Paeds Gastro Flashcards
What are the most common pathogens causing gastro?
viruses 70%
- norovirus, enteroviruses
bacteria 15%
- salmonella, campylobacter, staph toxin
How should oral rehydration be done in gastro?
offer 0.5mls/kg of fluid every 5mins
Use either oral rehydration solutions (sodium and glucose replete) or dilute apple juice (not replete but higher success rate)
Cordial and soft drink have very low sodium content so are not suitable
For 5-10% dehydration what is the rate of NG and IV rehdration?
50mls/kg over 4hrs of rehdration solution or with IV 0.9% saline + 5% dextrose
Slower rate 8-12hrs with respiratory/intracranial infections, infants < 6months, or pre-existing significant medical issues
What is the typical findings in pyloric stenosis?
85% male
“olive” on abdominal exam
Hypochloraemic hypokalaemia metabolic alkalosis
Projectile non-biliary vomiting
What is the typical findings in Necrotizing enterocolitis?
90% premature neonates
Most common GI emergency in neonates
Feeding intolerance, vomiting, shock, blood from both ends
XR: Dilated bowel loops with air in the walls, pneumatosis intestinalis
What are the typical findings in intussusception?
Any age but most common 2months to 2yrs, older children usually have a pathological lead point
Ileocolic most common (idiopathic), ileoilleal most commonly associated with HSP
Usually intermittent severe abdominal pain (15-30min break in between), sausage shaped abdominal mass, red currant jelly stools
Target sign on abdominal ultrasound
What are the risk factors for intussusception? what are the complications?
Risks
Rota virus vaccine
Meckels diverticulum
HSP
Kawasakis disease
Recent viral gastro or URTI (enlarged Peyers patches)
Recent bowel surgery
Lymphoma
Luminal polyps (Peutz Jegher Syndrome)
Complications
- Sepsis
- Perforation
- fluid/electrolyte shifts
- Bowel necrosis
What is a Meckels diverticulum and what is the significance?
Most common congenital bowel malformation
Remnants of the vitelline (omphalomesenteric duct) containing heterotopic tissue such as gastric mucosa
Associated with intussusception and also painless spontaneous GI bleeds with varying stools from red blood to malaena
What are the most common sites for FB’s to lodge in the oesophagus?
Upper oesophageal sphincter at the thoracic inlet (C6-T1)
Aortic arch/tracheal bifurcation (T4-6)
Lower oesophageal sphincter, diaphragmatic hiatus (T10-11)
When should button batteries be removed from GI tract?
Emergency if lodged in the oesophagus as causes severe mucosal burns and perforation
If passes into the stomach then will usually pass on its own, but if not passed within 48hrs will need to be removed
What is gallbladder hydrops?
Massive fluid distension of the gallbladder
Caused by biliary duct obstruction without inflammation
Associated with URTI’s/GI infections, Kawasakis, strep throat, nephrotic syndrome, mesenteric adenitis and leptospirosis
What is the initial treatment of abdominal sepsis in children (ie intussusception)?
Support airway and breathing
If shock give crystalloid boluses, then give IV maintenance fluid
IV/IN analgesia
Consider NGT placement and make patient NPO
Seek and treat hypoglycaemia
Empiric ABx
- IV Ampicillin 50mg/kg
- Metronidazole 15mg/kg
- Gentamicin 5-7.5mg/kg
OR
- Tazocin IV 100mg/kg
What is the sensitivity and specificity of U/S for intussusception?
Sen 96%
Spec 97%
Negative predictive value 99%
Can be used as a SnOut
Target sign, bulls eye, coiled spring
Usually in the RLQ
What are the success rates and contraindications to air enema for intusussception?
Contraindicated in unstable children (needs theatre)
83% success for pneumatic, 70% for hydrostatic (water/contrast used)
0.4% rate of causing perforation
How is Pyloric stenosis diagnosed?
U/S = 97% Sen, 100% spec
Clinical- Succusion splash, palpable mass in R)UWQ, visible peristalsis
What are the components of the Alvarado score for appendicitis?
