Paediatric Gastrointestinal Disorders

Question 1

Pyloric stenosis

Answer 1

M>F
5-10% Family history in parents
Projectile non bile stained vomiting at 4-6 weeks of life
Diagnosis is made by test feed or USS
Treatment: Ramstedt pyloromyotomy (open or laparoscopic)

Question 2

Acute appendicitis

Answer 2

Uncommon under 3 years

When occurs may present atypically

Question 3

Mesenteric adenitis

Answer 3

Central abdominal pain and URTI

Conservative management

Question 4

Intussusception

Answer 4

Telescoping bowel
Proximal to or at the level of, ileocaecal valve
6-9 months age
Colicky pain, diarrhoea and vomiting, sausage shaped mass, red jelly stool.
Treatment: reduction with air insufflation

Question 5

Malrotation

Answer 5

High caecum at the midline
Feature in exomphalos, congenital diaphragmatic hernia, intrinsic duodenal atresia
May be complicated by development of volvulus, infant with volvulus may have bile stained vomiting
Diagnosis is made by upper GI contrast study and USS
Treatment is by laparotomy, if volvulus is present (or at high risk of occurring then a ladds procedure is performed

Question 6

Hirschsprung’s disease

Answer 6

Absence of ganglion cells from myenteric and submucosal plexuses
Occurs in 1/5000 births
Full thickness rectal biopsy for diagnosis
Delayed passage of meconium and abdominal distension
Treatment is with rectal washouts initially, thereafter an anorectal pull through procedure

Question 7

Oesophageal atresia

Answer 7

Associated with tracheo-oesophageal fistula and polyhydramnios
May present with choking and cyanotic spells following aspiration
VACTERL associations (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities - typically have 3+ of these abnormalities)

Question 8

Meconium ileus

Answer 8

Usually delayed passage of meconium and abdominal distension
Majority have cystic fibrosis
X-Rays may not show a fluid level as the meconium is viscid (depends upon feeding), PR contrast studies may dislodge meconium plugs and be therapeutic
Infants who do not respond to PR contrast and NG N-acetyl cysteine will require surgery to remove the plugs

Question 9

Biliary atresia

Answer 9

Jaundice > 14 days
Increased conjugated bilirubin
Urgent Kasai procedure - removes the blocked bile ducts and gallbladder and replaces them with a segment of the child’s own small intestine. This segment of intestine is sewn to the liver and functions as a new extrahepatic bile duct system.

Question 10

Necrotising enterocolitis

Answer 10

Prematurity is the main risk factor
Early features include abdominal distension and passage of bloody stools
X-Rays may show pneumatosis intestinalis and evidence of free air
Increased risk when empirical antibiotics are given to infants beyond 5 days
Treatment is with total gut rest and TPN, babies with perforations will require laparotomy