GI bits Flashcards
intussception defintion + commonest site
the invagination of one portion of bowel into the lumen of the adjacent bowel
ileo-caecal region
what ages intussception commonly present
6-18months old
boys twice as often as girls
intussception presentation
intermittent, severe, crmapy, progressive abdo pain
inconsolable crying
draw knees up + turn pale
sausage shaped mass in RUQ
bloodstained stool red-currant jelly = late sign
intussception investigation
ULTRASOUND - target like mass
management of intussception
1st line = reduction by air insufflation under radiological control
if fails/peritonitis signs -> surgery
pyloric stenosis + typical age of presentation
hypertophy of circular muscles of pylorus
2-4wks after birth (rarely up to 4months)
- 4x more common in males
- 1st borns affected more
- 15% have fam hx
pyloric stenosis presentation
prohectile vomiting, 30mins after feed
- constipation/dehydration
- palpable mass in upper abdo
hypochloraemic, hypokalaemic alkalosis
diagnosis + management of pyloric stenosis
ultrasound
Ramstedt pyloromyotomy
Hirschsprung’s disease pathophys
aganglionic segment of bowel (obstruction) due to a developmental failure of the parasympatheric Auerbach + meissner plexuses
- neuroblasts fail to migrate from neural crest to distal colon
rare, imprtant ddx in kids constipation
Hirschsprung’s disease association
downs syndrome
3x more in males
Hirschsprung’s disease presentation
neonates = failure / delay to pass meconium
older kids = constipation, abdo distension
Hirschsprung’s disease investigation
gold standard diagnosis = rectal biopsy
- abdo xray
Hirschsprung’s disease management
initially - rectal washouts/bowel irrigation
definitive mx = surgery to affected segment of colon
meckels diverticulum
congenital diverticulum of small intestine
- remenant of omphalomesenteric duct - contains ectopic ileal, gastic or pancreatic mucosa
rules of 2s
- 2% of population
- 2feet from ileocaecal valve
- 2 inches long
meckels diverticulum presentation
usually asymptomatic
abdo pain mimicking appendicitis
rectal bleeding
intestinal obstruction - 2nd to omphalomesenteric band, volvulus + intussception
commonest cause of painless massive GI bleed in kid age 1-2 requiring transfusion
Meckel’s diverticulum
meckels diverticulum investigation
haemodynamically stable = 99m technetium pertechetate (Meckel’s scan)
more severe (transfusion req.) = mesenteric arteriography
management of meckels diverticulum
removal if narrow neck or symptomatic
- wedge excisionn or small bowel resection + anastamosis
oesophageal atresia
assoc with tracheo-oesophageal fistula + polyhydramnios
px = choking + cyanotic spells following aspiration
