Gastro

Question 1

Normal weight gain in childhood?

Answer 1

Per 3 months

200g/week
150g/week
85-100g/week
50-75g/week

Question 2

Options for nutritional supplementation?

Answer 2

Concentrate normal formula

High calorie density formula - Infantrini, Nutrini

Question 3

What causes malnutrition?

Answer 3

Low intake

• physically unable ie. cleft
• anorexia and vomiting
• psychological

Excessive losses

• diarrhoea
• stoma losses

Increased metabolic demand

• cardiac/resp
• recurrent infections

Malabsorption

• coeliac disease
• cystic fibrosis
• enteritis, CMPI

Question 4

What are indications for gastrostomy/jejunostomy insertion?

Answer 4

• chronic disease with nutritional impairment e.g. CF, BPD
• difficulties with feeding e.g. CP
• GORD with fundoplication
• intensive nutritional therapy e.g. Crohns

Jejunostomy needs continuous feed to avoid dumping

Question 5

What is obesity and how should it investigated?

Answer 5

BMI >98th centile

TFT, fasting glucose, lipids, insulin level, LFTs

Question 6

GI manifestations of CF?

Answer 6

Pancreatic

• enzyme deficiency —> steatorrhoea, poor weight gain
• pancreatitis
• insulin dependence

Intestinal

• Meconium ileus
• atresia
• rectal prolapse
• DIOS
• strictures secondary to enzyme replacement

Hepatic

• fatty liver
• cirrhosis
• obstruction of CBD

Comment on jaundice, ascites, portal hypertension

Question 7

What are colonoscopy findings in Crohn’s disease?

Answer 7

Transmural
Skip lesions
Cobblestone appearance

Question 8

How does Crohns present?

Answer 8

Abdo pain
Diarrhoea
Weight loss

Can be systemically unwell
Pallor secondary to anaemia

Eyes - uveitis
Joints - arthritis
Skin - erythema nodosum, pyoderma gangrenosum, erythema multiforme

Growth failure, delayed sexual development

Question 9

How is Crohns investigated?

Answer 9

Bloods
Faecal calprotectin

Colonoscopy and endoscopy
MRI with contrast

Question 10

How is Crohns treated?

Answer 10

Exclusive enteral nutrition for up to 8w - may need NG
Steroids
Azathioprine
5-ASA - can use enemas
Monoclonal antibodies I.e. info I iamb
Abx
Surgery

Question 11

How does coeliac disease present?

Answer 11

Short
Pale
Reduced subcutaneous fat
Poor muscle bulk
Buttock wasting
Abdo distension

Chronic diarrhoea
Poor weight gain
Irritability
Dermatitis herpetiformis

Question 12

Which allergens are avoided in coeliac disease?

Answer 12

Gluten

Wheat, rye and barley

Also oats

Question 13

What is coeliac disease associated with?

Answer 13

Turners
Downs
T1DM
Autoimmune liver conditions
Thyroid disease

Question 14

How is coeliac disease investigated?

Answer 14

IgA total and TGA
If >10x then EMA and no scope
If <10x then scope on gluten

Question 15

What are histological findings in coeliac disease?

Answer 15

Sub total villous atrophy
Crypt hyperplasia
Inflammation

Question 16

What are pathological causes of constipation?

Answer 16

Hirschsprungs - bowels opened in first 24hrs
Thyroid disease - ?goitre
Meconium ileus
Spina bifida - comment that lower back normal with normal tone, power, reflexes

Comment that would ideally examine peri anal area

Question 17

Causes of hepatomegaly?

Answer 17

Infective
- EBV, CMV, hepatitis

Infiltrative

• primary tumour
• secondary e.g. lymphoma, leukaemia, neuroblastoma

Obstructive

• cardiac failure
• hepatic vein thrombosis

Storage disorders (metabolic)

• fat: CF, obesity, malnutrition, TPN
• lipid: Gauchers
• glycogen: glycogen storage disorders
• cholesterol: Niemann Pick

Miscellaneous

• Wilson’s
• alpha 1 antitrypsin

Question 18

Causes of splenomegaly?

Answer 18

Infective

• acute
• chronic: TB,
• parasite: malaria, toxoplasmosis

Inflammation

• SLE
• JIA
• ITP

Haematological

• leukaemia
• lymphoma
• thalassaemia
• anaemia: sickle cell, spherocytosis, G6PD

Other

• portal hypertension
• Gauchers
• cirrhosis
• cardiac failure

Question 19

What is portal hypertension and how does it present?

Answer 19

Splenomegaly
Ascites
Portosystemic shunts

FTT

GI haemorrhage
Encephalopathy
Thrombocytopenia, anaemia, leukopenia

Question 20

What are causes of portal hypertension?

Answer 20

Pre hepatic

• portal vein thrombosis (no liver symptoms)
• umbilical vein catheterisation
• sepsis

Intra-hepatic

• cirrhosis
• congenital hepatic fibrosis
• veno-occlusive disease

Post hepatic

• constrictive pericarditis
• right ventricular failure
• Budd-Chiari (hepatic vein outflow obstruction)

Question 21

What is congenital hepatic fibrosis?

Answer 21

AR
Look well

Large hard liver, normal function
Large spleen
Large polycystic kidneys

Question 22

Causes of cirrhosis?

Answer 22

Biliary tract

• Biliary atresia
• Congenital hepatic fibrosis
• CF
• Sclerosing cholangitis

Genetic

• alpha 1 antitrypsin
• Wilsons
• glycogen storage disorder

Infection

• hep B/C
• CMV

Nutrition

• alcohol
• TPN

Question 23

Causes of ascites?

Answer 23

Infective

• TB
• pancreatitis

Infiltrative

• metastasis
• nephrotic syndrome
• malnutrition

Obstructive

• hepatic vein thrombosis
• cirrhosis
• congestive cardiac failure

Question 24

How does Alagilles present?

Answer 24

Minimal intra-hepatic bile ducts
Hemivertebrae
Hypoglycaemia
Peripheral pulmonary stenosis

Question 25

What is alpha 1 antitrypsin deficiency?

Answer 25

Cholestasis in infancy
Cirrhosis in childhood
COPD in adults

Question 26

What are complications of cirrhosis?

Answer 26

Portal hypertension—> bleeding, ascites, encephalopathy

Increased infections, malnutrition

Pulmonary hypertension, renal failure

Question 27

How is cirrhosis managed?

Answer 27

Treat the cause

Dietician input for high calorie and nutrient diet

Salt restriction +/- diuretics

Admit any bleeds - 2x cannula + cross match
Peritonitis - abx
Encephalopathy - lactulose, reduced ammonia

Question 28

Indications for liver transplant?

Answer 28

End stage chronic disease
Unacceptable quality of life
Growth or developmental impairment
Liver failure