Symptoms of Pyloric Stenosis
PROJECTILE (non-bile stained) vomit
Typically occurs after each meal
Constant hunger
Weight loss
Risk factors of Pyloric Stenosis
Boys
First borns
Family history
Pyloric Stenosis Ix
Pyloric mass or ‘olive’ palpable in RUQ
Ultrasound
Barium meal
Pyloric Mx
IV fluid for resuscitation and to correct electrolytes
Pyloromyotomy (muscle, but not mucosa of pylorus is cut)
Gastroenteritis symptoms
-Infective diarrhoea and vomit
Causes of Gastroenteritis in kids?
Rotavirus
Adenovirus
Causes of bloody diarrhoea?
Bacterial
Campylobacter
Shigella
Intussusception
IBD
Toddler diarrhoea classic presentation?
‘Pea and carrots syndrome’ (presence of undigested veg in the stools)
Underlying cause of toddler diarrhoea?
Delay in intestinal motility
Malabsorption symptoms
Anaemia
Abnormal stools (difficult to flush and very smelly)
Diarrhoea
Abdominal protrusion
Coeliac disease symptoms
Dermatitis herpetiformis
Abnormal stools
Abdominal distension
Buttock wasting
Irritable
<2 years
Pathology behind coeliac
Villus atrophy –> Flat mucosa
Coeliac diagnosis
Jejunal biopsy (will confirm villus atrophy)
Screen for autoantibodies:
IgA, Anti-reticulum, Anti endomysium
Coeliac Mx
Gluten free diet
Common protein intolerances
Cow’s milk
Soya
Wheat
Fish
Chicken eggs
Describe Hirschsprung’s Disease
A condition that affects the large intestine (colon) and causes problems with passing stool.
The condition is present at birth (congenital) as a result of missing nerve cells (parasympathetics) in the muscles of the baby’s colon
Symptoms of Hirschspring’s Disease
Failure to pass stool in first 48 hours of life
Abdominal distension
Bile stained vomit
Hirschsprung’s Disease Ix
Findings of Ix
PR exam
On withdrawal of finger, a gush of liquid stools and flatus
How do you treat Hirschsprung’s Disease?
Surgery
Presentation of tracheo-oesophageal fistula?
Chronic cough since birth
Nasal regurgitation
Recurrent aspiration pneumonia
Cough and cyanosis when feeding
Child has a history of becoming unwell (i.e with chest infection) and getting mild jaundice which resolves once the infection clears.
What is the most likely diagnosis?
Gilbert’s syndrome
Intussception symptoms
Recurrent jelly like stools
Palpable sausage shaped mass
Vomiting (could be bilious)
Episodic colicky abdo pain
Is intussception most likely to affect boys or girls
boys
Physiology of Intussception
Part of the bowel (usually the ileoceacal valve) has invaded into the next part of the bowel further on
Where is the most common site for duodenal atesia to present?
Second part of the duodenum
Characteristic appearance of a duodenal atresia on X-ray
Double bubble and no gas in bowel distally
How do you treat duodenal atresia?
NG tube
IV fluids
What is biliary atresia?
Failure of biliary tract to develop
Conjugated bilirubin accumulates in blood (it has been produced but it has no way of entering the gut)
Causes jaundice & pale stools
Ix Biliary atresia
Abdo USS
Liver biopsy
When would necrotising enterocolitis usually present?
Babies in their first week of life
Symptoms of necrotising enetrocolitis
Pass blood
Pass mucous
Distended abdomen
Perforation
Ix Necrotising Enterocolitis
Stool cultures
Abdominal X-ray
Treatment of Necrotising Entercolitis
Stop feeding orally
Broad spec antibiotics
Parenteral nutrition
Surgery
Long term complications of necrotising entercolitis?
Malabsoprtion
Strictures