1
Q
What is Hirschprung’s and the pathophysiology?
A
- congenital condition
- aganglionic section of bowel
- PS ganglion cells fail to migrate
- absent in distal bowel and rectum (rectosigmoid section)
2
Q
Which nerve plexuses are absent in Hirschprung’s?
A
- Auerbach’s plexus (between muscle layers, motor)
- Meissner’s plexus (submucosal for secretion and absorption)
3
Q
What are risk factors for Hirschprung’s?
A
- genetic
- FHx inc chance
- Down’s
- male
4
Q
How does Hirschprung’s cause obstruction?
A
- uncoordinated peristalsis leads to functional obstruction
- proximal to obstruction: distention and fullness
5
Q
How does Hirschprung’s present?
A
- delay in passing meconium
- chronic constipation since birth
- abdo pain and distention
- vomiting
- poor weight gain and FTT
6
Q
What syndromes is Hirschprung’s associated with?
A
- Down’s
- Neurofibromatosis
- Waardenburg syndrome
- multiple endocrine neoplasia type II
7
Q
What is Hirschprung-Associated Enterecolitis? When does it present?
A
- inflammation and obstruction of intestine
- occurs in 20% neonates w/ Hirschprung’s
- presents 2-4 weeks after birth
8
Q
How does hirschprung-associated enterocolitis present?
A
- fever
- abdo distention
- (bloody) diarrhoea
- sepsis features
- can lead to toxic megacolon and bowel perf
9
Q
How is hirschprung-associated enterocolitis managed?
A
- urgent Abx
- fluid resus
- decompression of obstruction
10
Q
How is Hirschprung’s investigated?
A
- Abdo x-ray
- gold: rectal biopsy
- histology showing absence of ganglionic cells
11
Q
What sign on X-Ray indicates Hirschprung’s?
A
- saw-tooth
- highlights transition zone between contracted and dilated bowel
12
Q
How is Hirschprung’s managed?
A
- fluid resus if unwell
- rectal washout
- surgical removal of aganglionic section: pull-through
- may be left with disturbances of function/incontinence
13
Q
What is intussusception?
A
- bowel invaginates into itself
- thickens overall size and narrows lumen
- obstructs passage of faeces
- most commonly in ileo-caecal region
14
Q
What is the epidemiology of intussusception?
A
- infants 6mo - 2yrs
- more common in boys
15
Q
What conditions are associated with intussusception?
A
- concurrent viral illness
- HSP
- cystic fibrosis
- intestinal polyps
- Meckel’s diverticulum
16
Q
How does intussusception present?
A
- severe, colicky abdo pain
- drawing knees to chest
- pale, lethargic, unwell
- redcurrant jelly stool (late sign)
- sausage shaped RUQ mass
- vomiting
- intestinal obstruction
17
Q
How is intussusception diagnosed and what is seen?
A
- USS: shows target like mass
- contrast enema
18
Q
How is intussusception managed?
A
- air insufflation under X-ray
- surgical reduction
- surgical resection if gangrenous or peritonitic
19
Q
What are some complications of intussusception?
A
- obstruction
- gangrenous bowel
- perforation
- death
20
Q
What is the pyloric sphincter?
A
- ring of smooth muscle forming the canal between the stomach and duodenum
21
Q
What is pyloric stenosis?
A
- hypertrophy of the circular muscles and narrowing of the pylorus
- prevents food travelling to duodenum as normal
22
Q
What is the epidemiology of pyloric stenosis?
A
- males
- first born
- FHx
23
Q
How does pyloric stenosis present?
A
- 2-8 week baby
- projectile non bilious vomiting (30mins post meal)
- constipation/dehydration
- thin pale baby
- failure to thrive
24
Q
Why is there projectile vomiting in pyloric stenosis?
A
- peristalsis tries to push food into duodenum
- lumen obstruction
- ejects food into oesophagus and out of mouth
25
What is seen on examination of pyloric stenosis?
- firm round mass in upper abdomen
- feels like large olive
26
What is seen metabolically on investigation of pyloric stenosis?
- hypochloemic, hypokalaemic metabolic alkalosis
- due to vomiting HCl acid
27
How is pyloric stenosis diagnosed?
- abdo USS: target sign (hypertrophic pylorus)
- contrast studies: string sign
28
What is appendicitis and what is the epidemiology?
- inflammation of the appendix
- patients aged 10-20 yrs
29
How is pyloric stenosis managed?
- NBM with IV fluids
- Ramstedt pyloromyotomy to widen canal (laparoscopic)
30
What is the anatomy of the appendix?
- small, thin tube arising from caecum, leads to dead end
- located where 3 teniae coli meet
31
What is the pathophysiology behind appendicitis?
- pathogens trapped due to obstruction where the appendix meets the bowel
- trapped pathogens > infection, inflammation, oedema, ischaemia
- can lead to peritonitis
32
What are the characteristics of pain in appendicitis?
- central abdo pain > R iliac fossa
- tenderness at McBurney's point on palpation
- guarding
- rebound and percussion tenderness
- pain worse on coughing
33
What are other features of appendicitis?
- anorexia
- nausea and vomiting
- mild pyrexia
34
How is appendicitis diagnosed?
- clinical presentation
- neutrophil predominant leucocytosis
- urinalysis (rule out UTI etc)
- USS rules out gynae
- potential diagnostic laparoscopy
35
What are the key differential diagnoses of appendicitis?
- ovarian cysts
- Meckel's diverticulum
- ectopic pregnancy (hCG to exclude)
36
How is appendicitis managed?
- appendectomy
- laparoscopic surgery is ideal over open
- prophylactic IV Abx
37
What is Rovsing's sign?
- palpation of the LIF causes pain in the RIF
38
What is psoas sign in appendicitis?
- pain on extending hip if retrocaecal appendix
39
What is rebound tenderness?
- increased pain when quickly releasing pressure
40
What is biliary atresia?
- congenital narrowing or absence of bile duct
- prevents excretion of conjugated bilirubin
41
What is the epidemiology of biliary atresia?
- females
- neonates: up to 8 weeks
42
What are the 3 classes of biliary atresia?
1: atresia of CBD
2: atresia of CBD and hepatic duct
3: atresia of all extrahepatic ducts inc porta hepatis (90% cases)
43
How does jaundice in biliary atresia present?
- persistent jaundice
- in term babies if >14 days
- >21 days in prem babies
- abnormal growth
44
What are other features of biliary atresia (other than jaundice)?
- dark urine
- pale stools
- bruising if vit K deficient
45
How is biliary atresia investigated?
- high conjugated bilirubin levels
- abnormal USS
46
How is biliary atresia managed?
- Kasai portoenterostomy
- attaching section of small intestine to liver where bile duct normally attaches
- or full liver transplant
47
What is typical presentation of constipation?
- <3 stools per week
- hard or rabbit dropping stools
- straining and painful passage
- abdo pain
- overflow soiling
- retentive posturing
- rectal bleeding
48
What lifestyle factors cause constipation?
- habitually not opening bowels
- low fibre diet
- poor fluid intake
- sedentary lifestyle
- psychosocial problems
49
What is encopresis?
- faecal incontinence
- rectum loses sensation due to stretching
- overflow soiling
50
What is faecal impaction?
- large hard stool blocking rectum
- leading to desensitisation
51
What are red flags of constipation in newborns and infants?
- not passing meconium within 48hrs: CF, Hirschprung's
- vomiting: intestinal obstruction
52
What physical exam findings are red flags in constipated children?
- Abnormal anus or lower back/buttocks (spina bifida, cord lesion, abuse)
- Neurological signs, especially in lower limbs (cerebral palsy, cord lesion)
53
What systemic signs are red flags in constipated children?
- Failure to thrive (coeliac, hypothyroidism, safeguarding)
- Acute severe abdominal pain and bloating (obstruction, intussusception)
54
How is constipation managed?
- high fibre diet
- hydration
- laxatives: movicol
- bowel diary
55
What are complications of constipation?
- pain
- reduced sensation
- fissures
- haemorrhoids
- overflow and soiling
56
What is GORD?
- reflux through lower oesophageal sphincter into throat and mouth
- immaturity of sphincter in babies
- commonest cause of vomiting
57
How does GORD present?
- chronic cough
- hoarse cry
- distress after feeding
- reluctance to feed
- pneumonia
- poor weight gain
58
What systemic signs should raise concern in a vomiting child?
- Respiratory symptoms (aspiration and infection)
- Blood in the stools (gastroenteritis, cow's milk)
- Signs of infection (fever, lethargy)
- Rash, angioedema, other signs of allergy (cow's milk)
59
What associated abdominal and neurological signs are concerning in a vomiting child?
- Abdominal distention (obstruction)
- Reduced consciousness
- Bulging fontanelle
- Neurological signs
(meningitis, raised ICP)
60
What are vomiting red flags?
- Not keeping down any feed
- Projectile or forceful vomiting
(both pyloric stenosis or obstruction)
- Bile-stained vomit
- Haematemesis
(peptic ulcer, oesophagitis, varices)
61
How is GORD managed conservatively?
- small, frequent meals
- burping regularly
- not over-feeding
- keep baby upright
- sleeping on back
- 30 degree head up during feeds
62
How can GORD be managed medically?
- gaviscon mixed with feeds
- thickened milk or formula
- but NOT together
63
In what circumstances may PPIs be used in infants?
- 1 or more
- unexplained feeding difficulties
- distressed behaviour
- faltering growth
64
What are causes of intestinal obstruction?
- meconium ileus
- Hirschprung's
- oesophageal atresia
- duodenal atresia
- intussusception
- malrotation with volvulus
65
How does intestinal obstruction present?
- persistent, green, bilious vomiting
- abdominal pain and distention
- failure to pass wind or stools
- high pitched, tinkling bowel sounds
66
How is intestinal obstruction diagnosed?
- abdominal xray
- dilated bowel loops
- absence of air in rectum
67
How is intestinal obstruction managed?
- paediatric surgical unit
- nil by mouth
- NG tube to drain stomach
- IV fluids
68
What is cow's milk protein allergy and what is the epidemiology?
- hypersensitivity to protein in cow's milk
- usually presents in first 3mo of life
- usually outgrown by age 3
69
What are the two types of cow's milk protein allergy?
- IgE mediated (within 2hrs)
- Non-IgE mediated (slow over several days)
70
What factors increase the risk of cow's milk protein allergy?
- formula feeding
- FHx of atopic conditions
71
What GI symptoms does cow's milk protein allergy present with?
- bloating and wind
- abdo pain
- diarrhoea
- vomiting
72
What general allergic symptoms does cow's milk protein allergy present with?
- urticarial rash
- angio-oedema
- cough/wheeze
- sneezing
- watery eyes
- eczema
73
How is cow's milk protein allergy investigated?
- skin prick testing
- total and specific IgE for cow's milk protein
74
How is cow's milk protein allergy managed if breastfed?
- continue breastfeeding
- mother avoid cow's milk
- calcium supplements for mother
- replace with extensively hydrolysed formula
- use when breastfeeding stops until 12mo of age + at least 6mo
75
How is cow's milk protein allergy managed if formula fed?
- 1st line mild-moderate: replace with extensively hydrolysed formula
- severe: amino acid based formula
76
What is the milk ladder?
- every 6 months can be tried on first step of milk ladder
- malted milk biscuits
- slowly progress up ladder until develop symptoms
77
What is cow's milk intolerance?
- presents with same GI features but no allergic features
- outgrow by 2-3 years
- after 1yr can be started on milk ladder
78
What is acute gastritis?
- inflammation of the stomach
- presents with nausea and vomiting
79
What is enteritis?
- inflammation of intestines
- presents with diarrhoea
80
What is gastroenteritis?
- inflammation from stomach to intestines
- presents with nausea, vomiting, diarrhoea
81
What are differentials for diarrhoea?
- gastroenteritis
- IBD/IBS
- lactose/gluten intolerance
- CF
- medication
82
What are common causes of viral gastroenteritis?
- rotavirus
- norovirus
- adenovirus
83
How gastroenteritis caused by E. coli transmitted?
- spread through infected faeces, unwashed salad, contaminated water
84
What toxin does E.coli produce and what are the symptoms?
- produces shiga toxin
- causes abdo cramps, bloody diarrhoea, vomiting
85
What is haemolytic uraemic syndrome?
- shiga toxin destroys blood cells
- also caused by use of Abx
86
Which bacteria commonly causes gastroenteritis?
- E. coli
- campylobacter jejuni
- shigella
- bacillus cereus
87
What type of bacteria is campylobacter jejuni and how is it spread?
- causes travellers diarrhoea
- gram negative curved/spiral bacteria
- raw/improperly cooked poultry, untreated water, unpasteurised milk
88
What are the symptoms and treatment of campylobacter jejuni infection?
- abdo cramps, bloody diarrhoea, vomiting, fever
- azithromycin and ciprofloxacin
89
How does shigella spread and what are the symptoms?
- faeces contaminating drinking water, pools and food
- abdo cramps, bloody diarrhoea, fever
- shiga toxin > haemolytic uraemia syndrome
90
What toxin does E. coli produce and what symptoms does this lead to?
- shiga toxin
- abdo cramps, bloody diarrhoea and vomiting
- destroys blood cells > haemolytic uraemia syndrome
91
How is salmonella spread and what are the symptoms?
- raw eggs and poultry
- watery diarrhoea with mucus/blood, abdo pain and vomiting
92
What type of bacteria is bacillus cereus and on what food is it produced?
- gram positive rod
- inadequately cooked food/food not immediately refrigerated
- fried rice
93
What toxin does bacillus cereus produce and what symptoms does it cause?
- cereulide
- abdo cramping, vomiting and water diarrhoea
94
What is giardiasis, what are the symptoms and how is it treated?
- Giardia lamblia is a microscopic parasite spread by faeco-oral transmission
- can be asymptomatic or cause chronic diarrhoea
- treated with metronidazole
95
How is gastroenteritis managed?
- barrier nursing
- off school for 48hrs
- MC&S
- fluid challenge
96
What treatment shouldn't be given in gastroenteritis?
- anti-diarrhoeal
- antiemetic
- Abx only when causative organism identified
97
What complications might arise from gastroenteritis?
- Lactose intolerance
- Irritable bowel syndrome
- Reactive arthritis
- Guillain–Barré syndrome
98
How does coeliac disease present?
- failure to thrive
- fatigue
- diarrhoea
- weigh loss
- anaemia 2º to iron, B12, folate deficiency
- dermatitis herpetiformis
99
Which conditions is coeliac disease associated with?
- T1DM
- thyroid disease
- autoimmune hepatitis
- primary biliary cirrhosis
- primary sclerosing cholangitis
- HLA-DQ2 gene
100
What is Meckel's diverticulum?
- congenital abnormality of the GI tract
- outpouching on anti-mesenteric border of ileum
101
What causes Meckel's diverticulum?
- incomplete obliteration of the vitelline duct
102
How does Meckel's diverticulum present?
- most remain asymptomatic
- ectopic mucosa can cause inflammation and ulceration
- resulting in painless dark red rectal bleeding
- abdominal pain
- obstruction 2º to volvulus/intussusception
103
How is Meckel's diverticulum investigated?
- present acutely with bleeding or diverticulitis
- CT scan
- diagnostic laparoscopy
- nuclear scintigraphy
104
How is Meckel's diverticulum managed?
- urgent surgery
- Meckel's diverticulectomy
- bowel resection if obstruction
105
What are differentials for Meckel's diverticulum?
- acute appendicitis: periumbilical pain, tenderness, vomiting
- bowel obstruction (can cause)
- gastroenteritis
- peptic ulcer disease
106
What is the rule of 2s in Meckel's diverticulum?
- 2ft proximal to ileocaecal valve
- 2in in length
- 2 types of ectopic tissue: gastric and pancreatic
- 2x more common in males
107
What is meconium ileus?
- small bowel obstruction in CF
- thick sticky meconium
108
How does meconium ileus present?
- failure to pass meconium within 12-24hrs
- abdo distention
- green bilious vomiting
109
What is volvulus?
- torsion of the colon around its mesenteric axis
- leads to compromised blood flow and closed loop obstruction
110
How is meconium ileus diagnosed?
- abdo X-ray: soap bubble sign
- contrast enema: microcolon and meconium pellets
- DRE: empty rectum
111
How is meconium ileus treated?
- NG tube to relieve
- contrast enema
- surgery: decompression, resection or ileostomy
112
What is malrotation?
- midgut undergoes abnormal rotation and fixation during embryogenesis
113
How does malrotation (and volvulus) present?
- feeding intolerance
- abdo pain and constipation
- bloody stools
- bilious vomiting: volvulus
114
How is malrotation (and volvulus) investigated?
- upper GI contrast study
- USS
115
How is malrotation (with volvulus) treated?
- surgical intervention: laparotomy
- Ladd's procedure if volvulus: division of Ladd bands and widening of mesenteric base
- IV fluids if dehydrated
116
What is duodenal atresia and what condition is it linked with?
- first part of duodenum is blocked
- Down's syndrome
- presents a few hours after birth
117
What is the management of duodenal atresia?
- duodenoduodenostomy
118
How is duodenal atresia investigated and what is seen?
- abdo X-ray
- double bubble sign
- confirm with contrast
119
What is necrotising enterocolitis?
- disorder affecting premature neonates
- bacterial invasion of intestinal wall
- bowel becomes necrotic and can lead to perforation and shock
120
What are the risk factors for necrotising enterocolitis?
- v low birth weight
- formula feeds
- resp distress + ventilation
- sepsis
- PDA/CHD
121
How does necrotising enterocolitis present?
- reduced feeding
- green bilious vomiting
- abdo distention
- bloody stools
- absent bowel sounds
122
What is seen on bloods in necrotising enterocolitis?
- thrombocytopenia
- neutropenia
- gas: metabolic acidosis
- cultures: sepsis
123
What is seen on X-ray of necrotising enterocolitis?
- supine abdo X-ray
- dilated bowel loops
- bowel wall oedema
- pneumatosis intestinalis: gas in bowel wall
- pneumoperitoneum: free air in abdomen
- Rigler sign: air outlining bowel
- portal venous gas: air in portal veins
124
What is the management of necrotising enterocolitis? STAIN
- surgical emergency
- total parenteral nutrition
- antibiotics
- IV fluids
- NBM
125
What is the presentation of infantile colic and epidemiology?
- infants <3 mo
- excessive crying
- pulling up legs
- worse in evening
126
What are features of hyponatraemic dehydration?
- jittery
- increased tone
- hyperreflexia
- convulsions
- drowsy
127
When should you do a stool culture in diarrhoea?
- suspect septicaemia
- blood/mucus in stool
- immunocompromised
128
How is dehydration treated?
- 50ml/kg low osmolality oral rehydration solution over 4hrs
- cont breastfeeding
- supplement with fluids - milk/water
129
In gastroenteritis, which factors put children at risk of dehydration?
- 6 or more diarrhoeal stools in 24h
- vomited ≥3 in 24hrs
- stopped breastfeeding
130
What factors indicate idiopathic constipation?
- starts after a few weeks of life
- life changes may correspond to start of symptoms
- meconium passed <48hrs
- normal growth
MLA
flashcards
Decks in class (28)
# Cards
-
Renal148
-
Respiratory161
-
CV264
-
Derm109
-
Endocrinology271
-
Oncology72
-
Rheumatology226
-
3a Neuro228
-
3a Obstetrics247
-
GI303
-
Ophthalmology250
-
ENT102
-
Gynaecology286
-
Paeds resp117
-
Paeds GI130
-
Sexual Health105
-
Paeds endo26
-
Paeds cardio59
-
Haematology158
-
Ortho90
-
Anaesthesia + surgery4
-
Paeds neuro52
-
Paeds derm41
-
Paeds infectious68
-
Psychiatry269
-
Paeds MSK69
-
Paeds renal5
-
Paeds Genetics38
