GI

Question 1

most common cause of vomiting in infancy

Answer 1

GORD

Question 2

risk factors for GORD in children

Answer 2

preterm delivery
neurological disorder

Question 3

features of GORD in children

Answer 3

typically before 8 weeks
vomiting/regurgitation (milky after feeds)
excessive crying

Question 4

management of GORD

Answer 4

feeds with baby at 30 degrees head up
sleep on their backs
not overfed and smaller more frequent feeds
trial of thickened formula
trial of alginate therapy

Question 5

complications of GORD

Answer 5

distress
failure to thrive
aspiration
frequent otitis media
dental erosions in older children

Question 6

when does pyloric stenosis present

Answer 6

2-4 weeks of life (can be up to 4 months)

Question 7

what is pyloric stenosis

Answer 7

vomiting caused by hypertrophy of the circular muscles of the pylorus

Question 8

features of pyloric stenosis

Answer 8

projective vomiting 30 minutes after a feed
constipation and dehydration
palpable mass present in upper abdo
hypochloraemic, hypokalaemic alkalosis due to vomiting

Question 9

diagnosis of pyloric stenosis

Answer 9

US

Question 10

management of pyloric stenosis

Answer 10

ramstedt pyloromyotomy

Question 11

what is hirschsprung’s disease

Answer 11

an aganglionic segment of bowel due to developmental failure of the parasympathetic auerbach and meissner plexuses

Question 12

associations with hirschsprung’s disease

Answer 12

3 times more common in males
down’s syndrome

Question 13

presentation of hirschsprung’s disease

Answer 13

neonatal period: failure or delay to pass meconium
older children: constipation, abdominal distension

Question 14

investigations for hirschsprung’s disease

Answer 14

abdo x-ray
rectal biopsy

Question 15

management of hirschsprung’s disease

Answer 15

initially: rectal washout/bowel irrigation
definitive: surgery to affected segment of the colon

Question 16

what is intussusception

Answer 16

invagination of one portion of the bowel into the lumen of adjacent bowel, most commonly around the ileo-caecal region

Question 17

what age does intussusception affect

Answer 17

between 6-18 months
boys more than girls

Question 18

features of intussusception

Answer 18

intermittent, severe, crampy progressive abdominal pain
inconsolable crying
during paroxysm baby draws their knees up and turns pale
vomiting
blood stained stool- red currant jelly
sausage shaped mass in RUQ

Question 19

investigations for intussusception

Answer 19

ultrasound- shows a target like mass

Question 20

management of intussusception

Answer 20

treated with reduction by air insufflation under radiological control
if the fails or child has signs of peritonitis surgery is performed

Question 21

what presentation of hernia is highest risk of strangulation

Answer 21

presenting within the first few months of life
- repair urgently

Question 22

management of children over 1 year with inguinal hernia

Answer 22

elective surgery:
- herniotomy without implantation of mesh

Question 23

what is biliary atresia

Answer 23

condition involving either obliteration or discontinuity within the extrahepatic biliary system causing an obstruction in bile flow

Question 24

presentation of biliary atresia

Answer 24

neonatal presentation of cholestasis
within the first few weeks of life
jaundice beyond 2 weeks
dark urine and pale stools
appetite and growth disturbance

Question 25

investigations for biliary atresia

Answer 25

serum bilirubin (total may be normal but **conjugated bilirubin is abnormally high**) LFTs serum alpha-1-antitrypsin sweat chloride test (cystic fibrosis) ultrasound of biliary tree and livere percutaneous liver biopsy

Question 26

management of biliary atresia

Answer 26

surgical intervention abx and bile acid enhancers following surgery

Question 27

complications of biliary atresia

Answer 27

unsuccessful anastomosis formation progressive liver disease cirrhosis with hepatocellular carcinoma

Question 28

when do children normally present with coeliac disease

Answer 28

before the age of 3

Question 29

features of coeliac

Answer 29

failure to thrive diarrhoea abdominal distension anaemia coincide with introduction of cereals

Question 30

diagnosis of coeliac

Answer 30

jejunal biopsy showing subtotal villous atrophy anti-endomysial and anti-gliadin antibodies

Question 31

when does cow's milk protein intolerance present

Answer 31

presents in the first 3 months of life in formula fed infants (rarely in breastfed)

Question 32

difference between terms CMPA and CMPI

Answer 32

CMPA: for immediate reactions (IgE mediated) CMPI: for mild-moderate delayed reactions (non-IgE mediated)

Question 33

features of CMPI/CMPA

Answer 33

regurgitation and vomiting diarrhoea urticaria, atopic eczema colic symptoms wheeze, chronic cough rarely angioedema and anaphylaxis

Question 34

diagnosis of CMPI/CMPA

Answer 34

often clinical (improved with cow's milk protein elimination) investigations: skin prick/patch test, total IgE and specific IgE

Question 35

management of CMPI/CMPA

Answer 35

if formula fed: - extensive hydrolysed formula milk - amino acid-based formula with severe if breastfed: - continue breastfeeding - mum stop eating cow's milk, consider prescribing calcium

Question 36

what is meckel's diverticulum

Answer 36

congenital diverticulum of the small intestine

Question 37

rule of 2s with meckel's diverticulum

Answer 37

occurs in 2% of the population is 2 feet from ileocaecal valve is 2 inches long

Question 38

presentation of meckel's diverticulum

Answer 38

abdominal pain mimicking appendicitis rectal bleeding intestinal obstruction (volvulus or intussesception)

Question 39

investigation for meckel's diverticulum

Answer 39

if haemodynamically stable with less severe bleeding: meckel's scan- 99m technetium pertechnetate if haemodynamically unstable (needing a transfusion)- mesenteric arteriography used

Question 40

management of meckel's diverticulum

Answer 40

removal if narrow neck or symptomatic - can be wedge excision or formal small bowel resection