Gastrointestinal

Question 1

what is oesophageal atresia

Answer 1

birth defect where oesophagus ends in a pouch

• often occurs alongside a tracheo-oesophageal fistula
• associated with polyhydramnios in utero

Question 2

presentation of oesophageal atresia

Answer 2

excessive oral secretions
aspiration / regurgitation when fed
episodes of cyanosis

Question 3

persistent crying/discomfort in a healthy thriving infant, particularly at night/ after feeds is most likely to be ?

Answer 3

colic

Question 4

advice for management of colic

Answer 4

small frequent meals – avoid overfeeding
burping regularly to help milk settle
keep baby upright post feed

Question 5

what treatment options are available for infants with problematic colic? i.e. poor weight gain, refusing feeds

Answer 5

gaviscon mixed with feeds

ranitidine (H2 inhibitor)

Question 6

what is pyloric stenosis

Answer 6

hypertrophy of the pyloric sphincter causing narrowing of the pylorus
- prevents food from passing from stomach to duodenum normally

Question 7

presentation of pyloric stenosis

Answer 7

projectile milky vomit after every feed

Question 8

blood gas result in pyloric stenosis

Answer 8

hypochloric metabolic alkalosis

- baby is vomiting hydochloric acid from the stomach

Question 9

investigation + management of pyloric stenosis

Answer 9

abdo USS - visualise thickened pylorus

tx - laparoscopic pyloromyotomy (Ramstedt operation)

Question 10

what is coeliacs disease

Answer 10

autoimmune reaction to gluten causing inflammation in the small intestine
- usually presents in early childhood but can present at any age

Question 11

antibodies in coeliacs disease

Answer 11

IgA anti-tissue transglutamase (Anti-TTG)
anti-endomysial (Anti-EMA)
- important to test for total IgA levels, as patients with low IgA will be negative for these antibodies even if they have the disease

Question 12

symptoms of coeliacs disease

Answer 12

failure to thrive

• diarrhoea
• fatigue
• weight loss
• mouth ulcers
• anaemia

dermatitis herpetiformis rash

Question 13

gene linked to coeliacs disease

Answer 13

HLA- DQ2

Question 14

what condition is strongly linked to coeliacs disease

Answer 14

type 1 diabetes

Question 15

findings on endoscopy coeliac disease

Answer 15

villous atrophy

crypt hyperplasia

Question 16

management of coeliac disease

Answer 16

life long gluten free diet

Question 17

presentation of IBD in children

Answer 17

abdominal pain
diarrhoea (bloody in UC/allergic colitis)
failure to thrive – weight loss

Question 18

screening test for IBD

Answer 18

faecal calprotectin - raised due to inflammation in intestines
- 90% specific to IBD

Question 19

what should you suspect in baby with delayed passage of meconium, dilated bowel loops + absence of rectal air on XR

Answer 19

Hirshsprungs disease

Question 20

what is Hirshsprungs disease

Answer 20

aganglionic segment of bowel (loss of parasympathetic)

• causes delayed passage of meconium in infants
• differential of constipation + abdo pain in young children

Question 21

what is meconium ileus

Answer 21

delayed passage of meconium + abdo distention

Question 22

what condition do the majority of babies with meconium ileus have?

Answer 22

cystic fibrosis

Question 23

what should you suspect in a baby with persistent jaundice (past 14 days), pale stools + dark urine, splenomegaly ?

Answer 23

biliary atresia

Question 24

what is biliary atresia

Answer 24

section of bile duct is either narrowed or absent

• results in cholestasis
• high conjugated bilirubin levels

Question 25

red current jelly stools + sausage shaped abdo mass

Answer 25

intussusception

Question 26

what is intussuception

Answer 26

telescoping of the bowel

Question 27

investigation of intussusception

Answer 27

USS

Question 28

bile stained vomit

Answer 28

malrotation

Question 29

Ix + management of malrotation

Answer 29

upper GI contrast + USS | surgery

Question 30

what is Meckels Diverticulum

Answer 30

congenital diverticulum of small intestine - occurs in 2% of population - 2 feet from ileocaecal valve - 2 inches long

Question 31

most common cause of painless massive GI bleeding in children 1-2

Answer 31

Meckels Diverticulum

Question 32

laxative choice in children with constipation

Answer 32

movicol paediatric plan (osmotic) | + Senna if ineffective

Question 33

colicky abdominal pain where child draws knees up to chest

Answer 33

intussusception

Question 34

double bubble sign

Answer 34

duodenal atresia

Question 35

what is gastroschisis? | how is this managed?

Answer 35

abdominal contents on outside of body with NO peritoneal covering surgery as soon as possible i.e. within 4 hours

Question 36

what is exomphalos? | how is this managed?

Answer 36

abdo contents on outside of body WITH a peritoneal covering | staged closure by 6 - 12 months

Question 37

what is the initial management of Hirshsprungs? | what is the definitive management?

Answer 37

initial -- bowel irrigation / rectal washout | definitive -- anorectal pull through

Question 38

what is Toddlers diarrhoea

Answer 38

benign condition due to fast transit through digestive system watery stools that often contain undigested food child otherwise thriving will resolve

Question 39

what is a common complication of gastroenteritis in children

Answer 39

lactose intolerance

Question 40

Target sign

Answer 40

intusseseption

Question 41

management of intusseseption

Answer 41

reduction under fluoroscopic guidance

Question 42

features of necrotising enterocolitis

Answer 42

common in premature infants | - abdo distention, bloody stools, dilated bowel loops, bowel wall oedema, intramural gas

Question 43

imaging used in suspected necrotising enterocolitis

Answer 43

XRAY

Question 44

management of necrotising enterocolitis

Answer 44

gut rest, TPN feeding, antibiotics | - required laparotomy if perforation

Question 45

management of an umbilical hernia

Answer 45

majority spontaneously resolve | elective repair if persists past 4/5 years or causing significant symptoms

Question 46

what is mesenteric adenitis

Answer 46

abdominal pain caused by inflamed lymph node in the mesentery - will typically follow viral infection - resolves spontaneously

Question 47

how is the diagnosis of hirschsprungs made

Answer 47

rectal biopsy showing absence of ganglionic cells