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Child Health > Paediatric GI - GORD, Intussusception, Hirschsprung, Gastroenteritis and Pyloric Stenosis > Flashcards

Paediatric GI - GORD, Intussusception, Hirschsprung, Gastroenteritis and Pyloric Stenosis Flashcards

1
Q

What happens in intussusception?

A

One segment of bowel telescope and invaginate into adjacent distal bowel

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2
Q

What part of the bowel is most likely to intussuscept?

A

Enlarged peyers patch in the ileum

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3
Q

What does invagination of the bowel lead to?

A

Engorgement of the bowel which eventually goes gangrenous

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4
Q

What classical triad of symptoms does intussusception normally present with?

A

Colicky abdominal pain

Bilious Vomiting

Sausage shaped abdominal mass

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5
Q

What other symptoms does intussusception present with?

A 
Pallor
Distress
Drawing up legs
Rectal bleeding - redcurrant jelly stool
Peritonitis and shock
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6
Q

When is intussusception most common?

A

6-18 months

Post viral gastroenteritis - peyers patches enlarged

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7
Q

What imaging would you choose to visualise intussusception and what would you expect to see?

A

USS

Target sign

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8
Q

If you suspect intussusception, what should you do?

A

Immediate diagnostic enema

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9
Q

How is intussusception managed?

A

Supportive care - large volume of fluids, antibiotics, analgesia, NG tube

Pneumatic resolution - rectal insufflation of air

Operative reduction

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10
Q

What is the pathophysiology of Hirschprung’s Disease?

A

Failure of parasympathetic ganglion cells to move to the myenteric plexus

So no coordinated peristalsis

So functional obstruction due to no relaxing at transition zone

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11
Q

How do infants with Hirschprung’s present?

A

Present in first few days of life:

Failure to pass meconium >48h
Lower intestinal obstruction
Abdominal distention
Bilious vomit

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12
Q

What is a severe life-threatening complication of Hirschprung’s? How would it present?

A

Enterocolitis (C.Diff)

Pain, distention, watery, bloody diarrhoea, sepsis

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13
Q

How can older children present with Hirschprung’s?

A

Chronic severe constipation from birth

Abdominal distention

Absence of faeces in narrow rectum

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14
Q

How is Hirschprung’s diagnosed?

A

Barium enema to demonstrate change in diameter

Confirmation by suction biopsy showing absence of ganglion cells

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15
Q

How is Hirschprung’s managed?

A

Surgical removal of aganglionic bowel

Pull through anastomosis of normal bowel with anus

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16
Q

What is Hirschprung’s associated with?

A

Down’s syndrome

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17
Q

What is GORD?

A

Effortless reflux of contents back into the oesophagus. It is repeated and severe enough to cause harm

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18
Q

What makes GORD common in babies?

A

Liquid diet
Horizontal position
Low resting lower oesophageal sphincter pressure
Slow gastric emptying

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19
Q

What puts children at extra risk of having GORD?

A 
Prematurity
Parental history of GORD
Obesity
Hernia (inc history of hernia)
Neurodisability
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20
Q

How does GORD present in children?

A 
Regurgitation
Irritability
Feeding difficulty
Failure to thrive - calorie deficiency
Sandifers syndrome
Resp symptoms
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21
Q

What is sandifers syndrome?

A

Extension and lateral turning of the head and dystonic posture

22
Q

What do you ask about in a feeding history?

A 
Position
Attachment
Technique
Duration
Frequency
Type and volume of milk
Vomits
Relationship of symptoms to feed
23
Q

What do you assess on physical examination of a child with GORD?

A

Hydration status
Signs of malnutrition
Growth charts

24
Q

How can GORD be diagnosed?

A

Mostly clinical diagnosis

Can do:
24hr oesophageal pH studies
Barium studies
Endoscopy

25
Q

How is GORD managed conservatively?

A

Nurse infants head at 30 degrees

Thickened feeds, small frequent meals, no food before sleep, avoid acidic fatty foods

Reassure it will resolve

26
Q

What medical and surgical management options are there for GORD?

A

Ranitidine or Omeprazone

Prokinetic drugs - domperidone (speed up gastric emptying)

Nissen’s fundoplication

27
Q

What complications can GORD lead to?

A

Oesophageal stricture
Barrett’s oesophagus
Failure to thrive
Anaemia

28
Q

What can cause gastroenteritis?

A

Virus - ROTAVIRUS, norovirus, adenovirus

Bacterial - Campylobacter, Salmonella, Shigella, E. COli

29
Q

How is gastroenteritis typically characterised?

A

Sudden onset diarrhoea with or without vomiting

30
Q

How does gastroenteritis present?

A 
Watery diarrhoea
Vomiting
Cramping abdo pain
Fever
Dehydration
Electrolyte disturbance
31
Q

What additional features would make you think the gastroenteritis is bacterial?

A

Dysentery
Malaise
Tenesmus

32
Q

How is gastroenteritis normally transmitted?

A

Faecal-oral transmission

33
Q

How long do vomiting and diarrhoea each normally last in gastroenteritis?

A

Vomiting - 1-2 days

Diarrhoea - 5-7 days

34
Q

Which children are at greatest risk of dehydration?

A

<6 months old

Pass >5 stools in last 24 hrs

Vomit >2x in last 24 hrs

Children stopped breastfeed while ill

35
Q

When would you admit a child with gastroenteritis?

A

Signs systemically unwell
>10% dehydrated
Unable to tolerate oral fluids
No improvement in 48hours

36
Q

What investigations may you consider for gastroenteritis?

A

Stool and blood culture

Plasma U&E - consider hypernatraemic dehydration

37
Q

How do you treat gastroenteritis?

A

Supportive rehydration

Rotavirus vaccine

Hygiene advice - no school for 48 hours

38
Q

What are the maintenance fluid requirements for a child?

A

0-10kg - 100ml/kg/day
10-20kg - 50ml/kg/day
20+ kg - 20ml/kg/day

39
Q

How do you rehydrate a child who is normonatraemically dehydrated?

A

Maintenance fluid + Rehydration

Done over 24hours

Rehydration = body mass x % dehydrated x 10

40
Q

How do you rehydrate a child who is hypernatraemically dehydrated?

A

Maintenance fluid x2 + rehydration

Done over 48 hours ( x2 maintenance)

Rehydration = body mass x % dehydrated x 10

41
Q

What is the role of antibiotics in gastroenteritis?

A

Not commonly needed as don’t change symptoms

Given if:

Risk of disseminated disease
Systemically unwell
<6months old
C.Diff

42
Q

What are possible complications of gastroenteritis?

A

Haemolytic uraemic syndrome

Toxic megacolon

Acquired/secondary lactose intolerance

43
Q

What causes pyloric stenosis?

A

Hypertrophy of the smooth circular muscle of the pylorus –> narrowed pyloric canal

44
Q

What is the incidence of pyloric stenosis?

A

1-2 per 1000 live births

45
Q

What are the risk factors for pyloric stenosis?

A

Male 4:1
White
Family history

46
Q

How does pyloric stenosis present?

A

2-8 weeks old

Projectile, non-bilious vomit after every feed
Hungry
Constipation
Dehydration

47
Q

What can you see on examination of a child with pyloric stenosis?

A

Visible peristalsis

Palpable olive sized pyloric mass - esp. during feed

48
Q

What tests are done to diagnose pyloric stenosis?

A

Test feed

USS

Bloods - hypochloraemic, hypokalaemic metabolic alkalosis

49
Q

How is pyloric stenosis managed?

A

Correct fluid and electrolyte abnormality

Empty stomach - NG tube

Ramstedt’s Pyloromyotomy - thickened pyloric muscle split

50
Q

When is surgical correction of pyloric stenosis done?

A

After fluid and electrolyte abnormalities have been corrected

Child Health (30 decks)

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