Paediatric Gastroenterology Flashcards

1
Q

What is abdominal migraine?

A

Episodes of central abdominal pain lasting more than 1 hour

Intense and acute pin

Interferes with normal activity

Associated N+V, headache, photophobia, aura

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2
Q

How can abdominal migraine be treated?

A

Dark, quiet room

Paracetamol

Sumatriptan

Propylaxis –> Pizotifen

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3
Q

What is classed as constipation in children?

A

<3 stools per week (does not apply to exclusively breastfed babies)

Rabbit dropping stools

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4
Q

How can you differentiate between primary and secondary constipation?

A

Secondary constipation is from birth

If meconium takes longer than 48 hours to pass, ribbon stools, faltering growth, or vomiting - referral needed

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5
Q

How is primary/idiopathic constipation treated?

A

First line in children is an osmotic laxative e.g. Movicol

If no response can add a stimulant e.g. Senna +/Lactulose

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6
Q

What is the main cause of reflux in babies?

A

Immaturity of the lower oesophageal sphincter

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7
Q

How can reflux in babies be managed?

A

Small, frequent feeds

Burp regularly

Keep baby upright after feeding

If still problematic can mix Gaviscon with feeds

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8
Q

What is pyloric stenosis?

A

Hypertrophy and narrowing of the pyloric sphincter (the ring of muscle between the stomach and duodenum)

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9
Q

How does pyloric stenosis present?

A

Usually presents in 2nd-4th week of life

Peristalsis tries to push food down to the duodenum but it instead ejects upwards

Projectile vomiting (non-bilious)

May be constipation/diarrhoea

May be a palpable mass due to hypertrophied pyloric sphincter (often mentioned as olive shaped mass)

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10
Q

What blood gas results are seen in pyloric stenosis?

A

Low chloride

Low potassium

Alkalosis

Due to baby vomiting hydrochloric acid from stomach

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11
Q

What are signs of clinical dehydration in children?

A

Decreased urine output

Sunken eyes

Dry mucuous membranes

Tachycardia

tachypnoea

Reduced skin turgor

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12
Q

What are signs of clinical shock in children?

A

Decreased consciousness

Cold extremities

Pale/mottled skin

Tachycardia

Tachypnoea

Weak peripheral pulses

Prolonged cap refill

Hypotension

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13
Q

How to calculate replacement fluids in children?

A

(% dehydration x kg x 10) = mls of fluids

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14
Q

How to calculate maintenance fluids in children?

A

First 10kg = 100ml/kg

Next 10kg = 50ml/kg

After that = 20ml/kg

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15
Q

How to calculate resuscitation fluids in children?

A

Resuscitation fluids = 20ml/kg

EXCEPT IN….

neonates, DKA, septic shock, trauma, cardiac pathology (heart failure) = 10ml/kg

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16
Q

What is Hirschsprung’s disease?

A

A congenital condition where the nerve cells of the myenteric plexus are absent = absence of parasympathetic ganglion cells along a section of the bowel

Aganglionic section does not relax - causing obstruction of the bowel

17
Q

What conditions are associated with Hirschsprung’s disease?

A

Down’s syndrome

Neurofibromatosis

MEN II

18
Q

How does Hirschsprung’s disease present?

A

Delay in passing meconium

In older children - constipation, vomiting, abdominal pain

19
Q

What is the gold standard diagnosis for Hirschsprung’s disease?

A

Rectal biopsy

20
Q

What is intussusception?

A

An invagination of a portion of the bowel

21
Q

How does intussusception present?

A

Severe colicky abdominal pain

RED CURRANT JELLY STOOL

Sausage shaped mass in the RUQ

Pale, unwell child

Vomiting

22
Q

What is seen on abdominal ultrasound in intussusception?

A

Target shaped mass

23
Q

How is intussusception managed?

A

Reduction via radiology

24
Q

What is biliary atresia?

A

A congenital condition where a section of the bile duct is narrowed or absent , preventing the excretion of conjugated bilirubin

25
Q

How does biliary atresia present?

A

Presents in first few weeks of life with prolonged jaundice

Dark urine

Pale stools

26
Q

How is biliary atresia diagnosed?

A

Raised conjugated billirubin

ERCP Cholangiogram

27
Q

How are umbilical hernias in children managed?

A

Common in neonates – usually resolve by 3 years
If not resolved by 5 years can consider surgical repair

Note: Umbilical hernias are more common in Down syndrome

28
Q

What is congenital diaphragmatic hernia?

A

Herniation of the abdominal viscera into the chest cavity due to incomplete formation of the diaphragm

29
Q

How does congenital diaphragmatic hernia present?

A

Pulmonary hypoplasia + hypertension

Respiratory distress shortly