Paeds Flashcards
M:F pyloric stenosis
4:1
Features of pyloroic stenosis on examination
Olive mass RUQ
What age does Pyloric Stenosis present?
around 6 weeks
Ix pyloric stenosis
USS
Test feed
Treatment pyloric stenosis
Ramstedt pyloromyotomy
What age and below would you not expect a child to have acute appendicitis?
<3
Features of mesenteric adenitis
Central abdominal pain
URTI
Mimics appendicitis
Mx of mesenteric adenitis
Conservative
What is intussusception
one segment of bowel is pulled into itself or a neighbouring loop of the bowel by peristalsis (telescoping)
Where in the GIT does intussusception usually occur?
proximal to ileocaecal valve
(Ileocolic)
Age at which intussusception presents
9 months
Sx intussusception
Colicky pain
Diarrhoea (red current)
Vomiting
On examination what would you feel in intussusception
Sausage shaped mass RUQ
What is red current jelly stools an indication of
Intussusception
That ischaemia has occured
Ix intussusception
XR - RUQ mass
Target sign USS
Fluoroscopy + contrast enema (gold standard)
Mx intussusception
Air insufflation
When not to use air insufflation in intussusception
Ileo-ileo intussuception
What is the most common cause of neonatal bowel obstruction ?
Hirschsprungs
M:F Hirschsprung
3:1
What is Hirschsprung’s
ganglionosis (absence of ganglion cells) in the distal colon and rectum in myenteric + submucosal plexuses
PS Hirschsprung’s
Failure to pass meconium in 1st 1-2 days post birth
Ix Hirschsprung
Rectal biopsy
Contrast enema
Mx Hirschsprung
Rectal washouts
Definitively anorectal pull through
What 3 things is oesophageal atresia associated with?
Tracheo-oesophageal fistula
Polyhydramnios
VACTERL
What is VACTERL
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-oesophageal fistula
Renal anomalies
Limb abnormalities
Sx oesophageal atresia
Choking + cyanotic spells following aspiration
Which condition is meconium ileus associated with?
Cystic fibrosis
Ix/Tx meconium ileus
Initially PR contrast studies - can actually dislodge meconium
NG N-acetylcysteine
If this fails –> surgery
Features of biliary atresia
Jaundice >14 days
increase in conjugated bilirubin
Mx biliary atresia
Urgent Kasia procedure
Biggest RF necrotising enterocolitis
Prematurity
Sx necrotising enterocolitis
Abdo distention
Passage bloody stools
XR features necrotising enterocolitis
Pneumatosis intestinalis
free air
Mx necrotising enterocolitis
Gut rest
TPN
If fails –> laparotomy
What is a Littres hernia
Hernia containing meckels diverticulum
Mx Littre’s hernia
Mesh repair
By what age do 95% of umbilical hernia’s resolve by?
Age 2
After what age would you surgically repair an umbilical hernia?
After 3rd birthday
Through where does a Morgagni hernia form?
foramen magni in diaphragm
What part of the bowel will more advanced Morgagni hernia contain?
Transverse colon
Management Morgagni hernia
Direct anatomical repair
Bochdalek vs Morgagni hernia - which is associated with polmonary hypoplasia and respiratory compromise?
Bolchadek
Where are the majority of Bochdalek hernias?
Left hemidiaphragm (85%)
Which gender > Bochdalek hernias?
Male
Mx Bochdalek hernias
Direct anatomical repair or mesh repair
Asymptomatic Meckels - what type of cells?
Ileal mucosa
Symptomatic Meckel’s - what type of cells?
Gastric mucosa
