high yield- GI Flashcards
why do babies get GORD?
-babies have immature lower oesophageal sphincter
how does GORD present?
- regurgitation
- chronic hiccups
- presents in 1st 2 months of life and improves in first year
investigations for GORD?
- clinical diagnoses
- older kids= 24 hour ambulatory oesophageal pH monitoring
- Suspect oesophagitis= endoscopy
treatment for GORD?
- self resolves in 1 year
- avoid over feeding, feed in prone
- gaviscon immediately after feed
how does pyloric stenosis occur?
progressive hypertrophy of pyloric sphincter muscle which leads to gastric obstruction
how does pyloric stenosis present?
- projectile vomiting (roughly 30 mins after feed)
- child remains hungry and eager to feed
- weight loss
- dehydration + constipation
what investigations are done for pyloric stenosis?
examination- olive shaped mass in RUG
USS- hypertrophic pyloric muscle (DIAGNOSTIC)
Blood gas- hypochloraemia, hypokalaemia + metabolic alkalosis
treatment for pyloric stenosis?
Ramstedt pyloromyotomy
what is intussusception?
- telescoping of small bowel leading to obstruction
- usually involving the ileocecal valve
- can cause bowel necrosis if left untreated
presentation of intussusception?
- child unwell/ floppy
- palpable ‘sausage’ mass
- red current jelly in stool
- vomit + episodic colicky abdo pain
investigations for intussusception?
USS- kidney bean or target/ bulls eye sign
treatment for intussusception?
conservative= air enema retraction
surgical= laparascopic surgery
what causes malrotation with volvulus?
- absent mesentery attachments
- allows organs to wrap around eachother (leading to volvulus)
presentation of malrotation with volvulus?
-green, bilious vomit is malrotation with volvulus until proven otherwise
investigations for malrotation with volvulus?
1st= Abdo Xray 2nd= upper GI contrast
treatment for malrotation with volvulus?
immediate referral to srugery
what is Cow’s protein allergy?
-immune mediated response to casein + weigh
how does Cow’s milk protein allergy present?
- Urticaria, atopic eczema
- colic, irritability, crying
- wheeze, cough
investigations for Cow’s milk protein allergy?
- elimination diet
- skin prick or RAST (radioallergosorbent test)
treatment for Cow’s milk protein allergy?
1st= use extensive hydrolysed formula (eHF)
severe= amino acid based formula
presentation coeliac?
- pale stool
- abdo pain/ bloating
- failure to thrive
- crypt hyperplasia, villi flattening
investigations for coeliac?
GOLD STANDARD= endoscopy w/ith duodenal biopsy
IgA tissue transglutaminase (TTG)
coeliac treatment?
Gluten free diet
most common cause of gastroenteritis?
rotavirus
presentation gastroenteritis?
- acute onset vomiting
- followed by diarrhoea
- post infection lactose intolerance
treatment gastroenteritis?
- oral rehydration therapy (ORT)
- diaorylate
treatment for dehydration?
1st= encourage breast feeding
2nd= oral rehydration solution (ORS) over 4 hours
severe= 0.9% NaCl (slow infusion over 48 hours)
most common cause of lower GI bleed in new born?
- necrotising enterocolitis
- anal fissure
most common cause of lower GI bleed in 1 month- 1 year?
Intussusception
Anal fissure
most common cause of lower GI bleed in 1-2 years?
- polyps
- Meckel’s diverticulum
most common cause of lower GI bleed in >2 years>
- polyps
- intussusception
- IBD
treatment for neonatal sepsis?
IV nezyl penicillin + gentamicing
presnetation of neonatal sepsis?
- fever, tachy ot bradicardia, hypoxia
- poor feeding, vomiting, hypoglycaemia
- resp distress, grunting, apnoea
- seizures
RED FLAGS:
- confirmed or suspected sepsis in mum
- signs of shock (pyrexial or hypothermic)
- resp distress starting >4 hours after birth
- seizures
what is biliary atresia?
- congenital condition
- part of the biliary tract is narrowed/ absent leading to cholestasis
cholestasis= liver disease that occurs when the flow of bile from liver is reduced or blocked
what are the types of biliary atresia?
3= left + right ducts at the level or porta hepatis are narrowed/ absent (>90%)
2= cystic duct + cystic structures are absent
3= proximal ducts are patent but the common duct is not
how does biliary atresia present?
- prolonged jaundice (>14 days)= pale stool + dark urine
- abnormal growth
- hepatosplenomegaly
investigations for biliary atresia?
abdominal USS
liver biopsy
treatment for biliary atresia?
-surgical dissection of abnormalities in ducts
