Paeds gastro, infection and immunity Flashcards Preview

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Flashcards in Paeds gastro, infection and immunity Deck (225)
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What is the cause of GOR in babies?

Inappropriate relaxation of the LOS (functional immaturity)


By when does GOR usuallly resolve?

12 months - if persistent, may be due to GORD


How is GOR diagnosed?

Clinical diagnosis
- 24 hour LOS pH monitoring (it should remain above 4)


Recall the factors affecting choice to refer for GOR

Same day referral if haematemesis, melaena or dysphagia

- Assess by paediatrician if there are:
1. Red flags (eg faltering growth)
2. Unexplained IDA
3. No improvement after 1 y/o
4. Feeding aversion
5. Suspected Sandifer's syndrome

-Refer if there are complications


Recall the management options for GOR

1. Reassure - it's v common!
2. Must sleep on back
If breast fed: assess breast-feeding, consider alginate for 1-2 weeks, if not --> pharmacology

If formula-fed: review feeding history, try a smaller, more frequent feed and thickened formula, if doesn't work, try alginate


What safety net should you watch out for when assessing GORD?

Keep an eye on the vomit - if it's blood-stained or green seek medical attention


At what age does pyloric stenosis present?

2-8 weeks


Is pyloric stenosis more common in girls or boys?

Boys (4 x more common)


Recall a genetic association of pyloric stenosis

Turner's syndrome


What is the main symptom of pyloric stenosis?

Projectile, non-billious vomiting


Recall some other symptoms of pyloric stenosis other than vomiting

Weight loss and depressed fontanelle from dehydration and loss of interest in food


Recall some signs of pyloric stenosis

Palpable 'olive' mass
Visible peristalsis in upper abdomen


What will be the acid-base profile in pyloric stenosis?

Hypochloraemic, hypokalaemic metabolic alkalosis (may progress to a dehydrated lactic acidosis - which is the opposite biochemial picture)


What is the best investigation for pyloric stenosis?

USS - shows target lesion of >3mm thickness
You also need to do an ABG to guide management


How should pyloric stenosis be managed?

1. IV slow fluid resuscitation + correct any disturbances:
1.5 x maintenance rate
5% dextrose
0.45% saline

2. Laparoscopic Ramstedt pyloromyotomy


What are the symptoms of colic?

Inconsolable crying and drawing up of the hands and feet - child remains distressed in between episodes


What should be considered if the colic is persistent?

Cow's milk protein allergy or reflux
- 2 week trial of hydrosylate formula followed by
- 2 week trial of anti-reflux treatment


In what age group is appendicitis less common, and what is a more likely cause of similar symptoms in this age group?

Rare in under 3s, then it's more likely to be faecolith (stony mass of impacted faeces)


Recall the management of appendicitis in children

G: group and save
A: Abx IV
M: MRSA screen
E: eat and drink NBM

Then laparoscopic appendectomy


What is intussusception?

Invagination of proximal bowel into distant component (telescoping distally)


What is the most common site of intussusception?

Ileum through to caecum through ileocaecal valve


Recall the appearance of stool in intussusception, and the pathophysiology of how this happens

Red-currant jelly (blood and mucus) due to venous obstruction and compression --> oedema and mucosal bleeding
This is a LATE sign


What are the causes of intussusception?

May be idiopathic
May have a physiological lead point: Peyer's patch
May have a pathological lead point: malignancy, Meckl's diverticulum, Henoch-Schonlein purpura


What are the symptoms of intussusception?

Intermittent colicky pain
Vomit - depending on type of intususception, may be bile-stained or not


What are the signs of intussusception?

Abdominal distention with sausage shaped mass in RUQ
Emptiness on palpation in RLQ (Dance's sign)
Red-currant jelly stool is a late sign


What are the appropriate investigations for intussusception?

1. Abdo USS: may show donut sign (think: intUSSusception)
2. AXR (may be normal)
3. Barium/ gastrogaffin enema if have one of 3 Ps:
- Perforation
- Peritonitis
- Pale complexion


How should intussusception be managed?

It's an emergency

If stable:
- Fluid resuscitation
- Enema: pneumatic - forces bowel to un-telescope - take x rays throughout

If unstable:
- Don't mess about with contrast, go in with open surgery
- Remove any non-viable bowel


What should be done if there is recurrent intussusception?

Investigate for a lead point


What is Meckel's diverticulum?

Ileal remnant of vitello-intestinal duct on anti-mesenteric border containing ectopic gastric mucosa or pancreatic tissue


What is the rule used to remember all you need to know about Meckel's diverticulum?

Rule of twos
2 years old
2 x more common in boys
2 feet from ileocaecal valve
2 inches long
2 different mucosae (gastric and pancreatic)