Paediatric Gastroenterology Flashcards
What is abdominal migraine?
Episodes of central abdominal pain lasting more than 1 hour
Intense and acute pin
Interferes with normal activity
Associated N+V, headache, photophobia, aura
How can abdominal migraine be treated?
Dark, quiet room
Paracetamol
Sumatriptan
Propylaxis –> Pizotifen
What is classed as constipation in children?
<3 stools per week (does not apply to exclusively breastfed babies)
Rabbit dropping stools
How can you differentiate between primary and secondary constipation?
Secondary constipation is from birth
If meconium takes longer than 48 hours to pass, ribbon stools, faltering growth, or vomiting - referral needed
How is primary/idiopathic constipation treated?
First line in children is an osmotic laxative e.g. Movicol
If no response can add a stimulant e.g. Senna +/Lactulose
What is the main cause of reflux in babies?
Immaturity of the lower oesophageal sphincter
How can reflux in babies be managed?
Small, frequent feeds
Burp regularly
Keep baby upright after feeding
If still problematic can mix Gaviscon with feeds
What is pyloric stenosis?
Hypertrophy and narrowing of the pyloric sphincter (the ring of muscle between the stomach and duodenum)
How does pyloric stenosis present?
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)
What blood gas results are seen in pyloric stenosis?
Low chloride
Low potassium
Alkalosis
Due to baby vomiting hydrochloric acid from stomach
What are signs of clinical dehydration in children?
Decreased urine output
Sunken eyes
Dry mucuous membranes
Tachycardia
tachypnoea
Reduced skin turgor
What are signs of clinical shock in children?
Decreased consciousness
Cold extremities
Pale/mottled skin
Tachycardia
Tachypnoea
Weak peripheral pulses
Prolonged cap refill
Hypotension
How to calculate replacement fluids in children?
(% dehydration x kg x 10) = mls of fluids
How to calculate maintenance fluids in children?
First 10kg = 100ml/kg
Next 10kg = 50ml/kg
After that = 20ml/kg
How to calculate resuscitation fluids in children?
Resuscitation fluids = 20ml/kg
EXCEPT IN….
neonates, DKA, septic shock, trauma, cardiac pathology (heart failure) = 10ml/kg
What is Hirschsprung’s disease?
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
What conditions are associated with Hirschsprung’s disease?
Down’s syndrome
Neurofibromatosis
MEN II
How does Hirschsprung’s disease present?
Delay in passing meconium
In older children - constipation, vomiting, abdominal pain
What is the gold standard diagnosis for Hirschsprung’s disease?
Rectal biopsy
What is intussusception?
An invagination of a portion of the bowel
How does intussusception present?
Severe colicky abdominal pain
RED CURRANT JELLY STOOL
Sausage shaped mass in the RUQ
Pale, unwell child
Vomiting
What is seen on abdominal ultrasound in intussusception?
Target shaped mass
How is intussusception managed?
Reduction via radiology
What is biliary atresia?
A congenital condition where a section of the bile duct is narrowed or absent , preventing the excretion of conjugated bilirubin
How does biliary atresia present?
Presents in first few weeks of life with prolonged jaundice
Dark urine
Pale stools
How is biliary atresia diagnosed?
Raised conjugated billirubin
ERCP Cholangiogram
How are umbilical hernias in children managed?
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
What is congenital diaphragmatic hernia?
Herniation of the abdominal viscera into the chest cavity due to incomplete formation of the diaphragm
How does congenital diaphragmatic hernia present?
Pulmonary hypoplasia + hypertension
Respiratory distress shortly
