Paeds GI Flashcards

1
Q

CASE

A baby who keeps vomiting
O/E - looks fine, putting weight on well

Diagnosis?

A

GORD

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2
Q

What is the pathophysiology of vomiting in GORD?

A

Functional immaturity of the oesophageal sphincter
Lying down loads (cause they’re a baby)
Predominantly liquid food
Short intra-abdominal length of the oesophagus

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3
Q

What are the risk factors for developing GORD?

A

Cerebral palsy
Pre-term - especially if broncho-pulmonary dysplasia
After surgery for oeseophageal atresia or diaphragmatic hernia

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4
Q

How would you investigate a baby with GORD?

A

Clinical diagnosis basically

But then if they fail to respond to treatment or complications - oesphageal pH monitoring (degree of acid reflux) and endoscopy + oesophageal biopsies for oesphagitis + other causes

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5
Q

How would you treat a baby with mild GORD?

A

Reassurance
Add thickening agent to feeds
Small frequent meals
Avoid food before sleep
Avoid fatty foods, citrus, caffeine, carbonated drinks
Position with head at 30 degrees prone after feeds

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6
Q

How would you treat a child with significant GORD?

A

H2 receptor antagonist eg Ranitidine
PPI eg omprazole

If complications - Nissen fundoplication

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7
Q

What are the complications of GORD?

A
Oesophageal stricture
Oesophagitis
Recurrent pulmonary aspiration
Barrett's oesophagus
Failure to thrive
Anaemia
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8
Q

CASE

Baby that is vomiting after feeds, is getting worse and is now projectile

Differentials?

A

Pyloric stenosis
Really bad GORD
Obstruction - malrotation
Duodenal atresia

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9
Q

What would you see in the bloods of a patient with pyloric stenosis / recurrent vomiting?

A

Hypochloraemic, hypokalaemic metabolic acidosis

So low chloride, potassium (and sodium)
And low bicarb, low base excess, low pH and probably low CO2 cause of respiratory compensation

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10
Q

How would you investigate a baby with suspected pyloric stenosis?

A
Immediate resuscitation if needed
ABG
Test feed
Visible gastric peristalsis - left to right
Palpable OLIVE SHAPED MASS in the RUQ
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11
Q

What could you do to help you to examine (with palpation) a baby with pyloric stenosis?

A

Feed - milk calms a hungry baby

NG tube to get rid of air in the stomach if its overdistended

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12
Q

How would you manage a child with pyloric stenosis?

A

Rehydration - 0.45% saline and 5% dextrose and potassium supplementation
Pyloromyotomy - feed after 6 hours, discharge after 2 days

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13
Q

What are the symptoms and signs of appendicitis?

A

Abdominal pain - colicky, initially central and then localised to RIF
Anorexia
Vomiting

Flushed face
Oral fetor
Low grade fever
Abdo pain worse on movement
Tenderness and guarding at McBurney's point
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14
Q

How would you investigate a child with suspected appendicitis?

A

Bloods - neutrophilia
USS to exclude other things
CT
Laparoscopy

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15
Q

What might you see on abdominal X ray in a child with appendicitis?

A

Faecoliths

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16
Q

How would you manage a child with suspected appendicitis?

A

Nil by mouth

Appendicectomy - usually laporoscopic

17
Q

How would you manage a child with a perforated appendix?

A

Fluid resus

IV metronidazole before surgery

18
Q

CASE

A 1 year old with episodes of abdominal pain, vomiting and some blood stained mucous in the their nappy

Differentials

A

Intusussception

19
Q

What are the symptoms and signs of intussusception?

A

PAIN - paroxysmal, colicky - drawing up of legs, lethargy between episodes

VOMITING - can be bile stained

Sausage shaped MASS in RUQ

REDCURRANT JELLY

Abdo distension

Shock

20
Q

How would you investigate a child with redcurrant jelly stool?

A

Examination - sausage shaped stool
Rectal exam - blood

AXR - small bowel obstruction, soft tissue mass

USS - target sign

21
Q

What would you see on an abdominal X ray in a child with small bowel obstruction?

A

Distended small bowel

Absence of air in distal colon and rectum

22
Q

What is intussusception?

A

Invagination of proximal bowel into distal (telescoping)

23
Q

Where does intussusception commonly occur?

A

Ileo-caecal valve

24
Q

How would you manage a child with intussusception?

A

ABCDE
IV fluids
Analgesia
NG tube if vomming

Radiological reduction of intussusception - by rectal air insufflation

25
Q

What are the risks associated with the procedure to reduce an intussusception?

A

Perforation

Incomplete reduction

26
Q

What are the complications of intussusception?

A

Bowel perforation
Peritonitis
Gut necrosis

27
Q

CASE

A child with profuse fresh rectal bleeding

Diagnosis?

A

Meckel’s diverticulum

28
Q

What is Meckel’s diverticulum?

A

Ileal remnant of the vitello-intestinal duct

29
Q

Give some features of Meckel’s diverticulum

A
RULE OF 2s
2% of the population
Age presentation before 2
2 inches long
Within 2 feet of the ileo-caecal valve
2 types of tissue - gastric and pancreatic
30
Q

What are the complications of Meckel’s diverticulum

A

Severe rectal bleeding
Intussusception
Volvulus
Diverticulitis - mimics appendicitis

31
Q

How would you diagnose Meckel’s diverticulum?

A

Technetium scan - shows increased uptake by gastric mucosa tissue

32
Q

When and how would you treat a child with a Meckel’s diverticulum?

A

If symptomatic

Laparoscopic resection

33
Q

CASE

A 2 day old baby presents with dark green vomiting

Diagnosis?

A

Obstruction - somewhere below the level of the bile duct

In this age group - usually malrotation

34
Q

How would you investigate a child with bilious vomiting?

A

Urgent upper GI contrast study

35
Q

What is malrotation?

A

Mesentery not fixed at the duodenojejunal flexure or ileocaecal region - volvulus during rotation of the small bowel in foetal life

If Ladd bands (fibrous bands attaching caecum to retroperioneum in RLQ) cross the duodenum - bowel obstruction

36
Q

How would a child present with malrotation?

A

Dark green vomiting - bilious

Abdominal pain + tenderness - peritonitis or ischaemic bowel

37
Q

How would you diagnose malrotation>

A

Upper GI contrast study

If signs of vascular compromise - urgent laparotomy

38
Q

How would you treat a child with malrotation?

A

ABCDE
Fluid resuscitation
Surgery (urgent) to untwist the volvulus
+ generally remove the appendix to avoid diagnostic confusion if they later present with signs of appendicitis