Paeds GI 2

Question 1

Why is reflux v common in infancy?

Answer 1

oes sphincter isn’t mature

fluid diet, horizontal posture

Question 2

Gastro-oesophageal reflux is v common in infancy, often resolves by 12 months. What symptoms alongside reflux make it into gastro-oesophageal reflux DISEASE?

Answer 2

• faltering growth
• oesophagitis
• pulm aspiration
• Sandifer syndrome

Question 3

What might be the signs of oesophagitis as part of GORD?

Answer 3

haematemesis, feeding discomfort

Question 4

What might be some signs of pulm aspiration as part of GORD?

Answer 4

cough, wheeze, pneumonia!

Question 5

What is Sandifer syndrome?

Answer 5

dystonic neck posturing in association with GORD

Question 6

Name two groups for whom GORD is more common.

Answer 6

preterms

neurodisability (cerebral palsy)

Question 7

Are investigations used to diagnose GORD?

Answer 7

no
if complex / atypical - 24hr oes pH monitoring

(or suspect other cause eg urine dip)

Question 8

Name some risk factors for GORD.

Answer 8

prematurity
neurodisability (CP)
obesity
hiatus hernia
FHx

Question 9

If breastfed with frequent regurgitation causing marked distress, what should you give immediately after feeds?

Answer 9

alginate (eg. Gaviscon) mixed with water

Question 10

Management of GORD if formula fed?

Answer 10

1. Little and often feeds
2. Add Thickener to formula
3. Add Alginate to formula instead
4. RANITIDINE OR OMEPRAZOLE

Question 11

If thickener and alginate (Gavsicon) don’t work, what medications can be used to treat GORD?

Answer 11

ranitidine (anti-histamine)

omeprazole (proton pump inhibitor)

Question 12

What is the DEFINITIVE treatment for GORD?

Answer 12

Nissen’s fundoplication

Question 13

Nissen’s fundoplication is surgery for…

Answer 13

GORD

Question 14

What are two uncommon complications of GORD

Answer 14

recurrent aspiration pneumonia

recurrent otitis media

Question 15

Acute abdo pain could be caused by all sorts of GI stuff - appendicitis, obstruction, trauma, peritonitis, IBD, gastroenteritis, constipation, Meckel’s. What haem stuff could also cause abdo pain?

Answer 15

lead poisoning
sickle cell
Henoch Schonlein purpura

Question 16

What groin stuff could cause acute abdo pain?

Answer 16

inguinal hernia
testicular torsion

pregnancy / ectopic
ovarian torsion

Question 17

What kidney stuff could cause acute abdo pain?

Answer 17

acute pyelonephritis
UTI
hydronephrosis
renal calculus

Question 18

Apart from GI stuff, haem stuff, groin stuff, kidney stuff, what else could cause acute abdo pain?

Answer 18

RESP - lower lobe pneumonia
MSK - hip + spine

also hepatitis, pancreatitis, DKA.

Question 19

What age group most commonly get intussusception?

Answer 19

under 2yrs

Question 20

Define intussusception

Answer 20

invagination of proximal into distal

Question 21

What part of bowel is intussusception usually?

Answer 21

ileum into caecum

Question 22

Give me the 4 BASIC SYMPTOMS of intussusception.

Answer 22

paroxysmal colicky abdo pain + pallor
vomiting
sausage shaped abdo mass
redcurrant jelly stool

Question 23

How does intussusception cause shock?

Answer 23

distension – venous obstruction – bleeding into bowel – fluid pools in gut – HYPOVOL.
… perforation, peritonitis :/

Question 24

What investigations for intussusception?

Answer 24

abdo US

AXR

Question 25

What would abdo US show in intussusception?

Answer 25

distended small bowel | no gas in colon

Question 26

Treatment for intussusception?

Answer 26

IV fluid resusc | RECTAL AIR INSUFFLATION - pop it out!

Question 27

What is "rectal air insufflation" the treatment for?

Answer 27

intussusception | PLUS DONT FORGET IV FLUID RESUSC

Question 28

Remnant of vitello-intestinal duct in ileum in 2% of pop. What's this?

Answer 28

Meckel's diverticulum

Question 29

What is Meckel's diverticulum?

Answer 29

remnant of vitello-intestinal duct in ileum in 2% pop - it's weird tissue and it bleeds

Question 30

Most Meckel's diverticulum are asymptomatic. But can cause what bad stuff can happen?

Answer 30

PR bleeding acute drop in Hb diverticulitis / intussusception / volvulus

Question 31

What is the treatment for Meckel's diverticulum?

Answer 31

surgical resection

Question 32

When does malrotation present?

Answer 32

first 1-3 days of life

Question 33

Tell me about anatomy and malrotation.

Answer 33

``` it's when the gut grows weird in the womb have abnormalities like: - narrow stalk-like mesentery - Ladd bands - small bowel over on the right ``` so twists around causing VOLVULUS

Question 34

What happens in volvulus?

Answer 34

obstruction +/- compromised blood supply | bilious vom, acute abdo

Question 35

What is the investigation for malrotation + volvulus?

Answer 35

URGENT upper GI contrast study

Question 36

Suspected malrotation + volvulus, with signs of COMPROMISED BLOOD SUPPLY. Don't faff around with upper GI contrast study, do what?

Answer 36

urgent laparotomy | untwist volvulus, widen mesentery

Question 37

"Recurrent" abdo pain counts as how long?

Answer 37

>3 months; disrupts activities

Question 38

In what % of recurrent abdo pain is no structural cause identified?!

Answer 38

90%!

Question 39

Name some LADY causes of RECURRENT abdo pain.

Answer 39

dysmenorrhoea ovarian cysts PID

Question 40

Name some KIDNEY causes of RECURRENT abdo pain.

Answer 40

UTI | PUJ obstruction

Question 41

Name some GI causes of RECURRENT abdo pain

Answer 41

``` functional dyspepsia eosinophilis oesophagitis IBS constipation gastritis + peptic ulcer IBD ```

Question 42

Name some liver-ish causes of recurrent abdo pain.

Answer 42

hepatitis gallstones pancreatitis

Question 43

Child has recurrent abdo pain, with food sticking in her throat and vomiting for over 3 months. PMH of asthma, eczema and hayfever. What do you suspect and how confirm?

Answer 43

eosinophilic oesophagitis! endoscopy

Question 44

What is treatment for eosinophilic oesophagitis?

Answer 44

oral fluticasone | corticosteroid

Question 45

Child presents with recurrent abdo pain, headaches and facial pallor. She gets episodes of midline pain lasting 48hrs at a time. On social Hx you find she is stressed and being bullied at school. Suspect?

Answer 45

abdominal migraine - TOPIRAMATE

Question 46

What is treatment for abdominal migraine?

Answer 46

TOPIRAMATE