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Paeds gastro Flashcards

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1
Q

What is pyloric stenosis?

A

Thickening (hypertrophy) and narrowing of the pylorus. This prevents food from passing from the stomach to the duodenum as normal.

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2
Q

What is the pylorus?

A

Connection between the stomach and the duodenum

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3
Q

What is the key symptom of pyloric stenosis + why does it occur?

A

Projectile vomiting happens because:
After feeding, increasingly powerful peristalsis of the stomach attempts to push food into the duodenum. Eventually, it becomes so powerful that the feed is ejected into the oesophagus, out of the mouth and across the room

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4
Q

What ages does pyloric stenosis most commonly present in?

A

<3mths

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5
Q

What would a baby with pyloric stenosis look like?

A

Hungry baby that is thin, pale and failing to thrive.

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6
Q

What might you feel when palpating the abdo of a child with pyloric stenosis?

A

Firm, round mass ‘like a large olive’ caused by hypertrophic pylorus

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7
Q

What blood gas results would you get with a baby with pyloric stenosis + why?

A

Hypochloride (low chloride) metabolic alkalosis as HCl is being vomited form stomach

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8
Q

How do you diagnose pyloric stenosis?

A

Abdo US showing thickened pylorus

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9
Q

How do you treat pyloric stenosis + what is the prognosis?

A

Laparoscopic pylorotomy-incision in smooth muscle of pylorus to widen canal + create space for food to pass. Good prognosis post-op

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10
Q

What is intussusception?

A

When a section of the bowel slides/folds into itself in a telescoping motion which narrows the lumen + creates an obstruction

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11
Q

What parts of the bowel does intussusception normally effect?

A

Normally the ileum entering the caecum

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12
Q

What demographic is intussusception most common in?

A

Boys
Infants 3mth-2yrs

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13
Q

Name 4 conditions associated with intussusception

A

CF
Meckel diverticulum
Henoch-Schonlein purpura
Viral illnesses

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14
Q

How does intussusception typically present? (3 symptoms)

A

Severe, colicky abdominal pain
Bilious (green) vomiting
Redcurrant jelly stool(a mix of blood, mucus and stool) is a later sign

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15
Q

What might you see on examination with an intussusception?

A

“sausage-shaped” mass in the right upper quadrant
redcurrant jelly stool

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16
Q

What condition do you get a redcurrant jelly stool with + what is it?

A

Intussusception - it is a mix of blood, mucus and stool

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17
Q

How would a typical intussusception present in an exam q?

A

Had a viral URTI preceding the illness and will have features of intestinal obstruction (vomiting, absolute constipation and abdominal distention).
With redcurrant stool + sausage shaped abdo mass

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18
Q

How do you diagnose intussuception?

A

US showing target/doughnut sign

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19
Q

How do you treat an intussusception?

A

Therapeutic enema to reduce it
Surgical reduction if enema fails
Bowel resection if gangrene/perforation

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20
Q

What is Hirschsprung’s disease?

A

Congenital condition where ganglion cells of the enteric nervous system are absent in a distal portion of the bowel.
This means sections do not relax, become constricted + cause bowel obstruction

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21
Q

What is the enteric nervous system?

A

Brain of the gut

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22
Q

What are the 2 plexuses in the enteric nervous system + what do they do?

A

Myenteric plexus (Auerbach’s plexus), primarily responsible for peristalsis

Submucosal plexus (Meissner’s plexus), regulates fluid secretion, blood flow and absorption

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23
Q

How does Hirschsprung’s occur in foetal development?

A

Occurs when the ganglion cells do not migrate all the way down the colon, and a section is left without these cells.

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24
Q

What is total colonic aganglionosis?

A

When the entire colon is not innervated

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25
Name 3 RF for Hirschsprung's
FHx - strong genetic component Male Down's syndrome
26
How might Hirschsprung's present acutely after birth?
Acute intestinal obstruction: Absent meconium Abdominal distension Vomiting
27
How might Hirschsprung's present more gradually after birth?
Delay in passing meconium (more than 24 hours) Chronic constipation (starting at birth) Abdominal pain and distention Vomiting Poor weight gain and failure to thrive
28
How do you investigate suspected Hirschsprung's disease?
Rectal biopsy - histology will show absence of ganglionic cells
29
How do you manage Hirschsprung's disease + what is the prognosis?
Surgical removal of aganglionic section, should have normal life post-surgery but some have long-term bowel function disturbances and incontinence.
30
What is HAEC + when does it occur?
Hirschsprung-associated enterocolitis - inflammation of the intestine. It occurs in 20-30% of patients w/ Hirschsprung’s + can occur before/after surgery.
31
How does HAEC present?
Fever Abdominal distension Diarrhoea (often with blood) Features of sepsis
32
What is the prognosis for HAEC (Hirschsprung-associated enterocolitis)?
Life-threatening, can -> toxic megacolon + bowel perforation
33
How do you manage HAEC?
Urgent Abx Fluid resus Decompression of obstructed bowel
34
What is biliary atresia?
Congenital condition where a section of the bile ducts is either narrowed or absent, this causes a build up of conjugated bilirubin -> jaundice
35
What is the function of the bile ducts + how is this affected in biliary atresia?
Normally transport bile (containing conjugated bilirubin) from liver to intestines for excretion BUT in biliary atresia, they are blocked = jaundice
36
How does biliary atresia present?
Neonatal jaundice-yellow skin + sclera, pale stools, dark urine
37
How do you investigate suspected biliary atresia?
Bloods to check conjugated and unconjugated bilirubin lvls US
38
What is appendicitis + who does it most commonly affect?
Inflammation of appendix, most common in 10-20yr olds
39
What is the appendix + where is it located?
Small, thin tube arising from the caecum. It is located at the point where the three taeniae coli meet.
40
Describe how appendicitis occurs?
Pathogens get trapped due to obstruction at the point where the appendix meets the bowel. Trapping of pathogens leads to infection and inflammation. The inflammation may proceed to gangrene and rupture.
41
What is a key complication of appendicitis + how does it occur?
Peritonitis - as faecal contents + infective material from rupture go into peritoneal cavity
42
What is the key presenting feature appendicitis?
Abdo pain - central abdominal pain that moves down to the right iliac fossa (RIF)
43
Where would you find tenderness on examination with appendicitis + where is it?
McBurney's point (one-third of the distance from the anterior superior iliac spine (ASIS) to the umbilicus
44
Name 3 presenting symptoms of appendicitis (other than RIF pain)
Anorexia (loss of appetite) N+V Fever
45
Name 4 signs (incl. 1 names sign) on exam of a patient with appendicitis (other than RIF pain on palpation)
Guarding (on palpation) Rebound tenderness in RIF (increased pain on sudden release) Percussion tenderness (pain on percussion) Rovsing's sign - palpation of the left iliac fossa causes pain in the RIF
46
What 2 signs associated with appendicitis suggest peritonitis?
Rebound tenderness and percussion tenderness
47
How is appendicitis diagnosed?
Clinical Dx on signs + symptoms Can use scoring systems e.g. Alvarado score/paediatric appendicitis score
48
Name 2 investigations for suspected appendicitis to exclude differentials
Urine dipstick for urinary tract infections Pregnancy test for ectopic pregnancy
49
What would you see on bloods with appendicitis?
Raised WCC + CRP/ESR
50
What is the next step after clinical presentation suggest appendicitis?
Diagnostic laparotomy + potential appendicectomy
51
Name 4 key differentials for appendicitis
Ectopic Ovarian cysts-rupture/torsion Meckel's diverticulum Mesenteric adenitis-inflamed abdo lymph nodes
52
What is an appendix mass?
When the omentum surrounds and sticks to the inflamed appendix, forming a mass in the right iliac fossa
53
How do you manage an appendix mass?
Conservatively-Abx. fluids etc Then appendicectomy after acute condition has resolved
54
What is GORD?
Gastro-oesophageal reflux - when the contents of the stomach reflux through the lower oesophageal sphincter into the oesophagus, throat and mouth.
55
Name 4 contributing factors for an increased rate of GORD in infants
Immature lower oesophageal sphincter Shorter oesophagus Slower gastric emptying Liquid diet
56
Is reflux concerning in babies?
Normal for a baby to reflux and regurgitate feeds as long as you have normal growth + baby otherwise well Normally improves with age
57
What are 4 signs of problematic reflux in infants?
Chronic cough Hoarse cry Poor weight gain Distress/crying/reluctance to feed/after feeding
58
How might children >1 present with reflux?
Heartburn Acid regurg Bloating Nocturnal cough
59
Name 5 potential causes of vomiting in infants
Overfeeding GORD Cow's milk protein allergy Pyloric stenosis Gastritis/gastroenteritis
60
Name 5 potential causes of vomiting in children
Appendicitis DKA Infection-UTI/tonsilitis/otitis media or gastroenteritis Intestinal obstruction Cyclical vomiting syndrome
61
Name 3 red flags for reflux
Not keeping down any feed Projectile vomiting Bilious (green) pr red (haematemesis) vomit
62
Name 4 simple pieces of advice for decreasing relfux in non-worrying cases
Small, frequent feeds Burping regularly to help milk settle Not over-feeding Keeping the baby upright after feeding (not lying flat)
63
What is vomiting?
Physical act that results in the gastric contents forcefully brought up to and out of the mouth
64
What is regurgitation?
Effortless expulsion of gastric contents
65
What is possetting?
Small volume vomits during or between feeds in otherwise well child
66
Name 3 Tx's for more problematic paediatric GORD
Gaviscon infant mixed with feeds Thickened milk/formula PPIs
67
Name 3 specialist investigations would you carry out for concerning paediatric GORD?
Barium swallow Oesophageal pH monitoring Endoscopy
68
What is Sandifer syndrome?
Rare condition affecting infants that causes brief episodes of abnormal movements associated with gastro-oesophageal reflux.
69
What are the 2 key features of Sandifer syndrome?
Torticollis (forceful contraction of the neck muscles causing twisting of the neck) Dystonia (abnormal muscle contractions causing twisting movements, arching of the back or unusual postures)
70
How is sandifer syndrome Mxd + what is a typical outcome?
Exclude differentials Tends to self-resolve Good outcome
71
Name 4 causes of functional/idiopathic constipation
Reduced fluid intake Reduced fibre intake Reduced physical activity Psychosocial issues (e.g., toilet training problems, stress or abuse)
72
Name 4 secondary causes of constipation
Hirschsprung’s disease Cystic fibrosis (particularly meconium ileus) Hypothyroidism Medications
73
What meds can cause constipation?
antihistamines or opiates
74
What exam may you perform associated with constipation + why?
Inspect anus for infection, fissures, fistulas or bruising PR NOT routinely performed on children
75
Name an infection that can cause constipation + how it presents
Perianal group A streptococcal infection Causes pain + erythema at anus + surrounding skin
76
What are initial Txs for constipation in children?
Macrogol laxatives (e.g., Movicol paediatric) first-line Stimulate laxatives (e.g., Senna) second-line
77
How do macrogol laxatives work?
They are osmotic laxatives - draw water into the stool, making it softer and easier to pass.
78
What is a cow's milk protein allergy?
Hypersensitivity to the protein in cow’s milk, can be IgE mediated or non IgE mediated
79
What children are most commonly affected by a cow’s milk protein allergy?
Infants + children <3
80
How can you differentiate between an IgE and non IgE mediated cow’s milk protein allergy?
IgE mediated = rapid reaction, within 2hrs of ingestion Non IgE = slower reaction over multiple days
81
How is a cow’s milk protein allergy different to a lactose intolerance?
Ppl with cow’s milk protein allergy don't have allergy to lactose. Lactose is a sugar, not a protein
82
How is a cow’s milk protein allergy different to a cow's milk intolerance?
Similar GI symptoms but NO allergic features e.g. rash, sneezing etc because cow’s milk intolerance is not an allergic process and does not involve the immune system. Children will tolerate + grow on milk but just have some GI symptoms
83
What demographic is a cow’s milk protein allergy more common in?
Formula fed babies Personal/FHx of atopic conditions
84
At what age does cow’s milk protein allergy most commonly present?
Before 1yr-can present on weaning
85
Name 4 GI symptoms associated with cow’s milk protein allergy
Bloating + wind Abdo pain Diarrhoea Vomiting
86
Name 4 general allergic symptoms in response to cow’s milk protein
Urticarial rash (hives) Angio-oedema (facial swelling) Cough/wheeze, Sneezing + watery eyes
87
How do you diagnose cow's milk protein allergy?
Full Hx + exam Can use skin prick testing if needed Test if avoiding cow's milk helps symptoms
88
How do you manage a cow's milk protein allergy?
Breastfeeding mothers avoid dairy products Replace formula with special hydrolysed formulas
89
What happens to most children with a cow's milk protein allergy by age 3?
They outgrow the allergy
90
How do you reintroduce milk to a child with cow's milk protein allergy?
Steps of milk ladder e.g. malted milk biscuits
91
What is an inguinal hernia?
Where the bowel herniates through the inguinal canal.
92
What demographics are more prone to inguinal hernias?
Prem babies Males Under 1's
93
What is the inguinal canal?
A tube that runs between the deep inguinal ring + the superficial inguinal ring . In males, it contains the spermatic cord.
94
What is the main presenting feature of an inguinal hernia?
Soft lump in groin/scrotum which may be more noticeable on crying/coughing
95
How do you manage an inguinal hernia?
Surgical repair asap to reduce risk of complications
96
Name 4 potential complications of a hernia
Incarceration Bowel obstruction Strangulation (blood supply to herniated bowel is cut off) Recurrence after surgery
97

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