Intestinal Bleeding In Children Flashcards
How to diagnose
Signs of shock, abdominal gears, abdominal tenderness, portal hypertension, PR (and and rectal examination)
Do you need a gastroscope to make a diagnosis in a new born with upper gastrointestinal bleeding!
No = need anastesia only need nasogastric tube, test blood can be mothers blood
How to resuscitate
Nasogastric tube= is bleeding ongoing
Intravenous fluid started -20ml/kg ringer’s lactate, blood products for specific indications, somatostatin analogue- help stop bleeding
Can an infant haver a peptic ulcer and bleed from it?
Yes - not as common as adult
Is necrotising enter colitis preventable?
Yes due to breast milk
What are the presentations of necrotising enterocolitis
Signs of bowel obstruction
Sepsis, acidosis, shock
Blood per rectum
How to diagnose NEC
Abdominal x ray
Treatment of NEC
NPO
AB
TOTAL PARENTERAL FEEDS
SURGERY IF NECROTIC BOWEL, PERFORATION
How does malrotation with midgut volvulus present
- Sudden onset of blood
- bilious vomiting
- abdominal distension
- previously healthy baby
The cause of intussesception is unknown
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
What age is intussusception (IS) common
3-18 months (peak at 5 months)
Most common in healthy children with recent viral infection
How does IS present
- Mostly ileum invaginating into caecum
= colicky abdominal pain and vomiting, bowel obstruction, rectal bleeding
How to diagnose (IS)
Sonar when clinical suspicion
Npo, resuscitation
Pneumatic reduction
Laparatomy= manual reduction, resection (r-hemi-colectomy)
Mecke’s diverticulum _ where is it located
Terminal ileum- true diverticulum
What aver the complications ot meckel’s diverticulum
Complicates due to ectopic gastric tissue: ulceration+ bleeding, perforation, bowel obstruction (IS)
If you have an incidental finding of meckel’s diverticulum should you do a resection?
Yes
In anorectal malformation do you always investigate heart and kidneys for other abnormalities
Yes do all other abnormalities
What is anorectum malformation
Spectrum of abnormalities of rectums and anus
More common in males
Other malformations (VACTERAL) = specifically heart and kidney
ARM clinical features in girls
- bowel obstruction rare
* recto-vestibular fistula - passing meconium
ARM Clinical features in boys
Bowel obstruction after 1-2 days
Small or no recto-urinary fistula
Severe abdominal distension
Late sign: vomiting (low obstruction)
In anorectal malformation girls are less incontinent that boys after repair
Yes= boys have higher up malformation affect pelvic development thus will have flat bum cheeks
Treatment of boys ARM
3 stage procedure
- stoma
- anal surgery
- closure stoma
Treatment of ARM in girls
Low lesions
Colostomy not needed
Anoplasty or ano-rectoplasty
What is Hirshprung’s disease
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
How does HSP present
No meconium passed within 24 hours
Resonant abdominal distention, late vomiting
Explosive stool discharge on rectal exam
Perforation (3%)
Diagnosis of HSP
Abdominal X-ray
Contrast study
Will show narrow distal segment and dilated proximal bowel for 24h
Confirmation full thickness rectal biopsy
Treatment of HSP
- Rescus
Diverting colostomy to reliever obstruction
Resection of abnormal bowel
Anastomsis to anus
In a child with constipation should you always rule out hischprungs disease
Yes
Causes of constipation
Diet, lack of exercise, psychological
Anatomical ARM, HSP,
Neuromuscular CP, spina bifida)
Metabolic disorders (hypothyroidism)
Treatment of constipation
- Disimpaction
- adjust the diet
- good bowel habits with meds if needed
- education of parents/family
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
Treatment of fecal incontinence
Evaluation, disimpaction, high fiber diet and water, daily routine
