GI Flashcards
why is GORD common in infancy
*functional immaturity of the lower oesophageal sphincter
*predominantly fluid diet
*horizontal posture
*short oesophagus
at what age should GORD resolve by itself
1yr
clinical presentation of GORD
chronic cough
hoarse cry
distress, crying after feeding
reluctance to feed
poor weight gain
management/advice to prevent GORD
small, frequent meals
burping regularly
not overfeeding
keep baby upright after feeding
complications of GORD
sandifer’s syndrome
oesophagitis
failure to thrive
recurrent pulmonary aspiration
what is intussusception
invagination of proximal bowel into a distal segment
most common cuase of intestinal obstruction infants
what age is intussusception is common
3months -2yrs
clinical presentation of intussusception
severe colicky pain
pale
refusal of feeds
bile-stained vomit
red currant jelly stool
distension
what investigation is diagnostic in intussusception
USS - diagnostic
what is seen in xray in intussusception
absence of gas in distal colon or rectum
distended small bowel
initial intussusception management
supportive (IV fluids , NG tube )
air enema
surgery if air enema is unsuccessful or peritonitis
complications of intussusception
- necrosis
- bleeding
- peritonitis
complications of intussusception
- necrosis
- bleeding
- peritonitis
risk factors of pyloric stenosis
male
first borns
fh
2-7 weeks
clinical presentation of pyloric stenosis
projectile vomiting
hunger and dehydration
visible gastric peristalsis
weight loss
investigations of pyloric stenosis
bloods showing hypochloraemic metabolic alkalosis with hyponatraemia and hypokalaemia
USS showing thickening of pylorus
management of pyloric stenosis
correct fluid and electrolyte disturbances with IV fluids and then surgery
difference between marasmus and kwashiorkor
marasmus - deficiency of all macronutrients
kwashiorkor - protein deficiency malnutrition
clinical presentation of marasmus
- muscle wasting
- stunted growth
- anaemia
- children appear withdraw and apathetic
clinical presentation of kwashiorkor
- flaky paint dermatosis
- distended abdomen
- oedema
- hepatomegaly
- diarrhoea
management for marasmus and kwashiorkor
specially formulated milk-based feeds or ready to use therapeutic food
what is Hirschsprung’s disease
congenital condition where ganglion cells of the myenteric and submucosal plexuses are absent in the large bowel resulting in a narrow contracted segment
function of myenteric/ auerbach’s plexus
responsible for stimulating peristalsis of the large bowel
presentation of hirschsprung disease
failure to pass meconium in 24hrs
vomiting
abdo pain and distention
chronic constipation
poor weight gain and failure to thrive
neonatal period presentation of Hirschsprung disease
failure to pass meconium in 24hrs
what is hirschprung associated enterocolitis
inflammation and obstruction of the intestine in neonates with hirschprungs disease
complication of hirschprung associated enterocolitis
toxic megacolon and perforation of the bowel
how does hirschprung associated enterocolitis present
2-4 weeks after birth with fever, abdo distention, diarrhoea and features of sepsis
what is cows milk allergy
hypersensitivity to protein in cow’s milk
types of cows milk allergy
- IgE mediated - reaction within 2 hours of ingestion (allergy)
- non-IgE mediated- reaction between 2-72hrs (intolerance)
- mix of both
risk factors for cows milk allergy
- formula fed babies
- personal or fh or atopic conditions
clinical presentation of cows milk allergy
GORD
abdo pain
wind
diarrhoea
vomiting
allergy symptoms e.g. urticaria, SOB, angio-oedema
management of cows milk allergy
- breastfeeding mothers should avoid dairy products
- replace formula with special hydrolysed formulas (protein broken down so immune response not triggered)
milk ladder - expose to new dairy products every 6months or so until they develop symptoms
when shows kids outgrow cows milk allergy
by 3yrs
what is meckel’s diverticulum
congenital malformation of the distal ileum which is formed from tissue similar to that found in the pancreas or stomach
complications of meckel’s diverticulum
ulcers
peritonitis
volvulus
intussusception
clinical presentation of meckel’s diverticulum
generally asymptomatic
rectal bleeding- not bright red or melaena
treatment for meckels
surgical resection
what is biliary atresia
congenital condition where a section of the bile duct is either narrowed or absent which can result in cholestasis
clinical presentation of biliary atresia
jaundiced shortly after birth which lasts for more than 2 weeks in term babies and more than 3 weeks in premature babies
pale stools and dark urine
hepatomegaly
splenomegaly
management of biliary atresia
surgery- kasai procedure
patients might require full liver transplant
what are choledochal cysts
congenital swelling or dilatation of the bile ducts which can affect the extrahepatic and/or intrahepatic segments
classic triad of choledochal cysts
abdo pain
abdo mass
jaundice
investigations for choledochal cysts
UUS or radionuclide scanning
treatment for choledochal cysts
surgical excision
reasons for physiological jaundice in babies
- shorter life span of red cells
- hepatic bilirubin metabolism is less efficient in the first few days of life
when does physiological jaundice resolved
resolves itself in 2 weeks
complication of jaundice
kernicterus
what is kernicterus
encephalopathy due to deposition of unconjugated bilirubin in the basal ganglia and brainstem nuclei
(passes bbb)
what can kernicterus develop into
choreoathetoid cerebral palsy
sensorineural deafness
learning difficulties
clinical presentation of kernicterus
lethargy
poor feeding
increased muscle tone
seizures
at what level do babies become clinically jaundiced
80 µmol/L
what type of bilirubin in present in jaundice <24hrs or congenital jaundice
jaundice <24hrs = unconjugated bilirubin
congenital = conjugated
causes of jaundice <24hrs
rhesus haemolytic disease
ABO incompatibility
G6PD deficiency
spherocytosis
in ABO incompatibility what blood group is mother and foetus
mother - group o
foetus - group a or b
sensitisation in ABO incompatibility and Rh incompatibility
no sensitisation needed in ABO incompatibility so 1st pregnancy can be affected
sensitisation needed in Rh incompatibility so 1st pregnancy is safe
what is toddler’s diarrhoea
commonest cause of persistent/ chronic loose stools in preschool children
not serious and child is well
when does toddler’s diarrhoea stop
most outgrow symptoms by 5yrs
possible cause of toddler’s diarrhoea
maturation delay in intestinal motility leading to intestinal hurry
management for toddler’s diarrhoea
high fat diet
reduce fruit juice or squash
dont drink too much water
adequate fibre
4 Fs’: fat, fluid, fruit juices and fibre
