GI Obstruction in children **** Flashcards
Causes
Pyloric stenosis Duodenal atresia Intussusception Malroatation and volvulus Meckels Strangulated inguinal hernia Hirschsprung;s Meconium ileus
S+S
Vomiting - possibly bile stained if obstruction is below the sphinter of Oddi
Abdominal distention
Intussusception
What is it?
At what age?
What is is linked to?
Telescopiong of bowel usually ileum into cecum
6-36 months
Infection leading to Peyer’s patch hypertrophy
Polyps and tumours in older children
Intussusception
S+S especially in infants
What can be felt in the abdomen?
What is quite a late sign and what does it suggest?
Episodic, severe colickly pain and pallor with knees drawn up
Bile-stained vomit
Shock
Sausage shaped mass in abdomen and/or abdo distention
Redcurrent jelly stool - blood stained - bowel ischaemia
Intussusception
Imaging used and what you’d see
Management - 2
USS - doughnut sign
US-guided air enma insufflation
Surgery
Hirschsprung’s Disease
- What is it?
- Where does it usually effect?
- When is it usually diagnosed?
Congenital abscence of ganglion cells in the myenteric and submucosal plexus.
Abscence of parasympathetic action leads to bowel obstruction
Usually affects the rectosignmoid but can be whle colon
Usually <1 yr
Hirschprung’s Disease
- S+S
- Complication and what it can lead to?
- Investigations? - 1st and 2nd line and what can be used to confirm diagnosis
Abdominal distention
Delayed meconium passage
Chronic constipation and occasionally overflow diarrhoea
Vomiting which may be bilious
Enterocolitis - leads to explosive diarrhoea and sepsis
Barium enema - X-ray will show dilated proximal colon and contracted distal colon
Plain AXR - shows dilated colon
Rectal biopsy confirms diagnosis
Hirschprung’s Disease
-Management
Surgical removal of aganglionic bowel segment
Preceded by bowel irrigation to clear it out and reduce distention.
Tube place in rectum, saline enters, then exits through tube with bowel contents.
Differs from enema in which fluid is retained
Fluid and antibiotics first in enterocolitis.
Malrotation and Volvulus
Define
When does a volvulus usually occur?
M - a range of congenital anatomical abnormalties of the GI tract
Severe complication in which loop of bowel twists around its mesenteric attachment cuasing intestinal obstruction
<1 yr old
Malrotation and Volvulus
S+S
What would happen systemically and why?
What about malrotation?
Billious green vomiting
Severe acute abdo pain
Abdominal distention
Systemic symptoms if there is ischaemia (e.g. high HR and low BP)
Often assymptomatic or may cause intermittent, self-resolving obstruction
Malrotation and Volvulus
What study is used to diagnose?
What would be seen?
Upper Gi contrast study
Corkscrew duodenum in volvulus
Rx for Volvulus
Rx for malrotation
‘Drip and suck’
IV fluids and nasogastric decompression followed by urgent surgery
Elective surgery - usually Ladd’s procedure
Pyloric Stenosis
Risk factors
When does it present?
S+S
What can be felt on abdomen?
What could you see by just looking at abdomen?
Males
Firstborn
FH
2-7 weeks
Projectile, non-bilious vomiting after feeds
Hunger
Olive-shaped mass in RUQ
Visible peristalsis
Pyloric Stenosis
Imaging
Bloods
Blood gas - what you would look for?
USS
U&E’s - low chloride and low potassium
Metabolic alkalosis
Pyloric Stenosis
Management - 2
Fluids
Surgical repair through pylorotomy which involves longitudinal splitting of the pyloric muscle
