GIT Flashcards
Differentiate between hematochezia vs melena
Hematochezia is fresh unaltered blood passed per rectum, May be mixed with stools
Melena is altered, partially digested blood with tarry black colour and sticks
What special investigations would you do to confirm if stool has blood
• heme (guaiac test- especially for upper GIT bleeding as globin may be denatured by gastric juice)
• antibodies to globin (immunochemical test- used to screen for distal intestinal/ colonic bleeding)
Causes of massive bleed
Portal HPT: it’s gastroesophageal varices (jaundice, ascites, abdo wall varices, hepatomegaly, petechia/purpura/ecchymoses from lower platelet count in hypersplenism, spider naevi, clubbing) Abdo US to confirm
Meckels diverticulum with ectopic gastric mucosa causing intestinal ulceration typically ~18 months to 5 years of age with painless bright red
blood/ maroon blood and no other signs
• Epistaxis (easily swallow +- vomit blood after major nosebleed)
• Pulmonary haemorrhage: risk factors & signs/ symptoms of tuberculosis
• Gastritis/ peptic ulcer in hospitalized patients especially ICU/burns/ on non-
steroidal anti-inflammatory
• Peutz-Jeghers (oral mucosal freckling; axillary freckling in older children)-
bleeding from hamartomatous polyps
• Hereditary Haemorrhagic Telangiectasia (possible family history)-
mucocutaneous lesions may be present; consider abdominal ultrasound to
look for large solid organ arteriovenous malformations but elective upper and lower GIT endoscopy after bowel preparation may be needed to detect GIT
lesions
• Amoebic colitis: Infection (high grade fever) & acute abdomen (generalized
peritonitis) present?» urgent surgery together with high-dose metronidazole
(15mg/kg); fresh stool sample for ova/ histology
Possible causes of chronic slow or recurrent bleed
Physiological adaptation to Hb<6 , don’t transfuse if haemodynamically stable
Parasite infection
Haemangiomas
Intestinal polyps
Gastritis (peptic ulcer uncommon)
What are the most common causes of abdominal pain in paeds inorder of frequency
(NGCUVAS)
1. Non-specific abdominal pain (unknown cause)
2. Gastroenteritis
3. Constipation
4. Urinary tract infection: always check urine dipstick
5. Viral infection
6. Appendicitis: (~1% of general practitioner visits for abdominal pain)
7. Streptococcus Pharyngitis
8. Pharyngitis
9. Pneumonia
10. Otitis Media
Outline the Rome criteria that can be used to conform functional constipation (6)
• 2 or less stools per week
• 1 or more episodes of incontinence per week (after toilet training)
• History of excessive stool retention (trying to avoid passing stools)
• History of hard or painful bowel movements
• Presence of large faeculoma in the rectum (clinically or on X-Ray)
• History of passing large diameter stools (may even obstruct the toilet)
Indications for workup for possible Hirschsprung’s disease (5)
o Delayed passage of meconium (>48 hours in term infants)
o Constipation since first few weeks of life
o Chronic abdominal distension plus vomiting
o Family history of Hirschsprung’s disease
o Faltering growth in addition to any of the above
Causes of constipation
• Cerebral palsy or other central nervous system abnormalities
• Inherited and genetic abnormalities (Trisomy 21, cystic fibrosis, etc)
• Spinal defects (myelomengingocele, tethered cord, sacral agenesis, previous
pelvic or spinal surgery, traumatic spinal cord injury, etc)
• Autism
• Hypothyroidism
• Any anorectal disorder (imperforate anus, Hirschsprung’s disease)
Diet
Meds (opiates, antidepressants)
Red flags for constipation (where you need to refer for further investigation)
• Delayed passage of meconium, or constipation from the first weeks of life
• A family history of Hirschsprung’s disease
• Recurrent urinary tract infections (fistula/incontinence??)
• A history of soiling
• An acutely ill child with vomiting, abdominal distension, peritonism,
dehydration or evidence of sepsis
• Chronic abdominal distension with episodes of vomiting
• A child with malnutrition or failure to thrive
• Any evidence of an occult spinal defect
• Any evidence of an anorectal malformation
Management of constipation
Acute treatment
1. Empty colon: phosphate enema 2-3 days
-inpatients polyethylene glycol orally or via NGT at 10-30ml/kg/hr 6-8 hrs, repeat if necessary
-manual disimpaction of above fails
Maintainance
1. Diet advice
2. Behaviours modification: adequate stooling time 20-30min everyday, after breakfast
3. Stool softener orStimulant laxative in children <2 ie Lactulose + Senekot with bisacodyl
Indications for surgery in a paeds patient with GERD
• Inability to tolerate bolus oral or nasogastric feeds with failure to thrive
• Apnoea spells
• Recurrent lower tract infections
• Oesophageal stricture
Causes of intessusception
Idiopathic
-following gastrointeritis or a Resp infection
Meckels diverticulum
Following surgery (retroperitoneal surgery)
Symptoms of intessusception
• Sudden onset of colicky abdominal pain associated with vomiting.
• Pain is severe enough to wake the child. The classic feature is one of pulling the
legs up to the abdomen during the pain. The pain is colicky and intermittent and
may then go away only to return every half hour or so, lasting 20 to 30 seconds.
The child lies very still in between attacks.
• Vomiting may initially be milk feeds but becomes bilious, and later faeculent
• Passage of blood and mucus per rectum (“RED CURRANT JELLY” stools)
• Progressive abdominal distension.
How to Dx intessusception
- Abdo US
- Contrast enema
Can also do AXR after?
Management of intessusception
Initial stabilisation (IV fluids, NGT, IVAb, IV analgesia)
Non operative reduction
Surgical reduction
