GI pathologies Flashcards
Give some common causes of acute abdominal pain in children:
Gastroenteritis Constipation UTI Acute appendicitis Volvulus Intussusception HSP DKA Renal / biliary / uteric stones
A patient presents with pallor and intermittent colicky pain (screaming). They are between the ages of 3-24 months - what is the most likely diagnosis?
Intussusception
Red current jelly stool is a classic sign of what?
Intussusception
What is the most common cause of diarrhoea in children
Rotavirus
In a patient with intussusception, what examination finding would you expect?
Sausage shaped mass on abdominal palpation
On AXR what would be seen in intussusception?
Doughnut sign
Define intussusception and state where is intussusception most likely to occur?
Telescoping of one part of the bowel into another.
75% of cases involved the ileum and the caecum
How is intussusception managed?
Air or barium enema
if fails or patient has peritonitis –> laparotomy is required.
Perforation in acute appendicitis is rare in paediatrics true or false?
False
Perforation is extremely common, especially in much younger - up to 90% so appendectomy is always required!
What investigations would be appropriate in patients with suspected appendicitis?
USS of abdomen
Or abdominal ct
(Ab xray is useless)
Dipstick urine to rule out UTI
Define volvulus:
Torsion of a malrotated intestine i.e. when a preexisting malrotation leads to the intestines twisting around each other. Can result in an infarcted bowel
Patient presents with acute abdominal pain, which is severe and unrelenting in nature, abdominal distension accompanied with bilious vomit. What is the most likely diagnosis?
Volvulus
When would you see the coffee bean sign on an xray/
In a patient with a volvulus
Bile stained vomit in the first few days of life is most likely to be indicative of what?
Duodenal or ileal atresia
Congenital malrotation
Infant presents with vomiting after every feed, some failure to thrive, but always hungry. Potentially some episodes of crying in pain / colicky. What’s the likely diagnosis?
Reflux disease
Any febrile illness in infants can cause diarrhoea - true or false?
True.
Infants and paediatric patients often present with diarrhoea as the main symptom of any form on infection including UTIs, CNS and chest infections.
What form of acid-base disturbance would be seen in an infant with pyloric stenosis and why?
Metabolic alkalosis
Loss of H+ ions from persistent vomiting
What are some red flag signs in a dehydrated patient?
Sunken eyes Altered responsiveness Tachycardia Tachypnoea Reduced skin turgor (sunken fontanelles)
2y/o child presents with failure to thrive, anorexia, irritable, vomiting and diarrhoea which is pale and foul smelling. Signs include abdominal distension and pallor. What is the most likely diagnosis?
Coeliacs disease
What is a common parasitic cause of diarrhoea in children?
Giardia lamblia
When would faecal calprotectin be found in a stool sample?
In patients who suffer from inflammatory bowel disease.
What can commonly occur in children following an episode of gastroenteritis and why does it happen?
Short term lactose intolerance
The mucosal surface cells are stripped off the bowels during the gastroenteritis episodes; these cells contain lactase. The child will require lactofree substances for few weeks but it is not a permanent change.
What diagnosis must be considered in a child with abdominal pain if they are African / Caribbean ?
Sickle cell anaemia
What % of children will experience recurrent abdominal pain and how many will be from an organic source?
10-15% of schoolchildren will experience stomach pain
Only 1/10 of these will be from an organic source.
How is chronic constipation officially diagnosed?
They must have the symptoms for minimum 1 month and have two of the following:
- Less than 3 defecation a week
- At least one episode of soiling per week (post toilet trained)
- History of excessive stool retention or retention posturing
- Passing of stools with very large diameter
- Passing of stools which are painful and hard/dry
What are some of the risk factors for constipation?
Diet and dehydration Holding of stools Change in routine Lack of exercise Genetics Medications
What are some conditions in paediatrics which can lead to secondary constipation?
Hypothyroidism
Coeliac disease
Cystic fibrosis
List some investigations you would do in acute abdominal pain and why?
FBC - leukocytosis = appendicitis and UTI
Urine dipstick - UTI or haematuria = HSP
Urine culture - Infection source
Abdo Xray - Dilated bowel loops, faecal loading etc
Abdo USS - Intussusception, renal tract abnormality
CRP / ESR - will be raised in IBD and infections
