Gastro

Question 1

3 month old with increased irritability and intermittent arching and unusual neck postures. He born at term with no issues reported. He is frequently vomiting following feeds and has had one prev episode of pneumonia. What is an appropriate management?

Answer 1

GORD- gaviscon/omeprazole

Pneumonia- aspiration

Question 2

5 year old is significantly smaller than his younger brother. No birth/pregnancy issues. He passes soft stool 2-3 times/day and non bloody diarrhoea. Abdomen is soft and non tender. Which is the most appropriate initial investigation?

Answer 2

TTG

Question 3

Does coeliac present with diarrhoea or constipation in children?

Answer 3

can be both!

Question 4

Three investigations for coeliac disease?

Answer 4

TTG and other autoantibodies (anti-EMA, IgA)
Biopsy
Resolution of symptoms with gluten free diet

Question 5

Where might wasting be seen in children with coeliac disease?

Answer 5

buttocks

Question 6

3 week old male projectile vomits after feeding. Child is exhibiting feeding cues and is quick to take bottle. On exam, there is a palpable mass in the right upper quadrant. What is the likely diagnosis?

Answer 6

pyloric stenosis

Question 7

3 week old male projectile vomits after feeding. Child is exhibiting feeding cues and is quick to take bottle. On exam, there is a palpable mass in the right upper quadrant. What electrolyte abnormality will be seen?

Answer 7

Metabolic alkalosis
Hypokalaemia
Hypochloremia

Question 8

Is there bile in vomit of child with pyloric stenosis?

Answer 8

no as food has not passed stomach and reached duodenum

Question 9

Three differentials for jaundice in a baby?

Answer 9

breast milk jaundice, haemolysis, biliary atresia, physiological jaundice, hypothyroidism

Question 10

21 day old breast fed is referred to a clinic with worsening jaundice. Mother reports pale chalky stools. Baby’s mother is rhesus negative and received anti-D during her pregnancy. What is the diagnosis?

Answer 10

biliary atresia

haemolysis arises in first 24 hours, breast milk and hypothyroidism don’t present with pale stools

Question 11

What is the cause and treatment of physiological jaundice?

Answer 11

Liver not working as fast as blood is broken down, not an issue if bilirubin is stable and low. Phototherapy

Question 12

11 year old boy with 3 month history of diarrhoea with intermittent blood, nocturnal stooling and weight loss. Stool microbio is negative. Faecal calprotectin 1800. Biopsy shows skip lesions and granulomas. Diagnosis?

Answer 12

crohn’s

Question 13

One day old child has abdo distension and has not yet passed meconium. He has patent anus and is managing to suck on feeds. AXR there are dilated loops of bowel. Rectal exam is performed and explosive release of stool and air upon removal of the finger. What is the diagnosis?

Answer 13

Hirschprung’s= absence of parasympathetic ganglion cells in rectum

Question 14

How to differentiate between meconium plug and hirschprung’s?

Answer 14

squirt sign= explosion of faeces after DRE. Present in Hirschprung’s

Question 15

A 3 month old baby is brought by his mother with concerns that he arches his back during feeds and vomits frequently following them.

What is the most likely diagnosis?

Answer 15

GORD

Question 16

A 6 week old infant presents with a 5 day history of fresh blood mixed with stool, noticed in their nappy on changing. She was born at term and had an uncomplicated delivery. She is formula fed and is thriving. Her mother has also taken her to the GP for dry skin. She appears well on examination, with no specific findings.

What is the most appropriate management?

Answer 16

Trial of hydrolysed formula

Question 17

A previously well 6 month old baby is brought to ED with sudden onset paroxysmal screaming. His parents report him to draw his knees to his chest and become very pale, at the time of screaming. They state he has started passing bloody stools. What is the most likely diagnosis?

Answer 17

Intussusception

Question 18

List three signs of on inspection you might find during paeds gastro exam

Answer 18

ulcers
stomatitis (sore mouth)
candidiasis
glossitis

Question 19

Finger clubbing can be a sign on which diseases in children?

Answer 19

IBD, cystic fibrosis, coeliac disease, liver disease

Question 20

Can you feel the spleen and kidneys in children?

Answer 20

kidneys are easily felt
splee is palpable in infants (notch appears later in childhood)

Question 21

List three causes of hepatomegaly in children

Answer 21

Infection
Congestive cardiac failure
Tumours
Cystic fibrosis
Idiopathic

Question 22

List three cases of splenomegaly?

Answer 22

Infection-malaria
haematological- sickle cell, hereditary spherocytosis
portal hypertension
neoplastic
thalassaemia

Question 23

List three causes of hepatosplenomegaly

Answer 23

infection- EBV, CMV
portal hypertension
infiltration- leukaemia, lymphoma
haematological- thalassaemia
idiopathic

Question 24

List two serious complications of GORD in newborns

Answer 24

apnoea
failure to thrive
aspiration pneumonia

Question 25

What is the normal amount of feed in the first few months?

Answer 25

150ml/kg/day

Question 26

List three causes of rectal bleeding in children

Answer 26

anal fissure swallowed blood from epistaxis gastroenteritis hiatus hernia, peptic ulcer, meckel's diverticulum intussusception IBD

Question 27

What is intussusception?

Answer 27

bowel invaginates on itself which thickens the overall size of the bowel and narrows the lumen at the folded area, leading to a palpable mass in the abdomen and obstruction to the passage of faeces through the bowel.

Question 28

In which age group does intussusception arise?

Answer 28

6 months to 2 years, most common in boys

Question 29

List one condition that intussesception is associated with

Answer 29

Concurrent viral illness Henoch-Schonlein purpura Cystic fibrosis Intestinal polyps Meckel diverticulum

Question 30

How does intussesception present?

Answer 30

severe colicky abdominal pain pale lethargic child bleeding in stool vomiting intestinal obstruction right upper quadrant mass

Question 31

Redcurrant jelly stool is indicative of which condition?

Answer 31

Look out for the “redcurrant jelly stool” in your exams as this indicates intussusception as a diagnosis.

Question 32

A sausage shaped mass is detected on palpation. What is the likely diagnosis?

Answer 32

intussesception!!

Question 33

What is the initial investigation for intussesception?

Answer 33

USS

Question 34

1 year old child with viral upper respiratory tract infection develops severe abdo pain and vomiting with blood in stool. What is the likely diagnosis?

Answer 34

intussescption

Question 35

List two complications of intussesception

Answer 35

obstruction gangrenous bowel perforation death

Question 36

List two risk factors for IBD

Answer 36

family history family history autoimmune conditions- RA, thyroid disease

Question 37

Name two causes of haematemesis in child

Answer 37

ulceration- peptic, hiatus hernia bleeding disorders swallowed blood- epistaxis, breastfeeding acute gastritis, vomiting

Question 38

Name a highly sensitive and specific test for coeliac disease

Answer 38

TTG-IgA

Question 39

Name two histological features of coeliac disease

Answer 39

villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytosis.

Question 40

List two causes of acute diarrhoa

Answer 40

infection staph toxin in food poisoning response to infection- pneumonia hirschprung's, intussusception

Question 41

Name two organisms that cause acute diarrhoea in children

Answer 41

e.coli, rotavirus, campylobacter

Question 42

Name two causes of chronic dirrhoea

Answer 42

post infectious food tolerance- lactose IBD Coeliac, cystic- malabroption constipation with overflow

Question 43

Name two investigations for chronic diarrhoea

Answer 43

stool cultures bloods serum TTG faecal calprotectin peri anal inspection

Question 44

List two medical causes of acute abdo pain

Answer 44

infection constipation HSP acute nephritis DKA

Question 45

List two surgical causes of acute abdo pain in child

Answer 45

acute appendicitis intussuception volvulus strangulated inguinal hernia torsion of testes/ovary

Question 46

List three red flags for abdominal pain

Answer 46

bilious/persistent vomiting fever severe chronic diarrhoea rectal bleeding weight loss

Question 47

List three secondary causes of constipation

Answer 47

hirschprung's hypothyroidism anal stenosis intestinal obstruction sexual abuse cystic fibrosis

Question 48

What is a cause of projectile vomiting in a child

Answer 48

pyloric stenosis

Question 49

Which other condition must you test for is patient has coeliac disease?

Answer 49

T1D!! (remember OSCE station)

Question 50

List two complications of coeliac disease

Answer 50

anaemia osteoporosis vitamin deficiency small bowel adenocarcinoma enteropathy associated T cell lymphoma NHL

Question 51

How to induce remission of crohn's?

Answer 51

steroids +- immunosuppressants

Question 52

How do induce remission of UC?

Answer 52

aminosalicylate e.g. msealazine corticosteroids

Question 53

How to maintain remission in UC?

Answer 53

mesalazine azathioprine

Question 54

How to maintain remission in crohn's?

Answer 54

azathioprine mercaptopurine

Question 55

List three causes of intestinal obstruction in children

Answer 55

meconium ileus hirschprung's dudodenal atresia intussescption volvulus strangulated hernia

Question 56

Two signs of obstruction on AXR?

Answer 56

dilated loops of bowel proximal to obstruction and collapsed loops of bowel distal to obstruction absence of air in rectum

Question 57

Name two conditions that Hirschprung's disease is associated with

Answer 57

down's syndrome NF1 MEN 2