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3a > Paediatrics: Gastroenterology > Flashcards

Paediatrics: Gastroenterology Flashcards

1
Q

what are the 3 general categories for causes of abdominal pain?

A
  • Functional
  • Medical
  • Surgical
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2
Q

What does it mean when something is a functional disorder?

A

No disease process found to explain the pain (lack of pathology)

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3
Q

Name some medical causes of abdominal pain?

A
  • Constipation
  • UTI
  • Coeliac disease
  • IBD
  • Abdo migraine
  • Hoch-schonlein Purpura
  • pyelonephritis
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4
Q

Name some surgical causes of abdominal pain? (4)

A
  • Appendicitis
  • Intussusception
  • Bowel obstruction
  • Testicular torsion
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5
Q

What additional causes could there be for abdominal pain in girls? (6)

A
  • Pregnancy
  • PID
  • Dysmenorrhoea
  • Mittelschmerz
  • Ectopic pregnancy
  • Ovarian torsion
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6
Q

name some red flags for a presentation of abdominal pain?

A
  • Persistent or bilious vomiting
  • Severe chromic diarrhoea
  • Fever
  • Rectal bleeding
  • Weight loss
  • Dysphagia
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7
Q

Px presenting with abdominal pain is found to anaemic. What could this indicate? (2)

A
  • Inflammatory bowel disease
  • Coeliac

(I think due to iron deficiency- failure to absorb in duodenum/proximal jejunem)

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8
Q

Px presenting with abdominal pain is found to have raised inflammatory markers. What could this indicate?

A

IBD (or infection I guess)

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9
Q

Px presenting with abdominal pain is found to have raised anti-TTG/ anti-EMA . What could this indicate?

A

coeliac

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10
Q

Px presenting with abdominal pain is found to have raised feacal calprotectin. What could this indicate?

A

IBD

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11
Q

Px presenting with abdominal pain is found to have positive urine dipstick . What could this indicate?

A

UTI

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12
Q

what is the most common cause of constipation?

A

functional

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13
Q

name some secondary causes of constipation? (4)

A
  • Hirschprungs
  • CF
  • Hypothyroidism
  • drug induced
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14
Q

name some symptoms of constipation? (7)

A
  • <3 stools per week (though this can be normal)
  • hard stools that are hard to pass
  • Rabit dropping stools
  • Straining
  • Abdo pain
  • Rectal bleeding
  • Hard stool palpate in abdo
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15
Q

What lifestyle factors can contribute to constipation ? (5)

A
  • Habitually not opening bowels
  • Low fibre diet
  • Poort fluid intake
  • Sedentary lifestyle
  • Pscycosocial problems/stress
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16
Q

Describe how constipation causes desensitisation of the rectum and what this causes?

A

ignore sensation of full rectum => loses sensation => more infrequent bowel openings => faecal impaction => encopresis

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17
Q

Constipation red flag: what could not passing meconium in first 48 hrs indicate? (2)

A
  • CF
  • Hirschprungs disease
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18
Q

Constipation red flag: what could constipation plus neurological symptoms indicate?

A

CP

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19
Q

Constipation red flag: what could constipation plus vomiting indicate? (2)

A
  • Hirschprungs disease
  • Bowel obstruction
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20
Q

Constipation red flag: what could constipation plus ribbon stool indicate?

A

anal stenosis

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21
Q

Constipation red flag: what could constipation plus failure to thrive indicate? (3)

A
  • Coeliac disease
  • Hypothyroidism
  • Safeguarding concern
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22
Q

Constipation red flag: what could constipation plus sever abdominal pain indicate?

A
  • Intussusception
  • Obstruction
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23
Q

What percentage of infants posset?

A

40%

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24
Q

What is Gastro-Oesophageal Reflux?

A

It is where the contest of the stomach reflux through the lower oesophageal sphincter into the oesophagus, throat + mouth

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25
Q

why are babies prone to reflux?

A

babies have immature lower oesophageal sphincter so quite normal (as long as the baby can grow)

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26
Q

What pathophysiology explain GOR? (3)

A
  • Short, narrow oesophagus
  • Delayed gastric emptying
  • High fluid diet
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27
Q

RF for GOR? (3)

A
  • Prematurity
  • Parental Hx
  • Obesity
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28
Q

When does GOR become problematic

A

when symptomatic
- Chronic cough
- Hoarse cry
- Distress after feeding or reluctant to feed
- Pneumonia
- Poor weight gain

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29
Q

How to older children present with GOR?

A

similar to adults
- Heartburn
- Regurgitation
- Bloating
- Noctural cough

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30
Q

Causes of vomiting in babies?

A
  • Overfeeding
  • GOR
  • Pyloric stenosis
  • Gastritis
  • Infection (UTI, Meningitis)
  • raised ICP
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31
Q

what advice can you give for GORD?

A
  • Small meals
  • Do not overfeed
  • Burp the baby
  • Keep upright after feeding
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32
Q

Apart from advice, what is the management for GORD?

A
  • Gaviscon mixed with water immediately after feeds
  • PPI
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33
Q

what percentage of GOR presentations will spontaneously resolve within first yr of life?

A

90%

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34
Q

pyloric stenosis pathophysiology?

A

Narrowing of the pylorus => gastric outlet restriction => prevents normal passage of food from stomach to duodenum => powerful peristalsis => food return to oesophagus => powerful projectile vomiting

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35
Q

What causes pyloric stenosis?

A

hypertrophy and thickening of pylorus => stenosis

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36
Q

what are where is the pyloric sphincter?

A

ring off mouth muscle that forms canal between stomach + duodenum

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37
Q

pyloric stenosis RF?

A
  • Male
  • FHx
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38
Q

Describe the presentation of pyloric stenosis? at what age?

A

usually presents in first few weeks (4-6 weeks)
- Hungry baby that its hit, pale + failure to thrive
- non-bilious PROJECTILE vomiting after every feed
- Weight loss dehydration

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39
Q

What might be found on examination of a patient with pyloric stenosis? (2)

A
  • Visible peristalsis
  • Palpable olive-sized pyloric mass
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40
Q

what would the blood gas of a Px with pyloric stenosis show (+ electrolytes) ? explain

A
  • Hypochloric + hypokalaemia metabolic alkalosis
  • Vomit HCl => increase pH
  • low H+ => kidneys exchange K to retain H+ => hypokalaemia
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41
Q

What investigations for pyloric stenosis ? god standard?

A
  • Blood test
  • Abdominal US (gold standard):
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42
Q

what would be seen on AUSS in pyloric stenosis?

A

hypertrophic pyloric muscles

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43
Q

Management of pyloric stenosis?

A

Surgical - Laparoscopic pyeloromyotomy (widen canal of pylorus)

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44
Q

What is acute gastritis ? presents with?

A

Inflammation of the stomach
- Presents with nausea + vomiting

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45
Q

What is enteritis? Presents with?

A

Inflammation of the intestines
- Presents with diarrhoea

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46
Q

What is gastroenteritis? presents with?

A

Inflammation all the way form the stomach to the intestines so presents with Nausea + vomiting + diarrhoea

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47
Q

Usual prognosis of gastroenteritis ?

A

very common and usually self limiting

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48
Q

Most common cause of gastroenteritis ?

A

usually viral (norovirus or rotavirus)

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49
Q

Name a common bacterial cause of gastroenteritis ?

A

E.Coli

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50
Q

what strain of E. coli is particularly concerning? why?

A

E.Coli 0147
- produces Shiga toxin

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51
Q

what does the Shiga toxin cause? complication? produces by what organism ?

A

produced by E.Coli + shigella
- abdo cramps + bloody diarrhoea
- Haemolytic uraemic syndrome

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52
Q

what determines if a patient needs to be admitted with gastroenteritis s?

A

Hydration
- Need to work out if Px can self hydrate of if IV fluids are required

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53
Q

Name some things to consider for a diarrhoea differential?

A
  • Infection
  • IBD
  • Coeliac
  • Lactose intolorance
  • Coeliac
  • CF
  • IBS
  • Abx
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54
Q

Management of Gastroenteretitis ?

A
  • Immediate isolate to preven spear to other Px, barrier nursing, children stay off school
  • Stool culture
  • Maintain good hydration: fluid challenge, IV
  • Usually viral so self limiting
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55
Q

When are gastroenteritis patients given Abx?

A

only given to Px at risk of ocmplciaitons or once causative ogaisn has been identified

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56
Q

name some complications of gastroenteritis?

A
  • Lactose intolorance
  • IBS
  • Reactive arthritis (Reiters syndrome)
  • Guillian barre syndrome
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57
Q

A patient presents after having eaten leftover fried rice left out at room temp and then developed abdo cramping + vomiting + watery diarrhoea. What is the likely pathogen?

A

Bacillus cereus

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58
Q

What is Coeliac disease?

A

Lifelong gluten sensitive autoimmune disease of the small intestine (leading to inflam of small intestine)

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59
Q

Describe the pathophysiology of coeliac disease?

A

autoantibodies are produced in response to exposure to gluten => target epithelial cells of small intestine

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60
Q

Which 2 autoantibodies are associated with coeliac disease? what type of antibody?

A

IgA antibodies
- Anti-tissue transflutaminase (anti-TTG)
- Anti-endomysial (Anti-EMA)

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61
Q

Where does the inflammation in coeliac disease mainly effect?

A

jejunum

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62
Q

What genetic predisposition is associated with coeliac disease?

A

HLA-DQ2/DQ8

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63
Q

what is the chance of of PX to develop coeliac disease if they have the genetic predisposition ? if they don’t?

A

HLA-DQ2/DQ8
- negative value is almost 100%
- most ppl with these genes do NOT develop coeliac

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64
Q

what is the presentation of coeliac disease?

A
  • Failure to thrive
  • Diarrhoea
  • Fatigue
  • Mouth ulcers
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65
Q

What other disease should you always test for if you consider coeliac disorder?

A

type 1 diabetes
(they are closely linked)

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66
Q

How do you diagnose coeliac disease? gold standard?

A

while patient is on gluten-containing diet
- Check total IgA levels
- Anti TTG and anti-EMA
- Endoscopy and duodenal biopsy

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67
Q

Why test total IgA levels for coeliac diagnosis?

A

to exclude IgA deficiency (to make sure result will be valid)

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68
Q

What will be seen on duodenal biopsy in coeliac disease?

A
  • Crypt hypertrophy
  • Villous atrophy
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69
Q

Coeliac management ?

A

lifelong gluten free diet

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70
Q

What cell mediated autoumme response occurs in coeliac disease?

A

T-cell mediated

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71
Q

What is IBD?

A

Inflammatory Bowel Disease
- Umbrella term for 2 main disease causing inflammation of GI tract (Crohn’s, Ulcerative Colitis)

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72
Q

What pneumonic helps remember symptoms of Crohns ?

A

crows NESTS

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73
Q

What pneumonic helps remember details of UC?

A

U-C-CLOSEUP

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74
Q

What does NESTS Stand for? which condition?

A

Crohns
- No blood or mucus (less common)
- Entire GI tract (gum to bum)
- Skip lesions
- Transmural (full thickness inflam), Terminal ileum
- Smoking is RF (Don’t set the nest on fire)

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75
Q

where does Crohns usually affect?

A

Terminal ileum but can be anywhere gum=> bum

76
Q

what can transmural inflam in crohns lead to?

A

full thickness inflammation => produces deep ulcers + fissures (cobblestone appearance)

77
Q

What does CLOSEUP stand for? which condition?

A
  • Continuous inflammation (no skip lesions)
  • Limited to colon and rectum
  • Only superficial mucosa affected
  • Smoking protective
  • Excretion of blood and mucus
  • Use aminosalicylate
  • Primary sclerosis cholangitis (associated with UC)
78
Q

IBD presentation?

A
  • suspect in children presenting with diarrhoea, abdo pain, bleeding, weight loss, anaemia
  • Flare ups: Fever, malaise, dehydration
79
Q

What testing would you do for suspected IBD? gold standard?

A
  • Stool sample: faecal cal protective (released by intestines with inflamed)
  • Stool microscopy + culture: -ve to exclude infection as differential
    = Endoscopy: plus multiple intestinal biopsies (gold standard)
80
Q

What microscopic changes would be seen in crnohs intestinal biopsy?

A

non-caseating granulomatous inflammation

81
Q

What microscopic changes would be seen in UC intestinal biopsy?

A
  • Crypt abscess formation
  • reduced goblet cells
  • Non-granulomatous
82
Q

Why would you do a CT or USS in IBD?

A

look for complications (fistulas, abscesses + strictures)

83
Q

What is the general management of IBD?

A
  • Referral to secondary care + MDT approach (+dieticien )
  • Monitor growth and pubertal development
  • Induce remission
  • maintain remission (meds not always taken)
84
Q

Describe the management in crohns ?

A
  • Induce remission: steroids (oral prednisone or IV hydrocortisone), consider immunosuppression: azathioprine
  • Maintain remission: azathioprine, surgery
85
Q

when would surgery be a good idea of crohns?

A

if only affects distal ileum then can remove to preven further flares

86
Q

Complication of Crohns disease?

A

sever exacerbations may be life-threatening
- Severe systemmtic supet
- Bowel perforation
- intestinal obstruction
- Abcess formation
- Fistulas
- Strictures
- mortality

87
Q

describe the management of UC?

A
  • Inducing remission: aminosalicylate or coricosteroids
  • Maintain remission: amionsalisylate, surgery (removal of colon + rectum will remove disease)
88
Q

Complication of UC?

A

life threatening I flare ups
- sever systemic upset
- toxic megacolon
- colonic performation
- Bowel adenocarcinoma
- mortality

89
Q

what is biliary atresia? aetiology?

A

Congenital condition where section of bile duct is narrowed or absent

90
Q

Biliary atresia pathophysiology? what it causes?

A

bile duct obstruction => cholestasis => bile cannot be traposrted form liver to the bowel

91
Q

biliary atresia prevents the excretion of what? be specific

A

conjugated bilirubin
- conjugated billirbin is excreted in bile so biliary atresia prevent CB excretion

92
Q

How does Biliary atresia usually present? when?

A

presents shortly after birth with significant jaundice

93
Q

High levels of what cause the symptoms of biliary atresia?

A

high levels of CB cause jaundice

94
Q

What investigations might you do for suspected biliary atresia? results? explain

A
  • Conjugated + unconjugated bilirubin: high proportion CB (suggest that liver is processing but unable to excrete)
95
Q

Management of biliary atresia

A

surgical management
- bile duct construction of full liver transplant (rarer)

96
Q

What is intestinal obstruction? what does it cause? explain

A

A physical obstruction prevents flow of faeces through intestines => back pressure + vomiting + absolute consiptation

97
Q

What is absolute constipation ?

A

unable to pass stools or wind

98
Q

Name some causes of Intestinal obstruction ? (6)

A
  • Meconium ileus
  • Hirschprungs disease
  • oesophageal/doudenal atresia
  • intussusception
  • imperforate anus
  • malrotation of intestines (with volvulus)
99
Q

Bowel obstruction presentation?

A
  • Persistent vomiting
  • abdo pain + distention
  • absolute constipation
  • Abnormal bowel sounds
100
Q

describe the vomit in BO

A

bilious, persistent

101
Q

describe the bowel sounds in BO (2) what do they mean?

A
  • high pitched + tinkling (early)
  • absent (late sign)
102
Q

How would you diagnose intestinal obstruction?

A

AXR

103
Q

What would you see on AXR of Px with BO ? (3)

A
  • Dilated loops of bowel proximal to obstruction
  • Collapsed loop of bowel distal to obstruction
  • Absence of air in rectum
104
Q

Describe the management of BO? in the meantime ? why each thing

A

surgical emergency
- nil my mouth
- NG tube to empty stomach + stop vomiting
- IV fluids to correct fluid + electrolytes

while awaiting definitive management

105
Q

What is intussusception ?

A

telescoping/invagination of one part of the bowel onto the other

106
Q

Peak age incidence of intussusception?

A

peak incidence is between 5 - 7 months of age (rare to occur after 2 years)
- just lil babies then

107
Q

at what location are 90% of intussusception along GI tract?

A

ileo-colic type
(distal ileum passes into caecum through ileocaecal valve)

108
Q

Name some RF for intussusception ? (3)

A
  • Meckel diverticulum (most common)
  • Polyps
  • HSP
109
Q

Name the buzzword parts to intussception Hx ?

A
  • sudden onset inconsolable cry
  • red-current consistency stools
  • drawing up knees
  • pallor
110
Q

what condition presents with red-current consistency stools ? why is this?

A

intussusception
- due to presence of blood + mucus

111
Q

What would you find on examination of Px with intussusception ?

A
  • abdo distention
  • Palpable mass (RUQ)
  • signs of peritonitis
112
Q

Are bowel sounds present in intussusception?

A

yes (or abscent I think)

113
Q

describe the mass that might be palpable in intussuscpeton? where?

A

palpable sausage-shaped mass (RLQ - oleo-caecal)

114
Q

what should you consider in the differential for intussusception?

A
  • COlic
  • Testicular torsion
  • Appendicitis
  • Gastroentiritis
  • Volvulus
115
Q

How would you diagnose intussusception?

A
  • Abdo US (Target sign I think)
116
Q

Describe the management of intussusception?

A

Surgical management
- If signs of shock/dehydration: fluid resus
- non operative: air or contrast enema
- surgical reduction

117
Q

Complications of intussusception ?(3)

A
  • Obstruction
  • Perforation
  • Dehydration + shock
118
Q

What is hirschprungs disease (HD)? explain it?

A

congenital ganglionic megacolon disease

119
Q

Describe the pathophysiology of HD? where is affect (specific)

A

congenital disease where ganglionic cells of the mesenteric plexus fail to develop in the distal bowel => absence of parasympathetic ganglion cells (sections of colon left without) => delayed or failed passage of meconium

120
Q

What is another name for th mesenteric plexus? name a congenital condition that affects this?

A

auerbachs plexus
- Hirschprungs disease

121
Q

what does the mesenteric plexus do? where is it located?

A

enteric nervous system responsible for peristalsis

122
Q

Describe the classic triad presentation of HD?

A
  • Failure to pass meconium
  • Abdo distention
  • Bilious vomiting
123
Q

overall presentation of HD?

A
  • delay in passing meconium (>24 hrs), chronic constiaption
  • abdo distension + pain
  • billious vomiting
    ^ classic triad
  • poor weight gain
  • failure to thrive
124
Q

HD investigations ? what is require to confirm diagnosis - what will this show?

A
  • AXR
  • Rectal biopsy (required for diagnosis): will shows absence of ganglionic cells)
125
Q

what is the definitive management of HD?

A

surgical removal of aganglionic section

126
Q

explain a serious complication associated with Hirschprungs disease? management ?

A
  • hirschprungs associated enterocolitis: inflam + obstruction of intestine => toxic megacolon + perforation
  • Management: requires Abx, fluid rhesus and decompression of obstruction bowel
127
Q

What is appendicitis?

A

Inflammation of the appendix

128
Q

what is the appendix?

A

small thin tube sprouting from the caecum

129
Q

Describe the pathophysiology of appendicitis? explain how lead to complication

A

diret luminal obstruction => commensal bacteria multiply => acute inflam + reduced venous drainage => ischaemia => necrosis => perforation => release faecal contents + infective material into abdo => peritonitis

130
Q

At what age is peak incidence of appendicitis ?

A

10 - 30 years

131
Q

what 2 things can lead to direct luminal obstruction in appendicitis (2 most common) ?

A
  • secondary to faecolith
  • lymphoid hyperplasia
132
Q

describe the presentation of appendicitis? time course?

A

abdo pain starting at umbilicus which then moves to RIF
- anorexia, nausea + vomiting

133
Q

What could be found OE of appendicitis?

A
  • Tenderness at MrBurneys point
  • Rovsings sing
  • Guarding
  • Rebound tenderness
  • Percussions tenderness
134
Q

where is McBurneys point?

A

1/3 the distance from ASIS to umbilicus

135
Q

what finding might indicate peritonitis ? O/E (3)

A
  • Guarding
  • Rebound tenderness
  • Percussion tenderness
136
Q

how do you diagnosis appendicitis? what investigations?

A

based on clinical findings + raised inflam markers
- US often used in females
- urinalysis (assess renal or urological causes)

137
Q

name some other important differentials for appendicitis?

A
  • Ectopic pregnancy (do pregnancy test)
  • Ovarian cyst
  • decks diverticulum
  • mesenteric addenitis appendic mass
138
Q

What is an appendix mass? caused by what?

A

When momentum sticks to inflamed appendix => RIF mass

139
Q

Describe the management of appendicitis?

A

Removal of inflamed appendix (appendicectomy)

140
Q

what complications are associated with all surgeries? (7)

A
  • Bleeding
  • Infection
  • Pain
  • Scars
  • Unsuccessful
  • damage to other organs
  • anaesthesia
141
Q

describe what the word Gastroschisis means (pre + suffix)

A

gastro (GI tract)
schisis (separation)

142
Q

what is Gastroschisis? what does this lead to?

A

anterior abdominal wall fails to close so remains open (separated) throughout fetal development => abdo organs protrude out to outside environment?

143
Q

which oran is usually affected in gastroshcisis?

A

intestines

144
Q

describe anatomically where Gastroschisis protrudes? usually?

A

full thickness of abdominal wall defect
- the the R of umbilicus

145
Q

What can happen in Gastroschisis in utero? what does this cause?

A

organs protrude out => exposure to amniotic fluid => intestines irritated + inflamed => malabsorption

146
Q

After delivery: what protects the protruded organs in Gastroschisis ?

A

nothing
- organs exposed to air = no peritoneal layer

147
Q

RF for Gastroschisis ?

A
  • young maternal age < 20
  • Maternal alcohol and tobacco use
148
Q

How could Gastroschisis be diagnosed antenatally ? what finding?

A

antenatal: US, blood test (increased MSAFP)
at birth: its visible

149
Q

Gastroschisis Management? immediate? definitive?

A

Immediate: fluid resus, maintain temp, sterile clear covering
- Surgery: organs put back in body and defect repaired

150
Q

Generally what is Gastroschisis vs omphacocele ?

A

G: open, R of umbilicus
O: closed, central

151
Q

What is omphacocele ?

A

congenital abdo wall defect at insertion of umbilical cord => abdo contents herniate outside the abdo within a membranous sac

152
Q

what 2 layers does the memebransou sac surround omphacocele have?

A

peritoneum
amnion

153
Q

omphacocele pathophysiology ?

A

though to be failure of normal intestinal migration of physiological umbilical herniation

154
Q

omphacocele RF?

A
  • maternal age >40
  • Maternal smoking/drinking/SSRI use
155
Q

omphacocele investigations?

A
  • Increased alphafetoprotein
  • USS
156
Q

what does increased alpha fetoprotein antenatally suggest?

A

routinely measure in antenatal screening and is typically elevated in abdo wall defects

157
Q

omphacocele management ? immediate? definitive?

A

immediate: protect member, ensure adequate hydration and temp
- surgical: primary closure

158
Q

What is cows milk protein allergy (CMPA) ?

A

immune mediated allergic reaction to proteins in cows milk

159
Q

What immunoglobulin may CMPA be associated with?

A

IgE (can also be non-IgE mediated or mixed)

160
Q

What type of hypersensitivity reaction is CMPA?

A

type 1

160
Q

which protein trigger the reaction in CMPA?

A

casein and whey (cows milk proteins)

160
Q

what are the response time to IgE and non-IgE mediated CMPA?

A
  • IgE: rapid response (withhin 2 hrs)
  • Non-IgE: slower (occuring over several days)
161
Q

CMPA RF?

A
  • Formula fed babies
  • Personal Hx of atopy
162
Q

how old are kids with CMPA?

A

<3
(usually grow out of it by 3 yrs)

163
Q

CMPA presentation?

A
  • GI symptoms
  • General allergic symptoms
164
Q

name some CMPA GI symptoms ?

A
  • Bloating + wind
  • Abdo pain
  • Diarrhoea
  • Vomiting
165
Q

Name some CMPA allergic symptoms:

A
  • Rash (hives)
  • angio-oedema
  • Cough or wheeze
  • sneezing
  • Watery eyes
  • Eczema
  • If severe (rare): anaphylaxis
166
Q

how is CMPA allergy diagnosis made?

A

based on H + E

167
Q

CMPA management ? formula? breast?

A

avoid cows milk
- Breast feeding mothers should avoid dairy
- Replace formula with hydrolysed formula (contains cows milk by proteins broken down so no immune response)

168
Q

Difference between cows milk intolerance and allergy ?

A

intolerance is not allergic response as no immune response
- both can have similar GI symptoms but intolerance has no allergic symptoms

169
Q

What type of drink should ideally be avoided until diarrhoea is resolved

A

fruit juice

170
Q

What dermatological skin condition is associated with coeliac disease? distribution ?

A

Dermatitis herpetiformis
- rash with red raised patches (commonly seen on elbows, knees and buttocks)

171
Q

What is a hernia ?

A

protrusion of viscus through a defect of the walls of its containing cavity

172
Q

what are the 2 types of inguinal hernia ? describe them ?

A
  • Indirect inguinal hernia: bowel herniate through inguinal canal into the scrotum (due to incomplete closure of processes vaginalis)
  • Direct inguinal: due to weakness in the abdo wall
173
Q

which inguinal hernia type most common in kids ?

A

indirect inguinal hernia

174
Q

where does direct inguinal hernia occur ? anatomical landmark ?

A

hesselbach triangle
(this hernia is more common in adults)

175
Q

differential for limp in inguinal region ? scrotal region ?

A

scrotal: hydrocele, varicolcele
- inguinal: femoral hernia, lymph node, undescended testes/ectopici

176
Q

inguinal hernia presentation ?

A

groin swelling plus
- N+V
- constipation
- abdo pain

177
Q

inguinal hernia management ?

A

clinical diagnosis
consider USS
surgical repair

178
Q

what causes kwashiorkor ? deficiency of what ?

A

oedematous malnutrition
- lack of protein in diet => oedema

179
Q

what is Meckel diverticulum ? affecting where ?

A

Meckel’s diverticulum is a malformation of the distal ileum that occurs in around 2% of the population

180
Q

Meckel diverticulum Px ? (4) can cause what ? (2)

A
  • asymptomattic
  • but can bleed, become inflamed, rupture
  • can cause: volvulus, intussception
181
Q

Meckel diverticulum Mx ?

A

often removed prophylactically if identified in other abdominal surgeries

182
Q

what is toddlers diarrhoea ? and what could cause it ? (3)

A

chronic nonspecific diarrhea of childhood
- excessive fluid intake
- large amount of fruit juice (lots of sugar)
- immature digestive tract

183
Q
A

3a (43 decks)

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