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Phase 3a > Paeds 2 - GI, Liver, Renal > Flashcards

Paeds 2 - GI, Liver, Renal Flashcards

1
Q

What does dark green bile-stained vomit indicate?

A

Intestinal obstruction

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2
Q

What condition is indicated by projectile non-bilious vomiting in the first few weeks of life, up to an hour after feeding?

A

Pyloric stenosis

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3
Q

What condition is indicated by red-currant jelly stool?

A

Intussuception

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4
Q

What is the cause of gastro-oesophageal reflux in infants?

A

Inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity

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5
Q

What is a possible complication of GO reflux?

A

Chest infection from pulmonary aspiration
Oesophageal strictures
Barrett’s oesophagus
Failure to thrive

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6
Q

How is refractory (no spontaneous resolution) GO-reflux treated?

A

Overnight oesophageal pH study - acid in oesophagus for more than 4% of the day
Thickening agents, small feeds, nurse upright (head up slope of 30 degrees and prone)
Gaviscon
Ranitidine
Domperidone (prokinetic drug)
Omeprazole
Nissen fundoplication

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7
Q

What is the cause of pyloric stenosis?

A

Hypertrophy of the pyloric muscle

Idiopathic

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8
Q

What metabolic abnormality is seen in patients with pyloric stenosis?

A

Hypochloraemic hypokalaemic metabolic alkalosis

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9
Q

What can be found on investigation in a patient with pyloric stenosis?

A

Test feed - visible gastric peristalsis, pyloric tumour
Abdo exam - pyloric mass (olive-like) in RUQ
USS - confirms or excludes diagnosis

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10
Q

What is the treatment of pyloric stenosis?

A

IV 0.45% saline, 5% dextrose, 20mmol/L K+ supplements
Withold feeds and empty stomach with NGT
Ramstedt’s pyloromyotomy

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11
Q

What presentation is characteristic of infant colic?

A

Paroxysmal inconsolable crying with knees drawn up

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12
Q

What is Meckel’s diverticulum?

A

Ileal remnant of the vitello-intestinal duct containing ectopic gastric mucosa or pancreatic tissue

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13
Q

What is the rule of 2s with Meckel’s diverticulum?

A 
2% of the population
2 inches long
2 feet proximal to ileo-caecal valve
2 years of age onset
2 types of ectopic tissue
2% symptomatic
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14
Q

What is the symptom of Meckel’s diverticulum?

A

Painless severe rectal bleeding

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15
Q

How is Meckel’s diverticulum diagnosed?

A

Technetium scan - increase uptake by ectopic gastric mucosa

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16
Q

What is the GI anatomy in malrotation?

A

Caecum goes from RIF to right hypochondrium
SI has a narrow base (volvulus)
Duodenum covered by fibrous bands of Ladd

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17
Q

What is the presentation of intestinal obstruction in days 1-3 of life?

A

Dark green bilious vomiting
Abdo pain and distension
Blood and mucous in stools
Circulatory collapse

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18
Q

How is malrotation diagnosed?

A

Urgent upper GI contrast study

AXR - double bubble

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19
Q

What are the symptoms of appendicitis?

A

Anorexia, vomiting, pain initially central –> RIF
Tenderness and guarding over McBurney’s point
Fever

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20
Q

How is appendicitis diagnosed?

A

Abdominal X-Ray - faecoliths

Ultrasound - thickened appendix with increased blood flow

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21
Q

What is intussusception?

A

The invagination of proximal bowel into a distal segment

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22
Q

What is the most common location for intussusception?

A

Ileum passing into caecum through ileo-caecal valve

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23
Q

What are the risk factors for intussusception?

A

Viral infection leading to enlargement of Peyer’s patches (lymphoid hyperplasia)
Childhood leukaemia/small bowel lymphoma

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24
Q

What investigations are required in the diagnosis of intussusception?

A

Abdo exam - palpable sausage shaped mass
AXR - distended small bowel, absence of gas distally, outline of intussusception
AUS - target sign

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25
Q

What are the symptoms of intussusception?

A

Paroxysmal colicky episodes, refusal of feeds, bile stained vomiting, redcurrant jelly stool, abdo distension
Child falls asleep between episodes

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26
Q

What is the gold standard of treatment of intussusception?

A

Rectal air insufflation under fluoroscopic control

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27
Q

What is an abdominal migraine?

A

Functional abdominal pain and functional headaches. Can have vomiting

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28
Q

What is the eradication regime for h.pylori infection?

A

Amoxicillin/clarithromycin, metronidazole

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29
Q

What is the treatment of functional dyspepsia?

A

Hypoallergenic diet

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30
Q

What is the most common gasteroenteritis causing organism for under 2s?

A

Rotavirus

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31
Q

Blood in the stool signifies a bacterial cause for gastroenteritis, such as

A

E.coli
Campylobacter jejuni
Shigella

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32
Q

What are the complications of gastroenteritis in children?

A

Dehydration

Malnutrition

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33
Q

What is the management of a child with gastroenteritis?

A

Antidiarrhoeals and antibiotics not routinely used

Self resolution

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34
Q

When are antibiotics prescribed for gastroenteritis?

A

Sepsis
Extra-GI spread of infection
Malnutrition
Immunocompromised

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35
Q

What is post-gastroenteritis syndrome?

A

Following episode of gastroenteritis, intro of normal diet produces watery stools, and temporary lactose and dietary intolerances.

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36
Q

Why are infants at a greater risk for dehydration?

A

Greater surface area:weight ratio and greater insensible losses

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37
Q

What are the symptoms of dehydration in infants?

A 
Decreased urine output
Decreased consciousness
Sunken fontanelle
Dry mucous membranes
Prolonged capillary refill
Pale/mottled skin
Cold extremities
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38
Q

What are the three degrees of dehydration in infants?

A

No clinically detectable dehydration (<5% body weight loss)
Clinical dehydration (5-10%)
Shock (>10%)

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39
Q

What is the most common type of dehydration?

A

Isonatraemic

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40
Q

Children with diarrhoea can suffer with what type of dehydration and why?

A

Hyponatraemic - they drink water so there is a greater net loss of Na than water

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41
Q

What is a consequence of hyponatraemic dehydration?

A

Water shifts from extracellular to intracellular compartment, increasing brain volume and causing seizures

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42
Q

What are the causes of hypernatraemic dehydration?

A

High insensible losses (high fever, hot environment)

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43
Q

How do you treat shock from dehydration?

A

Rapid infusion of 0.9% NaCl solution

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44
Q

What is the presentation of malnutrition?

A

Abnormal stools
Failure to thrive
Nutrient deficiencies

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45
Q

What are three causes of malnutrition

A

Biliary atresia
Short bowel syndrome
Exocrine pancreatic dysfunction
Coeliac disease

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46
Q

When is coeliac disease most likely to present?

A

8-24 months

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47
Q

How is coeliac disease diagnosed?

A

IgA, IgA tissue transglutaminase, anti-gliaden and endomysial antibodies

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48
Q

What vitamin deficiencies are most likely to be seen in coeliac disease?

A

Vitamin B12,
Iron
Folate

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49
Q

What is characteristic of coeliac disease in the small bowel?

A

Flat mucosa, villous atrophy, crypt hypertrophy

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50
Q

What are the signs and symptoms of Crohn’s disease?

A 
Growth failure, abdominal pain, diarrhoea
Delayed puberty
Oral lesions
Perianal skin tags
Uveitis
Erythema nodosum
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51
Q

What is the treatment of Crohn’s disease?

A

Glucocorticoid monotherapy for flares: prednisolone

Enteral nutrition if concerns about growth

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52
Q

What is the difference between Crohn’s disease and Ulcerative colitis?

A

Crohn’s - transmural inflammation mouth –> anus

UC - inflammation confined to colon (90% children pancolitis)

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53
Q

What are the red flags for constipation in children?

A 
Sacral dimple
Abdominal distension
Decreased growth
Abnormal lower limb neurology
Perianal fistulae/abscess/fissures
Fever
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54
Q

At what age should children have a comparable stool pattern to adults?

A

4 years

4/day in first week, 2/day by 1 year

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55
Q

How would you manage a child with constipation?

A

Fluid and diet advice
Osmotic laxative/movicol
If no effect, stop and add senna

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56
Q

What are the causes of constipation in babies?

A 
Hirschprung's disease
Anorectal abnormalities
Hypothyroidism
Hypercalcaemia
Dehydration
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57
Q

Which large bowel nerve plexuses are missing ganglion cells in Hirschprung’s disease?

A

Myenteric and submucosal

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58
Q

What is the cause of Hirschprung’s?

A

Defect in the craniocaudal migration of neural crest cells in the first 12 weeks of gestation

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59
Q

What is the gold standard for diagnosis of Hirschprung’s?

A

Suction rectal biopsy to demonstrate absence of plexuses or large AChE positive nerve

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60
Q

How does Hirschprung’s disease present?

A

Failure to pass meconium, DRE produces watery stool
Bowel and abdo distension
Bile stained vomiting
Enterocolitis

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61
Q

How is Hirschprung’s disease treated?

A

Anastamose innervated bowel to anus

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62
Q

What is the main laboratory tool used to assess the kidneys and urinary tract?

A

PCr (plasma-creatinine ratio)

Then eGFR

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63
Q

What is an MCUG?

A

Micturating cystourethrogram - contrast introduced to bladder via urethral catheter to visualise anatomy

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64
Q

What is Potter syndrome and how is it caused?

A

Deficiency of amniotic fluid from renal agenesis or bilateral multicystic dysplastic kidney

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65
Q

How are most congenital renal conditions diagnosed?

A

Antenatal ultrasound

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66
Q

What is the most common inherited cystic kidney disease?

A

Autosomal dominant polycystic kidney disease - cysts on both kidneys fill with fluid and enlarge, compress the renal parenchyma and compromise function

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67
Q

What is the treatment of ADPKD?

A

RRT: dialysis or transplant

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68
Q

What is ARPKD?

A

Underdeveloped kidneys leading to neonatal death, or hypertension and haematuria in childhood

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69
Q

What is the cause of multicystic dysplastic kidney?

A

Failure of the union of the ureteric bud and nephrogenic mesenchyme.

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70
Q

What are the characteristics of multicystic dysplastic kidney?

A

Ureteric atresia, non functioning/no renal tissue with no connection to the bladder

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71
Q

Name two other congenital malformations of the kidney

A

Horseshoe kidney, duplex kidney

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72
Q

What is a risk factor for vesicoureteric reflux?

A

Family history

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73
Q

Why do children with VU reflux have recurrent UTIs?

A

Renal or ureteric scarring (especially if intrarenal reflux)

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74
Q

What is reflux nephropathy?

A

Shrunken, poorly functioning, scarred renal tissue from recurrent infection

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75
Q

When should you investigate for VUR and what would this entail?

A

Atypical/recurrent UTIs
Ultrasound
MCUG to diagnose
DMSA to look for renal scarring

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76
Q

How is VUR managed?

A

Prophylactic antibiotics

Endoscopic injection/surgery

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77
Q

What are three causes of primary nocturnal enuresis?

A

UTI
Polyuria
Faecal retention severe enough to cause bladder neck dysfunction

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78
Q

How is primary nocturnal enuresis treated?

A

Star chart, enuresis alarm, desmopressin for short term treatment

79
Q

What are three common organisms associated with UTI?

A

E.coli (95%)
Klebsiella
Pseudomonas

80
Q

How is UTI diagnosed?

A

Pyuria (neutrophils)

Leucocyte esterase and nitrites in the urine

81
Q

What are the differing symptoms of UTI in infants and older children?

A

Infants - poor feeding, fever, vomiting, offensive urine

Children - dysuria and frequency, loin pain, fever and rigors, v+d, offensive/cloudy urine

82
Q

A triad of proteinuria, hypoalbuminaemia, and oedema, corresponds to what condition?

A

Nephrotic syndrome

83
Q

Give three causes of primary nephrotic syndrome

A 
Minimal change disease
Focal segmental glomerulosclerosis
Membranous glomerulonephritis
Membranoproliferative glomerulonephritis
Rapidly progressive glomerulonephritis
84
Q

Give three causes of secondary nephrotic syndrome

A

SLE
Diabetic nephropathy
Syphillis
Multiple myeloma

85
Q

What are the signs of nephrotic syndrome?

A

Periorbital oedema, particularly on waking
Scrotal/vulval/leg oedema
Breathlessness from pleural effusion and ascites
Foamy urine
Anaemia

86
Q

What investigations would you commence in suspected nephrotic syndrome?

A

Urine protein dipstick
MCS or MSU
UEs, electrolytes, creatinine
Biopsy if atypical picture

87
Q

What level of protein: creatinine in the urine is likely to cause hypoalbuminaemia?

A

<600mg (normal is less than 20mg)

88
Q

What is the management of steroid sensitive nephrotic syndrome?

A

PO prednisolone 60mg/m2, 8 weeks

89
Q

What are the characteristics of steroid resistant nephrotic syndrome?

A

Increased BP
Haematuria
Decreased renal function

90
Q

What is the management of steroid resistant nephrotic syndrome?

A

Manage oedema with diuretics, salt restriction, and ACEIs

91
Q

Who is the typical patient with nephrotic syndrome?

A

Male, 2-5 years

92
Q

What are the complications of nephrotic syndrome?

A

Hypovolaemia
Thrombosis
Infection
Hypercholesterolaemia

93
Q

What are the causes of persistent proteinuria in children?

A

Hypertension
Reduced renal mass
Glomerular abnormalities

94
Q

What investigations should be carried out in a chid with haematuria?

A

Check for FH of stone formation and nephritis
History of trauma
MCS of MSU and bloods
Renal biopsy if kidney function abnormal or persistent macroscopic haematuria

95
Q

What are the symptoms of Henoch Schonlein Purpura?

A 
Trunk-sparing, symmetrical skin rash on extensors and buttocks
Knee and ankle arthralgia 
Periarticular oedema
Abdominal pain
Golmerulonephritis
96
Q

Who is the typical patient with HSP?

A

Boys aged 3-10 years

97
Q

What can precipitate HSP?

A

URTI

98
Q

What is the treatment of HSP?

A

Analgesia and symptom control

99
Q

What are three causes of acute nephritis?

A

IgA nephropathy
Post-strep
Vasculitis

100
Q

What are the symptoms of acute nephritis?

A

Decreased urine output
Hypertension that may cause seizures
Periorbital oedema
Haematuria and proteinuria

101
Q

What is the treatment of acute nephritis?

A

Diuretics

102
Q

Give three causes of haematuria in children

A 
Nephritis
Stones
Infection
Trauma
Sickle cell disease
Renal vein thrombosis
103
Q

How is blood pressure measured in children?

A

Cuff over 2/3 the length of the upper arm

104
Q

Define hypertension in children

A

Blood pressure above the 95th percentile for height, age, sex

105
Q

Give three causes of hypertension in children

A

Renal parenchymal disease e.g. PKD
Aortic coarctation
Catecholamine excess (phaechromocytoma/neuroblastoma)
CAH/Cushing’s

106
Q

What are the symptoms of hypertension in children?

A

Vomiting
Headaches
Hypertensive retinopathy
Facial palsy

107
Q

What are the predisposing causes for renal calculi?

A

UTI
Structural/metabolic abnormalities
Proteus infection

108
Q

What is nephrocalcinosis?

A

Deposition of calcium in renal parenchyma

109
Q

How do renal calculi present?

A

Haematuria
Loin to groin pain
UTI
Stone passage

110
Q

What is the syndrome that causes generalized proximal tubular dysfunction?

A

Fanconi syndrome

111
Q

Give three causes of Fanconi syndrome

A 
Vitamin D deficiency
Idiopathic
Heavy metals
Wilson disease
Tyrosinaemia
112
Q

Which molecules are lost to the urine in Fanconi syndrome?

A

Amino acids, Glucose, phosphate, bicarbonate, Na, K, Ca, urate

113
Q

What is the presentation of Fanconi syndrome?

A 
Polydipsia and polyuria
Dehydration
Hyperchloraemic metabolic acidosis
Ricketts
Failure to thrive
Hypokalaemia
Hypophosphataemia/hyperphosphaturia
114
Q

What is the treatment of Fanconi syndrome?

A

Replace substances lost in urine

115
Q

What are the three categories of AKI causes in children?

A

Prerenal, renal, post-renal

116
Q

Name some renal causes of AKI

A

Glomerulo/interstitial/pyelonephritis
HUS
Renal vein thrombosis

117
Q

What is the ultrasound finding in AKI?

A

Chronic - small kidneys

Acute - large bright kidneys

118
Q

What is the presentation of AKI?

A

Oliguria
Metabolic acidosis
Hyperphosphataemia and hyperkalaemia

119
Q

How would you manage a patient with AKI?

A

Severe acidosis/multisystem failure: dialysis
Increased phosphate: calcium carbonate
Metabolic acidosis: Sodium bicarbonate
Increased potassium: calcium gluconate

120
Q

What is the triad of symptoms in haemolytic uraemic syndrome?

A

Acute renal failure
Microangiopathic (haemolytic) anaemia
Thrombocytopenia

121
Q

What infection is HUS usually secondary to?

A

GI infection with verocytotoxin producing e.coli

122
Q

What is the prodrome in HUS?

A

Bloody diarrhoea and miserable

123
Q

How is HUS managed?

A

Supportive therapy
Isolation
Dialysis

124
Q

Define chronic renal failure

A

GFR<15ml/min/1.73m2

125
Q

What are the symptoms of CKD?

A 
Anorexia
Polydipsia and polyuria
Failure to thrive
Bony deformities - renal rickets
HTN
126
Q

What is the most common cause of persistent neonatal jaundice?

A

Unconjugated hyperbilirubinaemia (resolves spontaneously)

127
Q

What are the laboratory finding and symptoms in PNJ cause by liver disease?

A

Raised conjugated bilirubin (>20mcmol)

Dark urine, pale stools, bleeding, failure to thrive

128
Q

Give three causes of liver disease producing PNJ

A

Biliary atresia
Neonatal hepatitis
Haemolytic anaemia
Alagille syndrome

129
Q

What are the symptoms of clotting dysfunction in liver disease?

A

Epistaxis
Bruising
Petechiae

130
Q

What is biliary atresia?

A

Progressive destruction and absence of the extra-hepatic biliary tree and intrahepatic bile ducts

131
Q

Why does portal hypertension occur in neonatal liver disease?

A

Hepatomegaly and splenomegaly

132
Q

What is the gold standard diagnostic test for biliary atresia?

A

Operative cholangiography

133
Q

What type of inheritance is alpha-anti-trypsin deficiency?

A

Autosomal recessive

134
Q

Galactosaemia is caused by a lack of galactose-digesting enzymes. What are the symptoms?

A

Poor feeding, vomiting
Jaundice and hepatomegaly
When fed milk

135
Q

What are the features of viral hepatitis?

A

Nausea and vomiting
Abdominal pain and jaundice (70%)
Lethargy
Large tender liver and splenomegaly

136
Q

What are the causes of acute liver failure in children?

A 
Hepatitis (A, B, C)
Paracetamol overdose
Wilson disease
Tyrosinaemia
Reye syndrome
137
Q

What can acute liver failure progress to?

A

Encephalopathy - irritability, confusion, drowsiness
Cerebral oedema
Haemorrhage from gastritis or coagulopathy
Pancreatitis
Sepsis

138
Q

Elevation of what occurs in acute liver failure?

A

Transaminases
Serum ammonia
Bilirubin in late stages

139
Q

What is the name of the condition characterized by an acute non-inflammatory encephalitis and fatty infiltration of the liver, and what is its cause?

A

Reye syndrome

Taking aspirin under the age of 12

140
Q

How is chronic liver disease diagnosed?

A 
Elevated total protein
Hypergammaglobulinaemia
Autoantibodies
Low serum C4
Histology - liver biopsy
141
Q

What is the most common liver abnormality in cystic fibrosis?

A

Hepatic steatosis

142
Q

Thick, concentrated bile in cystic fibrosis can cause what?

A

Biliary fibrosis –> cirrhosis –> portal hypertension

143
Q

What is the treatment of biliary cirrhosis in CF?

A

Urseodeoxycholic acid

144
Q

The condition where copper accumulates in the liver, brain, kidney, and cornea from decreased caeruloplasmin synthesis is called what?

A

Wilson disease

145
Q

How are oesophageal varices best diagnosed?

A

Endoscopy

146
Q

What is a serious complication of liver disease?

A

Spontaneous bacterial peritonitis

147
Q

What are the indications for liver transplant in children?

A

Severe unresponsive malnutrition
Recurrent complications
Growth failure
Poor quality of life

148
Q

What are the differentials for gastroenteritis?

A

Lactose intolerance
Intussusception
HUS (blood in stool and miserable)

149
Q

What is the most common cause of AKI in children?

A

Haemolytic uraemic syndrome

150
Q

What investigation confirms the diagnosis of HUS?

A

FBC and blood film
Low Hb, low platelets
Schistocytes (fragmented RBC)

151
Q

How is pyloric stenosis diagnosed?

A

Test feed - hyperperistalsis, pyloric mass, projectile vomit

152
Q

In what condition does perianal itching occur and why?

A

Lactose intolerance - acidic stool

153
Q

What conditions is coeliac disease associated with?

A 
Dermatitis herpetiformis
Vitiligo
Pernicious anaemia
Hashimoto's thyroiditis
Type 1 diabetes
Small bowel lymphoma
154
Q

What is the most common inflammatory bowel disease in children?

A

Crohn’s disease

155
Q

What is the most common location for Crohn’s disease?

A

Terminal ileum

156
Q

How does terminal ileum involvement in Crohn’s disease lead to malabsorption?

A

Loss of bile salts

157
Q

What are three presentations of Crohn’s disease in children?

A

Weight loss with diarrhoea (bloody) and abdominal pain
Growth failure with delayed puberty
Toxic megacolon

158
Q

What is seen on barium enema in Crohn’s disease?

A

Thickening of wall
Strictures
Cobblestone mucosa
Rose thorn ulcers

159
Q

What is the treatment of Crohn’s disease?

A

Elemental diet for 6 weeks to induce remission
Sulfasalazine/mesalazine
Steroids for relapses
Azathioprine

160
Q

In what condition are children born with blue sclerae and what is the pattern of inheritance?

A

Osteogenesis imperfecta

Autosomal dominant but can be sporadic

161
Q

What is a Mongolian blue spot?

A

Blue/grey dermal melanocytosis

162
Q

What is the most common cause of nephrotic syndrome?

A

Minimal change disease

163
Q

What is HSP?

A

A type of IgA vasculitis

164
Q

What is physiological jaundice and why does it occur?

A

Onset days 2-5 of life, self resolving

High RBC volume at birth, decreased RBC survival, decreased hepatic uptake

165
Q

How long can breast milk jaundice last for?

A

2 weeks

166
Q

What is kernicterus?

A

Dystonic cerebral palsy due to extreme hyperbilirubinaemia

167
Q

What is the treatment of biliary atresia?

A

Kasai hepatoportoenterostomy

168
Q

At what age should a child be able to walk, speak in 2 word sentences, and ride a tricycle?

A

Walk - 18 months
2 words - 2 years
Tricycle - 3 years

169
Q

When is hand preference shown in children?

A

2 years

170
Q

What are the risk factors for recurrent UTI?

A 
FH of VUR
Spinal lesion
Structural anomaly
Constipation
Dysfunctional voiding
171
Q

What is a common cause of urinary obstruction in boys?

A

Posterior urethral valve

172
Q

When should recurrent UTI be investigated further?

A

One or more UTIs first 6m

2 or more UTIs over 6m

173
Q

What is a DMSA scan and what is it used for?

A

Radioisotope that binds to proximal tubules

Used in recurrent UTI to detect renal parenchymal damage

174
Q

What is the management of posterior urethral valves?

A

Cystoscopic ablation

175
Q

What is a risk factor for necrotizing enterocolitis?

A

Prematurity

176
Q

What causes hyperperistalsis in pyloric stenosis?

A

Stomach tries to push food past the obstruction

177
Q

Obstruction proximal to the 2nd part of the duodenum produces what type of vomiting?

A

Non-bilious - bile has not entered the duodenum yet

178
Q

What does a scaphoid abdomen suggest?

A

Diaphragmatic hernia

With bilious vomiting - malrotation and intussusception

179
Q

What histological finding confirms minimal change disease?

A

Fused podocytes

180
Q

What is seen on MCUG in VUR?

A

Gross dilatation of the ureter, pelvis, and calyces

Ureteral tortuosity

181
Q

What is Rovsing’s sign?

A

Palpation of the LIF produces pain in the RIF in appendicitis

182
Q

What is seen on X-Ray in intussusception?

A

Alternating echogenic and hypoechogenic rings

183
Q

What is the pathophysiology behind the hypochloraemic hypokalaemic metabolic alkalosis in pyloric stenosis?

A

Hydrogen chloride loss from vomiting results in hypochloraemic metabolic alkalosis
Renal compensation by maximising bicarbonate reabsorption, exchanging K+ and Na+ ions for H+ ions

184
Q

Midgut malrotation predisposes to…

A

Midgut volvulus

185
Q

What are the symptoms of a midgut volvulus?

A

High intestinal obstruction at duodenal level that is rapidly followed by infarction of the entire midgut

186
Q

What is the treatment of volvulus?

A

Laparotomy to untwist the volvulus

187
Q

What is a common consequence of volvulus?

A

Massive intestinal necrosis (seen on second look laparotomy) leading to short gut syndrome requiring IV feeding

188
Q

Apart from rectal air insufflation, what else is needed in the management of intussusception?

A

IV fluid
Antibiotics
Analgesia
NGT

189
Q

One third of babies with duodenal atresia have what genetic anomaly?

A

Trisomy 21

190
Q

What is the presentation of duodenal atresia?

A

Bile stained vomiting

191
Q

What is seen on AXR in duodenal atresia?

A

Double bubble sign

192
Q

What is the treatment of duodenal atresia?

A

Side to side duodenoduodenostomy

193
Q

What is the gold standard diagnosis of necrotizing enterocolitis and what is seen?

A 
Abdominal X Ray
Pneumatosis intestinalis (gas in intestinal wall)

Phase 3a (18 decks)

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