20. Paediatric Gastroenterology

Question 1

Common paediatric GI symptoms

Answer 1

• Abdo pain
• Constipation
• Vomiting and reflux
• Diarrhoea
• Rectal bleeding
• Failure to thrive

Question 2

Abdominal pain in paeds:

Answer 2

• Functional or recurrent
• IBS
• Duodenal ulcer

Question 3

Constipation with overflow treatment

Answer 3

• Softener (Movicol/lactulose)

- Stimulant (Senna/picosulphate)

Question 4

ROME IV classification

Answer 4

• Functional dyspepsia (Epigastric pain and fullness)
• IBS (recurrent pain with defecation changes)
• Abdominal migraine (paroxysmal pain with anorexia, N&V, headache, photophobia)
• Functional abdominal pain, not otherwise specified (>4x episodes/month, not any of the above)

Question 5

Differentials for infant reflux:

Answer 5

• GORD
• Eosinophilic oesophagitis
• Anatomic abnormalities
• Intestinal obstruction

Question 6

Red flags in infant reflux:

Answer 6

• Severe symptoms (+ other problems, eg eczema)
• Haematemesis
• Failure to thrive

Question 7

Poor appetite and weight loss: CD or UC?

Answer 7

CD

Question 8

Bloody diarrhoea: CD or UC?

Answer 8

UC

Question 9

Investigations for IBD:

Answer 9

• Hb (normal)
• Platelets (raised)
• CRP (raised)
• Faecal calprotectin (raised)

Question 10

When to suspect IBD?

Answer 10

Lower GI symptoms for >6 weeks; 4 week referral to specialist assessment

Question 11

UC histology:

Answer 11

Diffuse inflammation

Question 12

Chron’s disease:

Answer 12

Snail track ulcers, histopathology, COBBLESTONING, thickened abnormal terminal ileum

Question 13

Clinical dehydration:

Answer 13

5% of body mass dehydration

Question 14

Clinical shock:

Answer 14

10% of body mass dehydration

Question 15

Children at increased risk in D&V:

Answer 15

• <6 months old
• Low birth weight
• > 6 diarrhoeas
• > 3 vomits
• Not tolerating fluids or breast milk

Question 16

Signs of clinical dehydration:

Answer 16

• Altered responsiveness
• Sunken eyes
• Tachycardia
• Tachypnoea
• Reduced skin turgor

Question 17

Clinical shock signs:

Answer 17

• All clinical dehydration signs+
• Cold extremities
• Pale skin
• Hypotension
• Prolonged capillary refill time

Question 18

Maintenance fluid volume:

Answer 18

1ST 10kg: 100ml/kg/day
2ND 10kg: 50 ml/kg/day
Subsequent kg: 20ml/kg/day

Question 19

Clinical dehydration fluid maintenance:

Answer 19

Initial: 50ml/kg over 4 hours in addition to maintenance
Rehydration: Maintenance requirements + 50 ml/kg (=5% body weight) replacement over 4 hours

Question 20

Clinical shock fluid maintenance:

Answer 20

Initial: 20ml/kg stat
Rehydration: Maintenance PLUS 100ml/kg (10% body weight)

Question 21

Coeliac disease diagnosis condition:

Answer 21

Do not start gluten free diet before the diagnosis/test

Question 22

When is coeliac disease diagnosis confirmed?

Answer 22

• Symptoms (diarrhoea and weight loss)
• TTG >10x upper limit
• EMA+ve
  Also signs and symptoms must improve on a gluten free diet

Question 23

When is biopsy done in coeliac disease?

Answer 23

If only 1 or 2 criteria out of 3 for diagnosis are met

Question 24

Coeliac antibodies in diagnosis:

Answer 24

• Tissue TransGlutaminase = 200 >10x upper limit

- Anti-endomysial antibody = positive

Question 25

Chronic diarrhoea after acute onset:

Answer 25

• Persisting infection
• Immunocompromised host
• Residual damage (1st presentation of coeliac disease, 2nd lactose intolerance – hypolactasia)
• Rectal bleeding (constipation fissure, polyps, IBD, worms, bacterial infections)