Intestinal Bleeding In Children Flashcards

1
Q

How to diagnose

A

Signs of shock, abdominal gears, abdominal tenderness, portal hypertension, PR (and and rectal examination)

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2
Q

Do you need a gastroscope to make a diagnosis in a new born with upper gastrointestinal bleeding!

A

No = need anastesia only need nasogastric tube, test blood can be mothers blood

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3
Q

How to resuscitate

A

Nasogastric tube= is bleeding ongoing
Intravenous fluid started -20ml/kg ringer’s lactate, blood products for specific indications, somatostatin analogue- help stop bleeding

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4
Q

Can an infant haver a peptic ulcer and bleed from it?

A

Yes - not as common as adult

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5
Q

Is necrotising enter colitis preventable?

A

Yes due to breast milk

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6
Q

What are the presentations of necrotising enterocolitis

A

Signs of bowel obstruction
Sepsis, acidosis, shock
Blood per rectum

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7
Q

How to diagnose NEC

A

Abdominal x ray

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8
Q

Treatment of NEC

A

NPO
AB
TOTAL PARENTERAL FEEDS
SURGERY IF NECROTIC BOWEL, PERFORATION

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9
Q

How does malrotation with midgut volvulus present

A
  • Sudden onset of blood
  • bilious vomiting
  • abdominal distension
  • previously healthy baby
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10
Q

The cause of intussesception is unknown

A

No, however we do know that common patient have virus then abnormal lymp nodes
Basically yes and no, the specific agent is unknown however pathophysiology is known

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11
Q

What age is intussusception (IS) common

A

3-18 months (peak at 5 months)

Most common in healthy children with recent viral infection

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12
Q

How does IS present

A
  • Mostly ileum invaginating into caecum

= colicky abdominal pain and vomiting, bowel obstruction, rectal bleeding

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13
Q

How to diagnose (IS)

A

Sonar when clinical suspicion
Npo, resuscitation
Pneumatic reduction
Laparatomy= manual reduction, resection (r-hemi-colectomy)

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14
Q

Mecke’s diverticulum _ where is it located

A

Terminal ileum- true diverticulum

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15
Q

What aver the complications ot meckel’s diverticulum

A

Complicates due to ectopic gastric tissue: ulceration+ bleeding, perforation, bowel obstruction (IS)

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16
Q

If you have an incidental finding of meckel’s diverticulum should you do a resection?

17
Q

In anorectal malformation do you always investigate heart and kidneys for other abnormalities

A

Yes do all other abnormalities

18
Q

What is anorectum malformation

A

Spectrum of abnormalities of rectums and anus
More common in males
Other malformations (VACTERAL) = specifically heart and kidney

19
Q

ARM clinical features in girls

A
  • bowel obstruction rare

* recto-vestibular fistula - passing meconium

20
Q

ARM Clinical features in boys

A

Bowel obstruction after 1-2 days
Small or no recto-urinary fistula
Severe abdominal distension
Late sign: vomiting (low obstruction)

21
Q

In anorectal malformation girls are less incontinent that boys after repair

A

Yes= boys have higher up malformation affect pelvic development thus will have flat bum cheeks

22
Q

Treatment of boys ARM

A

3 stage procedure

  • stoma
  • anal surgery
  • closure stoma
23
Q

Treatment of ARM in girls

A

Low lesions
Colostomy not needed
Anoplasty or ano-rectoplasty

24
Q

What is Hirshprung’s disease

A

Aganglionosis of distal colon and rectum
Migration of ganglion cells (8th-10th week gestation)
From cranial to caudal
There fore cannot develop hirschsprung’s it is present at birth

25
How does HSP present
No meconium passed within 24 hours Resonant abdominal distention, late vomiting Explosive stool discharge on rectal exam Perforation (3%)
26
Diagnosis of HSP
Abdominal X-ray Contrast study Will show narrow distal segment and dilated proximal bowel for 24h Confirmation full thickness rectal biopsy
27
Treatment of HSP
* Rescus Diverting colostomy to reliever obstruction Resection of abnormal bowel Anastomsis to anus
28
In a child with constipation should you always rule out hischprungs disease
Yes
29
Causes of constipation
Diet, lack of exercise, psychological Anatomical ARM, HSP, Neuromuscular CP, spina bifida) Metabolic disorders (hypothyroidism)
30
Treatment of constipation
* Disimpaction * adjust the diet * good bowel habits with meds if needed * education of parents/family
31
What is faecal incontinence
Constipation with impaction and overflow incontinence= 82% of our patients = retentive also non= retentive Organic- ano-rectal malformation, surgery eg teratoma, spinal cord dysfunction
32
Treatment of fecal incontinence
Evaluation, disimpaction, high fiber diet and water, daily routine