Gastroenterology Flashcards
(33 cards)
Surgical causes of abdominal pain in children
Appendicitis
Intussussception
Obstruction
Testicular torsion
Secondary causes of constipation
Hirschsprung’s disease
CF - meconium ileus
Hypothyroidism
Spinal cord lesions - cerebral palsy, spina bifida
Sexual abuse
Intestinal obstruction
Anal stenosis
Cow’s milk intolerance
Red flag symptoms with constipation
Not passing meconium within 48 hours of birth - CF or Hirschsprung’s
Neurological signs - cerebral palsy or spinal cord lesion
Vomiting - intestinal obstruction or Hirschsprung’s
Ribbon stool - anal stenosis
Abnormal anus - anal stenosis, IBD, sexual abuse
Failure to thrive - coeliac’s, hypothyroidism, safeguarding
Management of idiopathic constipation
Recommend high fibre diet and good hydration
Start laxatives - movicol is first line
Faecal impaction may require disimpaction regime with high doses of laxatives
Encourage and praise visiting the toilet - bowel diary and star charts
Is reflux in children a problem?
If under the age of 1 and is not causing distress and not affecting growth, it is not a problem.
Presentation of reflux in children
Chronic cough
Hoarse cry
Distress, crying or unsettled after feeding
Refluctance to feed
Pneumonia
Poor weight gain
Red flag symptoms with reflux
Projectile vomiting - pyloric stenosis or intestinal obstruction
Bile stained - intestinal obstruction
Haematemesis or melaena - peptic ulcer, oesophagitis or varices
Reduced consciousness, bulging fontanelle or neurological signs - meningitis or raised intracranial pressue
Blood in stool - gastroenteritis or cows milk protein allergy
Management of reflux in children
Advise: small, frequent meals, bumping regularly, not overfeeding and keeping baby upright.
Gaviscon mixed with feeds
Thickened milk or formula
PPI if other methods inadequate
What is pyloric stenosis?
Hypertrophy of the pylorus preventing food to travel from the stomach to the duodenum. Increasingly powerful peristalsis eventually causes powerful ejection of food from the stomach to the mouth and out.
Features of pyloric stenosis
Projectile vomiting
Firm, round mass in the upper abdomen - hypertrophic muscle of the pylorus
Blood gas will show hypochloric metabolic alkalosis as many is vomiting hydrochloric acid from the stomach
Management of pyloric stenosis
Diagnosis made on abdominal ultrasound to visualise thickened pylorus
Treatment is laparoscopic pyloromyotomy - Ramstedt’s operation
Common causes of viral gastroenteritis
Rotavirus
Norovirus
Most common cause of gastroenteritis worldwide
Campylobacter - travellers diarrhoea.
Symptoms -
Abdominal cramps
Diarrhoea often with blood
Vomiting
Fever
Abe - azithromycin or cipro
Gastroenteritis management
Stool sample sent for microscopy, culture and sensitivity.
Maintain hydration
Abx if causative organism is confirmed
Presentation of biliary atresia
Typically presents in the first few weeks of life:
Jaundice - extending beyond the physiological 2 weeks
Dark urine and pale stools
Appetite and growth disturbance
Biliary atresia investigations
Serum bilirubin: total bilirubin may be normal but conjugated bilirubin will be abnormally high
USS - tract abnormalities may be visualiseed
Management of biliary atresia
Surgical management is the only definitive treatment - Kasai portoenterostomy
Causes of intestinal obstruction
Meconium ileus
Hirschsprung’s
Oesophageal atresia
Duodenal atresia
Intussussception
Imperforate anus
Malrotation of intestines - vulvolus
Strangulated hernia
Presentation of intestinal obstruction
Persistent vomiting - may be vicious
Abdominal pain and distention
Failure to pass stools or wind
Abnormal bowel sounds
Investigations for intestinal obstruction
Abdominal x-ray - dilated bowel loops
Management of intestinal obstruction
Refer to paediatric surgical team
Keep nil by mouth and insert NG tube
Provide IV fluids
Pathophysiology of Hirschsprung’s disease
Absent Auerbach’s plexus in distal bowel and rectum. Lack of parasympathetic ganglion cells causes bowel to constrict causing obstruction.
Presentation of Hirschsprung’s disease
Delay in passing meconium
Chronic constipation since birth
Abdominal pain and distention
Vomiting
Poor weight gain and failure to thrive
What is Hirschsprung’s-associated-entercolitis?
It is inflammation and obstruction of the large intestine occurring in 20% of patients with Hirschsprung’s. Presents 2-4 weeks after birth with fever, abdominal distension, diarrhoea (often with blood) and features of sepsis. Life-threatening condition which can lead to toxic megacolon and perforation of the bowel. Requires urgent Abx, fluid resus and decompression of the obstructed bowel
