Bleeding Per Rectum

Question 1

What is the onset, associations and presentation of NEC (Necrotizing enteirocolitis)?

Answer 1

Onset: 2 weeks
Associations: Preterm, Empirical Abs, Formula fed
Presentation:
-bilious vomiting
-Abdominal destination and cellulitis in abdominal wall
-bleeding per rectum

Question 2

What are the investigations and treatment of NEC?

Answer 2

Investigations:
-X-Ray: pneumonitis intestinalis and May pneumo-peritoneum.
-CBC: Acidosis, ⬆️TLC, CRP

Treatment:
-Medical: Ryle, NPO, TON, ABs
-Surgical: if pneumo-peritoneum (stoma)

Question 3

What is the onset, associations and presentation of Malrotation?

Answer 3

Onset: Any age
Associations: Bockdaleck hernia, Esophageal atresia, duodenal atresia
Presentation:
-Bilious vomiting
-On and off obstruction
-Bleeding per rectum

Question 4

What are the investigations and treatment of Malrotation?

Answer 4

Investigations:
-X-ray: IO
-Barium follow through (best choice)
-CT,US

Treatment: Ladd’s operation

Question 5

What is the Ladd’s operation?

Answer 5

1-Anticlockwise rotation of the intestine
2-Check viability & resection, anastomosis
3-Ladd’s band is divided
4- Large intestine put in the left side
5-Wide root mesentry
6-Small intestine in the Right side
7-Appendectomy

Question 6

What are the causes of bleeding per rectum in children?

Answer 6

-Anal fissure
-Intussusception
-Juvenile polyp
-Meckel’s diverticulum
-IBD

Question 7

What is the onset and presentation of anal fissure?

Answer 7

Onset: Any age (weaning)
Presentation: history of difficult painful defecation with bright red rectal bleeding

Question 8

What is the onset and presentation of Intussusception?

Answer 8

Onset: Most common (6 month to 2 year)
Presentation:
-Colicky pain (crying and drawing her legs up), sausage shaped mass and red jelly stool.

Treatment: reduction either pneumatic and hydrostatic and if failed by manual reduction by surgery

Question 9

What is the onset and presentation of Juvenile polyp?

Answer 9

Onset: Over 2 years
Presentation: bright red blood in toilet with no abdominal pain or Liam with defecation and no family history

Question 10

What is the onset and presentation of Meckel’s diverticulum?

Answer 10

Onset: Over 2 years
Presentation:
1-Incomplite obliteration of the proximal part of Vitello-intestinal duct (2%population, 2 inches, 2 feet from the ileocecal valve)
2-True diverticulum layers are formed by ileal mucosa but ectopic gastric mucosa can occur
3-Blood supply: vittline artery from Sup.mesenteric artery.
4-if symptomatic: abdominal pain & bleeding per rectum
5-Removal if narrow neck, symptomatic or in children.

Question 11

What is the onset and presentation of IBD in children?

Answer 11

Onset: around 10 years
Presentation: history of weight loss and bloody diarrhea