Paeds GI and Liver Flashcards
What is pyloric stenosis?
Thickening and narrowing of the pylorus
When does pyloric stenosis present?
First 2-8 weeks of life
What is the vomit like in pyloric stenosis?
Projectile vomit
Why is there projectile vomiting in pyloric stenosis?
Increasing peristaltic waves in the stomach
Food cannot pass to duodenum due to hypertrophy
Results in projectile vomiting.
Findings on examination in pyloric stenosis?
Firm round mass in upper abdomen
What do blood gas results show in pyloric stenosis?
Hypochloric metabolic alkalosis
Which investigation diagnoses pyloric stenosis?
Abdo USS
What is the management of pyloric stenosis?
Laparoscopic pylorotomy (incision in the smooth muscle of the pylorus to widen the canal)
What is infant colic?
Baby draws up their knees and is accompanied by inconsolable crying before passing wind
What are the clinical features of CMPA?
Symptoms 2 hours post feed
Pruritus
Erythema
Angioedema around lips
Nausea
Vomiting
Diarrhoea
Colicky pain
How is CMPA diagnosed?
Diagnosed clinically
Management of CMPA?
Hydrolysed formula milk
Soya milk (over 6months)
What is intussuception?
Invagination of one part of the bowel into another
What are the consequences of intusseption?
Bowel obstruction
When does intussuception commonly occur?
Ages 3months to 2 years
What are the clinical features of intussusception?
Paroxysmal colicky pain
Sudden onset of inconsolable crying episodes
Red current jelly stools
What are the stools like in intussuception?
Red current jelly stools
What can be felt on examination in intussuception?
Sausage shaped abdo mass in the right upper quadrant
Which part of the bowel does intussuception most commonly occur?
Ileocaecal valve
What is the preferred method of diagnosis for intussuception?
USS
What signs can be seen on transverse plane with USS in intussuception?
Doughnut sign
What is the management of intussuception?
Fluids
NG tube
Air or contrast enema to reduce intussuscepted bowel
Surgical reduction
What is Meckel’s diverticulum?
Remnant from the growing foetus of stomach or pancreas tissue, usually asymptomatic but can begin to secrete acid and form ulcers in the small intestine
Symptoms of meckel’s diverticulum?
Blood in the stoolS
Abdo pain
What are the risk factors for acute apendicitis?
Genetics
Caucasian
More common in summer
What is the pathophysiology of appendicitis?
Direct luminal obstruction of the appendix
Faecolith or impacted stool
Bacteria accumulate cause acute inflammation
Reduced venous drainage, and inflammation causing increased pressure and ischaemia of the appendix
Symptoms of appendicitis?
Anorexia
Vomitting
Abdo pain initially centrally then localising to the right hand side
Signs of appendicitis?
Rebound tenderness at mc burnleys point
Rosving’s sign (RIF pain on palpation of the LIF)
Guarding
Which score is used for appendicitis?
RIFT
What investigations should be carried out in cases of suspected appendicitis?
Urinalysis (rule out UTI)
Pregnancy test to rule out ectopic
USS or CT if clinical features are inconclusive
What is Hirschsprung disease?
Impaired nerve supply to the distal portion of the colon
This impacts peristalsis and can cause bowel obstruction.
What are the clinical features of hirschprungs?
Severe constipation
Not passing meconium within 24 hours
Abdo distention
Bile stained vomit
What is the gold standard investigation for hirschprungs?
Rectal suction with biopsy of the submucosa
What is the management of Hirschprungs?
Resection of the bowel with impaired nerve supply
What are the most common causes of gastroenteritis?
Rotavirus
Campylobacter
Norovirus
Adenovirus
E.coli
Clinical features of gastroenteritis?
Loose/watery stool
Vomiting
Abdocramps/pain
Mild fever
Management of gastroenteritis?
Assess how dehydrated the child is, in order to determine fluids
What must you not give in cases of gastroenteritis with diarrhoea?
Antidiarrhoeal agents as this prevents the excretion of the causative organisms.
What symptoms of gastroenteritis suggest an alternative diagnosis?
Temp above 38C
Breathlessness or tachypnoea
Altered GCS
Blood/mucus in the stool
How do you assess weight loss in children whom you do not have a previous weight?
Calculate how much they should weigh based off age, and work out difference between that and current weight.
(age +4) x2
Which fluids should be given in neonates?
10% glucose
What are the rules for maintenance fluid prescribing in paediatrics for a 24 hour period?
100ml/kg for first 10kg
50ml/kg for 10-20kg
20ml/kg for over 20kg
Divide by 24 if you want per hour
What is the max amount of fluids that can be prescribed for girls?
2L
What is the max amount of fluids that can be prescribed for boys?
2.5L
What is the first line type of fluids for children?
0.9% saline plus 5% glucose
What are the features of 5% dehydration?
Reduced urine output
Well ish but some signs
Unsettled
Normal skin
Slightly sunken eyes
Reduced tears
Dry mouth
What are the features of 10% dehydration?
Lethargic and confused
Unwellm
Weak peripheral pulses
Prolonged cap refil
Cold extremities
Pale and mottled
Hypotension is late sign
How do you calculate the fluid deficit?
% dehydration x Weight (kg) x10
What is a fluid challenge?
5ml every 5 mins of squash to see if they can keep it down
Which part of the bowel does crohns affect?
Mouth to anus
What is the characteristic appearance of crohn’s?
Transmural inflammation
Discontinuous with skip lesions
Non-caseating granulomatous inflammation
Deep ulcers and fissures
What are the characteristic symptoms of crohns?
Abdo pain
Diarrhoea
Weight loss
Oral lesions
Uveitis
Erythema nodosum
What are the extra intestinal features of crohns?
Erythema nodosum
Oral lesions
Perianal skin tags
Uveitis
Arthralgia
What investigations would you do for crohns?
Faecal calprotectin
Stool sample (rule out infectious cause)
Colonoscopy
Which drugs are used to maintain remission in crohns?
Azathioprine
What kind of diet should be encouraged to maintain remission in crohns?
Polymeric diet (liquid diet/entral diet)
Which part of the bowel does UC affect?
Colon
What are the findings in UC on histology?
Continuous ulcers
Mucosal inflammation
Crypt damage
How to treat mild UC?
Mesalazine
What are the symptoms of UC?
Rectal bleeding
Diarrhowa
Colicky pain
Erythema nodosum
Arthritis
What can be prescribed in children with constipation?
Movicol
What is kwashiorkor?
Deficiency of protein in the diet
What is marasmus?
Deficiency of all nutrients from the diet
Characteristic symptoms of kwashiorkor?
Stomach oedema
Inability to gain weight or grow
Oedema of hands and feet
What is the treatment of marasmus and kwashiorkor?
Slowly increasing calorie intake through several small meals.
Multivitamins
Protein supplements
What is coeliac disease?
Immunological respinse to gliadin
What are autoantibodies developed against in coeliac disease?
Tissue transglutaminase
What is the gold standard test for coeliac disease?
Duodenal biopsy
Common symptoms of coeliac disease?
Loose stools
Steatorrhea
Failure to thrive and weight loss
What is the cause of jaundice?
High levels of unconjugated bilirubin in the blood causing yellowing of the skin
When is jaundice considered normal?
2-14 days old
When is jaundice abnormal?
< 24 hours old jaunduce is always abnormal
When should you be concerned about the length of time jaundice is lasting?
Lasts longer than 2 weeks this can be pathological
What is the usual cause of jaundice less than 24 hours old?
Haemolysis
What is rhesus haemolytic disease?
Mum us Rh -ve and baby is +ve
Blood mixing during delivery can cause haemolysis, leading to jaundice
How is rhesus haemolytic disease prevented?
Anti D at 28 weeks and after delivery
What is ABO incompatibility?
WHen mum is O and baby is either A or B.
Mum can develop anti A or Anti B just by immune respinse to common pathogens
These can pass across the placenta causing haemolysis in baby
Which test is used to diagnose ABO incompatibility?
Coombes test
What are the TORCH infections?
Toxoplasmosis
Syphilis
Parovirus
Varicella zoster
Rubella
CMV
Herpes/hepatitis
Other causes of jaundice in babies under 24 hours old?
TORCH
ABO incompatibility
G6PD deficiency
Hereditary spherocytosis
What are the causes of jaundice between 2-14 days old?
Physiological jaundice due to liver not working as fast
Breast milk jaundice (feeding difficulties leading to dehydration and impaired bilirubin elimination)
What are the causes of jaundice lasting longer than 2 weeks?
Breast milk jaundice
Congenital hypothyroidism
CF
Biliary atresia
What are the causes of jaundice lasting longer than 2 weeks?
Breast milk jaundice
Congenital hypothyroidism
CF
Biliary atresia
What is kernicterus?
Acute bilirubin encephalopathy
What is the pathophysiology of kernicterus?
Deposition of bilirubin in the basal ganglia and brainstem
Symptoms of kernicterus?
Seizures
Hypertonia
Opisthotonus (dramatic abnormal posture causing arched back)
What is the treatment for jaundice?
Phototherapy is first line
What is biliary atresia?
Obstruction or absence of the lumen in the bile duct. So CBD may be missing or even the gall bladder itself
What is the pathophysiology of biliary atresia?
Bile duct is blocked, leading to build up of bile back to the liver
Increase pressure in the liver
Causes unconjugated bilirubin to leak into the blood
Treatment for biliary atresia?
Kasai procedure (surgical treatment)
Liver transplant
What is a choledochal cyst?
Congenital abnormality of the bile duct causing a swelling. Bile backs up into the liver
Symptoms of choledochal cyst?
Abdo mass
Pain in RUQ
Jaundice
N&V
Fever
What signs are seen on USS in intussuception?
Target sign
After starting phototherapy how often should serum bilirubin be checked?
Every 4-6 hours
Can be lowere to 12 hours when bilirubin is stable
