Gastroenterology part 2

Question 1

Why do 50% of all newborns become jaundiced?

Answer 1

Incr release of Hb from breakdown of RBC
Shorter RBC lifespan in children
Hepatic bilirubin metabolism less effective 1st few days life

Question 2

What serious condition can neonatal jaundice lead to

Answer 2

Kernicterus

Question 3

What is kernicterus

Answer 3

Unconjugated bilirubin is deposited in BG –> encephyalopathy as can cross BBB

Question 4

Sx acute kernicterus

Answer 4

Lethargy

Question 5

Sx severe kernicterus (2)

Answer 5

Irritability

Seizures

Question 6

What condition can kernicterus lead to

Answer 6

Cerebral palsy

Question 7

Causes of neonatal jaundice - <24hrs old (5)

Answer 7

Rhesus 
ABO incompatibility 
G6DP deficiency 
Spherocytosis 
Infection - TORCH/Rubella/CMV, HSV

Question 8

How can ABO incompatibility lead to neonataljanudice>

Answer 8

Group O women’s IgG’s haemolyse RBC of group A infants

or group B

Question 9

Causes of jaundice - 24h to 2w (7)

Answer 9

Physiological 
Breast milk jaundice 
Infection 
Haemolysis 
Bruising 
Polycythaemia 
Crigler-nijjar

Question 10

Causes of jaundice - conjugated - >2 weeks (3)

Answer 10

Bile duct obstruction
Neonatal hepatitis
Biliary atresia

Question 11

Causes of jaundice - unconjugated - >2w (6)

Answer 11

Physiological/breast milk 
Infection - UTI 
Hypothyroidism 
Haemolytic - G6PD 
GI obstruction - pyloric stenosis 
Crigler Nijjar

Question 12

Ix neonatal jaundice

Answer 12

Serum bilirubin - is it conjugated or unconjugated
FBC
Coombs
Infection screen prn

Question 13

Mx neonatal jaundice

Answer 13

Correct dehydreation
Phototherapy - UV light 450nm. Cover infants eyes and repeat serum biliruin levels at 4-6hrs
exchange transfusion if severe via art line

Question 14

What will happen if you perform phototherapy on a conjugated hyperbilirubinaemia baby

Answer 14

baby will get macular rash and bronzed skin

Question 15

What is biliary atresia

Answer 15

Progressive fibrosis and obliteration of extrahepatic and intrahepatic biliary tree

Question 16

What happens if you do not intervene with biliary atresia?

Answer 16

Chronic liver disease and death within 2 years

Question 17

PS biliary atresia (5)

Answer 17

Mild jaundice 
Pale stools 
Faltering growth 
Hepatomegaly 
Splenomegaly

Question 18

Ix biliary atresia (4)

Answer 18

LFTs
Abdo USS
ERCP
Liver biopsy

Question 19

What would you see on an abdominal USS - biliary atresia

Answer 19

Contracted/absent GB

Question 20

Tx biliary atresia

Answer 20

Palliative surgery

If fails offer liver transplant

Question 21

What age does coeliac disease PS

Answer 21

8-24m (when gluten intro;d to diet)

Question 22

PS coeliac disease (5)

Answer 22

FTT
ABdo distention 
Buttocks wasting 
irritable 
Anaemia

Question 23

Ix Coeliac (3)

Answer 23

+ve IgA antibodies serology
Flat mucosa jejunal biopsy
Resolution of Sx once gluten withdrawn

Question 24

Mx coeliac (3)

Answer 24

Gluten free diet
Annual review to check height + W
Gluten challenge

Question 25

What is a 1' food allergy

Answer 25

Child fails to devlop immune tolerance against food

Question 26

What is a 2' food allergy

Answer 26

Initially tolerate but becomes allergic due to cross reactivity betw proteins + those in allergens

Question 27

Sx IgE med food allergies (3)

Answer 27

Anaphylaxis Facial swelling 10-15mins post ingestion

Question 28

Sx non-IgE mediated food allergy (3)

Answer 28

Diarrhoea Vom Abdo pain

Question 29

RF food allergy (4)

Answer 29

``` FHx Atopy PMHx Age Asthma ```

Question 30

What is T2HS?

Answer 30

Neutrophils bind to substance, lytic enzymes are released --> tissue damage

Question 31

Mx T1 HS

Answer 31

Child must be able to manage attacks | Anti-histamines/epipen

Question 32

Mx T2HS allergy

Answer 32

Avoid food

Question 33

Def malabsoprtion

Answer 33

Subnormal intestinal absorption of dietary constituents w/ XS faecal nutrient loss

Question 34

DDx malabsorption - intraluminal (5)

Answer 34

``` Lactose intolerance CF Pancreaitits Pernicious anemia Protein E malnutrition ```

Question 35

DDx malabsorption - mucosal abnormality (4)

Answer 35

Coeliac Short bowel syndrome CMPA IBD

Question 36

Ix malabsorption

Answer 36

bloods coeliac ab stools MCS If still unclear - endoscopy/biopsy/ sweat test a1-antitrypsin etc

Question 37

What is colic? (3)

Answer 37

Paroxysmal insolable crying Drawing up of knees Excessive flatulence

Question 38

What % of babies suffer w/ oclic

Answer 38

40%

Question 39

Mxc colic

Answer 39

Entirely benign Visit GP if worried HV/Cry-SIS - give support to parents