Paediatrics: Gastrointestinal + general surgery Flashcards
How do you differ between the following causes of abdominal colic?
Constipation
Gastroenteritis
Mesenteric adenitis
Coeliac
Appendicitis
Constipation // Gastro // MA // Coeliac // appendicitis
Stools: < 3 stools, rabbit drops // watery +/- blood // no change // diarrhoea or constipation // no change
Other: Hard stool in abdomen // vomiting // no change // bloating, reflux, rashes, weight loss // RIF pain, low grade fever, pain on straightening leg
What signs indicate faecal impaction in constipation?
severe symptoms
Overflow soiling
Faecal mass in abdomen
How do you treat constipation?
- Movicol (polyethylene glycol 3350 + electrolytes): escalating if impacted, lesser dose if not
- Add stimulant laxative if no change after 2 weeks
- Swap stimulant for osmotic (eg lactulose) if movicol not working
+ Add extra water into child’s diet
How do you manage gastroenteritis?
MC + S if concerned about HUS (travel, blood, IC)
Supportive if viral
Admit if HUS/acutely unwell / dehydrated
Dehydrated: 50ml/kg low osmolarity oral rehydration solution 4hrs + small maintenance amounts
How can you differentiate between dehydration and shock
Common: Raised hr, low BP
Dehydration: Normal skin temp and colour, normal peripheries
Shock: Pale, mottled skin, reduced peripheral pulse/CRT
How do you further investigate and treat coeliac disease in children?
- 6 week gluten inclusion then anti-tTG, EMA (can do biopsy if confirmation needed)
Rx: Gluten free diet
How do you manage appendicitis in children?
Admit for appendectomy
What paeds GI conditions can cause bleeding?
NEC: neonates, billous vomiting
intussussception (red-currant): pain brings knees up, RUQ mass
Meckel’s diverticulum: large bleeding, asymptomatic
IBD: systemic inflammation, mucus in stool
What are the causes of vomiting in children and how can you differentiate them?
Bilious
NEC: premature births, bloody stool, abx therapy
Meconium ileus: 2 days, CF association
Malrotation: within a week
Duodenal atresia: few hours after birth
Jejunal atresia: 24 hours
Non-bilious
Pyloric stenosis: Projectile, non-billous, <6wks old
Intussusception: Draw knees up, sausage mass
How do you investigate and treat NEC?
CXR supine shows thickened wall + trapped gas
Rx
- NBM + IV fluids, TPN
- Antibiotics
How do you diagnose and treat intussusseption?
USS shows target/telescoping bowel
Rx: Air insufflation, surgery if fails
How do you investigate and treat meckle’s diverticulum
99m technetium scan if mild, arteriography if worse
Rx: Surgical removal of diverticulum
How do you investigate and treat hirschprung’s disease?
Ix: AXR –> rectal biopsy is gold standard
Rx: Rectal washouts –> pull through procedure
How do you diagnose and treat pyloric stenosis?
Ix: Test feed or USS
Rx: Ramstedt pyloromyotomy to loosen stenosis
What other conditions should be born in mind regarding abdo pain in teenagers?
Males: Testicular torsion
Females: Gynaecological pains
How do you investigate and treat suspected duodenal atresia?
AXR shows double bubble sign
Duodenoduodenectomy
