Child health- GI

Question 1

main causes of diarrhoea in children

Answer 1

poor sanitation
malnutrition

Question 2

treatment of diarrhoea in children

Answer 2

oral rehydration- uses Na/glucose co transporter
zinc supplements

Question 3

most common cause of vomiting in infancy

Answer 3

GORD

Question 4

risk factors for GORD in children

Answer 4

preterm birth
neurological disorders

Question 5

when does GORD typically present in infants

Answer 5

before 8 weeks

Question 6

NICE defines malnutrition as-

Answer 6

BMI less than 18.5 OR
unintentional weight loss >10% in last 3-6 months
or
BMI less than 20 and unintentional weight loss >5% in last 3-6 months

Question 7

most common hernia in children

Answer 7

indirect inguinal hernia

Question 8

inguinal hernias more common in right/left side?

Answer 8

right side

Question 9

are inguinal hernias more common in boys/girls?

Answer 9

boys

Question 10

clinical features of inguinal hernias

Answer 10

groin swelling which usually disappears when lying down
palpable cough impulse

Question 11

investigation used for inguinal hernias

Answer 11

dynamic USS

Question 12

what is gastroenteritis

Answer 12

broad term, but usually used to refer an infective illness which causes diarrhoea, vomiting, and abdominal pain

Question 13

commonest viral cause of vomiting and diarrhoea in children under 3 years old

Answer 13

gastroenteritis- norovirus

Question 14

how does gastroenteritis present in children

Answer 14

vomiting
diarrhoea
abdominal pain
fever

Question 15

what is gastroenteritis in children commonly associated with

Answer 15

cruise ships

Question 16

main symptom of appendicitis

Answer 16

abdominal pain- central pain that migrates to right iliac fossa

Question 17

what is mcburneys point

Answer 17

point on lower right quadrant of the abdomen at which tenderness is maximal in cases of acute appendicitis

Question 18

in atypical/non-urgent cases of appendicitis what investigation is used

Answer 18

USS

Question 19

constipation in children= < how many stools per week

Answer 19

< 3 stools per week

Question 20

red flags for constipation in children

Answer 20

onset reported from birth or first few weeks of life
passage of meconium >48 hours
‘ribbon’ stools
faltering growth (amber flag)
abnormal appearance of anus

Question 21

factors which suggest faecal impaction

Answer 21

severe constipation
overflow soiling
faecal mass palpable in abdomen

Question 22

first line treatment for constipation in children

Answer 22

movicol paediatric plain- polyethylene glycol 3350 + electrolytes

Question 23

if no response to movicol paediatric plain for constipation in children, what is added

Answer 23

stimulant laxative

Question 24

treatment for constipation in children if movicol paediatric plain not tolerated

Answer 24

substitute stimulant laxative singly or in combo with osmotic laxative

Question 25

what is intestinal obstruction

Answer 25

physical obstruction prevents the flow of faeces through the intestine; causes absolute constipation and leads to back pressure through the GI system which causes vomiting

Question 26

what is a volvulus

Answer 26

loop of intestine twists around itself and the mesentery that supports it, resulting in bowel obstruction

Question 27

what is malrotation

Answer 27

congenital anatomical anomaly that results from an abnormal rotation of the gut as it returns to the abdominal cavity during embryogenesis

Question 28

when do babies with malrotation show signs-

Answer 28

40% first week of life 50-60% diagnosed by 1 month and 75% by 1 year

Question 29

causes of intestinal obstruction in children

Answer 29

malrotation of intestines with midget volvulus meconium ileus hirschsprungs disease oesophageal atresia duodenal atresia Intussusception imperforate anus strangulated hernia

Question 30

clinical features of intestinal obstruction

Answer 30

persistent vomiting- bile (bright green) abdominal pain and distention failure to pass stool or wind abnormal bowel sounds- can be high pitched and tinkling early in obstruction and absent later

Question 31

investigation for intestinal obstruction

Answer 31

abdominal XRAY

Question 32

intestinal obstruction on XRAY-

Answer 32

may show dilated loops of bowel proximal to the obstruction and collapsed loops of bowel distal to obstruction absence of air in rectum

Question 33

what is intussusception

Answer 33

the bowel 'invaginates' or 'telescopes' into itself, narrowing the lumen, which results in a palpable mass in the abdomen and an obstruction of the passage of faeces into the bowel

Question 34

conditions associated with intussusception

Answer 34

concurrent viral illness henoch-schonlein purpura cystic fibrosis intestinal polyps meckel diverticulum

Question 35

symptoms of intussusception

Answer 35

severe, colicky abdominal pain pale, lethargic, unwell vomiting

Question 36

signs of intussusception

Answer 36

signs of dehydration 'redcurrant jelly stool' right upper quadrant mass on palpation

Question 37

intussusception on USS

Answer 37

target sign

Question 38

management of intussusception

Answer 38

air reduction- relieves obstruction in >85% of cases surgical reduction if non-invasive measure fails

Question 39

'target sign' on USS-

Answer 39

intussusception

Question 40

what is congenital pyloric stenosis

Answer 40

narrowing of the opening from the stomach to the first part of the small intestine (the pylorus)

Question 41

signs and symptoms of pyloric stenosis

Answer 41

projectile vomiting without the presence of bile (vomiting milk), most occurs after baby is fed keen to feed dehydration peristalsis across abdomen may feel abdomen mass

Question 42

typical age symptoms of pyloric stenosis becomes obvious in a baby

Answer 42

2-12 weeks typically 6 weeks

Question 43

what investigation is used to diagnose pyloric stenosis

Answer 43

US upper abdomen

Question 44

management of pyloric stenosis

Answer 44

surgery- pyloromyotomy (open or lap)

Question 45

which acid-base abnormality is likely to be seen in a patient with pyloric stenosis

Answer 45

hyochloraemic hypokalaemic metabolic alkalosis

Question 46

what is jejunal atresia

Answer 46

congenital anomaly characterised by obliteration of the lumen of the jejunum

Question 47

how does jejunal atresia present

Answer 47

abdominal distention and bilious vomiting within first 24 hours of birth

Question 48

investigation for jejunal atresia

Answer 48

abdominal XRAY

Question 49

management of jejuna atresia

Answer 49

surgical correction

Question 50

what is necrotising enterocolitis

Answer 50

disorder affecting premature neonates, where part of the bowel becomes necrotic

Question 51

clinical features of necrotising enterocolitis

Answer 51

intolerance to feeds vomiting, particularly green bile generally unwell distended, tender abdomen absent bowel sounds blood in stool

Question 52

bloods in babies with necrotising enterocolitis

Answer 52

thrombocytopenia neutropenia crp- inflammation

Question 53

capillary blood gas in babies with necrotising enterocolitis

Answer 53

metabolic acidosis

Question 54

abdominal XRAY findings in necrotising enterocolitis

Answer 54

dilated loops of bowel bowel wall oedema gas in bowel wall gas in peritoneal cavity

Question 55

management of necrotising enterocolitis

Answer 55

nil by mouth with IV fluids and TPN antibiotics- clindamycin and cefotaxime immediate referral to neonatal surgical team