GI disorders Flashcards
Pyloric stenosis
M>F 5-10% FH in parents Projectile non-bile stained vomiting at 4-6 weeks Dx by test feed or USS Ramstedt pyloromyotomy
Acute appendicitis
Uncommon < 3
May present atypically
Mesenteric adenitis
Central abdo pain and URTI
Conservative management
Intussusception
Telescoping bowel
Proximal to or at level of ileocaecal valve
6-9 months
Colicky pain, diarrhoea and vomiting, sausage shaped mass, red jelly stool
Reduction with air insufflation
Malrotation
High caecum at midline
Feature in exophalos, congenital diaphragmatic hernia, intrinsic duodenal atresia
May be complicated by development of volvulus, infant with volvulus may have bile stained vomiting
Upper Gi contrast study and USS
Tx by laparotomy if volvulus present / at high risk of occuring
Hirschprung’s disease
Absence of ganglion cells from myenteric and submucosal plexuses
1/5000 births
Full thickness rectal biopsy
Delayed passage of meconium and abdominal distention
Rectal washouts, anorectal pull through procedure
Oesophageal atresia
Associated with tracheo-oesophageal fistula and polyhydramnios
May present with chocking and cyanotic spells following aspiration
VACTERL associations
Meconium ileus
Usually delayed passage of meconium and abdo distention
Associated with CF
X-RAYS will not show a fluid level as meconium is viscid, PR contrast studies may dislodge meconium plugs and be therapeutic
Infants who do not respond to PR contrast and NG N-acetylcysteine will require surgery to remove plugs
Biliary atresia
Jaundice > 14 days
Increased conjugated bilirubin
Urgent Kasai procedure
Necrotising enterocolitis
Prematurity main risk factor
Abdo distention and passage of blood
X-rays may shoe pneumatosis intestinalis and evidence of free air
Increased risk when empirical abx are given to infants beyond 5 days
Tx with total gut rest and TPN, babies with perforations will require laparotomy
