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Child Health > GI/Surgery Problems > Flashcards

GI/Surgery Problems Flashcards

1
Q

What is the differential for non-bloody diarrhoea in children?

A

Infectious: gastroenteritis or any infection (UTI, appendicitis)
Malabsorption: CF, Coeliac (also causes constipation)
Dietary: cow’s milk protein allergy, lactose intolerance
IBD
IBS

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2
Q

What is the differential for bloody diarrhoea in children?

A

Infectious + inflammatory:
- bacterial GE, IBD, NEC, HUS
Obstruction:
- intussusception, midgut volvulus
Cow’s milk protein allergy (flecks of blood)
Juvenile polyps or Meckel’s may cause PR bleeding without diarrhoea

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3
Q

What is Toddler diarrhoea?

A

Chronic diarrhoea syndrome
No other abdominal symptoms –> thriving child
Usually resolves by 5 years

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4
Q

What are the differentials for acute vomiting in children?

A

Infection:

  • gastroenteritis or any other infection
  • pyloric stenosis
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5
Q

What are the differentials for blood-stained vomiting in children?

A

Oesophagitis
PUD
Malrotation
Pertussis

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6
Q

What does bile stained vomit suggest in children?

A

GI obstruction

- obstruction below the sphincter of Oddi

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7
Q

What does chronic vomiting suggest in children?

A

GORD

Overfeeding

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8
Q

What are the risk factors for GORD in children?

A 
Prematurity
Parental history of heartburn or reflux
Obesity
Hiatus hernia
Repaired congenital diaphragmatic hernia
Repaired congenital oesophageal atresia
Neurodisability e.g. cerebral palsy
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9
Q

What is the difference between GOR + GORD?

A

Gastro-oesophageal reflux is normal in infants if asymptomatic

GORD is the presence of symptoms/complications from the reflux

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10
Q

What are the symptoms of GORD in infants?

A

Distressed behaviours e.g. excessive crying, unusual neck postures, back arching
Unexplained feeding difficulties e.g. refusing, gagging, choking
Hoarseness +/- chronic cough
Episode of pneumonia
Faltering growth

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11
Q

What is the management for effortless regurgitation after feeds?

A

If otherwise well –>

no intervention, improves with age, reassurance is key

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12
Q

What is the management for GORD in breastfed infants?

A

Alginate (Gaviscon) mixed with water immediately after feeds

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13
Q

What is the management for GORD in formula-fed infants?

A

Ensure infant not over-fed (no more than 150ml/kg/day)
Decrease feed volume by increasing frequency
Use feed thickener if still no better
Stop thickener and start alginate added to formula

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14
Q

If there is no improvement following alginate therapy for two weeks, what should be done next for an infant with GORD?

A

Try ranitidine

or omeprazole

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15
Q

When should serological testing for Coeliac disease be offered to children?

A 
Persistent, unexplained GI symptoms
Faltering growth
Prolonged fatigue
Unexpected weight loss
Severe or persistent mouth ulcers
Unexplained iron, B12 or folate deficiency
T1DM or AI thyroid disease at diagnosis
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16
Q

How is Coeliac disease diagnosed?

A

Patient must have gluten in diet for at least 6 weeks before test

Test for total IgA + IgA tissue transglutaminase (tTG)

If serology positive –> duodenal biopsy:

  • lymphocytic infiltration
  • crypt hyperplasia +/- villous atrophy
  • biopsy sometimes not necessary in children if classic symptoms + tTG > 10x upper limit of normal

Second sample for:

  • anti-endomesial antibodies (EMA)
  • HLA DQ2 + DQ8 phenotyping
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17
Q

Which conditions are associated with Coeliac disease?

A 
T1DM
AI thyroid disease
Juvenile chronic arthritis
Down's syndrome
Turner syndrome
Williams syndrome
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18
Q

What are the complications associated with Coeliac disease?

A 
Osteoporosis
Anaemia
Short stature
Delayed puberty
Female infertility
Intestinal malignancies (T cell lymphoma)
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19
Q

How is constipation diagnosed in children?

A

At least 2 of the following, present for at least 1 month:

  • < 3 bowel movements per week
  • faecal incontinence at least once per week (after toilet trained)
  • excessive stool retention or retentive posturing
  • painful or hard bowel movements
  • large faecal mass in rectum
  • large diameter stools
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20
Q

Which features of constipation may be suggestive of a organic cause?

A

Delayed passage of meconium >24 hours
Recurrent rectal prolapse (CF)
Failure to thrive
Abnormal position of anus
Explosive passing of stools following rectal exam (Hirschsprung’s)
Skin tags - usually caused by healed fissures (Crohn’s, sexual abuse)

21
Q

How is constipation treated in children?

A

Softeners e.g. laxido
Monitor with Bristol stool chart
May need to add stimulant e.g. Docusate or Senna

22
Q

What are the features of GI obstruction in children?

A

Vomiting, may be bile stained if obstruction below the sphincter of Oddi
Abdominal distension, esp if lower

23
Q

What are the possible causes of GI obstruction in children?

A 
Pyloric stenosis
Duodenal atresia (first 24 hours of life)
Intussusception
Malrotation + volvulus
Meckel's diverticulum
Strangulated inguinal hernia
Hirschsprung's
Meconium ileus
24
Q

What is intussusception and when does it usually present?

A

Telescoping of the bowel, usually of ileum into caecum

Usually age 6-36 months

25
Q

What are the clinical features of intussusception?

A

Episodic, severe colicky pain + pallor, with knees drawn up
Sausage shaped mass in abdomen +/- distension
Redcurrent jelly stool (blood stained) - late sign, suggests ischaemia has occurred
Bile-stained vomit
Shock

26
Q

How is intussusception diagnosed?

A

USS –> doughnut sign

27
Q

How is intussusception managed?

A

US guided air enema insufflation

Surgery needed in 25%

28
Q

What is Hirschsprung’s disease?

A

Congenital absence of ganglion cells in mesenteric + submucosal plexus
Absence of parasympathetic action –> bowel obstruction
10% also have Down’s

29
Q

What are the clinical features of Hirschsprung’s?

A

Delayed passage of meconium > 48 hours
Abdominal distension
Chronic constipation + overflow diarrhoea
Vomiting, may be bilious
Enterocolitis is a serious complication (explosive diarrhoea + sepsis)

30
Q

How is Hirschsprung’s diagnosed?

A

Rectal biopsy –> absence of ganglion cells

Barium enema shows dilated proximal colon + contracted distal colon

31
Q

What is malrotation + volvulus?

A

Malrotations are congenital anatomical abnormalities of the GI tract
Volvulus is a severe complication of this –> loop of bowel twists around mesenteric attachment –> obstruction

32
Q

Where are when does malrotation volvulus most commonly occur?

A

Midgut volvulus –> twisting around SMA (superior mesenteric artery)
< 1 year old

33
Q

What are the clinical features of malrotation volvulus?

A

Bilious (green) vomit
Severe, acute abdominal pain
Abdominal distension
Systemic symptoms if there is ischaemia

34
Q

Which investigation is done for malrotation volvulus and what does it show?

A

Upper GI contrast study, with contrast through NG tube or bottle
–> corkscrew duodenum

35
Q

How is malrotation (without volvulus) managed?

A

Elective surgery –> Ladd’s procedure to untwist bowel

36
Q

How is volvulus managed?

A

Drip + suck –> IV fluids + NG decompression

Followed by urgent surgery

37
Q

What are the clinical features of pyloric stenosis?

A

Presents at 2-7 weeks with:

  • projectile, non-bilious vomiting after feeds
  • hunger
  • olive shaped mass in RUQ
  • visible peristalsis
38
Q

How is pyloric stenosis managed?

A

Fluids

Surgical repair –> pylorotomy (splitting pyloric muscle)

39
Q

What is mesenteric adenitis and how does it present?

A

Mesenteric lymph node enlargement, associated with URTI or other viral infection

  • generalised abdominal pain
  • main differential of appendicitis in children
  • may have headache + photophobia
40
Q

Which FBC feature would be present in mesenteric adenitis?

A 
Raised lymphocytes
(neutrophils would be raised in appendicitis)
41
Q

How is mesenteric adenitis managed?

A

Simple analgesia

42
Q

What is cow’s milk protein allergy?

A

Allergic reaction to casein or whey proteins in milk (not lactose)
Can be IgE mediated (type 1 hypersensitivity) or non-IgE mediated (type 4)

43
Q

What are the risk factors for cow’s milk protein allergy?

A

Family history of atopy

Breast feeding increases risk of non-IgE mediated but reduces risk of IgE mediated

44
Q

What are the features of IgE mediated cow’s milk protein allergy?

A

Immediate urticaria + face swelling

If severe: diarrhoea, vomiting + anaphylaxis

45
Q

What are the features of non-IgE mediated cow’s milk protein allergy?

A

Failure to thrive + poor feeding
Loose stools, may contain streaks of blood
Abdominal pain
Vomiting, possible with blood
May be treatment resistant GORD, eczema or colic

46
Q

How is cow’s milk protein allergy diagnosed?

A

Usually clinically based on good history + examination

Blood test for specific IgE to cow’s milk protein (RAST testing) can be useful for IgE mediated allergy if unclear

47
Q

How is cow’s milk protein allergy managed?

A

Avoidance of cow’s milk in all forms, including mother’s diet if breast feeding
If formula fed replace with hypoallergenic formula:
- extensively hydrolysed formula (made from cow’s milk but proteins broken down)
- amino acid formula (second line)
Re-evaluate every 6-12 months to assess tolerance to cow’s milk protein

48
Q

Can soya milk be used in cow’s milk protein allergy?

A

Not recommended due to oestrogenic effect

Child Health (16 decks)

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