Constipation and diarrhoea

Question 1

What are the types of cause of cnstipation?

Answer 1

Social

Pathological

Question 2

What are some pathological causes of constipation in babies?

Answer 2

Impaction
MEconium ileus
Volvulus 
Bowel obstruction
Hirschsprung's disease

Question 3

What is the management of faecal impaction?

Answer 3

Empty impacted rectum and colon

Maintain regular stool passage- Movicol- with slow weaning off treatment

Question 4

What is meconium ileus?

Answer 4

Meconium becomes thick and congested in intestines and fails to pass

Question 5

What is meconium ileus a red flag for?

Answer 5

CF

Question 6

What is the presentation of meconium ileus?

Answer 6

Within first 48 hours
Bilious vomiting
Abdo distension
No passage of meconium, constipation

Question 7

What is the investigation of meconium ileus?

Answer 7

AXR- fluid levels

Investigate for CF

Question 8

What s the management of meconium ileus?

Answer 8

Surgical decompression

Question 9

What are the risk factors for volvulus?

Answer 9

Malrotation

Hirschsprung’s

Question 10

What is the presentation of volvulus?

Answer 10

Bowel obstruction
Peritoneal signs
Haemodynamic instability

Question 11

What is the management of volvulus?

Answer 11

Emergency surgery

Question 12

What causes bowel obstruction in newborns?

Answer 12

Imperforate anus
Congenital atresia/stenosis
Volvulus
Meconium uleus

Question 13

What is the most common cause of bowel obstruction in 2-3 months?

Answer 13

Strangulated hernia

Question 14

What is the most common cause of bowel obstruction in 3-18 months?

Answer 14

Intususseption

Question 15

What is Hirschsprung’s disease?

Answer 15

Absence of ganglion cells from myenteric and submucosal plexuses causing chronic constipation

Question 16

What is the presentation of Hirschsprung’s?

Answer 16

Delayed passage of meconium
Chronic constipation
Abdo distension

Question 17

What is the management of Hirschsprung’s?

Answer 17

Anorectal pull through

Question 18

What is the most common cause of gastroenteritis?

Answer 18

Rotavirus

Question 19

What is the presentation of gastroenteritis?

Answer 19

Fever, vomiting and diarrhoea

Question 20

What are the types of cows milk protein allergy?

Answer 20

Immediate IgE related- 45% remain intolerant

Delayed non IgE mediated- majority tolerant by age 3

Question 21

What s the presentation of CMPA?

Answer 21

Regurgitation, vomiting
Diarrhoea
Irritability, crying
Failure to thrive

Question 22

How is CMPA diagnosed?

Answer 22

Clinically via removal of cow’s milk protein

Question 23

What is the management of CMPA in breastfeeding?

Answer 23

Maternal avoidance of cow’s milk protein

Question 24

What is the management of CMPA in formula feeding?

Answer 24

1st line= extensive hydrolysed formula

2nd= amino acid based formula

Question 25

When does IBD normally present?

Answer 25

Adolescence

Question 26

What is the histology of Crohn's?

Answer 26

Inflammation of all layers at any level | Skip lesions, non caseating granulomas, crypt abscesses

Question 27

What is the presentation of Crohn's?

Answer 27

Non bloody diarrhoea Prominent weight loss Abdo pain

Question 28

What is the histology of UC?

Answer 28

Lesions start at rectum and move proximally | Continuous mucosal inflammation with pseudo polyps

Question 29

What is the presentation of UC?

Answer 29

Bloody diarrhoea | Abdo pain

Question 30

What investigations should eb done for IBD?

Answer 30

Bloods- raised CRP, anaemia, low vit D and B12 Faecal calprotectin- increased MR enterography- gold standard Endoscopy, colonoscopy and biopsy- diagnostic

Question 31

What is the emergency imaging in IBD?

Answer 31

CT abdomen

Question 32

What are some causes of malabsorption?

Answer 32

Pancreatic disease- classically CF Chronic liver disease Cholestasis

Question 33

What can cause both diarrhoea and constipation?

Answer 33

IBS | Coeliac

Question 34

What is coeliac?

Answer 34

Autoimmune disease causing sensitivity to gladin fraction of gluten, leading to villous atrophy

Question 35

What are some risk factors for coeliac?

Answer 35

FH Other autoimmune conditions HLA DQ2 and DQ8

Question 36

What is the presentation of coeliac?

Answer 36

``` Abdo bloating and pain Diarrhoea/constipation Failure to thrive Tiredness Dermatitis herpetiformis ```

Question 37

What investigations are done for coeliac?

Answer 37

Coeliac serology and IGA HLA DQ2 and DG8 Duodenal biopsy

Question 38

What is done on a coeliac serology?

Answer 38

Anti tissue transglutaminae TTG Anti endomysial Anti-gladin

Question 39

What are the indications to diagnose coeliac without biopsy?

Answer 39

Anti TTG >10x upper limit + anti E + HLA

Question 40

What is the management of coeliac?

Answer 40

Gluten free diet | Refractory- steroids