GI Flashcards
(243 cards)
1
Q
What are the 9 quadrants of the abdomen?
A
Right hypochondriac, epigastric, Left hypochondriac, right flank, umbilical, left flank, right iliac fossa, hypogastric, left iliac fossa
2
Q
What can the causes of abdominal pain in children be split up into?
A
Non-organic, medical and surgical causes
3
Q
What is the most common cause of abdominal pain in children over 5?
A
Non-organic/ functional
4
Q
What are the differential diagnoses of organic abdominal pain?
A
Constipation UTI Coeliac IBD IBS Mesenteric adenitis Abdominal migraine Pyelonephritis HSP Tonsilitis DKA Infantile colic
5
Q
What additional causes of abdominal pain are there in girls?
A
Dysmenorrhea Mittelschmerz (ovulation pain) Ectopic pregnancy PID Ovarian torsion Pregnancy
6
Q
What are the surgical causes of abdominal pain?
A
Appendicitis
Intussusception
Bowel obstruction
Testicular torsion
7
Q
What are the red flags for abdominal pain?
A
Persistent/ bilious vomiting Severe chronic diarrhoea Fever Rectal bleeding Weight loss/ faltered growth Dysphagia Night pain Abdominal tenderness
8
Q
What investigations should be done to rule out what pathologies?
A
FBC for anaemia (IBD or coealiac) Inflammatory markers (IBD) Anti-TTG/ Anti-EMA (coeliac) Faecal calprotectin (IBD) Urine dipstick (UTI)
9
Q
When is a diagnosis of recurrent abdominal pain made?
A
When a child presents with repeated episodes of abdominal pain without an identifiable cause. (Non-organic/ functional pain)
10
Q
What does recurrent abdominal pain usually correspond to?
A
Stressful life events
11
Q
What is the leading theory for the cause of recurrent abdominal pain?
A
Increased sensitivity and inappropriate pain signals from visceral nerves in response to normal stimuli
12
Q
What measures can be used to manage recurrent abdominal pain?
A
Distraction
Encourage parents not to ask about it
Sleep/ eating/ hydration/ reducing stress advice
Probiotic supplements
Avoid NSAIDS
Address pshycosocial triggers/ exacerbating factors
13
Q
What is an abdominal migraine?
A
Episode of central abdominal pain lasting more than 1 hour
14
Q
What symptoms may also occur with an abdominal migraine?
A
N&V Anorexia Pallor Headache Photophobia Aura
15
Q
How can you treat an acute attack of abdominal migraine?
A
Low stimulus environment
Paracetamol
Ibuprofen
Sumatriptan
16
Q
What medications can be used to prevent abdominal migraines?
A
Pizotifen
Propanolol
Cyproheptadine
Flunarazine
17
Q
What is the main medication used to prevent abdominal migraine and what information should patients be given about it?
A
Pizotifen
Needs to be withdrawn slowly when stopping as it is associated with withdrawal symptoms (depression, anxiety, poor sleep, tremor)
18
Q
What is the most common cause of constipation in children?
A
Idiopathic/ functional
19
Q
What are some secondary causes of constipation in children?
A
Hirschsprung's disease Cystic fibrosis Hypothyroidism Spinal cord lesion Sexual abuse Intestinal obstruction Anal stenosis Cows milk intolerance
20
Q
What are the typical features of a constipation history/ examination?
A
< 3 stools per week Hard/ difficult to pass stools Rabbit dropping stools Straining/ painful passage Abdominal pain Retentive posturing Rectal bleeding Overflow soiling caused by faecal impaction Palpable abdomen Loss of sensation of neeed to open bowels
21
Q
What is encopresis?
A
Term for faecal incontinence
22
Q
At what age does encopresis become pathological?
A
Older than 4
23
Q
What is the most common cause of encopresis?
A
Chronic constipation causing the rectum to become stretched and lose sensation. Large hard stools remain, and only loose stools are able to bypass the blockage and leak out
24
Q
What are other causes of encopresis?
A
Spina bifida Hirshchprung's disease Cerebral palsy Learning disability Psychosocial stress Abuse
25
What lifestyle factors can contribute to the development/ continuation of constipation?
```
Bad toilet habits
Low fibre diet
Poor fluid intake
Sedentary lifestyle
Psychosocial problems
```
26
What is faecal impaction?
Where a large, hard stool blocks the rectum
27
What is desensitisation of the rectum and when does it occur?
When patients develop the habit of not opening their bowels and ignore the sensation of a full rectum, leading to retained faeces and faecal impaction. THis causes the rectum to stretch and dill with more faeces, leading to further desensitisation.
28
What red flags should you look our for with a constipation presentation?
```
No meconium within 48 hours of birth
Neurological signs
Vomiting
Ribbon stool
Abnormal anus
Abnormal lower back/ buttocks
Failure to thrive
Acute severe abdominal pain/ bloating
```
29
What are the complications of constipation?
```
Pain
Reduced sensation
Anal fissures
Haemorrhoids
Overflow/ soiling
Psychosocial morbidity
```
30
How is idiopathic constipation managed?
High fibre diet
Good hydration
Start laxatives ( may need disimpactation regimen)
Encourage good toilet habits
31
What laxative is usually used in children with constpation?
Movicol
32
What is GORD?
Where contents of the stomach reflux through the lower oesophageal sphincter into the oesophagus, throat and mouth
33
Why is GORD common in babies?
Due to immaturity of the lower oesophageal sphincter
34
By what age do 90% of infants stop having reflux?
1
35
What are signs of problematic reflux?
```
Chronic cough
Hoarse cry
Distress/ crying
Reluctance to feed
Pnaeumonia
Poor weight gain
```
36
What symptoms of GORD may children over 1 have?
```
Similar to adults:
Heartburn
Acid regurgitation
Retrosternal/ epigastric pain
Bloating
Nocturnal cough
```
37
What are the causes of vomiting in infants?
```
Overfeeding
GORD
Pyloric stenosis
Gastritis/ gastroenteritis
Appendicitis
Infections
Intestinal obstruction
Bulimia
```
38
What are the red flags of vomiting?
```
Not keeping food down
Projectile/ forceful vomiting
Bile stained vomiting
Haematemesis/ melaena
Abdominal distention
Reduced consciousness/ bulging fontanelle/ neurological signs
Resp symptoms
Blood in stools
Signs of infection
Rash, angiodema/ other signs of allergy
Apnoeas
```
39
What are the key differential diagnoses with projectile or forceful vomitin?
Pyloric stenosis or intestinal obstrution
40
What are the key differential diagnoses with not being able to keep any feed down?
Pyloric stenosis or intestinal obstruction
41
What is the key differential diagnosis with bile stained vomit?
Intestinal obstruction
42
What are the key differential diagnoses with haematemesis/ melaena?
Peptic ulcer
Oesophagitis
Varices
43
What is the management advice for mild cases of GORD?
Small frequent meals
Burping regularly
Don't overfeed
Keep baby upright after feeding
44
What is the management advice for more problematic cases of GORD?
Gaviscon
Thickened milk or formula
Ranitidine
Omeprazole
45
What may need to be done in severe cases of GORD?
Further investigation with barium meal and endoscopy
| Surgical fundoplication in very severe cases
46
What is Sandifer's syndrome?
Rare condition causing brief episodes of abnormal movements associated with GORD in infants
47
What are the key features of Sandifer's syndrome?
Torticollis (forceful contraction of neck muscles)
| Dystonia (abnormal muscle contractions causing twisting movements, arching of the back or unusual postures
48
How does Sandifer's syndrome resolve?
As the reflux is treated/ improves
49
What is the pyloric sphincter?
The ring of smooth muscle that forms the canal between the stomach and duodenum
50
What is pyloric stenosis?
Hypertrophy and therefore narrowing of the pylorus
51
What is the key feature that indicates pyloric stenosis?
Projectile vomiting
52
Why does pyloric stenosis cause projectile vomiting?
Pyloric stenosis causes increasingly powerful peristalsis in the stomach to try to push food into the duodenum. Eventually it becomes so powerful that it ejects food into the oesophagus, out of the mouth and accross the room
53
What age range is affected by pyloric stenosis?
Neonate (birth- 6 months)
54
When does pyloric stenosis usually present?
In the first few weeks of life
55
How does a baby with pyloric stenosis usually present?
Projectile vomiting
Thin
Failing to thrive
Hungry
56
What might examination of pyloric stenosis show?
Visible peristalsis
57
What may you feel on examination of pyloric stenosis?
Firm round mass in upper abdomen- feels like large olive
58
Why can you feel a large mass in the upper abdomen in pyloric stenosis?
Hypertrophy of the pylorus muscle
59
What will blood gas analysis show in pyloric stenosis?
Hypochloric metabolic alkalosis
| low chloride
60
Why do you get hypochloric metabolic alkalosis in pyloric stenosis?
The baby is vomiting hydrochloric acid from the stomach
61
How is pyloric stenosis diagnosed?
History/ examination
Blood gas analysis
Abdominal USS
62
What does USS show in pyloric stenosis?
Thickened pylorus
63
How is pyloric stenosis managed?
Laparoscopic pyloromyotomy (Ramstedt's operation)
64
What is a Laparoscopic pyloromyotomy?
Incision made into smooth muscle of pylorus to widen canal
65
What causes pyloric stenosis?
Unknown?
| Sex, race, prematurity, family history ect risk factors
66
What is acute gastritis?
Inflammation of the stomach
67
How does acute gastritis present?
Nausea and vomiting
68
What is enteritis?
Inflammation of the intestines
69
How does enteritis present?
Diarrhoea
70
What is gastroenteritis?
Inflammation in the stomach and intestines
71
How does gastroenteritis present?
Nausea
Vomiting
Diarrhoea
72
What is the most common cause of gastroenteritis?
Viral
73
What is the main complication of gastroenteritis?
Dehydration
74
What are the key differential diagnoses of diarrhoea?
```
Gastroenteritis
IBD
Lactose intolerance
Coeliac disease
Cystic fibrosis
Toddler's diarrhoea
IBS
Medications (Abx)
```
75
What are the most common causes of viral gastroenteritis?
Rotavirus
| Norovirus
76
What are the most common causes of bacterial gastroenteritis?
```
E.coli
Campylobacter jejuni
Shigella
Salmonella
Bacillus
Cereus
Yersinia Enterocolitica
Staph aureus
```
77
Where is E.coli found under normal circumstances?
Normal intestinal bacteria
78
What strains of E.coli cause gastroenteritis?
E.coli 0157
79
How is E.coli infection spread?
Contact with infected faeces, unwashed salads or contaminated water
80
How does E.coli cause symptoms of gastroenteritis?
Produces the shiga toxin which causes abdominal cramps, bloody diarrhoea and vomiting.
81
What is the additional complication of infection by the Shiga toxin produced by E.coli?
Destroys blood cells and leads to haemolytic uraemic syndrome (HUS)
82
Why should antibiotics be avoided in E.coli infection?
Increases risk of haemolytic uraemic syndrome
83
What is the most common cause of travellers diarrhoea?
Campylobacter jejuni
84
How is campylobacter spread?
Raw/ uncooked poultry
Untreated water
Unpasteurised milk
85
What are the symptoms of infection with campylobacter?
Abdo cramps
Diarrhoea (without blood)
Vomiting
Fever
86
How long does campylobacter take to resolve?
Incubation 2-5 days
| Symptoms resolve after 3-6 days
87
When would antibiotics be considered with campylobacter infection?
After isolating the organism
If there are severe symptoms
If there are other risk factors (HIV, heart failure)
88
What antibiotics would be considered with campylobacter jejuni?
Azithromycin
| Ciprofloxacin
89
How is Shigella spread?
By food, water or pools containing contaminated faeces
90
What is the incubation period for Shigella and how long does it take to resolve?
1-2 days
| Resolves within 1 week
91
How is salmonella spread?
By eating raw eggs, poulty or food infected with animal faeces
92
What is the incubation period for salmonella and how long does it take to resolve?
incubation= 12 hours- 3 days
| Resolves within 1 week
93
What are the symptoms of salmonella?
Watery diarrhoea associated with mucus or blood, abominal pain and vomiting
94
What type of bacteria is bacillus cereus?
Gram positive rod
95
How is bacillus cereus spread?
Through inadequately cooked food (e.g fried rice left out)
96
How does bacillus cereus cause symptoms?
It produces the cereulide toxin which causes abdominal cramping and vomiting within 5 hours of ingestion, then produces different toxins in the intestines that cause watery diarrhoea/
97
What is the usual time course for bacillus cereus infection?
Vomiting within 5 hours, diarrhoea after 8 hours, resolution within 24 hours
98
What kind of bacteria is Yersinia Enterocolitica?
Gram negative bacillus
99
How is Yersinia spread?
Pigs= carriers so eating raw/ undercooked pork.
| Contimation with urine or faeces of other mammals
100
Who is most affected by Yersinia infection?
Children
101
What are the symptoms of Yersinia?
Watery/ bloody diarrhoea
Abdominal pain
Fever
Lymphadenopathy
102
What is the time course or Yersinia infection?
4-7 day incubation period
| Symptoms can last >3 weeks
103
How may older children with Yersinia infection present and what may this be confused with?
Mesenteric lymphadenitis, causing right sided abdominal pain and giving the impression of appendicitis
104
What does staph aureus produce and how does this cause gastroenteritis?
Enterotoxins, which can cause small intestine inflammation
105
What is Giardia lamblia?
Microscopic parasite
106
Where does giardia live?
In small intestines of mammals
107
How is giardiasis transmitted?
Faecal- oral transmission (mammals release cysts in stools which then contaminate food and water)
108
How is giardiasis diagnosed and treated?
Diagnosed by stool microscopy
| Treated with metronidazole
109
What are the principles of gastroenteritis management?
Infection control (Isolation and barrier nursing)
Stay of school for 48 hours
Manage dehydration
110
How is gastroenteritis investigated?
Can do stool sample for microscopy, culture and sensitivities
111
How is dehydration managed in gastroenteritis?
Establish if they can keep fluids down or need admission for IV fluids (fluid challenge)
112
What is a fluid challenge?
Recording a small volume of fluid given orally every 5-10 minutes to see if it is tolerated. If so, can be managed at home
113
How is gastroenteritis managed?
Fluid challenge
Dioralyte
IV fluids if required
Slowly introduce food once tolerated
114
Should you use antidiarrhoeal medication with gastroenteritis?
No- especially with e.coli or shigella infection
115
What are the possible post-gastroenteritis complications?
Lactose intolerance
IBS
Reactive arthritis
Guillain-Barre syndrome
116
What is Toddler's diarrhoea?
Chronic nonspecific diarrhoea
117
What kind of condition is coeliac?
Autoimmune
118
What is the pathophysiology of coeliac?
Autoantibodies are created in response to gluten exposure, which target the epithelial cells of the intestine and lead to inflammation. Inflammation causes atrophy of the intestinal villi, which leads to decreased nutrient absorption
119
What are the two antibodies created in coeliac disease?
Anti-tissue transglutaminase (anti-TTG)
| Anti-Endomysial (enti-EMA)
120
Which part of the GI tract is most affected by the inflammation caused by coeliac?
Jejunum
121
How does coeliac disease present in children?
```
Often asymptomatic
Failure to thrive
Diarrhoea
Fatigue
Weight loss
Mouth ulcers
Anaemia
Dermatitis herpetiformis
Neurological symptoms
```
122
What is dermatitis herpetiformis?
Itchy blistering skin rash on the abdomen
123
What genes are associated with coeliac disease?
HLA-DQ2 (90%)
| HLA-DQ8
124
How is coeliac disease investigated?
Blood tests for IgA levels and antibodies
| Endoscopy and intestinal biopsy
125
Why must immunoglobulin A levels be checked when testing for coeliac disease?
Anti-TTG and anti-EMA are both IgA, so in IgA deficiency, these may be low despite the presence of coeliac disease
126
How can you test for coeliac if the patient has IgA deficiency?
Test for the IgG version of the anti-TTG or anti-EMA antibody
Endoscopy
127
What will endoscopy and biopsy show in coeliac?
Crypt hypertophy
| Villous atrophy
128
What key conditions if coeliac disease associated with?
```
T1 diabetes
Thyroid disease
Autoimmune hepatitis
Primary biliary cirrhosis
Primary sclerosing cholangitis
Down's syndrome
```
129
What are the complications of untreated coeliac disease?
```
Vitamin deficiency
Anaemia
Osteoporosis
Ulcerative jejunitis
EATL of the intestine
Non-Hodgkin lymphoma
Small bowel adenocarcinoma
```
130
What is the treatment of coeliac disease?
Lifelong gluten free diet
131
What are the two forms of inflammatory bowel disease?
Crohn's disease
| Ulcerative colitis
132
What are the key features of Crohns that differentiate it from UC?
```
(NESTS)
No blood or mucus
Entire GI tract affected
Skip lesions on endoscopy
Terminal ileum most affected
Transmural inflammation
Smoking is risk factir
```
133
What are the key features of UC that differentiate it from Crohn's?
```
(CLOSEUP)
Continuous inflammation
Limited to colon and rectum
Only superficial mucosa affected
Smoking= protective
Excrete blood and mucus
Use aminosalicylates
Primary sclerosing cholangitis associated
```
134
How does IBD present?
```
Perfuse diarrhoea
Abdominal pain
Bleeding
Weight loss
Anaemia
Systemically unwell during flares (fevers, malaise, dehydration)
```
135
What are some extra-intestinal manifestations of IBD?
```
Finger clubbing
Erythema nodosum
Pyoderma gangrenosum
Episcleritis & Iritis
Inflammatory arthritis
Primary sclerosing cholangitis
```
136
How is IBD diagnosed?
Blood tests
Faecal calprotectin
Endoscopy
Imaging
137
What blood tests are done to investigate IBD?
```
Anaemia
Infection
TFT's
LFT's
U&E's
Inflammatory markers
```
138
What is faecal calprotectin and when its raised what does it indicate?
Marker for inflammation in the GI tract
139
What is the gold standard test for diagnosis of IBD?
Endoscopy
140
When might imaging be done in IBD?
To look for complications such as fistulas, abscesses and strictures
141
Who should managed the care of a child with an IBD?
```
MDT:
Paediatrician
Specialist nurses
Pharmacists
Dieticians
Surgeons if necessary
```
142
What should be monitored in children with IBD?
Growth and pubertal development
143
What are the IBD treatment aims?
Inducing remission during flares and maintaining remission
144
How is Crohn's treated to induce remission during a flare?
Steroids (oral prednisolone or IV hydrocortisone)
| May need further immunosuppressant medication
145
What are the first line medications used to maintain remission in Crohns?
Azathioprine
| Mercaptopurine
146
What are alternative options for maintaining remission in Crohns?
Methotrexate
Infliximab
Adalimumab
147
How else may Crohn's be managed?
If it only affects distal ileum, can surgical resect this area
148
What medications are used to induce remission in mild/ moderate UC?
Aminosalicyclate
| Corticosteroids
149
What medications are used to induce remission in severe UC?
IV corticosteroids
| IV ciclosporin
150
What medications can be used to maintain remission in UC?
Aminosalicyclate
Azathioprine
Mercaptopurine
151
How can UC be cured?
Removing the colon and rectum (panproctocolectomy)
152
What is the pateint left with after surgery for UC?
Ileostomy (stoma bag) or J-pouch (ileo-anal anastomosis)
153
What is a J-pouch?
Where the ileum is folded back on itself and fashioned into a larger pouch that functions like a rectum. Is then attached to the anus
154
What is biliary atresia?
Congenital condition where a section of the bile duct is narrowed or absent
155
What does biliary atresia cause?
Cholestasis (bile cannot be transported from liver to bowel)
156
How and when does biliary atresia present?
With significant jaundice shortly after birth
157
Why do you get jaundice in biliary atresia?
Conjugated bilirubin is excreted in the bile, so biliary atresia prevent the excretion of conjugated bilirubin
158
When should biliary atresia be suspected?
In babies with persistent jaundice
159
What time frame is classified as persistent jaundice?
>14 days in term babies
| >21 days in premature babies
160
What is the initial investigation for biliary atresia?
Conjugated and unconjugated bilirubin levels
161
What will investigations into biliary atresia show?
High proportion of conjugated bilirubin
162
How is biliary atresia managed?
Surgery- attaching section of small intestine to opening of liver where bile duct attached
Often will need full liver transplant to resolve condition
163
What is intestinal obstruction?
Where physical obstruction prevents the flow of faeces through the intestines
164
What does the blockage cause?
Back pressure that causes vomiting
| Absolute constipation
165
What are the causes of intestinal obstruction?
```
Meconium ileus
Hirschsprung's disease
Oesophageal/ duodenal atresia
Intussusception
Imperforate anus
Malrotation of intestines with volvulus
Strangulated hernia
```
166
What is meconium ileus?
Where the meconium is thick and sticky, causing it to get stuck and obstruct the bowel (Common in CF)
167
How does a bowel obstruction present?
```
Persistent vomiting
Abdominal pain
Distention
Failure to pass stools or wing
Abnormal bowel sounds
```
168
What are the classic bowel sounds in bowel obstruction?
High pitched 'tinkling', followed by absence of bowel sounds
169
What is the investigation of choice for bowel obstruction?
Abdominal xray
170
What will xray show with bowel obstruction?
Dilated loops of bowel proximal to the obstruction
Collapsed loops of bowel distal to the obstruction
Absence of air in the rectum
171
How are bowel obstructions managed?
Emergency paediatric surgery referral
Initial= nil by mouth, insert NG tube to help drain stomach and stop vomiting
IV fluids to correct dehydration/ electrolyte imbalances
Treat underlying cause
172
What is the myenteric plexus?
The brain of the gut- forms the enteric nervous system
173
What is the myenteric plexus also known as?
Auerbach's plexus
174
Where does the myenteric plexus run?
All the way along the bowel in the bowel wall
175
What is the myenteric plexus made up of?
Complex web of neurones, ganglion cells, receptors, synapses and neurotransmitters
176
What is the myenteric plexus responsible for?
Stimulating peristalsis in the large bowel
177
What is Hirschsprung's disease?
Congenital condition where nerve cells of the myenteric plexus are absent in the distal bowel and rectum
178
What is absent in Hirschsprung's disease?
Parasympathetic ganglion cells in the distal colon and rectum
179
How do the parasympathetic ganglion of the cells usually form and develop?
Cells start higher in the GI tract and gradually migrate down to the distal colon and rectum
180
How does Hirschsprung's occur?
When the parasympathetic ganglion cells do not travel all the way down the colon, so a section is left without them
181
What is it called when the whole colon is affected by Hirschsprung's disease?
Total colonic aganglionosis
182
What happens to the aganglionic section in Hirschsprung's disease?
It does not relax, causing it to become constricted
183
What does the constriction of the aganglionic colon lead to?
Loss of movement of faeces and obstruction in the bowel
184
What happens to the bowel proximal to the obstruction?
It becomes distended and full
185
What increases the risk of Hirschsprung's disease?
```
Genetics
Family history
Downs syndrome
Neurofibromatosis
Waardenburg syndrome
Multiple endocrine neoplasia type II
```
186
How does Hirschsprung's vary in its presentation?
Depends on age at diagnosis and extent of bowel affected:
| May be acute intestinal obstruction shortly after birth or more gradual
187
What are symptoms of Hirschsprung's disease?
```
Delay in passing meconium (>24 hours)
Chronic constipation since birth
Abdominal pain and distension
Vomiting
Poor weight gain
Failure to thrive
```
188
What is Hirschsprung-Associated Enterocolitis (HAEC)?
Inflammation and infection of the intestine occurring in around 20% of neonates with Hirschsprung's disease
189
When does Hirschsprung-Associated Enterocolitis usually present?
Within 2-4 weeks of birth
190
How does Hirschsprung-Associated Enterocolitis present?
Fever
Abdominal distention
Diarrhoea (often bloody)
Features of sepsis
191
What can Hirschsprung-Associated Enterocolitis lead to?
Death
| Toxic megacolon and perforation of bowel
192
How is Hirschsprung-Associated Enterocolitis managed?
Urgent antibiotics
Fluid resuscitation
Decompression of obstructed bowel
193
How is Hirschsprung's disease managed?
Abdominal Xray
| Rectal biopsy
194
How does rectal biopsy confirm a diagnosis of Hirschsprung's disease?
Demonstrates absence of ganglionic cells
195
How is Hirschsprung's disease managed acutely?
Fluid resuscitation
| Management of intestinal obstruction
196
What is the definitive management of Hirschsprung's disease?
Surgical removal of aganglioinic section of bowel
197
What is intussusception?
Where the bowel folds inwards (invaginates/ telescopes) into itself
198
What does intussusception do to the overall size of the bowel and the lumen?
Thickens overall size of bowel and narrows lumen at folded area
199
What age range and population us most affected by intussusception?
6 months- 2 years
| More common in boyrs
200
What conditions are associated with intussusception?
```
Concurrent viral illness
HSP
Cystic fibrosis
Intestinal polyps
Meckel diverticulum
```
201
How does intussusception present?
```
Signs of bowel obstruction
Severe colicky abdominal pain
Pale, lethargic unwell child
Bloody stool
Right upper quadrant mass
Vomiting
Intestinal obstruction
```
202
What is the typical description of the stool in intussusception?
Redcurrant jelly stool
203
What is the typical description of the mass felt on palpation of intussusception?
Sausage shaped
204
Why do you get 'redcurrant jelly stool' in intussusception?
Trapped section of bowel goes ischaemic, and the mucosa responds by causing sloughing off into the gut
205
What is the investigation of choice for intussusception?
USS (or contrast enema)
206
What is the initial treatment of intussusception?
Therapeutic enemas- pumping contrast, water or air into the colon to force the folded bowel out into its normal position
207
What can be done to treat intussusception if enema doesnt work?
Surgical reduction
208
What must be done is the bowel becomes gangrenous or perforated?
Surgical resection
209
What are the complications of intussusception?
Obstruction
Gangrenous bowel (due to disruption of blood supply)
Perforation
Death
210
What is the appendix attached to?
The caecum
211
When does the appendix become inflamed?
Due to infection trapped in the appendix by obstruction at the point where it meets the bowel
212
What can inflammation of the appendix be quickly be proceeded by?
Gangrene and rupture
213
What does rupture of the appendix lead to?
Release of faecal content and infective material into the abdomen, leading to peritonitis
214
When is the peak incidence of appendicitis?
Patients afed 10-20 years
215
What is the key presenting feature of appendicitis?
Abdominal pain
216
What is the characteristic progression of the pain in appendicitis?
Central abdominal pain that moves down to right iliac fossa, and then becomes loalised at McBurney's point
217
What is McBurney's point?
Localised area one third the distance from the anterior superior iliac spine (ASIS) to the umbilicus.
218
What are the classic features of appendicitis?
```
Tenderness/ pain at McBurney's point
Anorexia
N&V
Rovsing's sign
Guarding
Rebound tenderness
Percussion tenderness
```
219
What is Rovsing's sign?
Palpation of the lLIF causing pain in the RIF
220
What signs indicate peritonitis?
Rebound tenderness
| Percussion tenderness
221
How is appendicitis diagnosed?
Based on clinical presentation and raised inflammatory markers
222
What scans may be done to investigate appendicitis?
CT to confirm
| USS to exclude ovarian/ gynae pathology
223
What is the next step when a patient has a clinical presentation suggestive of appendicitis but investigations are negative?
Perform a diagnostic laparoscopy to visualise the appendix directly
224
What are the key differential diagnoses of appendicitis?
```
Ectopic pregnancy
Ovarian cysts/ torsion
Meckel's diverticulum
Mesenteric adenitis
Appendix mass
```
225
What is Meckel's diverticulum?
Congenital malformation of the distal ileum that causes bulge in lower part of small intestine
226
What are the complications of Meckel's diverticulum?
Can bleed, become inflamed, rupture or cause a volvulus or intussusception
227
What is mesenteric adenitis?
Inflamation of the abdominal lymph nodes, presenting with abdominal pain
228
What is an appendix mass and when does it occur?
When the omentum surrounds and sticks to the inflamed appendix, forming a mass in the right iliac fossa/
229
How is appendicitis managed?
Appendicectomy
230
What are the complications of appendicectomy?
```
Bleeding, infection, scars, pain
Damage to bowel and bladder
Removal of normal appendix
Anaesthetic risks
VTE risks
```
231
What are the causes of vomiting in infants?
```
GORD
Feeding problems
Infection
Dietary protein intolerances
Intestinal obstruction
Inborn errors of metabolism
Congenital adrenal hyperplasia
Renal failure
```
232
What are the causes of vomiting in preschool children?
```
Gastroenteritis
Infection
Appendicitis
Intestinal obstruction
Raised intracranial pressure
Coeliac disease
Renal failure
Inborn errors of metabolism
Torsion of the testis
```
233
What are the causes of comiting in shool age/ adolescent children?
```
Gastroenteritis
Infection
Peptic ulceration
H.pylori
Appendicitis
Migraine
Raised ICP
Coeliac
Renal failure
DKA
Alchol/ drug ingestion
Cyclical vomiting syndrome
Bulimia
Pregnancy
Testicular torsion
```
234
What causes bile stained vomit?
Bowel obstruction
235
What is infant colic?
When in the first few months of life, there is paroxysmal inconsolable crying or screaming often accompanied by drawing up the knees and passing excessive flatus, for unknown reasons
236
What is volvulus?
Condition where the bowel twists around itself and the mesentery
237
Where does the blood supply to the bowel come from?
The mesentery (through mesenteric arteries)
238
What does twisting in the bowel lead to?
Closed-loop bowel obstruction (where section of bowel is isolated by obstruction on either side), leading to ischaemia and necrosis
239
What is malrotation?
When the bowel does not rotate into the normal position during fetal development
240
What are the two presentations of malrotation?
Obstruction
| Obstruction with compromised blood supply
241
How does malrotation usually present?
With volvulus in the first week of life
242
What are the symptoms of malrotation?
Bilious vomiting
243
How is malrotation managed?
Surgery to untwist volulus and return bowel to correct position.
