Flashcards in Gastroenterology Deck (14):
S/S: Often presents with delayed passage of meconium; constipation is a later presenting symptom; can lead to enterocolitis. On exam, palpable fecal mass in LLQ, but no stool in rectal vault.
Dx: Rectal biopsy (gold standard), barium contrast enema can be used.
Tx: Initially decompress with NGT; rectal irrigations.
Most frequent cause of intestinal obstruction in the first 2 years of life!
- Telescoping of the colon usually starting proximal to the ileocecal valve. Swelling, haemorrhage, incarceration and eventual perforation and peritonitis can occur if not managed quickly.
S/S: Intermittent colicky abdominal pain (child draws legs up), vomiting, currant jelly stools, sausage-shaped mass in RUQ.
Dx: Barium or air contrast enema
Tx: Barium or air enema with surgical backup.
Narrowing of the pylorus.
- Occurring the first few months of life.
- Electrolyte disorder - metabolic alkalosis.
S/S: Nonbilious projectile vomiting; weight loss, dehydration, often hunger after vomiting and eager to feed, 2 cm olive-shaped mass in mid-epigastric area beneath liver edge; + gastric peristaltic waves.
Tx: Stabilize electrolytes, rehydration, surgery.
Acute Malrotation (Volvulus)
- Volvulus occurs with 50% of malrotations.
S/S: Bilious vomiting is a surgical emergency.
Tx: Surgical correction with Ladd procedure is indicated for malrotation.
Progressive inflammatory process that involves the lumen of the appendix with occlusion.
S/S: Focal right lower quadrant pain to periumbilical pain, fever (not always), testicular pain, flank and back pain, nausea, vomiting, and anorexia.
PE: McBurney point tenderness, rebound tenderness, + psoas sign, + obturator sign.
Dx: Abdominal CT is choice imaging, but ultrasound is often used.
Tx: Urgent surgery, infection prevention if ruptured.
Typically occurs in children/adolescents with inflammatory bowel disease.
- Associated with infection, antidiarrheal agents, electrolyte disturbances.
- Marked dilation of the colon.
S/S: Presents with fever, abdominal distention, tenderness, tachycardia, hypotension, leukocytosis, hypokalemia, hypoalbuminemia.
Rupture of the entire wall of the stomach, small intestine, large bowel, or gall bladder.
- This condition is a medical emergency!
S/S: Acute abdominal pain, hemodynamic instability with presence of acidosis.
Dx: Xrays of the chest or abdomen may show air in the abdominal cavity (not in the stomach or intestines), suggesting a perforation. CT scan of the abdomen often shows the location of the perforation. The WBC is often higher than normal.
Complications: Bleeding, infection (including widespread sepsis, which can lead to death), intra-abdominal abscesses.
Tx: Immediate surgical exploration, treatment with broad-spectrum antibiotics and fluid/metabolic stabilization.
Inflammatory Bowel Disease
Crohn's Disease and Ulcerative Colitis
Involves any segment in the GI tract, mouth to anus.
- Skip lesions.
- Malabsorption of Fe, Zn, Folate, vit B12.
S/S: Abdominal pain, diarrhea, rectal bleeding, fissures/tags, fistulas, anorexia, weight loss.
Limited to the colon.
- Starts in the rectum and ascends continuously.
S/S: Bloody mucoid diarrhea, urgency to defecate.
Dx: Endoscopy (gold standard).
Tx: (First line) Salicylates, antibiotics, steroids.
- Hospitalization admission for severe exacerbation, bowel rest with IV nutrition, diagnostic procedures.
Inflamed pancreas, elevated pancreatic enzymes.
S/S: Sharp epigastric pain, radiating to left and back, nausea, vomiting.
Dx: Amylase level rises early and lasts 3-5 days, Lipase more specific - elevated longer, CRP peaks 36-48, Abdominal X-ray, CXR to rule out pleural effusion, abdominal ultrasound (repeat q3-4 days).
Tx: NPO, NGT decompression, IVF and parenteral nutrition, pain control, maintain on low fat diet until complete recovery.
Assessing Acute Abdominal Pain
- Intestinal obstruction
- Genito-urologic disorders
Features of GI Obstruction
Esophageal level (excessive secretions, vomiting), stomach (nonbilious vomiting), duodenum/jejunum (bilious emesis), ileum/colon (bilious emesis)