GI Disorders

Question 1

How much milk should children be fed?

Answer 1

150ml/kg/day

Question 2

What blood results are seen in pyloric stenosis and what other investigations should be done?

Answer 2

Alkalosis, hypochloraemia and hypokalaemia

Abdominal US to show pyloric thickening

Question 3

What is the presentation of pyloric stenosis?

Answer 3

Usually in 3-6 week old males
Non bilious projectile vomiting
Olive abdominal mass
Gastric peristalsis
Signs of dehydration
Failure to thrive or weight loss
FH of pyloric stenosis

Question 4

What is the management of pyloric stenosis?

Answer 4

Fluid resuscitation
Electrolyte rebalance
Laparoscopic or open pyloromyotomy

Question 5

What kind of vomiting is seen in Intestinal atresia, malrotation +/- volvulus, intussusception, ileus?

Answer 5

Bilious vomiting

Question 6

What investigations should be done in a possible intestinal blockage?

Answer 6

Abdominal x-ray
Consider contrast meal
Surgical opinion re exploratory laparotomy

Question 7

In what circumstances can GOR continue on into adolescence?

Answer 7

Cerebral palsy
Progressive neurological problems
Oesophageal atresia +/- TOF operated
Generalised GI motility problem

Question 8

What is the presentation of GOR in infants?

Answer 8

Vomiting
Haematemesis
Feeding problems
Failure to thrive
Apnoea
Cough
Wheeze
Chest infections

Question 9

What is Sandifer syndrome?

Answer 9

Sandifer’s syndrome is the association of gastro-oesophageal reflux disease with spastic torticollis and dystonic body movements. Nodding and rotation of the head, neck extension, gurgling sounds, writhing movements of the limbs, and severe hypotonia have been reported. If the reflux is treated then the neurological symptoms also dissipate

Question 10

What investigations can be done in GOR?

Answer 10

Radiological investigations
Videofluoroscopy
Barium swallow
pH study
Oesophageal impedance monitoring
Endoscopy

Question 11

What are the treatments for GOR?

Answer 11

Feeding advice- use caraval to thicken the liquid, feeding position
Nutritional support-Calorie supplements, exclusion diet (milk free), nasogastric tube, gastrostomy
Medical treatment-Prokinetic drugs, acid suppressing drugs
Surgery

Question 12

What are indications for surgery in GOR and what is the surgery that is done?

Answer 12

Persistent:
Failure to thrive
Aspiration
Oesophagitis

Nissen Fundoplication

Question 13

What is the definition of chronic diarrhoea?

Answer 13

4 or more stools per day

For more than 4 weeks

Question 14

What are the types of diarrhoea?

Answer 14

Active secretion (secretory)

• Acute Infective Diarrhoea*
• Inflammatory Bowel Disease

Malabsorption of nutrients (osmotic)

• Food Allergy*
• Coeliac Disease*
• Cystic Fibrosis

Motility disturbance

• Toddler Diarrhoea
• Irritable Bowel Syndrome

Question 15

What is the presentation of coeliac disease?

Answer 15

Abdominal bloatedness
Diarrhoea
Failure to thrive
Short stature
Constipation
Tiredness
Dermatitis herpetiformis

Question 16

What tests should be done in coeliac disease?

Answer 16

Serological Screens
-Anti-tissue transglutaminase
-Anti-endomysial
-Anti-gliadin
-Concurrent IgA deficiency in 2% may result in false negatives
Gold standard-  duodenal biopsy
Genetic testing 
-HLA DQ2, DQ8

Question 17

What are the causes of constipation?

Answer 17

Poor diet
Insufficient fluids
Excessive milk
Potty training
Current illness
Medications (opiates, Gaviscon)
Family history
Psychological
Anorectal malformations
Hypothyroidism

Question 18

What is the management of constipation?

Answer 18

Movicolon is used to remove impaction over a number of days or can give high dose stimulant laxatives, or give enemas (prefer not to as psychological effect).
Dietary- increase fibre, fruit, fluid and veg intake, reduce milk intake
Make going to toilet a pleasant experience (right height etc)
Avoid punitive behaviour from parents and reward good toilet behaviour with praise or incentives.
Medications- use lactulose or movicol (osmotic laxative which fights the bowel for the water), lactulose can cause wind, distension and abdominal pain so movicol better. Stimulant laxatives aggravate the colon and make it notice the stool (senna, picosulphate)-child will have a lot of liquid stools. Will need to see families frequently so can adjust dose.
Generally, however long constipation has lasted is how long treatment will need to last to fix the problem