GI Corrections

Question 1

What are some causes of bilious vomiting in neonates? (5)

Answer 1

1) Necrotising enterocolitis

2) Meconium ileus

3) Jejunal/ileal atresia

4) Malrotation with volvulus

5) Duodenal atresia

Question 2

What is bilious vomiting in within 24 hours of birth most commonly caused by?

Answer 2

Intestinal atresia –> duodenal, jejunal or ileal atresia.

Question 3

What is bilious vomiting classically caused by?

Answer 3

Obstruction beyond the sphincter of Oddi (where the common bile duct enters the duodenum).

Question 4

When does NEC typically present?

Answer 4

Usually 2nd week of life

Question 5

When does meconium ileus typicallly present?

Answer 5

First 24-48 hours of life

Question 6

when does intestinal atresia usually present?

Answer 6

Within first 24 hours of life

Question 7

When does malrotation with volvulus typically present?

Answer 7

3-7 days after birth

Question 8

What is a key risk factor for duodenal atresia?

Answer 8

Down syndrome

Question 9

What is seen on an AXR in duodenal atresia?

Answer 9

‘Double bubble’ sign

Question 10

What is the diagnostic investigation for necrotising enterocolitis?

Answer 10

AXR

Question 11

Is hypoglycaemia common in the neonatal period?

Answer 11

Yes - normal term babies often have hypoglycaemia especially in the first 24 hrs of life but without any sequelae.

They can utilise alternate fuels like ketones and lactate.

Question 12

Define typical blood glucose level for neonatal hypoglycaemia

Answer 12

<2.6 mmol/L

Question 13

What are some causes of persistent/severe hypoglycaemia in neonates?

Answer 13

1) Preterm birth (<37 weeks)

2) Maternal diabetes

3) IUGR

4) Hypothermia

5) Neonatal sepsis

6) Inborn errors of metabolism

7) Nesidioblastosis

8) Beckwith-Wiedemann syndrome

Question 14

Features of neonatal hypoglycaemia?

Answer 14

1) asymptomatic

2) autonomic:
- poor feeding/sucking
- weak cry
- drowsy
- hypotonia
- seizures

3) other:
- apnoea
- hypothermia

Question 15

What does management of neonatal hypoglycaemia depend on?

Answer 15

a) the severity of the hypoglycaemia

b) if the newborn is symptomatic

Question 16

In neonatal hypoglycaemia, what is the management if the newborn is asymptomatic?

Answer 16

1) encourage normal feeding (breast or bottle)

2) monitor blood glucose

Question 17

In neonatal hypoglycaemia, what is the management if the newborn is symptomatic (or the blood glucose is very low)?

Answer 17

1) admit to the neonatal unit

2) IV infusion of 10% dextrose

Question 18

Pneumatosis intestinalis (intramural gas) is a hallmark feature of what condition in neonates?

Answer 18

NEC

Question 19

What is the use of maternal labetalol a risk factor for in neonates?

Answer 19

Foetal hypoglycaemia

Question 20

What is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years?

Answer 20

Meckel’s diverticulum

Question 21

What are some causes of neonatal hypotonia?

Answer 21

1) Neonatal sepsis

2) Werdnig-Hoffman disease (spinal muscular atrophy type 1)

3) Hypothyroidism

4) Prader-Willi

Question 22

A baby is born with microcephaly, moderate hepatosplenomegaly and a petechial rash. Shortly after admission to the neonatal intensive care unit, they have a seizure.

What infection has the baby likely been exposed to in-utero?

Answer 22

CMV

Question 23

XR fluid levels in Hirschsprung’s disease vs meconium ileus?

Answer 23

Hirschsprung’s –> dilated loops of bowel with fluid levels .

Meconium ileus –> distended coils of bowel but no fluid levels (as the meconium is viscid).

Question 24

what is the usual clinical presentation of Hirschsprung’s?

Answer 24

Delayed passage of meconium + distension of abdomen.

Question 25

If a formula-fed baby is suspected of having mild-moderate cow's milk protein intolerance, what is the 1st management step?

Answer 25

An extensive hydrolysed formula should be tried.

Question 26

In an infant with bilious vomiting & obstruction, what is the likely condition?

Answer 26

Intesinal malrotation (can then progress to a volvulus).

Question 27

What condition is Hirschprung's disease associated with?

Answer 27

Down's syndrome 3x more common in males

Question 28

1st line management of Hirschsprung's?

Answer 28

rectal washouts/bowel irrigation

Question 29

How does malrotation typically present?

Answer 29

Bilious vomiting in neonates in first 30 days of life.

Question 30

Why can CF cause foul smelling stools?

Answer 30

As CF can give rise to pancreatic insufficiency and consequently steatorrhoea caused by GI malabsorption of fats.

Question 31

Which vaccine do people with coeliac disease receive every 5 yeas?

Answer 31

Pneumoccal vaccine due to hyposplenism. This protects against infections caused by encapsulated organisms like Streptococcus pneumoniae.

Question 32

What can precipitate a G6PD deficiency crisis?

Answer 32

1) Infections e.g. LRTI 2) Drugs e.g. ciprofloxacin, primaquine, sulphonamides, sulphasalazine, sulfonylureas 3) Fava (broad) beans

Question 33

What is seen on a blood film in G6PD deficiency?

Answer 33

Heinz bodies

Question 34

What is the key investigation in pyloric stenosis?

Answer 34

US

Question 35

What is incubation period for Giardiasis?

Answer 35

ranges from 1 to 2 weeks, but it can extend up to 6 weeks in some cases

Question 36

What are some causes of chronic diarrhoea in children? (4)

Answer 36

1) cows' milk intolerance (most common cause in developed world) 2) toddler diarrhoea 3) coeliac disease 4) post-gastroenteritis lactose intolerance

Question 37

When does intussusception typically present?

Answer 37

3-12 months

Question 38

When does Hirschsprung's typically present?

Answer 38

24-48h

Question 39

What is kolionychia? What condition is it seen in?

Answer 39

Spooning of the nails. Iron deficiency anaemia.

Question 40

Is conjugated or unconjugated bilirubin raised in biliary atresia?

Answer 40

Conjugated

Question 41

Risk factors for testicular cancer?

Answer 41

1) infertility 2) cryptochidism 3) FH 4) Klinefelter's syndrome 5) mumps orchitis

Question 42

What is the gold standard investigation to confirm a diagonsis of coeliac disease?

Answer 42

Small bowel biopsy

Question 43

Incubation period of: - Staphylococcus aureus - Bacillus cereus - Salmonella - E. coli - Shigella - Campylobacter - Giardiasis - Amoebiasis

Answer 43

1-6 hrs: Staphylococcus aureus, Bacillus cereus 12-48 hrs: Salmonella, Escherichia coli 48-72 hrs: Shigella, Campylobacter > 7 days: Giardiasis, Amoebiasis

Question 44

Wbat is the most appropriate treatment for sigmoid volvulus?

Answer 44

Urgent larapotomy

Question 45

What is the diagnostic investigatoin for NEC?

Answer 45

AXR

Question 46

What is Zollinger Ellison syndrome?

Answer 46

A condition characterised by excessive levels of gastrin 2ary to a gastrin secreting tumour. The majority of these tumours are found in the first part of the duodenum.

Question 47

Features of Zollinger Ellison?

Answer 47

- multiple gastroduodenal ulcers: epigastric pain - diarrhoea - malabsorption

Question 48

What condition is Zollinger Ellison often associated with?

Answer 48

MEN type 1

Question 49

What makes up MEN-1?

Answer 49

- parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia - pituitary (70%) - pancreas (50%, e.g. Insulinoma, gastrinoma) - also: adrenal and thyroid

Question 50

Are direct or indirect inguinal hernias more likely to become strangulated?

Answer 50

Indirect

Question 50

What is the annual probability of strangulation of an inguinal hernia?

Answer 50

3%

Question 51

What are the 2 types of abdominal wall hernias in children?

Answer 51

1) Congenital inguinal hernia 2) Infantile umbilical hernia

Question 52

Mx of a congenital inguinal hernia?

Answer 52

Should be surgically repaired soon after diagnosis as at risk of incarceration. URGENT referral for surgery.

Question 53

Who are congenital inguinal hernias more common in? (2)

Answer 53

Premature babies & boys

Question 54

Who are infantile umbilical hernias more common in? (2)

Answer 54

Premature babies & Afro-Caribbean babies

Question 55

Mx of infantile umbilical hernias?

Answer 55

Conservative --> most resolve without intervention before the age of 3 years. If large or symptomatic --> elective repair at 2-3 years of age. If small and asymptomatic --> elective repair at 4-5 years of age.

Question 56

What is the most common ocular malignancy found in children?

Answer 56

Retinoblastoma

Question 57

What is the average age of diagnosis of a retinoblastoma?

Answer 57

18 months

Question 58

What is the most common presenting symptom of a retinoblastoma?

Answer 58

Absence of red-reflex, replaced by a white pupil (leukocoria).

Question 59

Mx of bilateral vs unilateral inguinal hernias?

Answer 59

Bilateral --> laparoscopic mesh repair Unilateral --> open mesh repair

Question 60

Why do femoral hernias need to be repaired, regardless of whether they are symptomatic or not?

Answer 60

Due to the risk of strangulation

Question 61

What is the diagnostic criteria for functional constipation?

Answer 61

Rome criteria. Must include 2 or more of the folliowing in a child with a developmental age of at least 4 years: 1) <3 defecations per week 2) At least 1 episode of faecal incontinence per week 3) History of painful or hard bowel movements 4) Presence of a large faecal mass in the rectum 5) History of large diameter stools that may obstruct the toilet Criteria must be fulfilled at least once per week for at least 2 months before diagnosis.

Question 62

What is functional constipation caused by?

Answer 62

Situational, psychological, developmental or dietary issues. Behavioural: - young children may ignore the urge - negative feelings towards public toilets Food allergies: - milk, egg, wheat (most common allergens associated with constipation) Dietary factors: - reduced fluid and dietary fibre intake

Question 63

What are some contributing factors to functional constipation?

Answer 63

1) Changes in routine, diet 2) Stressful events e.g. birth of a sibling, parental divorce 3) Entering kindergarten and school 4) Intercurrent illness 5) Perianal irritation

Question 64

Pathophysiology of encopresis/soiling:

Answer 64

1) Prolonged stool retention and rectal distension 2) Loss of rectal senstation 3) Decreased urge to defecate 4) Liquid stool proximally percolate downstream around hard stools 5) Faecal soiling

Question 65

What are long term issues associated with constipation in paeds?

Answer 65

1) Decreased food intake 2) Vomiting 3) Urinary incontinence, UTI 4) Anal prolapse, fissures, haemorrhoids 5) Low self-esteem, depression

Question 66

What type of pneumonia can present as abdo pain?

Answer 66

Lower lobe pneumonia

Question 67

Define diarrhoea

Answer 67

Loose/watery and large frequent stools at least 3 times daily.

Question 68

Define chronic diarrhoea

Answer 68

Duration >4 weeks

Question 69

Secretory vs osmotic diarrhoea?

Answer 69

Secretory --> intestinal mucosa directly secretes fluids and electrolytes into the lumen. Eg. cholera, congenital diarrhoea. Osmotic --> malabsorption of an ingested substance pulls water into the lumen. E.g. lactose intolerance, pancreatic insufficiency.

Question 70

Possible investigations in diarrhoea?

Answer 70

1) Stool virology, MCS and ova/cysts/parasites 2) Faecal calprotectin 3) Bloods: U&Es, LFTs, TFTs, FBC, CRP, immunoglobulins, coeliac Abs 4) Faecal elastase 5) Faecal alpha 1 antitrypsin (protein losing enteropathy) 6) USS abdomen 7) Endoscopy & biopsies

Question 71

What 2 serotypes are seen in coeliac disease?

Answer 71

HLA-DQ2 HLA-DQ8

Question 72

Give some neuro features that may be seen in coeliac disease

Answer 72

1) Recurring headaches 2) Peripheral neuropathy 3) Epilepsy & seizures 4) Anxiety 5) Depression 6) Cerebellar ataxia 7) Chronic fatigue

Question 73

Give some bone/joint features of coeliac

Answer 73

1) Arthralgia 2) Arthritis 3) Osteoporosis 4) Bone fractures

Question 74

Give a key dermatological manifestation of coeliac

Answer 74

Dermatitis herpetiformis

Question 75

Give 2 derm manifestations of IBD

Answer 75

1) erythema nodosum 2) pyoderma gangrenosum

Question 76

Give 3 eye manifestations of IBD

Answer 76

1) uveitis 2) scleritis 3) episcleritis

Question 77

Give 3 liver manifestations of IBD

Answer 77

1) fatty liver 2) PSC 3) gallstones

Question 78

Give 3 joint manifestations of IBD

Answer 78

1) arthritis 2) sacro-ileitis 3) ankylosing spondylitis