GI

Question 1

Red flags in constipation and soiling

Answer 1

Failure to pass meconium within 24hrs
FTT, gross abdo distension
Spinal pathology
Bilious vomiting
Abnormal anal patency

Question 2

Management of constipation

Answer 2

Diet - increase hydration + fibre
Behaviour - toilet footrest, start charts

Movicol paediatric plain - treatment for at least 3 months. Dont stop immediately - want a prolonged period of good bowel habit, to allow baggy bowel to recover

Question 3

Management of Viral/Bacterial gastroenteritis

Answer 3

Oral rehydration solution (ORS) - Dont prescribe anti-diarrhoeals - can give NG tube if not tolerated PO

Give fluid deficit replacement (50 x Bodyweight)/4hrs
+
Maintenance fluid replacement

Question 4

Most common causes of viral and bacterial gastroenteritis

Answer 4

Viral - rotavirus, adenovirus, astrovirus

Bacterial - salmonella, campylobacter, shigella, E.coli, C.diff, vibrio cholerae

Question 5

Clinical features of GOR and GORD

Answer 5

GOR - effortless regurgitation of milk/gastric contents (posset). Not active process, no contraction of abdominal muscles

GORD - GOR but with complications - FTT, LRTI, aspiration, choking, apnoea, hoarsenss

Question 6

Management of GORD/GOR

Answer 6

Review feeding technique - keep upright immediately after feeds/smaller volumes

Thickened formula - Enfamil, SMA Staydown - for 6 months MAX

Dont routinely offer antacids/PPI

Question 7

What constitutes recurrent abdominal pain, and what are some investigations?

Answer 7

2+ discrete episodes in a 3 month period

Abdo USS/Xray, faecal calprotectin, 13C breath test for H pylori. IgA - tTG (coeliac)

Question 8

Investigations and management of Appendicitis

Answer 8

FBC - leukocytosis, Abdo/pelvic CT scan

Appendectomy, + broad spec Abx if peritonitis/perf

Question 9

Presentation of coeliac disease

Answer 9

Persistent GI symptoms - diarrhoea, pain, bloating
Fatigue, FTT
severe persistent mouth ulcers
Unexplained iron, vitamin B12, or folate deficiency

Associated with dermatitis herpetiformis

Question 10

Investigations in coeliac disease

Answer 10

IgA-tTG (tissue transglutaminase)
HOWEVER - must be on a gluten diet - for at least 3 months in order to register positive diagnostic test

Bowel biopsy - showing chronic villous atrophy, crypt hyperplasia —> remission on exclusion of gluten

Question 11

How much should babies feed - Amounts

Answer 11

0-6 weeks - 150ml/Kg
6 weeks - 4 months - 150ml/Kg
4 - 6 months - 150ml/Kg
6+ months - 120ml/Kg

Question 12

Conversion between mL to Ounce

Answer 12

1 ounce = 30 (~28) mL

Question 13

Pattern of weight gain for babies?

Answer 13

0-3 months = 200g / week
3-6 months = 150g / week
6-9 months = 100g / week
9-12 months = 75g / week

Question 14

Presentation of an inguinal hernia

Answer 14

Direct v indirect
Commonly in R groin
Intermittent lump in groin/scrotum - present on crying/ straining
May be irreducible
Can't get above lump

Question 15

Management of inguinal hernia

Answer 15

Surgical - due to risk of strangulation

High risk if cant reduce at all

Question 16

Pathological predisposition to intussusception

Answer 16

Usually following viral illness

Immature, enlarged peyer’s patches (lymphoid tissue in bowel) –> invagination of bowel and obstruction

Question 17

Clinical features of intussusception

Answer 17

acute onset, colicky pain
Early vomiting, rapidly becoming bilious
Sausage shaped mass, usually in RUQ
strawberry current (bloody stool)
Absence of lower bowel signs

Question 18

Investigation in intussusception

Answer 18

Abdo USS - Doughnut, or Target sign

AXR - dilated bowel loops

Question 19

Management of intussusception

Answer 19

Drip + suck - to remove pooled fluid from gut

Air enema to reduce bowel
Failing that - laparotomy

Question 20

Causes of jaundice?

Answer 20

Serum Bilirubin >25-30 mmol/L

Unconjugated - haemolysis, Gilberts, G6PD

Conjugated - cirrhosis, post-hepatic obstruction e.g. biliary atresia, choledochal cyst

Question 21

What is mesenteric adenitis

Answer 21

Non-specific abdo pain, lasting 24-48hrs
Following infection, commonly strep throat
Inflammation of lymphoid tissue within mesentery

Question 22

Investigations in pyloric stenosis?

Answer 22

Serum electrolytes - may show hypochloraemic alkalosis +- a mild hypokalaemia

USS pylorus - shows thickened sphincter, ^ canal length

Question 23

Management of pyloric stenosis

Answer 23

correct fluid/electrolyte imbalance

Ramstedt’s pyloromyotomy

Question 24

Different types of undescended testicle?

Answer 24

Anorchidism - no testicle there
Retractile - exaggerated cremasteric reflex
Ascending - short spermatic cord (later presentation)
Testicular maldescent - arrested (usually in inguinal canal, or ectopic (in suprainguinal pouch)

Question 25

management of undescended testicle

Answer 25

If not descended by 6 months, investigate If continues, surgical correction - orchidopexy - by 12 months

Question 26

Presentation of biliary atresia?

Answer 26

Persistent jaundice, shortly after birth Pale stool, dark urine Splenomegaly due to portal hypertension jaundice lasting >14 days - BA must be investigated

Question 27

Investigations in biliary atresia

Answer 27

serum and total bilirubin PT, and INR with be ^^ Serum AST/ALT, ALP and gamma GT ^^ USS - hepatobiliary scintigraphy

Question 28

Management of biliary atresia

Answer 28

Kasai - portoenterostomy Ursodeoxychloric acid to encourage bile flow 2nd line - liver transplantation

Question 29

What are HBsAG and Anti-HBs

Answer 29

HBs = Hep B surface antigen - indicates active acute/chronic infection Anti-HBs = anti- Hep B surface antigen = indicates resolved infection / prior vaccination

Question 30

What are Anti-HBc - IgM and IgG

Answer 30

IgM - anti - Hep B core antibodies - appear first during acute infection IgG - appear later - during resolved acute infection/chronic - but not after vaccination

Question 31

Difference between Hep A and Hep B

Answer 31

Hep A - faecal oral transmission. mild illness lasting 2-4 weeks. can be re-infected in future Hep B - often transmitted vertically from mother. Often chronic carriers.

Question 32

Clinical features of Hirschprung's disease

Answer 32

Aganglionic bowel - lacking parasympathetic nerve cells --> severe constriction Failure to pass meconium in first 48hrs of life + vomiting This is a GI emergency

Question 33

Investigations and management in Hirschprung's

Answer 33

Bowel biopsy is diagnostic Consider barium enema studies Surgical - anorectal pull through - removal of aganglionic bowel - maybe stoma until older

Question 34

Investigations and management of IBD

Answer 34

Fecal calprotectin. Endoscopy/colonoscopy for diagnosis Induce remission with Liquid diet for 6 weeks, or steroids (pred) + DMARDS - Azathioprine, methotrexate, infliximab, mesalazine

Question 35

What is toddlers diarrhoea?

Answer 35

Fast transit - through immature gut Diarrhoea with undigested food - however children usually well and thriving Most children grow out of it by age 5

Question 36

What is volvulus

Answer 36

Twisting of the small bowel around axis of the superior mesenteric artery - severe obstruction +- ischaemia - GI emergency Requires urgent laparotomy, correction (remove appendix while youre at it)