Paeds

Question 1

Pyloric stenosis

Answer 1

Progressive non bilious projectile vomiting in boys.
Age 2-12 months
Caterpillar sign on Axr
> or = 4 mm thick or 16 mm long

Question 2

Biliary atresia

Classification
Imaging
Treatment

Answer 2

Absence or severe deficiency of biliary tree. Destructive inflammatory process
Causes conjugated hyperbilirubinaemia. Role of radiology to differentiate from various non surgical causes (neonatal hepatitis).
10% syndromic
Kasai classification: 1. CBD 2a. CHD 2b. CBD, CD, CHD 3. L and R HDs at porta hepatis (90%)

US- triangular cord sign, enlarged hepatic artery
Tc 99 HIDA scan shows normal hepatic uptake and clearance but no passage to small bowel by 24h. In neonatal hepatitis see delayed hepatic clearance (activity at 24h) with variable small bowel excretion

Treatment is Kasia portoenterostomy

Question 3

Meckel diverticulum

Answer 3

0mphalomesediverticulitisnteric duct (vitelline duct) remnant.
2% population 2%Symptomatic, usually before age 2
2 inches long 2 feet from ic valve
2/3 ectopic mucosa; 2 types: gastric or pancreatic

Present with gl bleeding if gastric mucosa, sbo/intussusception or diverticulitis
TC-99 pertechnetate scan cen diagnose gastric mucosa

Question 4

Necrotising enterocolitis

Answer 4

1 -3 weeks of age in premature infants <1000g. Breast milk protective.

Usually ileum and right colon.

Focal bowel dilatation RLQ. Separation of small bowel loops (mural thickening) unchanged bowel gas pattern on serial films.

Pneumatosis. Portal venous gas. Pneumoperitoneum (lateral).

Staging (clinical and radiological features):
1- dilatation, 2- pneumatosis, portal venous gas, 3- ascites, 4-perforation

Question 5

High and low intestinal obstruction in neonates

Answer 5

High:
Malrotation and volvulus,] duodenal atresia , duodenal web, annular pancreas and stenosis, jejunal atresia

Low:

Meconium ileus, hirschsprung’s, meconium plug syndrome, ileal atresia, anal atresia

Question 6

Duodenal atresia/web/stenosis/annular pancreas

Answer 6

30% duodenal atresia associated with t21.
Atresia shows double bubble and no gas distal. Only see dilated
Bulb if chronic so can differentiate from volvulus

Stenosis: double bubble with distal gas

Web: windsock

Question 7

Meconium Ileus

Answer 7

Obstruction of distal ileus due to tenacious meconium.
Exclusively in Cf
Risk of perforation, volvulus, perforation.

Bubble like lucencies. Distal obstruction. Calcifications if perforation.

Other ileal cause of distal obstruction is ileal atresia

Question 8

Hirshsprung Disease

Answer 8

colonic aganglionosis
Involves anus and variable length contiguous colon.
4m:1f, 5% have t21
Reversal of recto sigmoid ratio. Tapered transition. Aganglionic segment may show sawtooth irregularity.

Distal obstruction.

Question 9

Meconicon plug syndrome ( small left colon)

Answer 9

Functional immaturity of ganglion cells
Functional obstruction of distal colon.
Self limiting, no association with Cf
Increased incidua in diabetes mothers or after magnesium administration
Small left colon, may see meconium plugs, normal caliber rectum

Question 10

Tracheo-oesophageal fistula / oesophageal atresia

Answer 10

85% oesophageal atresia with distal fistula (type C)
8% isolated oesophageal atresia
4% isolated fistula (H type)
1% each proximal fistula, distal atresia and double fistula, intervening atresia

Classically unable to pass NGT with gaseous bowel dilatation

Associated with vacterl and trisomies 13/18/21