paeds GI Flashcards
signs to look out for in GORD
Chronic cough Hoarse cry Distress, crying or unsettled after feeding Reluctance to feed Pneumonia Poor weight gain
mx for GORD?
Small, frequent meals
Burping regularly to help milk settle
Not over-feeding
Keep the baby upright after feeding (i.e. not lying flat)
- Gaviscon mixed with feeds
- Thickened milk or formula
- Ranitidine
- Omeprazole where ranitidine is inadequate
what is Sandifer’s syndrome?
GORD with abnormal movements- the baby is neurologically fine tho
torticollis: forceful contraction of the neck muscles causing twisting of the neck
Dystonia: abnormal muscle contractions causing twisting movements, arching of the back or unusual postures
resolves as reflux gets better
Pyloric stenosis
hypertrophy of pyloric
failure to thrive
Projectile vomitting!!!!
firm round mass in upper abdomen- feels like a large olive
hypochloric (low CL) and metabolic alkalosis
dx: abdominal USS
Tx: laparoscopic pyloromyotomy (known as “Ramstedt’s operation“
main concerns with gastroenenteritis in a child?
isolate- easily spread.
Dehydration
Cystic fibrosis?
Steatorrhoea means greasy stools with excessive fat content.
most common cause of viral gastroenteritis?
Rotavirus
Norovirus
E.coli and gastroenteritis?
produces Shiga toxin:
bloody diarrhoea and vomitting
-> HUS
don’t use abs!!- increase risk of HUS
travellers diarrhoea causes?
Campylobactor
Raw or improperly cooked poultry
Untreated water
Unpasteurised milk
abx for campylobacter diarrhoea?
azithromycin or ciprofloxacin.
Shigella diarrhoea?
1-2 day incubation
bloody diarrhoea and cramps
- can cause HUS
- > Azithromycin/ ciprofloxacin (like campylobacter)
Bacillus ceros diarrhoea?
guy eats rice and
vomiting within 5 hours,
diarrhoea after 8 hours,
then resolution within 24 hours.
gastroenteritis ccx?
Lactose intolerance
Irritable bowel syndrome
Reactive arthritis
Guillain–Barré syndrome
Coeliac antibodies?
anti-tissue transglutaminase (anti-TTG) -raised
anti-endomysial (anti-EMA)
-> these 2 are IgA, need to test for TOTAL IgA
coeliac presentation?
Failure to thrive Diarrhoea Fatigue Weight loss Mouth ulcers
Anaemia secondary to iron, B12 or folate deficiency
!!!!Dermatitis herpetiformis is an itchy blistering skin rash that typically appears on the abdomen
what disease associated with Coeliac?
test all patients with a new diagnosis of type 1 diabetes for coeliac disease, even if they don’t have symptom, because the conditions are often linked.
how does Crohns present?
N – No blood or mucus (these are less common in Crohns.)
E – Entire GI tract
S – “Skip lesions” on endoscopy
T – Terminal ileum most affected and Transmural (full thickness) inflammation
S – Smoking is a risk factor (don’t set the nest on fire)
UC presentation?
C – Continuous inflammation
L – Limited to colon and rectum
O – Only superficial mucosa affected
S – Smoking is protective
E – Excrete blood and mucus
U – Use aminosalicylates!!
P – Primary sclerosing cholangitis
how to test for IBD?
Faecal calprotectin
endoscopy- gold standard!
how to treat IBD?
steroids!!- Prednisalone/ IV hydrocortisone
How does Biliary atresia present?
presents shortly after birth
-significat conjugated jaundice (dark pee, pale poo)
lasting more than 14 days in term babies and 21 days in premature babies.
how to manage biliary atresia?
Surgery!!
Kasai portoenterostomy
what can cause surgical obstruction?
Meconium ileus Hirschsprung’s disease Oesophageal atresia Duodenal atresia Intussusception Imperforate anus Malrotation of the intestines with a volvulus Strangulated hernia
presentation of abdominal obstruction?
bilious vomitting
abdo pain and distention
failure to pass stool or wind
high pitched tinkling
ix and management of abdominal obstruction?
abdo xray!- dilated loops of bowel
absnece of air in rectum
Surgery!! nil by mouth, IV fluids
what is Hirshsprungs disease?
nerve cells in myenteric plexus in nervous system absent
Absence of parasympathetic ganglion cells
loss of movement of poo and obstruction of bowel-> listened and full
genes and hirshsprungs?
FH!!
associated with: downs, neurofibromatosis, waadernburg syndrome
multiple endocrine neoplasia type II
presentation of hurshprungs
acute intestinal obstruction shortly after birth
gradually developing symptoms
delay passing meconium
abdo pain and distention
vomitting
poor wight gain and FTT
what is Hirschsprung-assosiated enterocolitis?
2-4 weeks of birth with fever, abdominal distention, diarrhoea (often with blood) and features of sepsis.
life threatening-> toxic megacolon and perforation of the bowel.
urgent antibiotics,
fluid resuscitation and decompression of the obstructed bowel.
mx of hirshprungs?
abdo xray
rectal biopsy confirms diagnosis- there will be no ganglionic cells
need fluid rhesus, and mx of obstruction
definitive mx- surgical removal!!- but can be left with incontinence
Intussesception?
associated with concurrent viral illness
HSP
Cystic fibrosis
presentation:
Recurrent Jelly stool!!!!!
RUQ mass- Sausage shaped!!!
-usually kid would of had URTI before and sx of bowel obstruction
ix of choice for intussusception?
USS!!
mx of intussusception?
therapeutic enemas
surgery
