Paediatric Gastroenterology

Question 1

What is abdominal migraine?

Answer 1

Episodes of central abdominal pain lasting more than 1 hour

Intense and acute pin

Interferes with normal activity

Associated N+V, headache, photophobia, aura

Question 2

How can abdominal migraine be treated?

Answer 2

Dark, quiet room

Paracetamol

Sumatriptan

Propylaxis –> Pizotifen

Question 3

What is classed as constipation in children?

Answer 3

<3 stools per week (does not apply to exclusively breastfed babies)

Rabbit dropping stools

Question 4

How can you differentiate between primary and secondary constipation?

Answer 4

Secondary constipation is from birth

If meconium takes longer than 48 hours to pass, ribbon stools, faltering growth, or vomiting - referral needed

Question 5

How is primary/idiopathic constipation treated?

Answer 5

First line in children is an osmotic laxative e.g. Movicol

If no response can add a stimulant e.g. Senna +/Lactulose

Question 6

What is the main cause of reflux in babies?

Answer 6

Immaturity of the lower oesophageal sphincter

Question 7

How can reflux in babies be managed?

Answer 7

Small, frequent feeds

Burp regularly

Keep baby upright after feeding

If still problematic can mix Gaviscon with feeds

Question 8

What is pyloric stenosis?

Answer 8

Hypertrophy and narrowing of the pyloric sphincter (the ring of muscle between the stomach and duodenum)

Question 9

How does pyloric stenosis present?

Answer 9

Usually presents in 2nd-4th week of life

Peristalsis tries to push food down to the duodenum but it instead ejects upwards

Projectile vomiting (non-bilious)

May be constipation/diarrhoea

May be a palpable mass due to hypertrophied pyloric sphincter (often mentioned as olive shaped mass)

Question 10

What blood gas results are seen in pyloric stenosis?

Answer 10

Low chloride

Low potassium

Alkalosis

Due to baby vomiting hydrochloric acid from stomach

Question 11

What are signs of clinical dehydration in children?

Answer 11

Decreased urine output

Sunken eyes

Dry mucuous membranes

Tachycardia

tachypnoea

Reduced skin turgor

Question 12

What are signs of clinical shock in children?

Answer 12

Decreased consciousness

Cold extremities

Pale/mottled skin

Tachycardia

Tachypnoea

Weak peripheral pulses

Prolonged cap refill

Hypotension

Question 13

How to calculate replacement fluids in children?

Answer 13

(% dehydration x kg x 10) = mls of fluids

Question 14

How to calculate maintenance fluids in children?

Answer 14

First 10kg = 100ml/kg

Next 10kg = 50ml/kg

After that = 20ml/kg

Question 15

How to calculate resuscitation fluids in children?

Answer 15

Resuscitation fluids = 20ml/kg

EXCEPT IN….

neonates, DKA, septic shock, trauma, cardiac pathology (heart failure) = 10ml/kg

Question 16

What is Hirschsprung’s disease?

Answer 16

A congenital condition where the nerve cells of the myenteric plexus are absent = absence of parasympathetic ganglion cells along a section of the bowel

Aganglionic section does not relax - causing obstruction of the bowel

Question 17

What conditions are associated with Hirschsprung’s disease?

Answer 17

Down’s syndrome

Neurofibromatosis

MEN II

Question 18

How does Hirschsprung’s disease present?

Answer 18

Delay in passing meconium

In older children - constipation, vomiting, abdominal pain

Question 19

What is the gold standard diagnosis for Hirschsprung’s disease?

Answer 19

Rectal biopsy

Question 20

What is intussusception?

Answer 20

An invagination of a portion of the bowel

Question 21

How does intussusception present?

Answer 21

Severe colicky abdominal pain

RED CURRANT JELLY STOOL

Sausage shaped mass in the RUQ

Pale, unwell child

Vomiting

Question 22

What is seen on abdominal ultrasound in intussusception?

Answer 22

Target shaped mass

Question 23

How is intussusception managed?

Answer 23

Reduction via radiology

Question 24

What is biliary atresia?

Answer 24

A congenital condition where a section of the bile duct is narrowed or absent , preventing the excretion of conjugated bilirubin

Question 25

How does biliary atresia present?

Answer 25

Presents in first few weeks of life with prolonged jaundice

Dark urine

Pale stools

Question 26

How is biliary atresia diagnosed?

Answer 26

Raised conjugated billirubin

ERCP Cholangiogram

Question 27

How are umbilical hernias in children managed?

Answer 27

Common in neonates – usually resolve by 3 years
If not resolved by 5 years can consider surgical repair

Note: Umbilical hernias are more common in Down syndrome

Question 28

What is congenital diaphragmatic hernia?

Answer 28

Herniation of the abdominal viscera into the chest cavity due to incomplete formation of the diaphragm

Question 29

How does congenital diaphragmatic hernia present?

Answer 29

Pulmonary hypoplasia + hypertension

Respiratory distress shortly