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3a Child Health > GI > Flashcards

GI Flashcards

1
Q

What is intussusception

A

Invagination of the proximal bowel into a distal segment
i.e. bowel telescopes into itself

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2
Q

Where in the bowel does intussusception commonly occur

A

Commonly involves ileum passing into the caecum through the ileocecal valve

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3
Q

What is the peak age of presentation for intussuception

A

Infants aged 3m - 2 years

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4
Q

Give 4 conditions associated with intussuception

A
  • Concurrent viral illness
  • Meckel diverticulum
  • CF
  • Henoch-Schonlein purpura
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5
Q

What is the investigation of choice for stable children with suspected Meckel’s diverticulum

A

A technetium scan

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6
Q

Give 5 ways intussuception may present

A
  • Paroxysmal, severe colicky abdo pain
  • Blood and mucus in stool - redcurrant jelly stool (late sign)
  • Sausage-shaped palpable mass
  • inconsolable crying - may draw up legs
  • Vomiting - may be billous depending on the location
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7
Q

Investigations for intussuception

A
  • Abdo USS (diagnostic) - target/doughnut sign
  • Abdo XR - distended small bowel, absence of gas in large bowel
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8
Q

How is intussuception managed

A
  • IV fluid
  • Reduction by rectal air insufflation (enema)
  • Surgical reduction
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9
Q

When is surgical reduction required for intussuception

A
  • If an air enema is unsuccessful
  • Signs of peritonitis
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10
Q

Give 4 complications of intussuception

A
  • Hypovolaemic shock
  • Venous obstruction due to stretching and constriction of the mesentery
  • Bowel perforation
  • Gangrenous bowel
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11
Q

What is pyloric stenosis

A

progressive hypertrophy of the pyloric sphincter causing gastric outlet obstruction

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12
Q

At what age does pyloric stenosis typically present

A

2 - 8 weeks of age

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13
Q

3 RFs of pyloric stenosis

A
  • boys
  • maternal FHx
  • First born
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14
Q

Clinical presentation of pyloric stenosis (4)

A
  • Non-billous, projectile vomiting after every feed
  • Olive sized pyloric mass
  • Weight loss
  • Dehydration
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15
Q

How is pyloric stenosis investigated? Give positive findings

A
  • Abdo ultrasound - pyloric hypertrophy
  • Chemistry panel: Blood gas - Hypochloremic, hypokalaemic metabolic alkalosis, low plasma Na
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16
Q

How is pyloric stenosis managed

A
  • IV fluids - correct metabolic disturbance
  • (Ramstedt’s) Pyloromyotomy
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17
Q

What is Hirschsprung’s disease

A

A congenital condition where parasympathetic ganglionic cells of the myenteric plexus are absent in the distal bowel and rectum

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18
Q

Explain the pathophysiology of hirschsprung’s disease

A
  • parasympathetic neuroblasts fail to migrate from the neural crest to the distal colon
  • the nerve plexus is responsible for stimulating peristalsis of the large bowel
  • the aganglionic section of the colon does not relax, causing it to become constricted (uncoordinated peristalsis)
  • this leads to loss of movement of faeces and bowel obstruction
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19
Q

What length of the colon is affected in Hirschsprung’s disease

A

always located distally, but length of the segment varies
* mc confined to the rectosigmoid
* Can affect entire colon

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20
Q

The entire colon can be affected by Hirschsprung’s disease. What is the name for this

A

total colonic aganglionosis

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21
Q

When is Hirschsprung’s disease typically diagnosed

A

Within first year of life

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22
Q

Give 3 conditions associated with Hirschsprung’s disease

A
  • Down’s syndrome
  • multiple endocrine neoplasia type IIA
  • Neurofibromatosis
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23
Q

Presentations of Hirschsprung’s disease (5)

A
  • Abdo distension
  • Billous vomiting
  • Chronic constipation usually without soiling
  • Explosive passage of liquid and foul stool following rectal exam
  • Failure to pass meconium in 24h
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24
Q

What investigations should be done for Hirschsprung’s disease

A
  • Initial diagnosis: contrast enema
  • Abdo XR - dilated colon
  • Suction rectal biopsy (GS) - absence of ganglion cells + increased activity of acetylcholinesterase
25
Q

How is typical Hirschsprung’s disease managed

A
  • Bowel irrigation/ rectal washouts
  • Surgery: removal of distal aganglionic segment
26
Q

How is total colonic aganglionosis managed

A
  • Colectomy
  • Ileo-procto anastomosis
  • Protective ileostomy with closure later in life
27
Q

What is Hirschsprung-associated enterocolitis

A

Inflammation and obstruction of the intestine occasionally occurring in infants with Hirschsprung’s disease

28
Q

Why is Hirschsprung enterocolitis life threatening

A

Can lead to toxic megacolon and perforation of the bowel

29
Q

How is Hirschsprung enterocolitis treated

A
  • Bowel irrigation
  • Urgent Abx - Oral/ IV metronidazole
  • IV fluids
  • Decompression of obstructed bowel
30
Q

What is the cause of most cases of constipation in children

A

Idiopathic / functional constipation

31
Q

Give 4 secondary causes of constipation in children

A
  • Hirschsprung disease
  • hypothyroidism
  • coeliac disease
  • lower spinal cord problems
32
Q

How does constipation present in children

A
  • Less than 3 stools a week
  • Large, infrequent stools that can block the toilet
  • Straining and painful passages of hard stools
  • Overflow soiling caused by faecal impaction
  • poor appetite
33
Q

Explain how severe constipation can cause faecal impaction

A
  • the rectum becomes overdistended, with a subsequent loss of feeling the need to defecate
  • involuntary soiling may occur as contractions of the full rectum inhibit the internal sphincter
  • this leads to overflow
34
Q

Give 4 red flag symptoms associated with constipation in children

A
  • failure to pass meconium within 24h of life (Hirschsprung’s or CF)
  • failure to thrive (coeliac, hypothyroidism)
  • abnormal lower back/ bum (spina bifida occulta)
  • Perianal bruising or multiple fissures (sexual abuse
35
Q

How is constipation managed in children

A
  • correct any reversible conditions - high fibre diet, good hydration
  • Laxatives: 1st movicol , add stimulant (senna) if no response
  • Faecal impaction: disimpaction regimen followed by maintenance (movicol and stimulants)
  • encourage and praise using the toilet
36
Q

What is Meckel’s diveticulum

A

Congenital diverticulum (outpuching) of the small intestine containing ileal, gastric and pancreatic mucosa

37
Q

How does Meckel’s diverticulum typically present

A
  • Abdominal pain
  • Large painless rectal bleed in children age 1-2 years
  • Obstruction secondary to an omphalomesenteric band, intussusception and volvulus
38
Q

What is biliary atresia

A

Obstruction of the biliary tree due to sclerosis of the bile duct, reducing bile flow

39
Q

Describe the epidemiology of biliary atresia

A
  • mc in Females
  • Neonatal cholestasis presents within 2-8 weeks of life
  • Associated with CMV
40
Q

Describe the 3 types of biliary atresia

A
  • Type 1: Common duct is obliterated, proximal ducts are patent
  • Type 2: Atresia of the cystic duct in the porta hepatis
  • Type 3: mc, atresia of the right and left ducts to the level of the porta hepatis
41
Q

Describe the presentation of biliary atresia

A

typically presents in the first few weeks of life
* jaundice extending beyond physiological 2 weeks
* dark urine and pale stools
* appetite disturbance
* abnormal growth
* hepatosplenomegaly

42
Q

How is biliary atresia investigated, give positive findings

A
  • serum bilirubin: conjugated bilirubin high
  • LFTs raised
  • Alpha 1 antitrypsin to rule out deficiency
  • Sweat test to rule out CF
  • USS to look for structural abnormalities
43
Q

How is biliary atresia managed

A
  • surgical dissection of structural abnormalities
  • antibiotics following surgery
44
Q

Give 2 complications of biliary atresia

A
  • cirrhosis with eventual hepatocellular carcinoma
  • progressive liver disease
45
Q

What is intestinal malrotation

A

twisting loop of bowel leading to intestinal obstruction

46
Q

How does intestinal malrotation and volvulus typically present in children

A
  • billous vomiting
  • obstruction: absent bowel sounds, constipation, distended abdomen
  • poor appetite
  • abdo pain
  • commonly affects neonates in the first 30 days of life
47
Q

How is malrotation and volvulus investigated

A

abdominal XR with contrast - double bubble sign

48
Q

Management of intestinal malrotation with volvulus

A

Ladd’s procedure (includes division of Ladd bands and widening of the base of the mesentery)

49
Q

What is Gastro-oesophageal reflux

A

where contents from the stomach reflux through the lower oesophageal sphincter into the oesophagus, throat and mouth

50
Q

Give 2 RFs of gastro-oesophageal reflux in children

A
  • preterm delivery
  • neurological disorder
51
Q

When does gastro-oesophageal reflux typically develop in infants?

A

before 8 weeks of age

52
Q

What are the common features of gastro-oesophageal reflux in children

A
  • Vomiting or regurgitation
  • Milky vomits after feeds
  • Reflux may occur after being laid flat
  • Excessive crying, especially while feeding
53
Q

How is gastro-oesophageal reflux managed in children

A
  • Small, frequent meals
  • Burping regularly to help milk settle
  • Not over-feeding
  • Keep the baby upright after feeding (i.e. not lying flat)
  • thickened milk/ formula or gaviscon mixed with feeds
54
Q

What is infantile colic?

A

typically occurring in those less than 3 months old, characterized by excessive crying and pulling-up of the legs, often worse in the evening

55
Q

What is gastroenteritis

A

inflammation from the stomach to the intestines and presents with nausea, vomiting and diarrhoea

56
Q

What is the most common cause of gastroenteritis

A

viral
* rotavirus
* norovirus

57
Q

What is the main risk of gastroenteritis in children

A

severe dehydration

58
Q

Give 4 differentials of diarrhoea in children

A
  • most common cause in the developed world is cows’ milk intolerance
  • coeliac disease
  • post-gastroenteritis lactose intolerance
  • Toddler’s diarrhoea
59
Q

How is gastroenteritis managed

A
  • Children need to stay off school until 48 hours after the symptoms have completely resolved
  • rehydration

3a Child Health (19 decks)

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