Gastro Conditions

Question 1

Commonest cause acute abdomen in child

Answer 1

Appendicitis

Question 2

Commonest age group appendicitis

Answer 2

> 5 (difficult to diagnose under 2y)

Question 3

What is the natural progression of appendicitis

Answer 3

Obstructed by often faecolith. Vague central abdominal pain. 6-12h full thickness appendix involved. 24-36h appendix gangrenous and will perforate

Question 4

Appendicitis presentation

Answer 4

Periumbilical pain –> RIF when peritoneal irritation

Anorexia

Reluctance to move

Mild fever

Vomiting

Guarding

Rebound tenderness

Rovsings sign

Any change in bowel habits

Question 5

6w old baby non bilious projectile vomiting after feeds. Not gaining weight well.

Answer 5

Pyloric stenosis

Question 6

Abdo signs in pyloric sten

Answer 6

Olive mass

Visible peristalsis

Question 7

Pyloric stenosis Rx

Answer 7

Surgery

Question 8

Pyloric stenosis investigations

Answer 8

test feed

blood gas (hypochlor, hypokal met acidosis)

USS

Question 9

6m old with spasms of colic, drawing legs up. Distended abdo and later bilous vomit

Answer 9

Intusussception

Question 10

When can’t you do air enema in intussusception and why? What instead?

Answer 10

If got to redcurrant jelly phase or <24h as risk perf, so do laparotomy

Question 11

3m old child who vomits after feeds. Is being fed >200ml/kg milk a day and is otherwise well

Answer 11

Regurg secondary to overfeeding

Question 12

Bilous vomit means the obstruction is ____ to the sphincter of oddi

Answer 12

Distal

Question 13

Duodenal atresia xray sign

Answer 13

Double bubble

Question 14

Duodenal vs jejunal atresia distinction?

Answer 14

Duodenal double bubble xray

Jejunal abdo distention as more distal

Question 15

What predisposes a child to volvulus?

Answer 15

Malrotation

Question 16

What can show double bubble sign other than duodenal atresia?

Answer 16

Volvulus

Question 17

What will be dilated in volvulus

Answer 17

Stomach and duodenum

Question 18

Dx volvulus

Answer 18

Upper GI contrast study

Question 19

Rx volvulus

Answer 19

Laparotomy (?Ladds procedure if bowel healthy)

Question 20

1w old baby with bilious vomit, looks toxic, tender abdomen

Answer 20

Volvulus

Question 21

3 day old baby who didn’t pass meconium. Abdo distention, bilious vomiting.

Answer 21

Hirschprungs

Question 22

Can babies with NEC continue to be fed?

Answer 22

Stop enteral feed for 10 days + broad spec Abx

Question 23

A baby with VACTERL problems presents with choking and cyanotic spells after feeding

Answer 23

Oesophagel atresia

Question 24

A three week old baby presents with jaundice which is shown to have increased conjugated fraction

Answer 24

Biliary atresia

Question 25

A 5yo boy with central abdo pain and preceding fever and coryzal symptoms for 3 days

Answer 25

Mesenteric adenitis