GI Flashcards
Duodenal atresia AXR
double bubble
Obstruction AXR
air fluid levels
Bilious vomiting few hours after birth may be due to…
duodenal atresia
Bilious vomiting within 24h of birth may be due to…
jejunal/ileal atresia
Bilious vomiting with failure to pass meconium may be due to…
- meconium ileus
- meconium plug
- rectal atresia
- Hischsprung
Bilious vomiting 1-7 days after birth may be due to…
malrotation with volvulus
Bilious vomiting in 2nd week of life may be due to…
NEC
What is the SURGICAL Mx for GORD in children?
Nissen fundoplication
When does pyloric stenosis present?
2-8 weeks of age
What metabolic state does pyloric stenosis cause?
hypokalaemic hypochloraemic alkalosis (low Na, K and Cl)
Signs of pyloric stenosis on abdo exam
- palpable olive-like mass in RUQ
- visible peristalsis
What fluids are given in pyloric stenosis?
normal saline + potassium (to correct electrolyte imbalance)
1st line disimpaction regimen
Movical paediatric plan:
polyethylene glycol (macrogol) + electrolyte
escalating over 1-2 weeks/until impaction resolves
Maintenance Mx of constipation
polyethylene glycose + electrolyte (Movical paediatric plan) ± stimulant laxative (e.g. senna)
What does explosive discharge of liquid stool and gas following PR exam suggest?
Hischsprung
Diagnosis of Hischsprung
Suction rectal biopsy:
- absence of ganglion cells
- presence of large acetylcholinesterase-positive nerve trunks
When does intussusception present?
any age but peak 3 months - 2 years
How does intussusception present
- often prodromal period of viral illness (e.g. gastroenteritis) if PRIMARY intussusception
- paroxysmal, severe colicky pain with pallor
- (bile stained) vomit
- sausage shaped mass in abdomen
- redcurrant jelly/bloody stool
- abdo distension
- shock
Doughnut/target sign on US
intusussception
CIs to radiological reduction via rectal air insufflation for intussusception
- peritonitis
- shock
- perforation
- known pathological lead point (secondary intussusception)
How does Meckel diverticulum present
- most are asymptomatic
- may present with: severe rectal bleeding, usually with acute reduction in Hb
- may also have intussusception, volvulus or diverticulitis (mimicking appendicitis)
What Ix is indicated in any child with dark green vomit, and why?
upper GI contrast study to assess internal rotation (?malrotation and volvulus)
What are the adhesions called in malrotation?
Ladd bands
What Ix is always indicated in chronic/recurrent abdo pain in children?
urine MC&S for UTI
