Paediatrics - GI Flashcards
What are the differentials of an abdominal mass in a child?
Wilm’s tumour, neuroblastoma, leukemia, sarcoma. hepatoblastoma
Constipation
Enlarged kidneys
What are some ways to treat constipation?
Diet
Osmotic laxatives - movical, lactulose
Stimulant laxatives - sodium picosulfate, senna, bisacodyl
What are some symptoms of oesophageal atrusion?
persisten salivation and drooling
coughing and choking on feeding
cyanotic episodes
aspiration
What is the difference between gastroschisis and exomphalos?
gastroschisis - bowel protrudes through abdominal wall with no covering sac - these is greater risk of dehydration and hypothermia
What do you do with umbilical hernias?
leave them alone!
95% resolve spontaneously
How would you treat necrotizing enterocolitis?
stop oral feeds
broad spectrum antibiotics
abdo XR
surgery if bowel perforation - surgcial review
How would you test for oesophagel atrusion?
insert wide-calibre feeding tube and see if in stomach on XR
What are the symptoms of necrotizing enterocolitis?
feed intolerance
vomiting - bile stained
disended abdo
stool-fresh blood
Name 2 causes of large bowel atresia
Hirschrung disease
rectal atresia
Name 3 common causes of small bowel atresia
duodenal atresia/stenosis (esp Down) Jujunual atresia/stenosis malnutrition with volvulus meconium ileus meconium plug
How do you test for and treat Hirschprung?
rectal exam and suction rectal biopsy
treat - surgery, colostomy
What is the VACTERL association?
vertebral, anorectal, cardiac, tracheo-oesophageal, renal, radial limb anomalies
What increases the incidence of necrotizing enterocolitis?
Hisprungs
premature - vulnerable to ischaemic injury and bacterial invasion
What are the symptoms of Hirschprung disease?
do not pass meconium in 24-48 hours abdominal distension bile stained vomiting chronic constipation growth failure enterocolitis
What is different with treating inguinal hernias in children?
Need more urgent repair
Neonates - within days
Infants - within weeks
Name symptoms of small bowel atresia
persistent vomiting - bile stained
no normal stool +/- meconium
abdominal distension (esp when distal)
What is the meconium ileus?
thick insipissated meconium, putty consistency becomes impacted in lower ileum - 10% of people with CF
What is Hirschsprung disease?
absence of myenteric plexus of rectum and variable distance of colon
How would you treat GORD?
anatacid, H2 blocker e.g. ranitide, PPI e.g. omeprazole
What are the red flags for constipation?
no/delayed meconium, fever, vomiting, bloody stools, failure to thrive, tight, empty rectum and palpable mass, abnormal neuro exam
Name 5 causes of diarrhoea
gastroenteritis, UTI, meningitis, food allergy, appendicitis, intussception, haemolytic uraemic syndrome
What are red flags of abdo pain?
weight loss, decreased growth, GI blood loss, vomiting, diarrhoea, fever, family history, persistent right/upper or lower quadrant pain
Name 5 differentials for constipation
Hirschprung, anorectal malformation, spina bifida, neuromuscular disease, coeliac, food allergy, CF, anal fissure, hypothyroid, sexual abuse, drugs, spinal tumours
When does pyloric stenosis present?
2-8 weeks
What would you see on bloods of a child with pyloric stenosis?
hypochoremic metabolic acidosis
low sodium and potassium
Name symptoms of pyloric stenosis
vomiting - increased frequency and forcefullness eventually projectile
hunger - until dehydration results in loss of feeding
weight loss
What is the cause of neonatal jaundice is urgent and needs to be treated ASAP?
extrahepatic obstruction to bile flow
TEST - radioisotope, liver biopsy
TREAT - hepatoporto and enterostomy
Risk - liver cirrhosis
What is a major complication of jaundice?
Kernictereus - bilirubin deposits in basal ganglia and brainstem nuceli
due to unconjugated bilirubin being fat soluble so can cross blood-brain barrier
When would you be concerned about jaundice?
< 1 days old
dark urine
pale stools
failure to thrive
What are some causes of jaundice?
congenital, infection, haemolytic, polycythaemia, physiological, breast milk, biliary atresia
What is biliary atresia?
extrahepatic obstruction to bile flow = pale urine and dark stools
What does bile stained vomit indicate?
Intestinal obstruction
What does blood stained vomit indicate?
Peptic ulceration, gastritis, oesophageal varices
What does projectile vomit indicate?
Pyloric stenosis
What does blood in stool indicate?
intussusception, gastroenteritis
How would you test for pyloric stenosis?
ABG - metabolic alkalosis, low potassium and chloride
Test feed - NG tube and aspiration to empty stomach, give dioralyte - if an “olive” mass is palpable on liver edge = stenosed pylorus
What is the treatment of pyloric stenosis?
normalise fluid and electrolytes
Ramstedt’s pyloromytomy
How would you treat Crohn’s disease?
enteral nutrition, glucocorticoid
Maintainence - azathioprine
How would you treat UC?
glucocorticoids, aminosalicylates (e.g. mesalazine)
Maintainence - aminosalicylates
What are symptoms of intussusception?
sudden colicky pain, drawing legs up, pale, vomiting, redcurrent jelly stools
Target sign on US
What causes jaundice in firsts 24 hours?
haemolytic disease of the newborn, hereditary spherocytosis, G-6-PD deficiency, sepsis, TORCH infections
What causes jaundice 2 weeks after birth?
Biliary atresia, hypothyroidism, galactosaemia, UTI, Gilbert syndrome
What would high levels of conjugated or unconjugated bilirubin indicate?
Conjugated - hepatobiliary source
un-conjugated - extra-hepatic source
What is wilson’s disease?
Copper accumulating in liver, kidneys, eyes and brain
Kayser-Fleischer rings, parkinsonism, vit D resistant rickets, jaundice
How do you test and treat for Wilson’s disease?
24 hour urine copper assay, serum caeruloplasmin low
Treat - penicillamine, zinc, vit B6
What is Kernicterus?
unconjugated bilirubin in basal ganglia = GI haem, athetosis, gaze disturbance, hearing loss, convulsions, cerebal palsy, usually in first month of life
What is galactosaemia and some of its symptoms?
autosommal recessive where you lack the enzyme for galactose ingestion (in milk)
ingestion of galactose = vomiting, hepatomegaly, failure to thrive, DM, cataracts, developmental delay
transferase deficiency itself causes poor growth and problems with speech and mental development
What is phenylketonuria?
they cannot digest phenylalamine (eggs, milk, meat)
leads to brain damage, epilepsy and learning difficulties
When is phenylketonuria tested for?
Newborn heel prick test
How would you manage intussception?
NBM
IV fluids
75% reduced by air insuffiation rectally but this risks perforation so do in theatre
What counts as prolonged jaundice?
Beyond day 14 in term babies
Beyond dy 21 in preterm neonates
What are systemic symptoms of cow’s milk allergy?
diarrhoea, dermatitis, rhinitis
When does reflux start and how long does it last?
within first 8 weeks, peaks 3-4 months
90% resolve in one year
