Paeds GI Flashcards
How is transient synovitis managed ?
- Simple analgesia
- Safety net to attend A&E if symptoms worsen or they develop a fever !
What are the symptoms of an appendicitis ?
- Umbilical pain that spreads to the RIF
- Anorexia
- N&V
What are the signs of an appendicitis ?
- > Tenderness and guarding over McBurney’s point
- > Rovsing’s sign : palpation in LIF causes pain in the RIF
- > Fever
- > Abdo pain aggravated my movement
Give 2 signs of peritonitis
- Rebound tenderness : increased pain following quick release of pressure of RIF
- Percussion tenderness
Give 3 complications of an appendicitis
- Rupture -> peritonitis
- Abscess
- Appendix mass
Define biliary atresia
- Section of the bile duct is either narrowed or absent
- This leads to cholestasis, where bile cannot be transported from the liver to the bowel
How does biliary atresia present
- Persistent jaundice shortly after birth
- Dark urine, pale stools
- Hepatosplenomegly
Define prolonged jaundice in term and premature babies
- Term : 14 days
- Premature : 21 days
What investigations are used in biliary atresia ?
Raised levels of conjugated bilirubin
- > There will be a high proportion of conjugated bilirubin (the liver can process it but not excrete it)
How is biliary atresia managed?
- > Kasai portoenterostomy : attaching a section of the small intestine to the opening of the liver where the bile duct normally attaches.
- > Often require a liver transplant in later life
Explain the pathophysiology behind coeliac disease
- Gliadin in gluten provokes a damaging immunological response in the proximal small intestinal mucosa
- > Anti-TTG and anti-EMA antibodies target epithelial cells and cause inflammation
How does coeliac disease present ?
- Failure to thrive
- Diarrhoea
- Fatigue
- Weight loss
- Mouth ulcers
- Iron an/or folate deficiency anaemia
- Growth failure
- Dermatitis herpetiformis
What bloods are done in coeliac disease ?
- First check IgA levels to exclude IgA deficiency
- Raised anti-TTG
- Raised anti-EMA
What is seen on an endoscopy + biopsy in coeliac disease ?
- Jejunum is most affected
- Crypt hypertrophy
- Villous atrophy
- Increased intraepithelial lymphocytes
Define crohns disease
-Transmural granulomatous chronic inflammation of the GI tract
How does crohns disease present ?
- Abdo pain, diarrhoea, weight loss
- Growth failure due to malabsorption
- Delayed puberty
What are the extraintestinal symptoms of crohns?
- Oral lesions or perianal skin tags
- Uveitis
- Arthralgia
- Erythema nodosum
What bloods are seen in crohns ?
- Raised faecal calprotectin
- Raised plts, ESR and CRP
- IDA due to malabsorption
- low serum albumin
What is seen on endoscopy + biopsy in crohns
- Skip lesions
- Non-caseating granulomas
- Transmural damage, terminal ileum most severe
How is remission induced in crohns ?
- Nutritional therapy for 6-8 wks
- Systemic steroids if necessary (oral pred, IV hydrocortisone)
How is remission maintained/relapse treated in crohns?
- Immunosuppressant medication : azathioprine, mercaptpurine, methotrexate
- Infliximab, adalimumab if necessary
Give 3 complications of crohns
- Bowel strictures leading to obstruction
- Fistulae
- Abscess formation
What causes GORD ?
- Inappropriate relaxation of the lower oesophageal sphincter due to functional immaturity
- Most spontanesouly resolves by 12mnths of age and put on weight normally despite symptoms
Give 4 serious causes of GORD
- Cerebral palsy
- Other neurodevelopmental disorders
- Preterm infants
- Following surgery for oesopheal atresia or diaphragmatic hernia
What investigations are done for GORD ?
- Usually clinic
- 24hr oesophageal pH monitoring to assess degree of acid reflux
- Endoscopy with oesophageal biopsy
How is uncomplicated GORD managed ?
-Inert thickening agents to feeds and position upright after meals
How is more severe GORD managed?
- Acid suppression with ranitidine or PPI
- Severe : surgical fundoplication
Give 4 complications of GORD
- Failure to thrive in severe vomiting
- Oesophagitis
- Recurrent pulmonary aspiration
- Sandifer’s syndrome
What is sandifer’s syndrome ?
-Rare condition causing brief episodes of abnormal movements assocaited with GORD in infants
Give 2 characteristics of sandifer’s syndrome
- Torticollis : forceful contraction of the neck muscles
- Dystonia
Define Hirschsprung disease
-Congenital condition where the nerve cells in the myenteric plexus are absent (aganglionic) in the rectum and variable distance of the colon