation usually present?

A

With volvulus in the first week of life

242
Q

What are the symptoms of malrotation?

A

Bilious vomiting

243
Q

How is malrotation managed?

A

Surgery to untwist volulus and return bowel to correct position.

Paeds (18 decks)

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