gastrointestinal disorders

Question 1

does pyloric stenosis affect more boys or girls?

Answer 1

boys (M>F)

Question 2

a) key signs in pyloric stenosis?

b) at what age?

Answer 2

a) projectile vomiting, olive mass in RUQ

b) 4-6 weeks old

Question 3

how is pyloric stenosis diagnosed? 2 ways

Answer 3

• test feed

- USS

Question 4

management of pyloric stenosis?

Answer 4

Ramstedt pyloromyotomy

Question 5

presentation of mesenteric adenitis?

Answer 5

• central abdo pain

- URTI

Question 6

management of mesenteric adenitis?

Answer 6

conservative

Question 7

where does intussusception occur?

Answer 7

at the level of the ileocaecal valve

Question 8

age demographic for intussusception?

Answer 8

6-9 months

Question 9

signs of intussusception?

Answer 9

• colicky pain
• diarrhoea
• vomiting
• sausage-shaped mass
• red currant jelly stool

Question 10

management of intususception?

Answer 10

air insufflation

Question 11

which other conditions is malrotation commonly associated with?

Answer 11

• exomphalos
• diaphragmatic hernia
• duodenal atresia

Question 12

how can you tell that malrotation has been complicated by a volvulus?

Answer 12

the vomit will be bile-stained

Question 13

how is malrotation diagnosed?

Answer 13

• UGI contrast study

- USS

Question 14

management of malrotation?

Answer 14

• laparotomy

- Ladd’s procedure if volvulus is present

Question 15

what causes Hirschsprung’s disease?

Answer 15

absence of ganglion cells from myenteric + submucosal plexuses

Question 16

how is Hirschsprung’s disease diagnosed?

Answer 16

full-thickness rectal biopsy

Question 17

signs of Hirschsprung’s disease in neonate?

Answer 17

• distended abdomen

- failure to pass meconium

Question 18

management of Hirschsprung’s disease?

Answer 18

• rectal washouts

- anorectal pull through procedure

Question 19

presentation of oesophageal atresia?

Answer 19

• choking

- cyanotic spells (following aspiration)

Question 20

presentation of meconium ileus?

Answer 20

• delayed passage of meconium

- distended abdomen

Question 21

what is meconium ileus strongly associated with?

Answer 21

cystic fibrosis

Question 22

management of meconium ileus?

Answer 22

• PR contrast can dislodge the meconium plug
• NG N-acetyl cysteine
• surgery to remove plug

Question 23

presentation of biliary atresia?

Answer 23

• jaundice > 14 days
• dark yellow / brown urine
• pale stools
• hepatosplenomegaly
• failure to thrive

Question 24

management of biliary atresia?

Answer 24

Kasai procedure (urgent!)

Question 25

main risk factor for necrotising enterocolitis?

Answer 25

prematurity

Question 26

presentation of necrotising enterocolitis?

Answer 26

- abdo distension - poor feeding - passage of (fresh) bloody stools

Question 27

X-ray findings in necrotising enterocolitis?

Answer 27

- dilated bowel loops - pneumatosis intestinalis - air on both sides of bowel wall

Question 28

management of necrotising enterocolitis?

Answer 28

- broad spectrum ABx - total gut rest - TPN - laparotomy if there is any perforation

Question 29

complications of GOR?

Answer 29

- failure to thrive from severe vomiting - oesophagitis - iron deficiency anaemia - recurrent pulmonary aspiration - dystonic neck - ALTE

Question 30

how can GOR be investigated in an atypical history?

Answer 30

- 24h oesophageal pH test - endoscopy with oesophageal biopsy - contrast study of UGI tract

Question 31

management of GOR?

Answer 31

- reassurance - thickening agents in milk - position 30 deg head-up prone after feed - surgery where unresponsive to domperidone

Question 32

at-risk group for severe GOR?

Answer 32

- cerebral palsy | - any other neurodevelopmental disorder

Question 33

risk factors for hirschsprung's disease?

Answer 33

- male (3x more) | - Down's syndrome

Question 34

presentation of hirschsprung's disease in neonates?

Answer 34

failure / delay in passing meconium

Question 35

presentation of hirschsprung's disease in older children?

Answer 35

- constipation | - abdominal distension