Paediatrics: Gastrointestinal + general surgery Flashcards
How do you differ between the following causes of abdominal colic?
Constipation
Gastroenteritis
Mesenteric adenitis
Coeliac
Appendicitis
Constipation // Gastro // MA // Coeliac // appendicitis
Stools: < 3 stools, rabbit drops // watery +/- blood // no change // diarrhoea or constipation // no change
Other: Hard stool in abdomen // vomiting // no change // bloating, reflux, rashes, weight loss // RIF pain, low grade fever, pain on straightening leg
What signs indicate faecal impaction in constipation?
severe symptoms
Overflow soiling
Faecal mass in abdomen
How do you treat constipation?
- Movicol (polyethylene glycol 3350 + electrolytes): escalating if impacted, lesser dose if not
- Add stimulant laxative if no change after 2 weeks
- Swap stimulant for osmotic (eg lactulose) if movicol not working
+ Add extra water into child’s diet
How do you manage gastroenteritis?
MC + S if concerned about HUS (travel, blood, IC)
Supportive if viral
Admit if HUS/acutely unwell / dehydrated
Dehydrated: 50ml/kg low osmolarity oral rehydration solution 4hrs + small maintenance amounts
How can you differentiate between dehydration and shock
Common: Raised hr, low BP
Dehydration: Normal skin temp and colour, normal peripheries
Shock: Pale, mottled skin, reduced peripheral pulse/CRT
How do you further investigate and treat coeliac disease in children?
- 6 week gluten inclusion then anti-tTG, EMA (can do biopsy if confirmation needed)
Rx: Gluten free diet
How do you manage appendicitis in children?
Admit for appendectomy
What paeds GI conditions can cause bleeding?
NEC: neonates, billous vomiting
intussussception (red-currant): pain brings knees up, RUQ mass
Meckel’s diverticulum: large bleeding, asymptomatic
IBD: systemic inflammation, mucus in stool
What are the causes of vomiting in children and how can you differentiate them?
Bilious
NEC: premature births, bloody stool, abx therapy
Meconium ileus: 2 days, CF association
Malrotation: within a week
Duodenal atresia: few hours after birth
Jejunal atresia: 24 hours
Non-bilious
Pyloric stenosis: Projectile, non-billous, <6wks old
Intussusception: Draw knees up, sausage mass
How do you investigate and treat NEC?
CXR supine shows thickened wall + trapped gas
Rx
- NBM + IV fluids, TPN
- Antibiotics
How do you diagnose and treat intussusseption?
USS shows target/telescoping bowel
Rx: Air insufflation, surgery if fails
How do you investigate and treat meckle’s diverticulum
99m technetium scan if mild, arteriography if worse
Rx: Surgical removal of diverticulum
How do you investigate and treat hirschprung’s disease?
Ix: AXR –> rectal biopsy is gold standard
Rx: Rectal washouts –> pull through procedure
How do you diagnose and treat pyloric stenosis?
Ix: Test feed or USS
Rx: Ramstedt pyloromyotomy to loosen stenosis
What other conditions should be born in mind regarding abdo pain in teenagers?
Males: Testicular torsion
Females: Gynaecological pains
How do you investigate and treat suspected duodenal atresia?
AXR shows double bubble sign
Duodenoduodenectomy
How is malrotation investigated and treated
UGI contrast shows caecum at midline
Ladd’s procedure
How do you investigate and treat jejunal atresia?
AXR shows fluid levels
Laparotomy with resection + anastomosis
Baby with guts out where
No covering
Covering
Immediate repair
Staged repair
