Gastroenterology

Question 1

What is a posset?

Answer 1

A non forceful return of milk

Question 2

What is the term for a non-forceful return of milk after feeding?

Answer 2

Posset

Question 3

At what age does pyloric stenosis present? In whom?

Answer 3

Roughly 6 weeks

Boys with FH

Question 4

How does pyloric stenosis present?

Answer 4

Recurrent projectile vomiting immediately after feeding - non bilious +/- blood
May see visible peristalsis and olive shaped upper stomach mass

Question 5

What metabolic disturbance is present in pyloric stenosis?

Answer 5

Hypochloraemic hypokalaemic metabolic alkalosis

Question 6

At what age does intussusception tend to present?

Answer 6

6m-18m

Question 7

Following what does intussusception often present and why?

Answer 7

Post viral e.g. Gastroenteritis

Due to inflamed peyers patches acting as foci for telescoping

Question 8

What may be more likely the case if intussusception presents in an older child or adult?

Answer 8

Pathological focus e.g. Polyp or Meckel diverticulum

Question 9

Where is the most common site for intussusception?

Answer 9

Ileum telescoping into caecum through ileocoecal valve

Question 10

How does intussusception present?

Answer 10

Intermittent colicky abdominal pain presenting as episodic drawing up of knees, pallor between
Bile stained vomiting, may refuse feeds, abdominal distension
Red currant jelly stool a late and ominous sign
Sausage shaped abdominal mass

Question 11

Management of intussusception?

Answer 11

Radiological reduction with air enema (pneumatic reduction)

Or surgical laparotomy

Question 12

2 contraindications to radiological reduction of intussusception?

Answer 12

Pancreatitis

Gangrene

Question 13

When is intussusception most likely to recur?

Answer 13

Within first year post illness

Question 14

What is the point of localised tenderness/guarding in appendicitis?

Answer 14

McBurney’s point

Question 15

What is Rovsing’s sign?

Answer 15

Pressing on LLQ elicits pain in RLQ

Question 16

What complication may occur earlier in preschool children with appendicitis and why?

Answer 16

Peroration

As omentum is less well developed and doesn’t surround appendix as effectively

Question 17

Post viral differential for appendicitis?

Answer 17

Mesenteric adenitis

Question 18

2 major differentials for testicular torsion?

Answer 18

Epididymoorchitis

Torted cyst of Morgani

Question 19

How long do you have from onset of pain before testicular damage is caused in testicular torsion?

Answer 19

4 hours

Question 20

What is the most common hernia presenting in children?

Answer 20

Indirect Inguinal hernia

Question 21

What is the most common side for inguinoscrotal hernia? Why?

Answer 21

Right side as R testis descends later

Question 22

What needs to be done for childhood Inguinal hernia and why?

Answer 22

Surgical repair within a few weeks

As can incarcerate and strangulate, leading to vomiting and unwell child

Question 23

What causes meconium ileus particularly in CF?

Answer 23

Reduced pancreatic enzymes and thick, viscous meconium that tends to obstruct terminal ileum

Question 24

Management of meconium ileus?

Answer 24

Gastrograffin enema

Or laparotomy if contraindicated, unsuccesful or perforated

Question 25

Why is malrotation such an important diagnosis to make?

Answer 25

Volvulus of midgut may occur and is catastrophic and life threatening

Question 26

How does midgut malrotation without volvulus present and why?

Answer 26

Subacute duodenal level obstruction around 1-3 days of life
Due to obstruction by Ladds bands from malrotated midgut
Leading to non-specific bilious vomiting, abdo pain but no distension

Question 27

How does volvulus present?

Answer 27

Acute collapse, bile stained vomit

Scaphoid abdomen

Question 28

What does the double bubble sign on AXR suggest?

Answer 28

Duodenal atresia

Question 29

Later onset ddx for double bubble gas sign?

Answer 29

Annular pancreas

Question 30

What is the football sign?

Answer 30

Air either side of falciform ligament which splits liver in half
Seen in perforation (nec)