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Surgery > Intestinal Bleeding In Children > Flashcards

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?

A

Yes

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
Q

How does HSP present

A

No meconium passed within 24 hours
Resonant abdominal distention, late vomiting
Explosive stool discharge on rectal exam
Perforation (3%)

26
Q

Diagnosis of HSP

A

Abdominal X-ray
Contrast study
Will show narrow distal segment and dilated proximal bowel for 24h
Confirmation full thickness rectal biopsy

27
Q

Treatment of HSP

A
  • Rescus
    Diverting colostomy to reliever obstruction
    Resection of abnormal bowel
    Anastomsis to anus
28
Q

In a child with constipation should you always rule out hischprungs disease

A

Yes

29
Q

Causes of constipation

A

Diet, lack of exercise, psychological
Anatomical ARM, HSP,
Neuromuscular CP, spina bifida)
Metabolic disorders (hypothyroidism)

30
Q

Treatment of constipation

A
  • Disimpaction
  • adjust the diet
  • good bowel habits with meds if needed
  • education of parents/family
31
Q

What is faecal incontinence

A

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
Q

Treatment of fecal incontinence

A

Evaluation, disimpaction, high fiber diet and water, daily routine

Surgery (2 decks)

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