Abdominal pain

Question 1

treatment of pyloric stenosis

Answer 1

• Resuscitate

- surgery (division of the hypertrophic muscle)

Question 2

aetiology of pyloric stenosis

Answer 2

due to the progressive hypertrophy of the circumferential muscle layer of the pylorus –> outlet obstruction

Question 3

medical causes of constipation in children

Answer 3

cows milk allergy
coeliac disease
hypercalcaemia
hypothyroidism

Question 4

“typical” patient demographics with pyloric stenosis

Answer 4

male, 3-6 weeks of age with a family history

Question 5

a double bubble sign on xray is pointing to which Dx

Answer 5

malrotation with volvulus or dueodenal atresia

Question 6

clinical presentation of malrotation with volvulus

Answer 6

bile stained vomiting!
- feeding difficulties, typically in the first week
late signs: PR bleeding, abdominal distension, abdominal tenderness

Question 7

7 most common causes of abdominal pain in neonates

Answer 7

Hirschprung's 
intussuception
incarcerated hernia
irritable infant
Meckel's diverticulum
UTI
volvulus

Question 8

what is Meckel’s diverticulum

Answer 8

remnant of vitelline duct that connects the yolk sac with the primitive midgut

Question 9

signs on examination of pyloric stenosis

Answer 9

visible peristalsis
palpable olive at the pylorus
dehydration

Question 10

what is intussusception

Answer 10

invagination of the proximal bowel into the distal bowel

Question 11

most common cause of intussusception

Answer 11

inflamed peyer’s patches in the terminal ileum

Question 12

what is the ABG derrangement that pyloric stenosis can cause

Answer 12

hypochloraemic, hypokalaemic, metabolic alkalosis

Question 13

treatment for malrotation with volvulus

Answer 13

Surgery!

• deliver the bowel through the tummy
• untwist in an anticlockwise rotation
• place the gut back in
• widen the mesentry
• appendectomy

Question 14

DDx of non-bilious vomiting in neonatal period

Answer 14

• pyloric stenosis
• sepsis
• reflux
• over feeding
• metabolic diseases - rare
• CAH - rare

Question 15

gold standard investigation for intussusception

Answer 15

ultrasound - see target sign

Question 16

Age group for intussusception

Answer 16

3 months to 3 years

- Peaks at 5-11 months

Question 17

clinical presentation of intussusception

Answer 17

• intermittent abdominal pain
• vomiting
• lethargy
• red currant stools (late sign)

Question 18

what are some pathological lead points that can lead to intussusception

Answer 18

Meckel’s diverticulum
polyp
vascular malformation
duplication cyst

Question 19

6 most common causes of abdominal pain in infants/preschool

Answer 19

appendicitis
gastroenteritis
pneumonia
UTI
volvulus
constipation

Question 20

classical presentation of appendicitis

Answer 20

• periumbilical pain moving to the RIF
• vomiting
• anorexia
• guarding RIF
• fever
• lying still

Question 21

what degree of twist of malrotation with cause arterial ischaemia

Answer 21

720 degrees

Question 22

surgical causes of constipation in children

Answer 22

hirschprung disease
meconium ileus
anatomical malformation of the anus
spinal cord abnormalities

Question 23

what time of the year is intussusception most common

Answer 23

spring and autumn

Question 24

investigations for malrotation and voluvlus

Answer 24

upper GI contrast study - gold standard

Question 25

DDx of BILIOUS vomiting

Answer 25

• malrotation with volvulus
• duodenal atresia
• jejunoileal atresia
• meconium ileus
• necrotizing enterocolitis
• intussusception
• incarcerated hernia
• Hirschprung’s disease

Question 26

treatment of intussusception

Answer 26

• simple intussusception = air enema reduction

- complicated intussusception = laparotomy

Question 27

what signs on examination point to intussusception

Answer 27

palpable mass
pulling their legs up
pallor
dehydration

Question 28

consequences of intussusception

Answer 28

• dehydration
• bowel obstruction
• bowel ischaemia –> perforation

Question 29

peak age group of appendicitis

Answer 29

10-12

Question 30

aeitology of malrotation with volvulus

Answer 30

narrow base of mesentry between the ileocaecal junction and the duodeno-jejunal junction –> allowing the gut to twist around the superior mesenteric vessels

Question 31

when should you start feeds again after pyloric stenosis surgery

Answer 31

6 hours

Question 32

clinical presentation of pyloric stenosis

Answer 32

• forceful, projectile, non bilious vomiting
• vomiting after every feed
• effortless
• hungry straight afterwoods
• decreased stooling
• weight loss