Class notes
dermatology
- Course
- Institution
Lecture notes of 5 pages for the course medicine at U of G (dermatology)
[Show more]
Seller
Follow
alanoudj
Content preview
IntroductionIntussusception is a paediatric surgical emergency that occurs when a section of the bowel
telescopes into its neighbouring distal section, causing bowel obstruction. The most common
site is the ileocaecal valve (ileocolic intussusception).1,2
If left untreated, intussusception can result in serious complications including bowel necrosis,
perforation and peritonitis.
You might also be interested in our surgical flashcard collection which contains over 800
flashcards that cover key surgical topics.
Aetiology
In most cases of intussusception, there is no clear cause. It can be associated with a
preceding viral infection and may occur due to an enlarged Peyer’s patch acting as a ‘lead
point’, facilitating the telescoping of the ileum through the ileocaecal valve.3
Around 10% of cases occur due to the presence of a pathological lead point. This is an
abnormal area in the bowel which is caught and pulled by peristalsis, thus leading the
intussusception.2
Intussusception due to a pathological lead point is more likely in patients presenting outside the
typical age range or where intussusception occurs away from the ileocaecal valve.
Examples of pathological lead points and other secondary causes of intussusception include:4
● Meckel’s diverticula (and other congenital bowel defects)
● Intestinal polys
● Lymphomas and leukaemias
● Henoch-Schonlein purpura (HSP)
Figure 1. Intussusception occurs when a
segment of bowel telescopes into its distal neighbouring segment.
, Risk factors
Intussusception most frequently occurs in children aged four to eighteen months and is
slightly more common in boys.1
Clinical features
History
The typical triad of symptoms of intussusception include:2
● Intermittent, severe abdominal pain: may present as screaming episodes during which
the child is inconsolable and draws their knees up to their chest. The child may appear
well between episodes but will become more lethargic over time as dehydration
worsens.
● Vomiting: becomes bilious in later stages when bowel obstruction occurs
● Redcurrant jelly stool: a late feature that occurs when ischaemic mucosal tissue is
sloughed off and is excreted in the stool, mixed with blood and mucus (it is a rare
presenting feature).
In clinical practice, only one-third of patients present with all three of these symptoms. Other
symptoms may include lethargy or episodes of pain with odd posturing which may be
mistaken for seizure activity.4,5
Other important areas to cover in the history include:
● Birth and developmental history: including antenatal scans and neonatal problems
● Systemic enquiry: to identify cases where there is an underlying secondary cause, such
as HSP
Clinical examination
An ABCDE approach should be adopted in order to quickly identify the unwell, dehydrated
child who requires early resuscitation. This type of systematic examination is also important to
identify signs of an underlying cause of intussusception.
Observation is an important part of the initial clinical assessment. Typical findings on observing
the child may include:
● Signs of dehydration, such as sunken eyes and dry lips
● Episodes of screaming +/- drawing knees up to their chest
● Lethargy or excessive sleepiness
● Rashes or other features of secondary causes
The hallmark sign of intussusception is a sausage-shaped mass palpable in the right upper
quadrant of the abdomen.2
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller alanoudj. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $7.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
83225 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now