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3a Child Health > GI > Flashcards

GI Flashcards

1
Q

What is intussusception

A

Invagination of the proximal bowel into a distal segment
i.e. bowel telescopes into itself

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2
Q

Where in the bowel does intussusception commonly occur

A

Commonly involves ileum passing into the caecum through the ileocecal valve

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3
Q

What age does intussusception typically affect children

A

Infants aged 6 -18 months

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4
Q

Give 4 conditions associated with intussuception

A
  • Concurrent viral illness
  • Meckel diverticulum
  • CF
  • Henoch-Schonlein purpura
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5
Q

What is the investigation of choice for stable children with suspected Meckel’s diverticulum

A

A technetium scan

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6
Q

Give 5 ways intussuception may present

A
  • Paroxysmal, severe colicky abdo pain
  • Blood and mucus in stool - redcurrant jelly stool (late sign)
  • Sausage-shaped palpable mass
  • inconsolable crying - may draw up legs
  • Vomiting - may be billous depending on the location
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7
Q

Investigations for intussuception

A
  • Abdo USS (diagnostic) - target/doughnut sign
  • Abdo XR - distended small bowel, absence of gas in large bowel
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8
Q

How is intussuception managed

A
  • IV fluid
  • Reduction by rectal air insufflation (enema)
  • Surgical reduction
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9
Q

When is surgical reduction required for intussuception

A
  • If an air enema is unsuccessful
  • Signs of peritonitis
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10
Q

Give 4 complications of intussuception

A
  • Hypovolaemic shock
  • Venous obstruction due to stretching and constriction of the mesentery
  • Bowel perforation
  • Gangrenous bowel
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11
Q

What is pyloric stenosis

A

progressive hypertrophy of the pyloric sphincter causing gastric outlet obstruction

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12
Q

At what age does pyloric stenosis typically present

A

2 - 8 weeks of age

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13
Q

3 RFs of pyloric stenosis

A
  • boys
  • maternal FHx
  • First born
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14
Q

Clinical presentation of pyloric stenosis (4)

A
  • Non-billous, projectile vomiting after every feed
  • Olive sized pyloric mass
  • Weight loss
  • Dehydration
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15
Q

How is pyloric stenosis investigated? Give positive findings

A
  • Abdo ultrasound - pyloric hypertrophy
  • Chemistry panel: Blood gas - Hypochloremic, hypokalaemic metabolic alkalosis, low plasma Na
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16
Q

How is pyloric stenosis managed

A
  • IV fluids - correct metabolic disturbance
  • (Ramstedt’s) Pyloromyotomy
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17
Q

What is Hirschsprung’s disease

A

A congenital condition where parasympathetic ganglionic cells of the myenteric plexus are absent in the distal bowel and rectum

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18
Q

Explain the pathophysiology of hirschsprung’s disease

A
  • parasympathetic neuroblasts fail to migrate from the neural crest to the distal colon
  • the nerve plexus is responsible for stimulating peristalsis of the large bowel
  • the aganglionic section of the colon does not relax, causing it to become constricted (uncoordinated peristalsis)
  • this leads to loss of movement of faeces and bowel obstruction
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19
Q

What length of the colon is affected in Hirschsprung’s disease

A

always located distally, but length of the segment varies
* mc confined to the rectosigmoid
* Can affect entire colon

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20
Q

The entire colon can be affected by Hirschsprung’s disease. What is the name for this

A

total colonic aganglionosis

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21
Q

When is Hirschsprung’s disease typically diagnosed

A

Within first year of life

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22
Q

Give 3 conditions associated with Hirschsprung’s disease

A
  • Down’s syndrome
  • multiple endocrine neoplasia type IIA
  • Neurofibromatosis
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23
Q

Presentations of Hirschsprung’s disease (5)

A
  • Abdo distension
  • Billous vomiting
  • Chronic constipation usually without soiling
  • Explosive passage of liquid and foul stool following rectal exam
  • Failure to pass meconium in 24h
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24
Q

What investigations should be done for Hirschsprung’s disease

A
  • Initial diagnosis: contrast enema
  • Abdo XR - dilated colon
  • Suction rectal biopsy (GS) - absence of ganglion cells + increased activity of acetylcholinesterase
25
How is typical Hirschsprung's disease managed
* Bowel irrigation/ rectal washouts * Surgery: removal of distal aganglionic segment
26
How is total colonic aganglionosis managed
* Colectomy * Ileo-procto anastomosis * Protective ileostomy with closure later in life
27
What is Hirschsprung-associated enterocolitis
Inflammation and obstruction of the intestine occasionally occurring in infants with Hirschsprung's disease
28
Why is Hirschsprung enterocolitis life threatening
Can lead to toxic megacolon and perforation of the bowel
29
How is Hirschsprung enterocolitis treated
* Bowel irrigation * Urgent Abx - Oral/ IV metronidazole * IV fluids * Decompression of obstructed bowel
30
What is the cause of most cases of constipation in children
Idiopathic / functional constipation
31
Give 4 secondary causes of constipation in children
* Hirschsprung disease * hypothyroidism * coeliac disease * lower spinal cord problems
32
How does constipation present in children
* Less than 3 stools a week * Large, infrequent stools that can block the toilet * Straining and painful passages of hard stools * Overflow soiling caused by faecal impaction * poor appetite * retentive posturing: typical straight-legged, tiptoed, back arching posture
33
Give 4 red flag symptoms associated with constipation in children
* failure to pass meconium within 24h of life (Hirschsprung's or CF) * failure to thrive (coeliac, hypothyroidism) * abnormal lower back/ bum (spina bifida occulta) * Perianal bruising or multiple fissures (sexual abuse
34
How is constipation managed in children
* correct any reversible conditions - high fibre diet, good hydration * Laxatives: 1st movicol (macrogol) , add stimulant (senna) if no response * Faecal impaction: disimpaction regimen followed by maintenance (movicol and stimulants) * encourage and praise using the toilet
35
What is Meckel's diveticulum
Congenital diverticulum (outpuching) of the small intestine containing ileal, gastric and pancreatic mucosa
36
How does Meckel's diverticulum typically present
* Abdominal pain * Large painless rectal bleed in children age 1-2 years * Obstruction secondary to an omphalomesenteric band, intussusception and volvulus
37
What is biliary atresia
Obstruction of the biliary tree due to sclerosis of the bile duct, reducing bile flow
38
Describe the epidemiology of biliary atresia
* mc in Females * Neonatal cholestasis presents within 2-8 weeks of life * Associated with CMV
39
Describe the 3 types of biliary atresia
* Type 1: Common duct is obliterated, proximal ducts are patent * Type 2: Atresia of the cystic duct in the porta hepatis * Type 3: mc, atresia of the right and left ducts to the level of the porta hepatis
40
Describe the presentation of biliary atresia
typically presents in the first few weeks of life * jaundice extending beyond physiological 2 weeks * dark urine and pale stools * appetite disturbance * abnormal growth * hepatosplenomegaly
41
How is biliary atresia investigated, give positive findings
* serum bilirubin: conjugated bilirubin high * LFTs raised * Alpha 1 antitrypsin to rule out deficiency * Sweat test to rule out CF * USS of the biliary tree and liver
42
How is biliary atresia managed
* surgical dissection of structural abnormalities * antibiotics following surgery
43
Give 2 complications of biliary atresia
* cirrhosis with eventual hepatocellular carcinoma * progressive liver disease
44
What is intestinal malrotation
twisting loop of bowel leading to intestinal obstruction
45
How does intestinal malrotation and volvulus typically present in children
* billous vomiting * obstruction: absent bowel sounds, constipation, distended abdomen * poor appetite * abdo pain * commonly affects neonates in the first 30 days of life
46
How is malrotation and volvulus investigated
Upper GI contrast study - DJ flexure more medially placed Ultrasound - abnormal orientation of superior mesenteric artery and vein
47
Management of intestinal malrotation with volvulus
Ladd's procedure (includes division of Ladd bands and widening of the base of the mesentery)
48
What is Gastro-oesophageal reflux
where contents from the stomach reflux through the lower oesophageal sphincter into the oesophagus, throat and mouth
49
Give 2 RFs of gastro-oesophageal reflux in children
* preterm delivery * neurological disorder
50
When does gastro-oesophageal reflux typically develop in infants?
before 8 weeks of age
51
What are the common features of gastro-oesophageal reflux in children
* Vomiting or regurgitation * Milky vomits after feeds * Reflux may occur after being laid flat * Excessive crying, especially while feeding
52
How is gastro-oesophageal reflux managed in children
* Small, frequent meals * Burping regularly to help milk settle * Not over-feeding * Keep the baby upright after feeding (i.e. not lying flat) * thickened milk/ formula or gaviscon mixed with feeds
53
What is infantile colic?
typically occurring in those less than 3 months old, characterized by excessive crying and pulling-up of the legs, often worse in the evening
54
What is gastroenteritis
inflammation from the stomach to the intestines and presents with nausea, vomiting and diarrhoea
55
What are the most common causes of gastroenteritis in children
rotavirus and norovirus
56
What is the main risk of gastroenteritis in children
severe dehydration
57
Give 4 differentials of diarrhoea in children
* most common cause in the developed world is cows' milk intolerance * coeliac disease * post-gastroenteritis lactose intolerance * Toddler’s diarrhoea
58
How is gastroenteritis managed
* Children need to stay off school until 48 hours after the symptoms have completely resolved * rehydration

3a Child Health (19 decks)

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