Flashcards in Paeds gastro, infection and immunity Deck (225)
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?
- 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?
Is pyloric stenosis more common in girls or boys?
Boys (4 x more common)
Recall a genetic association of pyloric stenosis
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
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:
- Pale complexion
How should intussusception be managed?
It's an emergency
- Fluid resuscitation
- Enema: pneumatic - forces bowel to un-telescope - take x rays throughout
- 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