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3A > Paeds - GI > Flashcards

Paeds - GI Flashcards

1
Q

Pyloric stenosis aetiology

A

Hypertrophy of circular muscle in the pylorus
Gastric contents fail to pass through to intestines

Male
2-8 weeks old
First born
Family Hx

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2
Q

Pyloric stenosis presentation

A

Projectile vomiting - Non-bile stained
Olive shaped mass in RUQ
Visible peristalsis

Hypokalaemic, hypochloraemic, hyponatraemic

ALKALOSIS

General

  • FTT
  • Dehydration
  • Weight loss
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3
Q

Pyloric stenosis investigations

A

USS - Non-passing of gastric contents

XR

  • Double track sign
  • String sign
  • Beak sign

pH ^
pCO2 ^
HCO3 ^

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4
Q

Pyloric stenosis management

A
  1. Fluid resus + BOLUS
    • 0.9% NaCl + 5% dextrose
  2. Once urine output is adequate - ADD KCl

NG tube - NBM

RAMSTEDT PYLOROMYOTOMY

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5
Q

Intussusception aetiology

A

Telescoping of proximal bowel into distal segment
Most commonly at ICV

2months - 2years
Viral infection
Meckel’s diverticulum

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6
Q

Intussusception presentation

A

Red currant jelly stool
Bile stained vomit
Sausage mass - RUQ

Inconsolable crying
Drawing of knees to chest
Pallor
Abdo distension

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7
Q

Intussusception investigations / management / complications

A

USS - Target sign
XR - Proximal distension

Management

  • IV fluids
  • NG tube - NBM
  • Reduction with air insufflation
  • Laparotomy

Complications

  • Shock
  • Peritonitis
  • Obstruction
  • Perforation
  • Necrosis
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8
Q

Hischsprung’s aetiology and presentation

A

Absence of myenteric plexus in the bowel

Boys
Downs

48 hours - Failure to pass meconium

Constipation 
Distension 
Explosive diarrhoea 
Gas on PR exam 
Bile stained vomit 
FTT
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9
Q

Hischsprung’s investigations / management / complications

A

Suction rectal biopsy

  • Absence of ganglionic cells
  • Large Achesterase +ve nerve trunks

Management - Bowel resection

Complications

  • C. Diff
  • Toxic megacolon
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10
Q

Lactose intolerance

A

Post-gastroenteritis
Afro-Caribbean

Diarrhoea 
Green frothy stools 
Failure to thrive 
Weight loss 
Bloating

Hydrogen breath test
Stool chromatography - Lactose sugar ^

Avoid lactose

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11
Q

Cow’s milk protein intolerance aetiology and presentation

A

Family history

IgE mediated - RESP!

  • Rash
  • Lip oedema
  • Wheeze
  • Cough
  • Stridor

Non-IgE mediated - GI!

  • Diarrhoea
  • Vomiting
  • Failure to thrive
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12
Q

Cow’s milk protein intolerance investigations and management

A

Clinical - Eliminate cow’s milk
Skin prick test
IgE radioallergosorbant test (RAST) for cow’s milk protein

Formula fed

  • Extensive hydrolysed formula
  • Amino acid based formula

Breastfed - Eliminate CM from mother’s diet

Resolves with time

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13
Q

Meckel’s diverticulum pathophysiology

A

Remnant of vitello-intestinal duct

RULE OF 2s

  • 2 years old
  • 2 inches long
  • 2 feet from ICV
  • 2% of population
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14
Q

Meckel’s diverticulum presentation / investigations / management

A

Abdo pain
Rectal bleed
Intestinal obstruction - Can lead to intussusception

Investigations - Technetium scan

Management

  • Asymptomatic - Leave
  • Symptomatic - Surgery
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15
Q

GORD aetiology and presentation

A

< 8 weeks
Premature
CP
Horizontal feeding

Posseting after feeds

Respiratory

  • Apnoea
  • Aspiration
  • Wheeze
  • Cough

FTT

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16
Q

GORD investigations and management

A

Clinical diagnosis

Reassure
Thicken feeds
Feed upright
Small and frequent feeds

Severe

  • Alginate therapy - Gaviscon powder
  • PPI - Omeprazole
17
Q

GORD complications and red flags

A

Complications

  • Failure to thrive
  • Dystonic neck
  • Aspiration pneumonia
  • Oesophagitis

Red flags

  • Bilious vomiting
  • Blood in stool
  • Failure to thrive
  • CP features
18
Q

Duodenal atresia

A

Ds and Bs

Associated with Downs

Bilious vomiting hours after birth

AXR - Double bubble

Management - Surgery

19
Q

Biliary atresia aetiology and presentation

A

Absence or destruction of extra-hepatic biliary tree or bile ducts

Jaundice
Hepatomegaly
Splenomegaly

Pale stools
Dark urine

20
Q

Biliary atresia investigations and management

A

Conjugated and unconjugated bilirubin
LFTs
INR

USS

Management - Kasai procedure

21
Q

Failure to thrive causes

A

Inadequate intake
Inadequate absorption
Increased calorie consumption
Genetic

Haem - Thalassaemia
Cardiac - CHD

22
Q

Causes of inadequate intake

A

Impaired swallowing

  • Cerebral palsy
  • GORD
  • Cleft palate

Child abuse/neglect
Low socioeconomic status

23
Q

Causes of inadequate absorption

A

Toddler diarrhoea
Gastroenteritis
NEC

IBS/IBD
Coeliac
Lactose intolerance CMPI

Biliary atresia
CF

24
Q

Causes of increased calorie consumption

A

Diabetes
Hyperthyroid
Chronic disease
Downs

3A (31 decks)

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