Peads GI Flashcards
Does GORD usually reslove spontaneoulsy?
Yes it does
What 3 conditions result in GORD not being self-limitng
Cystic fibrosis
Neurological disorders
Motility disorders
how do you get bullous vomiting
what does it mean
It means bowel obstruction
but only at a level below the jejunum
this is cause bile is released from the gallbladder and into the jejunum
so, the obstuction must occur below cause else would it be travelling upwards for you to spew it up
what to the following AXR/US signs mean…
- double bubble
- triple bubble
- soap bubble
- football sign, loops of bowel & bowel oedema
- pneumatosis intestinalis (intramural gas)
- target sign
- duodenal artresia
- jejuno-ileo artresia
- mecnoium ileus
- NEC (perforated)
- NEC
If an AXR shows a soap bubble, what is it
what other condition is the kid deffo gonan have
how do you get it
Meconium ileus
Deffo gonna have CF
The meconium is way too sticky, so it doesn’t budge
If they have billous vomit & the baby has not yet passed meconium, what are the 3 differentials & why
Meconium ileus -> poo too sticky due to CF
Hirschprungs -> ganglion cells haven’t buggered off (not migrated)
Ano-rectal malformation -> rectum is buggered, so poo can’t physically leave lol
What are these…
- vomiting & regurgitation after feegding, nothing else wrong
- billous vomit, intramural gas (pneumotosis intestinalis), loops of bowel + oedema on AXR
- very sore, knees up to chest, sausage shapped mass
- congenita diaphragmatoc hernia, ompalocele
- GORD
- NEC
- intusseception
- malrotation
what’s the best imaging for intusseception & pyloric stenosis
USS
3 day old kid
Green vomit
Not passed meconium yet
Genetics show MEN 2B
what’s this
what is the diagnostic test
how do you treat
Hirschprungs disease
Rectal biopsy
1st line -> rectal washout/bowel irrigation
2nd line -> surgery
what genetic condition is hirschprugs associated with
MEN-2b
also associated with…
medullay thyroid ca
Phaenochromocytoma
when is mssconium usually passed
within 24hrs
start to worry if after 48
what is the big bad risk factor for meconium aspiration
post-term
Child
Painless GI bleeding
Can cause appendicitis like abdo pain
Needs blood transfusion
What is it
whats it a remnant of
whats it the main cause of
Meckel’s diverticulum
Yolk sac
Painless GI bleeding
what is a serious GI cause of death in premature babies
NEC
Nectorising EnteroColitis
Billous vomiting
Nappy is a bit red (blood)
Not feeding right
Abdo pain
Whats this
what investigation
management
NEC
AXR
Management
NBM
Lapratomty + abxs (broad spectrum)
what happens to the bowel in intusseception
One bit invaginates into another
colicky abdo pain
Knees to the chest
Billous vomit
“red currant jelly” in stool
whats this
what would the mass feel like on palpation
investigation to do
Management
Intussception
Sausage-shapped
USS
1st line -> air enema (reduction by air insufflation)
2nd line -> surgery & abxs
intussception
What does the mass feel like
When does billous vomiting occur
Most common location
Sauage-shapped
POST-natal period
Ielo-cecal valve
Fairy liquid vomit
Scaphoid abdomen
Red currant jelly in stool is sign of what
Intussception
what are the key signs of malrotation
Fairy liquid vomit
Sacphoid abdo
what sorta pain does intussecption present with
Colicky abdo pain
Knees drawn to chest as a result
Fairy liquid vomit
Scaphoid abdomen
May have omphaocele & congenital diaphragmatic hernia
whats this
investigation
management
whats going on if baby is unwell
Malrotation
USS + UGI contrast study
surgery -> Lapraotomy & LAD’s procedure
Volvulus
whats the main cause of billous vomit until proven otherwise
Malrotation
Small intesine is all tangeled up
What are the causes of billous vomiting
Anything that causes bowel obstruction below the jejunum
Malrotation
INtussecption
Duodenal & jejuno-ileal artresia
Meckels diverticulum
NEC
Hirchbrungs
Ano-rectal malformation
Mecnoium ieleus
Strangulated hernia
does pyloric stenosis cause billous vomiting
Absolutley not
cause the obstruction is clearly above the jejunum
Effotless vomiting is a sign of…
GORD
Effortless vomiting
whats this gonna be
when is it not self-limiitng
Investigations
Management
GORD
Not self-limiting -> cerbral palsy
investigations
Feeding trial (main)
Barrium swallow & video fluroscopy
Endoscopy
management
Change feeding position
v
Food thickeners
v
gaviscon
v
PPI
v
Surgery - nissan fundoplication
what surgery can be done for GORD
what are the indications
Nissan fundoplication
FTT
Recurrent aspiration
What are the different types of diarrhoea
Motility
Secretory
Osmotic
Inflammatory
Give causes for the following typrs of diarrhoea
Motility
Secretory
Osmotic
Inflammatory
Motility -> toddlers diarrhoea, IBS
Osmotic -> allergies, celiacs, CF (malabsorption)
Secretory -> infections
Inflamatory - >IBD
What are the differneces between osmeotic and secretory diarrhoea
osomtoic
Smaller stool volume
Goes away after you stop eating
Caused by malabsoprtion (allergies, coeliacs, CF)
secretory
Larger stool volume
Doesn’t stop after eating
caused by infections
Casues of malabsoroption
Coeliacs
Crohns
CF
Diarrhoea
Dehydrated
Can’t eat
Fever
whats this
management
are abxs usually used
Gastrotenteriris
stable -> Encourage fluids
unstable -> Oral rehydration therapy
very unstable -> IV fluids
Abxs are not usually used, only if like septic
bloody diarrhoea
just visited a zoo
whats the cause
E.coli 0157
a child presents with a puffy face
kinda looks like an allergy but unsure
what investigation needs to be done & wh7
Urine dip -> check for protein
Could be minimal change disease
how would you describe the vomiting in pyloric stenosis
Persistent & projectile
Low Cl & K
ALKALOTIC
if the diarrhoea is full of undigested food, what is the cuase
toddler’s diarrhoea
gastroeneteritis
Main cause
cause if you get loose stools after recovering from it
Rotavirus
Lactose intolerance
Diarrhoea
Causes of acute & chronic pls
acute -> gastroenteritis
Chronic
CMPA
Toddler’s diarrhea
Coeliacs
Kid is very jittery
Hypertonia
Hyperreflexia
Been having diarrhoea
What is going on
Hypernatraremic deyhradation
too much salt
causes of bloody diarrheoa in kids
E.coli
campylobacter
Salmonella
Shigella
Protozoa
Projectile vomiting
Visible gastric peristalsis
Mass in abdomen
weight loss
Low Cl & K
whats this
what shape is the mass
Inestigations
management
Pyloric stenosis
Olive shapped
USS
IV fluids & surgery (pyloromyotomy)
what surgical procedure is done for pyloric stenosis
Pyloromyotomy
causes of constipation in a kid
TOILET ANXIETY
Dehydration
Anal fissures
Hirschprungs
Opiates
Psychological -> sexual abuse
how is constipation treated
1st line -> movicol
2nd line -> add senna
what type of laxatives are movicol and senna
movicol -> osmotic
senna -> stimulant
how can impaction lead to overflow
Since stool is always sitting against the anal sphincter, the muscle weakens
so some shit is squirted out
diarrhoea/constipation
just started formula feeds
whats this
CMPA
cows milk protein allergy
whats like the normal range of stool frquency
4 per day -> 1 per week
whats the cycle of toliet anxiety that can lead to
Stool sits in rectum
v
stool absorbs water & gets bigger
v
Next poo is painful due to size
v
kid doesn’t want to go to toliet again
v
from the top now y’all
what is a complication of constipation & what are some signs
Imapaction
Pain
Pooing themselves (overflow)
what type of exams should you do if a kid presents with chronic constipation
Neuro of lower limbs
PR
CMPA
Is it IgE mediated?
Investigation
Management
No
Milk-free feeding trial
Hydrolysed feeds, PPIs
Few weeks old baby
Dark urine
Pale poo
Poor appetite
Hepatosplenomegaly
Most likely diagnosis
Type of raised bilirubin
investigations
management
Biliary artresia
CONJUGATED
Investigations
Bloods -> bilirubin & LFTs
USS of biliary tree
Management
Surgery -> kasai procedure
What do these surgical procedures treat…
- Nissan fundoplication
- Pyloromyotomy
- Kasai procedure
- GORD
- pyloric stenosis
- biliary artresia
what complication of jaundice can serious fuck up your brian
it’s the basal ganglia thats fucked
Kernickerus
Is jaundiced baby just after birth normal
Absolutley not
it’s ALAYS PATHOLOGICAL
Jaundiced baby at birth
Commonish/unexciting cause
where must you see it
Management
Bruising
Must be seen in the sclera
Management
Measure bilirubin within 2hrs
Blood film
Referral to PAU
Phototherapy (incubator)
Maybe IV fluids
Causes of conjugated & unconjugted jaundice
Conjugated
Biliary artesia
Neonatal hepatitis
Unconjugated
Hypothyroid
Gliberts
3 histologicla signs of coeliacs
Total villous atrophy
Crypt hyperplasia
WC infiltreation
causes of abdo pain in peads
- 5yo, RIF pain, no guarding/tenderness, recent viral infection
- 5yo, RIF pain, guarding & tenderness, raised CRP/ESR
- RIF pain, +ve urine dip
- 2yo, severe RIF pain, lots of rectal bleeding, needs transfusion
- <9m old, severe colicky abdo pain, knees to chest, red jelly stool
- mesenteric adenitis
- acute appendicitis
- pyleonephritis
- meckles diverticulum
- intussecpetion
