Paeds: Gastroenterology + Abdominal disorders Flashcards
First line treatment of threadworm?
Oral mebendazole
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An anti-helminthic.
Infestation with threadworms (Enterobius vermicularis, sometimes called pinworms) is extremely common amongst children in the UK. Infestation occurs after swallowing eggs that are present in the environment.
Topical clotrimazole may be indicated for fungal infections, not parasitic infections.
Oral metronidazole may be indicated for anaerobic or protozoal infections, not parasitic infections.
Oral fexofenadine and topical hydrocortisone are not indicated in the treatment of threadworms.
A two-day-old baby who has not passed meconium now has a distended abdomen and is vomiting green bile. It is suspected that he may have a congenital condition affecting the rectum. Most likely diagnsosis?
Hirschsprung’s disease
Under rectal biopsy, there is an absence of ganglionic cells. Most likely diagnosis?
Hirschsprungs disease
Definitive treatment for Biliary Atresia
Surgical intervention: Intervention may include dissection of the abnormalities into distinct ducts and anastomosis creation
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A hepatoportoenterostomy (HPE) can be performed. This is also known as Kasai portoenterostomy and it allows bile drainage. In this procedure, the blocked bile ducts are removed and replaced with a segment of the small intestine. This restores bile flow from the liver to the proximal small bowel.
Biliary atresia is a paediatric condition involving either obliteration or discontinuity within the extrahepatic biliary system, which results in an obstruction in the flow of bile. This results in a neonatal presentation of cholestasis in the first few weeks of life. The pathogenesis of biliary atresia is unclear, however, infectious agents, congenital malformations and retained toxins within the bile are all contributing factors.
A father brings his 16-day old baby presents to the emergency department. The baby is visibly jaundiced and distressed, and the father explains the baby has not been feeding well since yesterday. Examination reveals hepatomegaly and splenomegaly. A newborn jaundice screen indicates no infection, normal thyroid function tests, raised conjugated bilirubin, liver transaminases and bile acids. The urine is negative for reducing substances. Most likely diagnosis?
Biliary Atresia
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Neonatal jaundice, post-hepatic cause.
Other jaundice causes include infection (GBS) and hypothyroidism
What genetic conditions are associated with neonatal cholestasis?
- Alpha-1-antitrypsin deficiency
- Cystic fibrosis
A baby girl born 4 weeks ago has had persistent jaundice since 48 hours after birth. Her parents also noticed she is reluctant to take on breastfeeding and her urine appears quite dark.
Upon your examination, you confirm the infant is jaundiced and notice a firm, enlarged liver.
You review her bloods which show a conjugated hyperbilirubinaemia. Her serum alpha-1 antitrypsin levels and electrophoresis are normal and the neonatal heel prick test performed at birth was negative.
What is the treatment of choice for this condition?
Surgery, (a Kasai procedure- hepatoportoenterostomy)
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Attempts to restore bile flow from the liver to the proximal small bowel. This decreases hepatic damage, and avoids or delays the need for subsequent liver transplantation.
What does bilious vomitting in a neonate suggest?
Gastrointestinal (Bowel) obstruction
A 3-year-old girl is brought in by her mother. Her mother reports that she has been eating less and refusing food for the past few weeks. Despite this her mother has noticed that her abdomen is distended and she has developed a ‘beer belly’. For the past year she has opened her bowels around once every other day, passing a stool of ‘normal’ consistency. There are no urinary symptoms. On examination she is on the 50th centile for height and weight. Her abdomen is soft but slightly distended and a non-tender ballotable mass can be felt on the left side. Her mother has tried lactulose but there has been no significant improvement. What is the most likely diagnosis?
Wilm’s tumour (nephroblastoma)
