Conditions part 1

Question 1

What is GOR?

Answer 1

Gastroesophageal Reflux

• due to inappropriate relaxations of the LOS -> most resolves by 12 months

Question 2

Investigations for GOR?

Answer 2

Clinical diagnosis

o 24hr LOS pH monitoring (should remain mostly above 4)

o OGD

Question 3

Management for GOR?

Answer 3

Referral - same day if haematemesis, melaena or dysphagia

by paediatrician if:

• red flag symptoms present
• unexplained distress
• feeding aversion
• poor growth
• IDA

Complications:  
- recurrent aspiration pneumonia
epileptic seizure like events
dental erosio
upper airway inflammation

Question 4

Treatment for GOR?

Answer 4

reassure - common

breast-fed:

• assessment
• alginate - reflux
• pharmacological

formula:

• smaller, frequent feeds
• thickened formula
• alginate therapy

Pharmacological management

• 4 week PPI, H2 antagonist trail
• Gaviscon, Omeprazole, Ranitidine, Dunno (GORD)

PACES counselling + safety net.

Question 5

What is pyloric stenosis?

Answer 5

hypertrophy of the pyloric muscle causing gastric outlet obstruction

2-8 weeks, boys > girls
associated with turner’s syndrome

Question 6

Signs and symptoms of pyloric stenosis?

Answer 6

Projectile vomiting
30 mins after feed
non-bilious
olive mass in RUQ
visible peristalsis

Dehydrated baby due to poor feeding

Hypochloraemia Hypokalaemia metabolic alkalosis

Question 7

Investigations into Pyloric stenosis?

Answer 7

Test feed -> watch gastric peristalsis

USS confirmation

Question 8

Management of pyloric stenosis?

Answer 8

IV slow fluid resuscitation + correct imbalances

Laparoscopic Ramstedt pyloromyotomy

Question 9

What is infant colic?

Answer 9

40% babies complex symptoms - inconsolable crying + drawing up hands and feet

Causes: GI, over/underfeeding, protein allergy, exposure to smoke, LBW

Question 10

Management of infant colic

Answer 10

soothe infant - hold with gentle motion, winding technique
if persistent consider milk protein allergy

Support groups - or health visitor, family and freinds

Question 11

What is appendicitis?

Answer 11

inflammation of the inner lining of the vermiform appendix that spreads to its other parts.

Rare in under 3’s. Faecolith and/or perforation more common

Question 12

Signs and symptoms of appendicitis?

Answer 12

Anorexia, vomiting, nausea, umbilical to RIF pain, fever, tenderness

Question 13

Investigations for appendicitis?

Answer 13

FBC
pregnancy test (female)
Clinical watchful waiting
AXR + CTAP

Question 14

Managmenet for appendicitis?

Answer 14

G - Group and Save
A - Abx iv
M - MRSA screen
E - Eat and Drink, must be NBM

Question 15

What is Intussusception?

Answer 15

invagination of proximal bowel into distal component - 95% = ileum through caceum at the ileocaecal valve

Stretch/constrict of mesentery -> venous obstruction -> engorgmeent and bleeding - > bowel perforation, peritonitis and gut necrosis

Question 16

Causes of intussusception?

Answer 16

3 months to 2 years

idiopahtyic, enlarged peyer’s patchers, lead points, hypertrophy (seen in CF)

Question 17

Signs and symptoms of intussusception?

Answer 17

Colic
vomit - may be bile stained
redcurrant jelly stool
abdominal distension

Question 18

Investigations for intussusception?

Answer 18

abdominal USS - target mass
abdominal XRAY - less air in RUQ, dialled small bowel loops
barium/gastrograffin enema

Question 19

Management for intussception?

Answer 19

drip and suck
recital air insufflation/barium/gastrograffin enema

broad spectrum antibiotics

recurrence risk of 5%

Question 20

What is Meckel’s Diverticulum?

Answer 20

Very common between 1-2 years

Ileal remnant of the vitello-intestinal duct containing gastric mucosa or pancreatic tissue

Question 21

Signs and symptoms of meckel’s diverticulum?

Answer 21

Painless massive PR bleeding (dark)
bilious vomiting
dehydration
constipation

Question 22

Investigations for meckel’s diverticulum

Answer 22

Technetium scan -

AXR or abdominal USS