Paeds gastro Flashcards
(31 cards)
What is intussception?
This is where a section of bowel ‘telescopes’ into
another
Peak incidence 3-9 months
Most in terminal ileum or ascending colon
Normally around a ‘lead point’ i.e lymph
nodes
Normally follows a viral illness
Name some symptoms of intussception
Pain
drawing up legs
red jelly stool
What investigations carried out for inssuception?
FBC, CRP
AXR
USS: Target sign
What will you find on examination a paediatric patient that has intussception?
Palpable sausage shaped mass
What is the managment for intussception?
A-E assessment
Antibiotics + analgesia + fluids
Barium air enema reduction during XR
-risk of bowel perforation
-80% success rate
-If fails will require surgery
-25% will have recurrence in first 24 hrs
What is appendicitis and what are some of the symptoms?
Inflammation of appendix- most commonly
from a faecoalith
Symptoms:
Generalised abdominal pain that moves to
RIF
A/W D&V, fever, reduced appetite, lethargy
What are finding that ypu will see in a patitient with appendicitis?
Rebound tenderness
Guarding
pain and tenderness in th RIF
Postive Psosas sign, rovosing sing, mcburnerys point
Signs of shock if severe or ruptured
Investigation for appendicitis
Bloods FBC, CRP etc
- Urine dip + MC&S
- Stool MC&S
- NPA
- USS
Treatment for appendicitis
Treatment:
Refer to surgical team
IV fluids
IV abx
IV analgesia
NBM
Surgery
What is the Meckel’s diverticum?
Present at birth due to incomplete closure of the omphalomesenteric duct during fetal development.
Rule of 2s: Occurs in 2% of population, 2cm
long, 2 feet from ileocaecal valve, Presents
under 2 years of age, 2 x more common in
males
Symptoms Meckel’s diverticum?
Most can my asymptomatic but if symtopmatic then the can present with painless rectal bleeding.
What is volulus?
A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction
Name some symtoms of volulus?
Pain
Bilious vomiting
Poor feeding
Fever
Diarrhoea
Irritable
Name of the clincal signs of volulus
Distended abdomen, very tender, dehydrated,
tachycardiac, ?signs of shock
What the investigation for volulus?
AXR
- Bloods- FBC, CRP, U&E
- Barium swallow- if child stable enough
What is the management for volvulus?
Resuscitate! IV fluids, analgesia, Abx
- NG tube insertion- to decompress the abdo distension
- Emergency laparotomy for Ladds procedure +/- stoma
formation
- Complications: death, adhesions or small gut syndrome
requiring TPN
What is pyloric stenosis?
Hypertrophy of the pylorus muscle
Resulting in narrow channel and obstruction
Presenting with projectile vomiting
Male 3:1, most common between 3-6 wks
What are the signs and symptoms of pyloric stenosis?
- Projectile non bilious vomiting
- Poor feeding history, failure to thrive
- Dehydration signs
In a patient that has pyloric stenosis what will be paplated on examination?
Palpable ‘olive’ mass in midline
What investigations will be carried for a patient that has pyloric stenosis?
IV fluids
- NBM
- NG tube insertion
- Bloods: FBC, U&E, CRP
- Blood gas
- USS
What would be a typical ABG result of a patient with pyloric stenosis be?
metabolic alkalosis
Raised pH and raised
HCO3
Hypochloraemia +
Hypokalaemia
What is the treatment for pyloric stenosis?
Electrolyte correction
Surgery
What is Wilms tumour?
This a tumor found on the kidneys and it can cause distension of abdomen. It sis normally unilateral and it present with haemturia. About 80-90 cases a year and 10-20% have hypertension.
Mx : chemo and surgery
What is neuroblastoma?
This is tumour that grow in the adrenal glands or paraspinal sites. May present with abdo distention, mass and anorexia.
Catecholamines in urine are
metabolites of neuroblastoma.
If they are high there is a risk of
mets
Mx - chemo, radio and surgery
